The role of rigid bronchoscopy in complex airway disorders

Abstract

Rigid bronchoscopy is a diagnostic and therapeutic tool used to treat complex airways disorders. It plays a central role in the management of central airway obstruction caused by benign or malignant diseases; and requires close cooperation between the bronchoscopist and the anesthesiologist as they share the same operative field. Rigid bronchoscopy requires deep sedation or general anesthesia, intubation with the rigid bronchoscope and adequate oxygenation and ventilation during the procedure. The choice of ventilation techniques include apneic oxygenation, spontaneous assisted ventilation, controlled ventilation and jet ventilation. Rigid bronchoscopy is used to relieve respiratory symptoms due to airway obstruction by dilation for a tracheal stenosis or the mechanical debulking of endoluminal tumours, and supporting the airway by the placement of an endoluminal stent. Two types of stents are currently in use: silicone stents and metal stents with different lengths, diameters and shape configurations. They can significantly improve patients symptoms and their quality of life. Therapeutic rigid bronchoscopy, performed in appropriately selected patients and by skilled operators is effective and has a low morbidity rate.