“…Second, if internal airway pressure distal to the scope were to rise, the risk of embolus is thought to increase. For example, actions that mimic valsalva manoeuvre, such as coughing and straining, during the procedure, can create a sudden pressure increase distal to the needle, thus inducing embolus [ [3] , [4] , [5] , [6] , [17] , [18] , [19] , [20] ]. A potential learning point for physicians is to consider increasing sedation in patients who show signs of airway resistance during the procedure, including coughing, straining or deep breathing, to reduce risk of embolus.…”