Rigid bronchoscopy - NYSORA | NYSORA

Rigid bronchoscopy

Learning objectives 

  • Indications for rigid bronchoscopy
  • Advantages and disadvantages of rigid bronchoscopy
  • Anesthesia management for rigid bronchoscopy

Definition and mechanism

  • To gain better access to the patient’s airway
  • Allows insertion of instruments or airway devices 
  • Diagnosis of infections, cancers, inflammatory conditions, sarcoidosis, and lymphoma 
  • Treatment of airway obstruction, airway narrowing (stenosis), airway cancers, bleeding
  • Removal of foreign or aspirated objects
  • Considerations for surgical technique: stenting, laser, endobronchial electrosurgery, argon plasma coagulation, & balloon bronchoplasty
Can be inserted past airway obstructionRequires always general anesthesia
The airway is secure during the procedureOral and pharyngeal damage
Allows for:
Larger biopsies
Tamponade (stop) bleeding areas
Removal of airway tumors and foreign objects
Deploying airway devices (tracheobronchial stents) to keep collapsing airways open
Limited visualization
Nonflexible metal rod

Factors that complicate rigid bronchoscopy

  • Patients requiring high levels of supplemental O2
  • Patients with baseline hypercarbia and hemodynamic instability
  • Unstable cervical spine or diminished range of motion of the cervical spine caused by spondylosis
  • Maxillofacial trauma or oral disease preventing opening of the jaw (stenosis, obstructing neoplasms)
  • Procedure-specific complications: hemorrhage, airway trauma, perforation, fire, systemic gas embolism, & dissemination of post-obstructive pneumonia


rigid bronchoscopy, general anesthesia, circuit leak, high gas flow, apneic oxygenation, spontaneous assisted ventilation, controlled ventilation, manual jet ventilation, high-frequency jet ventilation, laryngeal mask, cuffed ET, self-inflating bag, 100% O2, TIVA, propofol, neuromuscular blockade (succinylcholine), CO2, etomidate, ketamine, fentanyl, alfentanil, remifentanil

Keep in mind

  • Full stomach vs. unsecured airway
  • High oxygen requirements with risk of fire ignition
  • Jet ventilation through obstructing stenoses with risk of air trapping & barotrauma

Suggested reading

  • Galway U, Zura A, Khanna S, Wang M, Turan A, Ruetzler K. Anesthetic considerations for bronchoscopic procedures: a narrative review based on the Cleveland Clinic experience. J Thorac Dis. 2019;11(7):3156-3170.
  • Kabadayi, Selin & Bellamy, Mark. (2016). Bronchoscopy in critical care. BJA Education. 17. mkw040. 10.1093/bjaed/mkw040. 
  • Pathak V, Welsby I, Mahmood K, Wahidi M, MacIntyre N, Shofer S. Ventilation and anesthetic approaches for rigid bronchoscopy. Ann Am Thorac Soc. 2014;11(4):628-634.

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