Anesthesia Considerations 

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