Rigid Bronchoscopy / Foreign Body Removal
Patient phenotype
Pediatric: foreign body aspiration (peanut classic), often 1-3 yo, witnessed event vs incidentaloma. Adult: massive hemoptysis, central airway tumor, stent placement. Sometimes emergent.
Procedure
Rigid scope through mouth into trachea. Surgeon ventilates through scope (jet ventilation or attached circuit). Forceps/cryo to remove FB or biopsy. 30-60 min.
Anesthetic plan
GA with shared airway. Spontaneous ventilation OR jet ventilation OR intermittent apnea. Total IV anesthesia (propofol + remi) preferred — no volatile when scope dominates.
Setup
- ·TIVA pumps (propofol + remi)
- ·Standard monitors + temp
- ·PIV
- ·Suction (more than usual)
- ·Pediatric airway cart + LMA + ETT backup
- ·Atropine pre-drawn (peds)
- ·Jet ventilator + high-pressure O₂
- ·Communication with surgeon on ventilation method
Biggest concerns by phase
Pediatric FB — preserve spontaneous ventilation
Inhalational induction maintaining spontaneous ventilation (sevo + 100% O₂). PPV before FB removal can push it deeper. Once induced + scope in: choice of continued spontaneous, jet, or intermittent apneic.
Inhalational induction + topical airway
Sevo + spontaneous vent. Once asleep: PIV, deepen with propofol. Topical lidocaine to vocal cords (4% spray or atomizer) blunts laryngospasm.
Ventilation modality choice
Spontaneous: TIVA + safe but shallow → CO₂ rises. Jet: high pressure, risk barotrauma + pneumothorax. Apneic + reoxygenate: safe but interrupts surgeon. Discuss ahead.
Hypoxia + bradycardia (peds)
Small lungs + interruption = fast desaturation. Bradycardia from hypoxia + vagal stim. Atropine ready. Pause surgery, reoxygenate.
Post-extubation laryngospasm + edema
Mucosal edema after scope manipulation. Steroids (dex 0.5 mg/kg) reduce. Awake or deep extubation. Stridor → racemic epi + dex + reintubation if severe.
Mock-defense scenarios
Practice answering these out loud. The probes show what an examiner is listening for.
2-yo, witnessed peanut aspiration 4h ago, now wheezing R chest. CXR: hyperinflation R lung. Rigid bronchoscopy planned. Plan?
What an examiner probes for
- ▹Spontaneous ventilation maintained until FB removed
- ▹Inhalational induction with sevo
- ▹Topicalize cords with lidocaine
- ▹Coordinate with surgeon on ventilation
- ▹Anticipate post-extubation edema
Sources
- Coté Peds Anesthesia 6e Ch 19
- Miller's Ch 79
Anatomy reference
Sourced reference images. 4 matches for "trachea bronchi airway".
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