Abstract
Bronchoscopy is performed to assess the airway in a child who has suspected laryngeal or tracheal anomalies, for investigation of stridor and obstruction, and for the removal of foreign bodies. Anesthesia is challenging as the airway is unprotected and shared with the surgeon. Spontaneous or controlled ventilation are possible, and each has advantages and disadvantages. Anesthesia includes the use of local anesthetic to topicalize the vocal cords, combined with inhalational and/or intravenous anesthetic agents. Dexmedetomidine is emerging as a useful adjunct to anesthesia. Providing anesthesia for removal of an inhaled foreign body is a common pediatric anesthetic dilemma. Diagnosis can be difficult as the symptoms can be non-specific and the chest X-ray often normal. Bronchoscopy may be required to simultaneously diagnose and manage the problem. The ventilating bronchoscope is the surgical instrument of choice to remove inhaled foreign bodies. It may be a challenging anesthetic that is best delivered by two anesthetists, one of whom is well trained in pediatric anesthesia.
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Further Reading
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Review Questions
Review Questions
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1.
How would you assess a 3 year old child who may have inhaled a small bead and is booked for bronchoscopy?
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2.
What are the differences in anesthesia for rigid bronchoscopy in adults in children?
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3.
Why are peanuts particularly dangerous as inhaled foreign bodies in children?
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What are some causes of stridor in infants?
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What are the possible causes if a child coughs and then desaturates during a rigid bronchoscopy for removal of a bronchial foreign body? How would you manage this situation?
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Johnson, M., Sims, C. (2020). Bronchoscopy and Removal of Foreign Bodies from the Trachea. In: Sims, C., Weber, D., Johnson, C. (eds) A Guide to Pediatric Anesthesia. Springer, Cham. https://doi.org/10.1007/978-3-030-19246-4_17
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DOI: https://doi.org/10.1007/978-3-030-19246-4_17
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