Anesthesia for pediatric rigid bronchoscopy and related airway surgery: Tips and tricks

Abstract

Bronchoscopy-guided diagnostic and interventional airway procedures are gaining in popularity and prominence in pediatric surgery. Many of these procedures have been used successfully in the adult population but have not been used in children due to a lack of appropriately sized instruments. Recent technological advances have led to the creation of instruments to enable many more diagnostic and therapeutic procedures to be done under bronchoscopic guidance. These procedures vary significantly in their length and invasiveness and require vastly different anesthetic plans that must be easily adapted to situational and procedural changes. In addition to close communication between the anesthesiology and procedural teams; an understanding of the type of procedure, anesthetic requirements, and potential patient risks is paramount to a successful anesthetic. This review will focus on new rigid bronchoscopic procedures, goals for their respective anesthetic management, and unique tips and trick for how to maintain adequate oxygenation and ventilation in each scenario.

Anesthesia for laryngotracheal reconstruction in children: A narrative review

“…38 The choice of propofol and fentanyl infusions has a foundation in established recommendations for pediatric open airway surgery. 39 This anesthetic choice is easily titratable, maintains an adequate depth of anesthesia, allows for spontaneous ventilation of the patient, and does not increase airway secretions. Spontaneous ventilation with judicious pressure support and PEEP is ideal to prevent atelectasis and its associated complications.…”

“…This balanced technique with low FiO 2 has the benefit of spontaneous ventilation with pressure support/positive end‐expiratory pressure (PEEP) while maintaining ideal surgical conditions, avoiding operating room pollution from inhaled agents, and reducing the risk of airway fire 38 . The choice of propofol and fentanyl infusions has a foundation in established recommendations for pediatric open airway surgery 39 . This anesthetic choice is easily titratable, maintains an adequate depth of anesthesia, allows for spontaneous ventilation of the patient, and does not increase airway secretions.…”

Bailout in a resource-limited emergency pediatric bronchoscopy setting

“…Bronchoscopy in pediatric patients, inherently a complex procedure, gets compounded due to significant variations of duration and invasiveness of the procedures and non-availability of appropriately sized instruments. Hence, we must adapt quickly to the “situational and procedural changes.”[ 1 ] We wish to present one such scenario and the novel solution we adopted. Following the distal migration of broken pieces of outer shell of groundnut in an eight-month-old baby after removal of the major chunk by rigid bronchoscope, we had to resort to using a flexible forceps that was compatible with only a 3.5-mm flexible bronchoscope at our setting.…”