Anaesthesia for bronchoscopy and shared airway surgery

Meet the patient

A 64-year-old smoker arrives with three weeks of worsening stridor and intermittent haemoptysis. CT shows a vascular tracheal tumour narrowing the airway to six millimetres. The ENT surgeon wants rigid bronchoscopy with laser debulking — a procedure where the FiO2 that keeps the patient pink is the FiO2 that turns the airway into a blowtorch.^[4]

The two questions that decide the case are the two that decide every shared-airway operation: how will I oxygenate through an open airway? and what is my rescue if oxygenation fails? Answer both before induction — never after the patient turns blue.^[1]

References4ShowHide

1. [1]Frerk C et al. Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults Br J Anaesth, 2015.PMID 26556848
2. [2]Brassard CL et al. Step-by-step clinical management of one-lung ventilation: continuing professional development Can J Anaesth, 2014.PMID 25389025
3. [3]Karzai W, Schwarzkopf K. Hypoxemia during one-lung ventilation: prediction, prevention, and treatment Anesthesiology, 2009.PMID 19417615
4. [4]Pathak V, Welsby I, Mahmood K, et al. Ventilation and anesthetic approaches for rigid bronchoscopy Ann Am Thorac Soc, 2014.PMID 24635585