Operative rigid bronchoscopy: indications, basic techniques and results

Abstract

Palliative airway treatments are essential to improve quality and length of life in lung cancer patients with central airway obstruction. Rigid bronchoscopy has proved to be an excellent tool to provide airway access and control in this cohort of patients. The main indication for rigid bronchoscopy in adult bronchology remains central airway obstruction due to neoplastic or non-neoplastic disease. We routinely use negative pressure ventilation (NPV) under general anaesthesia to prevent intraoperative apnoea and respiratory acidosis. This procedure allows opioid sparing, a shorter recovery time and avoids manually assisted ventilation, thereby reducing the amount of oxygen needed, while maintaining optimal surgical conditions. The major indication for NPV rigid bronchoscopy at our institution has been airway obstruction by neoplastic tracheobronchial tissue, mainly treated by laser-assisted mechanical dissection. When strictly necessary, we use silicone stents for neoplastic or cicatricial strictures, reserving metal stents to cover tracheo-oesophageal fistulae. NPV rigid bronchoscopy is an excellent tool for the endoscopic treatment of locally advanced tumours of the lung, especially when patients have exhausted the conventional therapeutic resources. Laser-assisted mechanical resection and stent placement are the most effective procedures for preserving quality of life in patients with advanced stage cancer.

Anesthesia Management in Patients With Central Airway Stenosis Undergoing Bronchoscopy Treatments - Safety Application of Muscle Relaxants and the Traditional Low-frequency Ventilation : A Retrospective Observational Study

“…Surgery may be the preferred approach, but not all patients are appropriate surgical candidates [4] . Therefore, bronchoscopy treatment remains the best tool for the safest management of airway obstructions, and provides prompt and durable palliation to patients ineligible for surgical treatment [3,7,12,13] .…”

Anaesthesia and peri-interventional morbidity of rigid bronchoscopy: A retrospective analysis

“…This largely reflected an older anaesthetic practice during the early phase of data collection. Management of central airway obstruction (CAO) due to neoplastic or non-neoplastic disease is responsible for the resurgence in the interest in rigid bronchoscopy [17]. The management of CAO includes stent placement, dilation, heat therapy using electrocautery or laser and debridement of obstructive lesion.…”

Airway Stents Implantation with Extra Pulmonary or Intrapulmonary Oxygen Support on Respiratory Failure Patients

“…It is usually 40-45 cm long (but shorter tubes are available). Its calibre varies from 6.5 to 13.5 mm with the beveled distal end which allowing mechanical resection of obstructing lesions [13] . The proximal end consists of a central opening and several side ports where instruments can be placed or ventilation tubes can be connected.…”