Educational Series about Anesthesia & Pulmonary Fibrosis: Part 1

This is part 1 of the educational series about anesthesia and pulmonary fibrosis, which teaches patients, relatives, and caregivers what to expect for common procedures. Thank you to our guest blog contributor, Dr. Wu, for volunteering his time and expertise to review this educational series and provide feedback prior to its launch. Learn more about him below, and then keep reading for information and considerations about anesthesia for patients with pulmonary fibrosis. 

 

A southern California native, Patrick Wu graduated from UC Irvine undergraduate as a neurobiology major, and then went to medical school at the University of Virginia in Charlottesville, VA.  He then returned to UCI for anesthesiology training and completed a fellowship in Critical Care.  He decided to work at the Long Beach VA after graduating residency to provide his training and services to the veterans in need of medical care.  He currently performs anesthesia, regional anesthesia, critical care, and stellate ganglion blocks for PTSD to the veterans under his care, which he finds extremely rewarding.  He has been married to his wife for going on 10 years and has two school age children at home.

 

Living with pulmonary fibrosis (PF) often means facing tests and procedures that involve anesthesia. That can sound scary, especially when breathing is already a daily effort. This blog is meant to give you a clear, patient-friendly overview of the types of anesthesia used for common lung procedures like bronchoscopies, biopsies, and lung transplants, and what they mean for someone with PF.

Big picture: Why anesthesia is a little different in pulmonary fibrosis

Pulmonary fibrosis is a restrictive lung disease; that is, your lungs are stiff and hold less air. That means:

• You may have less “reserve” if your oxygen or breathing are stressed.
• You may desaturate (your oxygen level drops) more quickly.
• You may be more prone to post-procedure complications like pneumonia or respiratory failure if things aren’t carefully managed. 

Studies show that people with interstitial lung disease (ILD), including PF, have a higher risk of complications after surgery, especially when general anesthesia and mechanical ventilation are used. 

Because of this, anesthesia teams caring for PF patients usually aim to:

• Use the lightest effective level of anesthesia for the procedure.
• Prefer regional or local anesthesia when possible (for non-chest surgeries).
• If general anesthesia is needed, use lung-protective ventilation (gentle pressures, careful oxygen levels) and plans for early, safe extubation (removal of breathing tube).

The main “types” of anesthesia in plain language

The American Society of Anesthesiologists (ASA) describes anesthesia and sedation as a continuum, from being relaxed and fully awake to being completely unconscious. They define four main “depths”: minimal sedation, moderate sedation, deep sedation, and general anesthesia. 

On top of that, there are also local/topical and regional/neuraxial techniques, which focus on numbing part of the body while you stay awake.

Below is what all of this means in everyday language, and how it shows up for people with PF.

Local/topical anesthesia (numbing just one area): Medicine is applied directly to a small area to numb it: like spray, gel, or tiny injections.

• Awake? Yes, fully awake; you feel pressure or movement but not sharp pain in that spot.
• Used for:
  • Numbing the nose, throat, and airways for bronchoscopy
  • Numbing the skin for IVs, small biopsies, ports, or catheter placements
• PF angle:
  • Has minimal impact on breathing by itself.
  • Often combined with some level of sedation (see below), especially for bronchoscopy, to control coughing and discomfort.

For bronchoscopy, lidocaine is the standard topical anesthetic, sprayed or dripped into the nose, throat, and airways to reduce gagging and coughing. 

Minimal sedation (anxiety relief): Light calming medicine. You’re relaxed, maybe a bit drowsy, but you respond normally when someone talks to you. Breathing and circulation are expected to stay normal.

• • What it feels like
    • “Chill pill” level. You’re awake, can answer questions clearly, and remember the procedure. 

• Used for:

• • • Very short or simple procedures
    • Pre-procedure anxiety (e.g., before going into the bronchoscopy suite or CT scanner)

• PF angle:

• • Very low respiratory risk; your breathing stays under your own control.
  • Helpful when anxiety itself worsens shortness of breath.

Moderate sedation (“conscious sedation”): You are sleepier but still respond on purpose when someone talks to you or gives you a gentle tap. You keep your airway open on your own, and your breathing and blood pressure are usually okay without extra help.

• What it feels like:
  • Often called “twilight sleep.”
  • You might doze off, wake up to a voice, then drift off again.
  • Many people remember little or nothing afterward.
• Used for:
  • Many flexible bronchoscopies
  • Some small biopsies and minimally invasive procedures
  • Things like colonoscopies in people without lung disease 
• PF angle:
  • Often a sweet spot for bronchoscopy: enough comfort to tolerate the scope, but you’re still breathing on your own. 
  • The team watches your oxygen very closely; they may use extra oxygen or noninvasive support if you tend to desaturate.

 

Deep sedation (Analgesia): You are very hard to wake up and only respond when something is repeated or painful. Your breathing can become shallow, and you may need help keeping your airway open. Blood pressure is usually okay but needs monitoring.

• What it feels like:

• • • From the patient’s point of view, it feels very close to being “fully out.”
    • You usually remember nothing.

• Used for:

• • • More complex bronchoscopic procedures like transbronchial lung cryobiopsy
    • Some advanced endoscopic or interventional procedures where you must be very still

• PF angle:

• • Gives the team a still, controlled airway for higher-risk procedures.
  • Because breathing can become weaker, there’s a higher risk of low oxygen and need for airway support, which is why PF patients are usually monitored intensely and often managed by an anesthesiologist.

 

General anesthesia: Medicines put you into a complete loss of consciousness. You do not wake up even if someone pinches you hard. You usually cannot maintain your airway or breathing on your own, so a breathing tube and ventilator are often used. Blood pressure and heart function can also be affected and are closely monitored.

• What it feels like:

• • • You’re fully “asleep” and unaware of anything during the procedure.
    • Time often feels like it jumps from “we’re starting” to “it’s all done.”

• Used for:

• • • Surgical lung biopsies (VATS or open)
    • Many transbronchial cryobiopsies in some centers
    • Any lung transplant surgery (always)
    • Most major chest or abdominal operations

• PF angle:

• • Essential for big surgeries like lung transplant, but it carries the highest respiratory risk for people with fibrotic lungs.
  • The anesthesia and surgical teams use lung-protective ventilator settings, careful fluid management, and post-op monitoring to lower the chances of complications like acute ILD exacerbation or prolonged ventilation.

 

Regional & neuraxial anesthesia (nerve blocks, epidurals, spinal)

• What it is: Numbing just part of the body by injecting anesthetic near nerves or the spinal cord (e.g., epidural, spinal, nerve block).
• Awake? Often awake or mildly sedated, breathing on your own.
• What it’s used for: Many non-lung surgeries (abdominal, leg, C-sections, etc.), and as an add-on for thoracic surgery for pain control.
• PF angle: For non-chest surgery, using regional instead of general anesthesia can reduce the risks of lung complications in ILD patients when appropriate. 

 

Monitored Anesthesia Care (MAC): Sedation with an anesthesia specialist at your side

You might hear the term “monitored anesthesia care” (MAC). This isn’t a separate “depth” of anesthesia like minimal, moderate, or deep sedation. Instead, it describes a type of service: an anesthesia professional is with you the whole time, giving sedation and pain medicine as needed and watching your breathing, heart, and blood pressure very closely.

Under MAC, you can be anywhere on the sedation continuum:

• Some people stay at minimal or moderate sedation (sleepy but responsive and breathing on their own).
• Others drift toward deep sedation, where you might need help keeping your airway open.
• If needed for safety, the anesthesia team can rapidly convert to general anesthesia (with a breathing tube and full life support).

For many people with pulmonary fibrosis, MAC is how sedation is delivered for things like flexible bronchoscopy, some biopsies, and minor procedures. The advantage is that you often avoid a full general anesthetic and breathing tube, while still having an anesthesia specialist whose only job is to keep you comfortable and protect your breathing. Oxygen levels, breathing pattern, and carbon dioxide are watched closely, and the team is ready with extra oxygen or airway support if you start to struggle.

 

Click here for Part 2 of this educational series about anesthesia and PF, where we dive into the details of procedures that patients with PF might undergo.

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