Anesthesia Methods for Airway Endoscopy

Airway endoscopy is frequently performed in pediatric patients and may be indicated for diagnostic and/or therapeutic interventions. Multiple factors present challenges for the pediatric anesthesiologist, including sharing the airway with the otolaryngologist as well as, in selected circumstances, providing anesthesia with an unprotected airway. Furthermore, anesthetic agents need to be titrated to provide anesthesia, analgesia, and blunting of airway reflexes while maintaining spontaneous respirations. For airway endoscopy, a focus on communication and teamwork is of utmost importance. In addition, the pediatric anesthesiologist needs to have alternative management plans at her disposal given that these procedures are often dynamic in nature, e.g., patients may initially maintain adequate spontaneous ventilation but later become apneic, necessitating an intervention and alterations in the previously developed plan. This chapter reviews basic concepts, ventilation strategies, anesthetic drugs used in airway endoscopies, and potential complications. An example of a possible anesthetic approach to airway endoscopy as practiced at our institution is included at the end.