Thoracic surgery and rigid bronchoscopy

Rigid bronchoscopy is an invaluable tool utilized by the interventional pulmonologist or thoracic surgeon providing a less invasive alternative to surgery for high-risk patients or inoperable lung tumors. Rigid bronchoscopy has many indications including examining the airway, intervening for central airway obstruction, and placement of tracheal or endobronchial stents. As insertion of the rigid bronchoscope is highly stimulating, general anesthesia or deep sedation is necessary; management can be challenging for the anesthesia provider in regard to both anesthetic technique and ventilation modality. Unique considerations are required as the airway is shared between the anesthesia provider and bronchoscopist. As with any invasive procedure, there are inherent risks and postprocedural complications associated with rigid bronchoscopy. This chapter provides the fundamentals of rigid bronchoscopy including the patient population encountered, equipment setup, procedural details, common interventions, as well as complications that may be encountered immediately in the postoperative period or later following discharge home.