Endobronchial Valve Insertion in Severe COPD

You are working in the preadmission clinic, reviewing your patients for a respiratory medicine bronchoscopy list in a week's time. Your next patient is a 74-year-old man who has been scheduled for an elective bronchoscopic lung volume reduction procedure by insertion of endobronchial valves. Medical history: Emphysematous chronic obstructive airways disease - home oxygen 1L/min, 18 hours per day Ex-smoker – ceased 5 years ago, 60+ pack-year smoking history Osteoarthritis Peripheral vascular disease Atrial fibrillation Medications: Ipratropium bromide MDI (21 mcg/puff) 2 puffs bd Seretide Inhaler (fluticasone/salmeterol 25/250 mcg) 2 puffs bd Salbutamol (100 mcg/puff) 2 puffs prn Paracetamol 1 g tds Rivaroxaban 15 mg daily The respiratory physician will perform the procedure in the bronchoscopy suite of your major tertiary hospital and has requested the case be performed under general anaesthesia with spontaneous ventilation. The patient has a planned admission for two days post-procedure to monitor for any complications.