Rigid Bronchoscopy 

 

 

Considerations

 

  • Indication for surgery, presence of central airway obstruction & major comorbidities:

    • Risk of complete airway obstruction with an inability to ventilate

    • Risk of dynamic hyperinflation with hemodynamic collapse

    • Typically urgent/emergent cases in physiologically distressed patients

  • Shared & unprotected airway:

    • Aspiration risk, potentially challenging ventilation, potential loss of airway access

    • Need for GA with TIVA, neuromuscular blockade +/- depth of anesthesia monitoring & CO2 monitoring with invasive arterial catheter

  • Considerations for surgical technique: stenting, laser, endobronchial electrosurgery, argon plasma coagulation, & balloon bronchoplasty

  • Procedure specific complications: hemorrhage, airway trauma, perforation, fire, systemic gas embolism, & dissemination of postobstructive pneumonia

 

 

Goals

 

  • Avoidance of complete airway obstruction during induction of anesthesia

  • Avoidance of dynamic hyperinflation & cardiovascular compromise

 

 

Conflicts

 

  • Full stomach vs. unsecured airway

  • High oxygen requirements with risk of fire ignition

  • Jet ventilation through obstructing stenoses with risk of air trapping & barotrauma

 

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