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

Area of Science:

• Pediatric Pulmonology
• Anesthesiology
• Diagnostic Procedures

Background:

• Flexible bronchoscopy under anesthesia is standard for pediatric respiratory disorders.
• General anesthesia for flexible bronchoscopy carries inherent risks.
• Diagnostic awake flexible bronchoscopy in children is under-documented.

Purpose of the Study:

• To assess the feasibility and utility of awake flexible bronchoscopy in pediatric patients.
• To identify precautions and potential complications associated with the procedure.
• To explore an alternative to general anesthesia for pediatric bronchoscopy.

Main Methods:

• Consecutive case series of 11 pediatric patients undergoing awake flexible bronchoscopy.
• Data collected: demographics, indications, attempts, findings, complications.
• Success defined by tracheal/mainstem bronchi visualization; failure by esophageal entry or scope obstruction.

Main Results:

• 11 patients (mean age 20 months, 72% male) underwent the procedure.
• Indications included foreign body suspicion (45.4%), chronic cough (36.4%), and stridor (36.4%).
• Mean attempts: 1.72; one patient had gagging/emesis, no other complications.

Conclusions:

• Awake flexible bronchoscopy was well-tolerated and a potentially useful diagnostic tool in select pediatric patients.
• Further studies are required to compare awake vs. general anesthesia flexible bronchoscopy.
• Limitations include suboptimal subglottic visualization and utility for sleep-related or therapeutic cases.