Bronchoscopy & Inhaled Foreign Bodies

Bronchoscopy & Management of Inhaled Foreign Bodies

Objectives-
Anatomy of Tracheobronchial tree
General Indications & Contraindications
Discuss problems & Options for management
How to manage a patient with a foreign body in the airway

Tracheobronchial Anatomy
Airway generations 0-23
0 – Trachea
1-4 – Main Lobar & segmental
5-11 – Small Bronchi
12-16 – Bronchioles
17-19 – Respiratory bronchioles
20-22 – Alveolar ducts
23 – Alveolar sacs

Tracheobronchial Anatomy

Indications for bronchoscopy
Diagnostic
Initial diagnosis (Flexible > Rigid)
Staging of disease

Indications continued
Therapeutic
R/O Foreign Body
Stent Insertion
Diathermy Resection

Airway Management
Insertion of DLT

Contraindications

Absolute
Don't exist?

Relative
Anaesthetic Risk
Surgical Risk - Biopsy
Tracheal Stenosis – Flexible type

Potential problems
Shared airway
Ventilation & Oxygenation
Potential for awareness
Scavenging
Concurrent disease

Work up
As for pneumonectomy especially if pre thoracotomy

What are they?

Minimal pulmonary function test criteria
Pre op Pneumonectomy criteria
PAP with unilateral occlusion
< 25 mmHg rest
< 35 mmHg exercise

Anaesthetic technique
Method of choice
TCI (Propofol +/- Remifentanil) for all but the shortest procedures
Exceptions
Upper airway obstruction
Bronchopleural fistula

Ventilation
Venturi – Sanders Injector

Ventilating bronchoscope

High Frequency Jet ventilation

Questions?
Inhaled Foreign Bodies

Who?
Children < 3y.o.

Elderly

Debilitated

Drunks
What?
Anything small enough to enter the airway
Organic e.g. Peanuts
Inorganic e.g. Coin

Case Example 1
2 y.o child presents after having coughing fit, stridor and shortness of breath
What is your management?

Case example 2
77 y.o man with a 6 week history of persistent cough

What are the findings on CXR?

X-Ray Findings
CXR
Acute presentation- Ipsilateral Obstructive Emphysema on Expiratory film
Chronic presentation - Features of collapse / consolidation distal to the FB
Anaesthetic technique

Inhalational Vs Intravenous

Upper airway obstruction or not?
Post operatively
When to Extubate?
Monitor for complications
Laryngospasm, Bronchospasm & pneumothorax


Summary

Anatomy
Indications / Contraindications
Problems & Management options
Specific management of inhaled foreign body