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.
Inhaled foreign bodies children Storz ventilating bronchoscope Optical grasping forceps Anesthesia for bronchoscopy
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