Awake flexible bronchoscopy in children: A case series, feasibility and precautions.

Int J Pediatr Otorhinolaryngol

Northwell Health, 2000 Marcus Avenue, North New Hyde Park, NY, USA; Cohen Children's Medical Center, Division of Pediatric Otolaryngology, New Hyde Park, NY, USA.

Published: October 2024

AI Article Synopsis

  • Flexible bronchoscopy in pediatric patients is a common diagnostic procedure, typically performed under general anesthesia, but this study explores the use of it while the child is awake, which is less documented.
  • The research involved 11 pediatric patients, mostly male, with various reasons for the procedure, including foreign body suspicion and chronic cough, showing a moderate success rate of about 1.72 attempts before successful visualization of the airways.
  • The study noted minimal complications, with only one patient experiencing gagging, and emphasized the potential of awake bronchoscopy as a viable option for assessing respiratory issues in children, while cautioning about the risks associated with anesthesia.

Article Abstract

Introduction: Flexible bronchoscopy under anesthesia is a mainstay diagnostic tool for evaluating respiratory disorders in pediatric patients. While flexible bronchoscopy is generally regarded as a safe procedure with low risk for major complications, it does entail additional risks associated with the use of general anesthesia. The use of diagnostic awake flexible bronchoscopy in children is not well documented in current literature.

Objectives: The objective of this case series is to investigate the feasibility and potential utility of awake flexible bronchoscopy in pediatric patients and to highlight important precautions and complications.

Methods: This was a consecutive case series of patients who underwent an awake flexible bronchoscopy over a two year period at a tertiary children's hospital. Data collection included demographics, indications, number of attempts, scope findings, and complications. Successful attempts of flexible bronchoscopy were defined by visualization of the trachea and mainstem bronchi while failed attempts include if the scope entered the esophagus or if cough, vocal fold adduction, or movement prevented the scope from entering the trachea.

Results: 11 patients were involved in this study (mean age 20 months, age range 0d to 5y 1m, 72 % male). Common indications for bronchoscopy were suspicion of foreign body (5, 45.4 %), chronic cough (4, 36.4 %), and stridor (4, 36.4 %). The mean number of attempts until successful was 1.72 (range 1-3). One patient experienced a 30-s episode of gagging with mucinous emesis. There were no other complications. One patient ultimately underwent another flexible bronchoscopy under general anesthesia to confirm the findings and to evaluate the tertiary bronchioles and another patient underwent a surgical resection of an oral mass under general anesthesia after awake flexible bronchoscopy.

Discussion: Awake flexible bronchoscopy was well tolerated in this study and could serve as a useful diagnostic tool without necessitating anesthetic. However, further study is needed to compare awake flexible bronchoscopy with flexible bronchoscopy under general anesthesia. Additionally, the patients selected for this study were limited to those with minimal risk, such as patients without cardiac disease. Limitations of this technique include suboptimal visualization of subglottic region and limited diagnostic utility for sleep related airway pathologies and cases where therapeutic intervention is needed.

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Source
http://dx.doi.org/10.1016/j.ijporl.2024.112084DOI Listing

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