Potential hazards of pediatric rigid bronchoscopy.

Bronchoscopy in infants and children has been facilitated by recent technologic advances. Better optical systems, intense "cold" light sources, and miniaturization of instrumentation have all contributed to the more effective use of the bronchoscope as a diagnostic and therapeutic tool. Despite these advances, two persistent problems remain major concerns for the endoscopist and anesthesiologist. The first concern is selection of an appropriately sized instrument for the pediatric patient. Our measurements demonstrate that the stated size of a rigid bronchoscope's internal diameter may differ significantly from its actual size. In many instances the actual diameter may be significantly greater than the stated size. The second problem concerns difficult ventilation of the patient while the bronchoscope is in place. Our measurements indicate that major increases in resistance to gas flow through the bronchoscope can be encountered particularly when utilizing smaller caliber instruments with accessory sheaths and/or telescopes. Appropriate knowledge and planning preoperatively should minimize the potential hazards associated with these problems.