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State of the Art in Clinical Management of Sedation and...
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State of the Art in Clinical Management of Sedation and Anesthesia Challenges

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Anesthesiology".

Deadline for manuscript submissions: closed (25 March 2026) | Viewed by 826

Special Issue Editor

Prof. Dr. Basavana Goudra

E-Mail Website
Guest Editor
Honickman Center, Department of Anesthesiology, Sidney Kimmel Medical College, Jefferson Health, Philadelphia, PA 19107, USA
Interests: sedation; airway management; anesthesia; oxygenation; sedative agents; hemodynamic monitoring
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Surgical procedures are constantly evolving, and many are being replaced with safer non-surgical interventions. Additionally, patients who are not candidates for aggressive surgical procedures benefit from less invasive options. Several such interventions have moved out of operating rooms to, unfortunately, lesser equipped procedure rooms. Even though the field of gastroenterology leads in this area, other disciplines such as respiratory medicine, cardiology, radiology, and reproductive healthcare are also making steady progress.

The drug and device industry has responded to this uniquely dynamic landscape. Newer sedative agents such as remimazolam and opioids such as oliceridine are some of the tools currently available. The device market has evolved to address the oxygenation and ventilation issues faced by anesthesia providers tasked with providing sedation and anesthesia in unfamiliar areas.

In this Special Issue, we aim to publish reviews, articles and clinical researchs that uniquely assist anesthesia providers and provide an overview of the challenges and suggest solutions.

Prof. Dr. Basavana Goudra
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • anesthesia
  • oxygenation
  • sedative agents
  • ventilation
  • airway management

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Published Papers (1 paper)

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Research

19 pages, 3100 KB  
Article
Relationship Between Navigation Success, Diagnostic Accuracy, and Ventilation Strategy: Retrospective Chart Review of 224 Consecutive Navigational Bronchoscopic Procedures Performed Under General Anesthesia
by Basavana Goudra, Prarthna Chandar, Divakara Gouda, Harrison Yang, Ganan Muhunthan, Suvan Sundaresh and Michael Green
J. Clin. Med. 2026, 15(4), 1569; https://doi.org/10.3390/jcm15041569 - 16 Feb 2026
Viewed by 497
Abstract
Background: Navigational bronchoscopy (NB) enables precise sampling of peripheral and central pulmonary nodules using shape-sensing or electromagnetic guidance. A major challenge is anesthesia-induced atelectasis, which alters lung anatomy, reduces registration accuracy, and is known to lower diagnostic accuracy. To counteract this, ventilatory [...] Read more.
Background: Navigational bronchoscopy (NB) enables precise sampling of peripheral and central pulmonary nodules using shape-sensing or electromagnetic guidance. A major challenge is anesthesia-induced atelectasis, which alters lung anatomy, reduces registration accuracy, and is known to lower diagnostic accuracy. To counteract this, ventilatory protocols such as the Ventilatory Strategy to Prevent Atelectasis (VESPA) and the Lung Navigation Ventilation Protocol (LNVP) have been recommended. Their adoption and clinical impact, however, remain uncertain. Methods: We conducted a retrospective review of 224 consecutive NB procedures performed under general anesthesia at a single academic medical center (January 2020–August 2024). Demographic, anesthetic, and ventilatory data were extracted from electronic records. Outcomes included navigational success (ability to reach the lesion) and diagnostic accuracy (concordance between bronchoscopic diagnosis and final clinical diagnosis after follow-up). Ventilatory practices were compared with published VESPA and LNVP recommendations. Results: Navigational success, defined as successful advancement of the bronchoscope to the target lesion with tissue acquisition, was achieved in 89.2% of cases. Overall diagnostic accuracy, defined as concordance between bronchoscopic diagnosis and final clinical diagnosis after follow-up, was 81.7%. Ventilatory management consistently diverged from recommended protocols. Most patients were ventilated with FiO2 > 0.6, PEEP in the range of 7–10 cm H2O, and tidal volumes of 300–500 mL. The only recommended maneuver systematically applied was recruitment immediately after intubation. Despite widespread deviation from both VESPA and LNVP, diagnostic performance remained favorable relative to published benchmarks. No major anesthesia-related complications occurred. Conclusions: In this retrospective series, navigational success comparable to published studies that adapted strict ventilation protocols was achieved with also comparable diagnostic accuracy without strict adherence to predefined ventilatory strategies. Recruitment maneuvers may represent the most influential component of current protocols, but institutional factors such as procedural expertise and case volume likely contributed to outcomes. Prospective studies are warranted to determine whether standardized ventilatory protocols are necessary for optimizing NB performance. Full article
(This article belongs to the Special Issue State of the Art in Clinical Management of Sedation and Anesthesia Challenges)
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