Open safety pin in the pediatric airway: Our experiences at a tertiary care teaching hospital

Background: Aspiration of an open safety pin in the airway is an extremely rare and critical condition that needs immediate and safe removal of the foreign body (FB). An open safety pin in the airway of the pediatric patient requires urgent recognition. Imaging will confirm the exact site of the open safety pin in the airway. Rigid bronchoscopy with optical forceps or grasping forceps is an ideal tool for the removal of the open safety pin from the airway. Objective: This study aims to evaluate the clinical details, management, and outcome of pediatric patients with an inhaled open safety pin in the laryngotracheal airway. Materials and Methods: This is a retrospective descriptive study done between November 2016 and December 2021. There were six children with inhaled open safety pins in the laryngotracheal airway. The diagnosis was done through proper history taking, clinical examination, and the X-ray of the neck and chest of the children. All children underwent rigid bronchoscopy with optical forceps to remove the open safety pin. Results: Out of the six children, four were boys and two were girls. Out of the six cases, four were in the proximal part of the airway and two were seen in the distal airway. The most common clinical presentation was coughing. In this study, open safety pins of the pediatric airway were removed successfully under general anesthesia with the help of a rigid bronchoscope. Conclusion: Open safety pin is rarely found in the laryngotracheal airway. Open safety pin may cause a life- threatening complication. During the removal of the open safety pin, the surgeon should maintain maximum care to not injure the surrounding structures by the sharp end of the open safety pin.

Cuerpo extraño de presentación tardía en bronquiotronco izquierdo. Caso clínico

RESUMEN Introducción: la introducción fortuita de un cuerpo extraño en las vías respiratorias es un accidente dramático que puede provocar complicaciones, aunque raro en los adultos, y sobre todo su presentación tardía, y en bronquio izquierdo. Caso clínico: se reporta el caso de un paciente de 71 años con un cuerpo extraño de presentación tardía en bronquiotronco izquierdo, que consultó por un cuadro de sepsis respiratoria, sin otros síntomas asociados, cuatro meses posteriores a referir haberse tragado un hueso de pollo, ocasión ésta en que el examen físico y los estudios radiológicos fueron negativos. Se realizó estudio con TAC de tórax y broncoscopia flexible evidenciándose una imagen sugerente de un cuerpo extraño en el bronquiotronco izquierdo. Discusión: después de realizar broncoscopia rígida y extracción de cuerpo extraño, presenta varias complicaciones, que requieren ingreso en terapia intensiva, la evolución clínica posterior fue favorable, con radiografía de tórax de control con adecuada reexpansión pulmonar y dándose de alta a los 55 días después del diagnóstico. Conclusiones: en presencia de un paciente con sepsis respiratoria después de un cuadro de broncoaspiración se debe tener en cuenta el diagnóstico de aspiración de un cuerpo extraño. La extracción del cuerpo extraño resulta la solución definitiva.

ABSTRACT Introduction: the fortuitous introduction of a foreign body in the respiratory tract is a dramatic accident that can cause complications, although rare in adults, and especially its late presentation, and in the left bronchus. Clinical case: we report the case of a 71-year-old patient with a late-onset foreign body in the left bronchial trunk, who consulted for respiratory sepsis, with no other associated symptoms, four months after reporting having swallowed a chicken bone. On which occasion the physical examination and radiological studies were negative. A CT scan of the chest and flexible bronchoscopy were performed, revealing an image suggestive of a foreign body in the left bronchial trunk. Discussion: after performing rigid bronchoscopy and extraction of a foreign body, he presented several complications, which required admission to intensive care, the subsequent clinical evolution was favorable, with a control chest X-ray with adequate lung re-expansion and being discharged 55 days later. of the diagnosis. Conclusions: in the presence of a patient with respiratory sepsis after a picture of bronchoaspiration, the diagnosis of aspiration of a foreign body should be taken into account. Extraction of the foreign body is the definitive solution.

RESUMO Introdução: a introdução fortuita de corpo estranho no trato respiratório é um acidente dramático que pode causar complicações, embora raras em adultos, e principalmente sua apresentação tardia, e no brônquio esquerdo. Caso clínico: relatamos o caso de um paciente de 71 anos com corpo estranho de início tardio no tronco brônquico esquerdo, que consultou por sepse respiratória, sem outros sintomas associados, quatro meses após relatar ter engolido osso de galinha. ocasião em que o exame físico e os estudos radiológicos foram negativos. Realizou-se TC de tórax e broncoscopia flexível, revelando imagem sugestiva de corpo estranho em tronco brônquico esquerdo. Discussão: após realização de broncoscopia rígida e extração de corpo estranho, apresentou diversas complicações, que exigiram internação em terapia intensiva, a evolução clínica posterior foi favorável, com radiografia de tórax de controle com reexpansão pulmonar adequada e alta hospitalar 55 dias depois do diagnóstico. Conclusões: na presença de um paciente com sepse respiratória após quadro de broncoaspiração, deve-se levar em consideração o diagnóstico de aspiração de corpo estranho. A extração do corpo estranho é a solução definitiva.

Central Airway Obstruction Tumour Debulking Using Rigid Bronchoscopy and Cryotherapy: A Case Report

@#Sarcomas usually frequented in the head and neck region of young adults. Trachea is a rare site, and due to scarce clinical data, its clinical outcome is unclear. We reported a case of 60-year old patient presented with progressive worsening shortness of breath, cough, and progressive worsening dysphagia. Computer tomography scan revealed extensive 2 lobulated soft tissue lesions within and surrounding the trachea at the T4 level. Rigid bronchoscopy with mass cryo-debulking was performed and ultimately synovial sarcoma was diagnosed. Shortness of breath was completely relieved post-procedure.

The value of rigid bronchoscopy combined with electronic bronchoscopy in the treatment of severe central airway stenosis / 西安交通大学学报(医学版)

Objective: To evaluate the clinical value and safety of rigid bronchoscopy combined with electronic bronchoscopy in the treatment of benign and malignant severe central airway stenosis. Methods: We retrospectively analyzed the clinical data of 46 patients with benign and malignant central airway stenosis treated from February 2015 to January 2019 in the Respiratory Endoscopy Room, The First Affiliated Hospital of Bengbu Medical College. We analyzed the patients' general data, diagnosis results, clinical manifestations, imaging and interventional treatment. The severity, type and distribution of stenosis were evaluated. The clinical symptoms and improvement of quality of life were evaluated by modified Medical Research Council Dyspnea Index (MRC DI) and Karnofsky Performance Score (KPS). Through regular follow-up, dynamic observation and evaluation of clinical efficacy, according to the occurrence of intraoperative and postoperative complications, safety assessment was carried out to evaluate the postoperative outcome. The clinical efficacy, safety evaluation and prognosis were observed. Results: The average age of 46 patients was (62.43±12.34) years old. 36 (78.26%) had tracheal stenosis, 6 (13.04%) had stenosis in the left main bronchus, 10 (21.74%) in the right main bronchus, and 2 (4.35%) in the right middle bronchus. Among them, 33 patients (71.74%) had malignant central airway stenosis and 13 (28.26%) had benign lesions. Forty-six patients underwent 58 interventional therapies, including stent placement, cryotherapy and balloon dilatation. Endoscopic estimation of the degree of tracheal stenosis was (85.42±7.81)% before the first intervention and (24.17±5.79)% after operation. The degree of stenosis in the right main bronchus was improved from (81.00±17.13)% to (20.50±6.43)%. The degree of left main bronchus stenosis (24.17±9.14)% was significantly improved compared with preoperative (77.50±16.66)%. The difference was statistically significant (t=42.73, t=22.43, t=19.02, P<0.001). The degree of dyspnea was relieved in all the patients. Postoperative MRC DI was 0.98±0.62, significantly lower than the preoperative one 3.42±0.57(t=19.65, P<0.001). KPS was 34.01±13.14 and 83.91±8.96 before and after interventional therapy, and KPS increased significantly after operation (t=21.28, P<0.001). The main complications were local hemorrhage, hypoxemia in 4 cases (8.70%, 4/46), transient ventricular premature rupture in 1 case (2.17%, 1/46), and tooth loss in 2 cases(4.35%, 2/46). Most patients had sore throat of varying degrees after operation. The 1-year survival rate of patients with malignant central airway stenosis was 13.79% (4/29), and 4 patients with malignant tumor were followed up; 13 patients with benign airway stenosis had good quality of life. Conclusion: For central airway stenosis, especially complex central airway stenosis, rigid bronchoscopy combined with electronic bronchoscopy shows immediate improvement of dyspnea and causes rare severe complications; thus it is safe and effective. It can improve the patients' quality of life.

Safety of modern rigid bronchoscopy related therapeutic procedures / 第二军医大学学报

Objective: To evaluate the safety of modern rigid bronchoscopy related therapeutic procedures. Methods: We retrospectively analyzed the clinical data of 100 patients with benign or malignant lesions who underwent modern rigid bronchoscopy operation between Apr. 2014 to Apr. 2016 at Respiratory Endoscopy Center of Changhai Hospital, Naval Medical University (Second Military Medical University). A total of 124 rigid bronchoscopy operations were performed. The intraoperative complications of rigid bronchoscopy were analyzed. Results: The intraoperative complications of rigid bronchoscopy were as follows: transient hypoxemia (4.03%, 5/124), injury of vocal cords and around mucosae (4.84%, 6/124), exposure keratitis (1.61%, 2/124), airway structural failure (2.42%, 3/124), damage of electronic bronchoscope (2.42%, 3/124), and insertion failure of rigid bronchoscopy (0.81%, 1/124). There were no deaths during operation. Conclusion: Modern rigid bronchoscopy is a treatment technique with high safety and few complications, and is worthy of clinical promotion and application. Standardized rigid bronchoscopy operation and related technique training should be carried out to improve its safety and reduce complications.

Application of rigid bronchoscopy in modern pediatric interventional respiratory diseases / 中国实用儿科杂志

Rigid bronchoscopy is an effective technique in the diagnosis and treatment of airway diseases,but it has a high operational risk and many complications. In recent years,with the improvement of equipment and technological advancement,the safety of rigid bronchoscopy operation has been improved, and clinical applications have begun to increase. However,in the clinical practice of rigid bronchoscopy, clinicians should judge according to clinical experience,master the insertion technology,and understand the application indications,in order to ensure the safe and effective application.

Rigid bronchoscopy in the real world: Controversies and thinking / 第二军医大学学报

Rigid bronchoscopy (RB) is one of the oldest bronchoscopic techniques. Since the advent of flexible bronchoscopy (FB) in 1970s, usage frequency of RB procedures has rapidly decreased, which made many clinicians question its clinical value. However, the fact of prosperous“rigid hot”in China has appeared in the field of interventional pulmonology in recent years, which confused some pulmonologists-why does RB become hot in the field of interventional pulmonology domestically? what is the practical value of RB in the endoscopic procedures of modern respiratory diseases? how about the developing trend and application prospects of RB in future? This review summarized and discussed the existing debates as well as the latest progress on RB in clinical application, and put forward our views and opinions.

Cuerpo extraño bronquial: experiencia de los últimos 18 años en Hospital Guillermo Grant Benavente, Concepción, Chile / Bronchial foreign body: experience of the last 18 years in Hospital guillermo grant Benavente, Concepcion, Chile

Introducción: Los cuerpos extraños en vía aérea (CEVA) continúan siendo un desafío clínico que genera un espectro de presentaciones, desde mínima sintomatología a compromiso respiratorio, falla respiratoria e incluso muerte. Objetivos: Describir y analizar las características epidemiológicas y clínicas de los pacientes con sospecha de CEVA evaluados en el Hospital Guillermo Grant Benavente. Material y método: Estudio retrospectivo y descriptivo de pacientes con diagnóstico de CEVA admitidos en nuestro servicio de urgencia, entre los años 1997 y 2015. Se analizaron diferentes variables, especialmente en relación a síntomas, signos, hallazgos radiológicos, complicaciones, tratamiento y resultados. Resultados: Se encontraron 117 broncoscopías rígidas, confirmándose CEVA en 94 (80,4%). La mayoría niños entre 1-3 años. Hubo más de una consulta previa al diagnóstico en el 29,8%, siendo la mayoría de las consultas precoces. La mayoría informó síndrome de penetración, pero esto no hizo la diferencia en el diagnóstico. El 80,9% de los casos confirmados tuvo alguna alteración radiológica (excluyendo cuerpos radio-opacos) (p <0,05). Se ubicó en árbol bronquial derecho mayormente, siendo de una naturaleza variada. Se extrajo en el primer intento sin incidentes el 91,5%. No hubo complicaciones reportadas en relación a las extracciones. Conclusiones: Un cuerpo extraño en el tracto respiratorio es una emergencia quirúrgica, pudiendo ser incluso fatal. Un alto índice de sospecha es fundamental para evitar complicaciones.

Introduction: Airway Foreign bodies (AFB) remain a clinical challenge, generate a spectrum of presentations, from minimal symptoms to respiratory distress, respiratory failure and even death. Aim: To describe and analyze the epidemiological and clinical characteristics of patients with suspected AFB. Material and methods: A retrospective and descriptive study of patients diagnosed with AFB admitted to our Emergency Service between 1997 and 2015. Different variables were analyzed, especiallytheir symptoms, signs, radiologic findings, complications, treatment and outcomes. Results: 117 rigid bronchoscopies associated with suspected AFB were found. The diagnosis was confirmed in 94 cases (80.4%). Most ofthem were children between 1-3 years. There was more than one consultation before the diagnosis in 29.85. Most of the patients reported penetration syndrome, but this made no difference on diagnosis. 80.9% ofthe confirmed cases had some radiological alteration (excluding radiopaque bodies) (p <0.05). Most of the cases were found in the right bronchial tree and were of a varied nature. They were extracted in the first attempt without incidents in 91.5% of the cases. There were no reported complications regarding extractions. Conclusions: A foreign body in the respiratory tract is a surgical emergency, and may even be fatal. A high index of suspicion is essential to avoid complications.

Remifentanil-based total intravenous anesthesia for pediatric rigid bronchoscopy: comparison of adjuvant propofol and ketamine

OBJECTIVE: Laryngoscopy and stimuli inside the trachea cause an intense sympatho-adrenal response. Remifentanil seems to be the optimal opioid for rigid bronchoscopy due to its potent and short-acting properties. The purpose of this study was to compare bolus propofol and ketamine as an adjuvant to remifentanil-based total intravenous anesthesia for pediatric rigid bronchoscopy. MATERIALS AND METHODS: Forty children under 12 years of age who had been scheduled for a rigid bronchoscopy were included in this study. After midazolam premedication, a 1 µg/kg/min remifentanil infusion was started, and patients were randomly allocated to receive either propofol (Group P) or ketamine (Group K) as well as mivacurium for muscle relaxation. Anesthesia was maintained with a 1 µg/kg/min remifentanil infusion and bolus doses of propofol or ketamine. After the rigid bronchoscopy, 0.05 µg/kg/min of remifentanil was maintained until extubation. Hemodynamic parameters, emergence characteristics, and adverse events were evaluated. RESULTS: The demographic variables were comparable between the two groups. The decrease in mean arterial pressure from baseline values to the lowest values during rigid bronchoscopy was greater in Group P (p = 0.049), while the reduction in the other parameters and the incidence of adverse events were comparable between the two groups. The need for assisted or controlled mask ventilation after extubation was higher in Group K. CONCLUSION: Remifentanil-based total intravenous anesthesia with propofol or ketamine as an adjuvant drug along with controlled ventilation is a viable technique for pediatric rigid bronchoscopy. Ketamine does not provide a definite advantage over propofol with respect to hemodynamic stability during rigid bronchoscopy, while propofol seems more suitable during the recovery period. .

Diagnostic and therapeutic value of endoscopy in foreign body aspiration in children / 中国小儿急救医学

Asphyxiation by an inhaled foreign body is a leading cause of accidental death among children younger than three years.The species of foreign body aspiration are many and varied.Immediately after inhalation the child starts to cough,wheeze,or have laboured breathing.The clinical manifestation will be different when foreign body stays in different part of bronchial tree.It's extremely easy to cause misdiagnosis.No matter whether aspiration or not,bronchoscopy should be taken.The bronchoscopy is not only the means of diagnosis,and removes the foreign body at the same time which helps to treat timely.

Prognostic Factors for Endotracheal Silicone Stenting in the Management of Inoperable Post-Intubation Tracheal Stenosis

PURPOSE: Stenting has been developed to deal with airway stenosis and is applicable in patients with post-intubation tracheal stenosis (PITS) in whom surgery would not be indicated. The purpose of this study was to investigate the prognostic factors in inoperable patients in whom a silicone stent was inserted due to PITS. MATERIALS AND METHODS: We retrospectively evaluated 55 PITS patients undergoing silicone stenting between January 2001 and December 2009. RESULTS: Silicone stent was inserted to narrowed trachea after the combination of pre-dilatation including laser cauterization, mechanical bougienation and ballooning. Following airway stabilization, the stent could be removed successfully in 40% (22/55) of the patients after median 12 months of stenting. However, in 60% (33/55) of patients, the stent could not be removed successfully and surgical management was needed after initial stabilization. Multivariate analysis revealed that the stent could be successfully removed more frequently in those who do not have cardiovascular disease [odds ratio (OR)=12.195; p=0.036] and the intervention was performed within 6 months after intubation (OR=13.029; p=0.031). CONCLUSION: Among those patients undergoing silicone stenting due to PITS, the stent could be successfully removed when patients do not have cardiovascular disease and stented within 6 months after intubation.

Airway fire injury during rigid bronchoscopy in a patient with a silicon stent: A case report / 대한마취과학회지

Therapeutic bronchoscopy is widely employed as an effective first-line treatment for patients with central airway obstructions. Airway fires during rigid bronchoscopy are rare, but can have potentially devastating consequences. Pulmonologist and anesthesiologist undertaking this type of procedure should be aware of this serious problem and be familiar with measures to avoid this possibly fatal complication. We report the case of a 24-year-old patient with a silicone stent who experienced an electrocautery-induced airway fire during rigid bronchoscopy.

Endoscopía en la extracción de cuerpo extraño en vía aero-digestiva / Endoscopic extraction of foreign body aero digestive track

Presentamos nuestra experiencia en la extracción de cuerpos extraños de la vía aérea y el esófago. Durante el periodo 2003-2008 se realizaron 3535 endoscopias en pacientes adultos, de los cuales 19 fueron para la extracción de cuerpos extraños. Del total de casos, 3 se ubicaron en el esófago y los 16 restantes en la vía aérea. En doce pacientes (63.16 por ciento) los elementos fueron extraídos con broncoscopio rígido, mientras que en los otros siete pacientes (36.84 por ciento) se utilizó un fibrobroncoscopio y pinzas de biopsia convencionales. Los cuerpos extraños ubicados en el esófago fueron extraídos con endoscopia rígida. El empleo del fibrobroncoscopio puede ser una técnica adecuada para la extracción de un cuerpo extraño, pero es imprescindible que el endoscopista tenga la posibilidady el entrenamiento para realizar en forma inmediata un procedimiento conbroncoscopio rígido.

We present our experience about the extraction of foreign bodies in the airway and esophagus. During the period 2003-2008 we made 3535 bronchoscopies in adult patients,19 were for foreign body extraction, 16 were in the airway and 3 in the esophagus. The rigid bronchoscope was used in 12 patients (63.16 percent), and the fiberbroncoscope and conventional biopsy tweezers were used in seven (36.84 percent). Rigid bronchoscopy wasused in the extraction of foreign bodies from the esophagus. Although the use offiberbronchoscope can be an adequate technique for foreign body extraction, it is strongly recommended that the endoscopists have the training and the means to use the rigid bronchoscope without delays.

Clinical value of chest CT in the diagnosis and management of tracheobronchial foreign bodies / 中国小儿急救医学

Objective The purpose of this study was to investigate the value of chest CT in the evaluation ofchildren with suspected foreign body aspiration. Methods Chest CT was performed in 45consecutive children with suspected foreign body aspiration. The patients were examined with 16-slice Multidetector CT (MDCT) using 100 ～ 150 kV,30 ～ 50 mA, 1 mm section thickness. 1.2 pitch ratio, and 0.6 ～1.0 mm reconstruction interval. multiplanar reformatted (MPR) imaging were carried out after MDCT examinations. Results Chest CT revealed all foreign bodies in 42 of the 45 patients. Three patients with suspected foreign body aspiration did not show evidence of foreign body on CT,and they were treated with antibiotics for one week. These patients avoided unnecessary operations and recovered completely. The other 42 patients had evidence of foreign bodies in their bronchi. We designed the surgerical plan and selected appropriate foreign body forceps based on the CT scans. All of the foreign bodies were removed successfully, and no severe complications were observed. The location, shape, and volume of the foreign bodies found at surgery were consistent with the CT images. Conclusion The diagnosis of foreign body aspiration of the airwayin children can be accomplished by using chest CT. It is often useful in delineating the exact shape, location, volume and form of a bronchial foreign body and can help the surgeon plan for operative bronchoscopy and safe removal of the foreign body.

Role of rigid bronchoscopy in massive haemoptysis

Massive haemoptysis can occur in lung abscess. Massive haemoptysis itself may be life threatening due to asphyxiation or respiratory failure secondary to acute large airway obstruction by blood clots. Prompt removal of the obstructing blood clots save life. We describe a case of lung abscess causing massive haemoptysis resulting in acute airway obstruction which required rigid bronchoscopy to remove the huge blood clot. (JUMMEC2010; 13(2): 107-110)

A Case of Tracheal Carcinoma Diagnosed by Rigid Bronchoscopy in Lidocaine Anaphylaxis Patient / 결핵및호흡기질환

The majority of flexible bronchoscopies are performed under topical anesthesia with lidocaine being the most commonly used agent. Anaphylaxis rarely occurs after local administration of lidocaine, but can be a fatal complication. We experienced a case of unexpected anaphylaxis. A 66-year-old woman was scheduled for flexible bronchoscopy to evaluate a tracheal mass and stenosis. The oral and nasal mucosa were pretreated with lidocaine. About 2~3 minutes later, the patient developed hypotension and we treated for anaphylaxis in the emergency room. Then, we decided to perform rigid bronchoscopy in this patient, under conditions of general anesthesia. A rigid bronchoscopy was performed in this patient, safely and successfully. The tracheal mass was determined to be squamous cell carcinoma.

Usefulness of Photodynamic Therapy in the Management of Early Central Lung Cancer: A Report of Three Cases / 결핵및호흡기질환

In photodynamic therapy, a chemical photosensitizer is activated by light of a specific wavelength., Photodynamic therapy has been combined with bronchoscopy in patients who are ineligible for surgical resection in order to treat patients with early central lung cancer. Here, we describe 3 patients with early central lung cancer who were treated effectively using photodynamic therapy. Our experience shows that this approach is a useful modality in the therapy of these types of tumors.

An endobronchial hamartoma removed via rigid bronchoscopy under general anesthesia / 대한내과학회지

A 54-year-old man presented with a cough, sputum, and fever. His chest X-ray showed atelectasis in the right middle lobe. Computed tomography revealed obstruction of the bronchus intermedius by an endobronchial tumor. The first bronchoscopic biopsy specimens suggested lipoma. We resected the tumor via rigid bronchoscopy under general anesthesia and the final pathology report revealed a cartilaginous hamartoma. Subsequently, he has been followed for more than 1 year without recurrence.

Esophageal Cancer with Left Main Bronchus Obstruction

A 66-year-old man with recurrent esophageal cancer was admitted to our health care facility for evaluation of resting dyspnea. He had undergone an esophagectomy with cervical esophagogastrostomy in May 2007 and had undergone radical radiation treatment from June to August 2007. After 6 months, he complained of cough and dyspnea. A metastatic lymphadenopathy, 4 cm in size, was in the para-aortic space and compressed the left main bronchus, resulting in total atelectasis of the left lung, as demonstrated on follow-up chest simple x-ray and CT (Fig. 1, 2). He initially received one cycle of chemotherapy consisting of docetaxel and cisplatin, but there was no change in the lung atelectasis and the dyspnea had worsened. The decision was therefore made to perform a rigid bronchoscopy. Under general anesthesia, an endobronchial obstructive lesion was removed using a mechanical core-out technique with rigid bronchoscopy (Fig. 3). After the procedure, the atelectasis resolved nearly completely, and neither severe bleeding nor other complications were noted (Fig. 4). The dyspnea was relieved from ATS (American thoracic society) grade 4 to grade 2. Following this treatment, chemotherapy for recurrent esophageal cancer was resumed

Removal of Sawdust Aspiration and Anesthetic Management: A case report / 대한마취과학회지

The aspiration of a tracheobronchial foreign body can be a life-threatening incident. Early diagnosis and the bronchoscopic removal of the foreign bodies can protect a patient from serious morbidity and even mortality. We report an unusual case of a 28-year-old man who inhaled sawdust that required emergency airway management and bronchoscopic removal of the sawdust fragments. Anesthesia for a rigid bronchoscopy is a challenging procedure for an anesthesiologist who must share the airway with the bronchoscopist and maintain the adequate depth of anesthesia. Most of the sawdust fragments were extracted successfully using a rigid bronchoscope. The patient was discharged uneventfully within one week of hospitalization.