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We perfo rmed a retrospective char t review to evaluate the indications for endotracheal intubatio n via flexi ble jiberoptic bronchoscopy in patients who were scheduled for surgery or who were hospitalized in the intensive care unit of our I,IOO-bed, tertiary care university hospital. We reviewed 9,201 clinical records of anesthetic pro cedures durin g which endotracheal intubation had been perform ed fro m Januar y to Decemb er 2002. We identified 66 patients who had been intubated withflexible jib eroptic bronchoscopy. On preanesthetic examinatio n, 61 ofthese patients fwd been fo und to be poor candidates f or conventional laryn goscopic intubat ion-51 because of abnorma l head and neck anatomy and 10 because of reduced visual access to the airway (Ma llampati class IV). The remainin g 5 patients were intubated via flexible jib eroptic bronchoscopy after conventional intubation had failed during eme rgency surgery. Our study emphasizes (1) the importan ce of the preanesthetic examination of surgical patients, to identify those in whom conventional intubation would likely be problematic, and (2) the need to havejib eroptic bronchoscopes and an anesthes iologist or bronchoscopist skilled in their use available in operating suites and intensive care units.

Tracheal stenosis (TS) requires a precise diagnosis and an experienced operator in both endoscopic and surgical treatment. We describe a case series at a tertiary care teaching hospital. Twenty patients with TS and/or subglottic stenosis were included. All underwent flexible bronchoscopy (FB). Spirometry (SP) was obtained in 8 patients, and helical computed tomography with three-dimensional reconstruction (HCT3D) was obtained in 11 patients. All cases were graded by each modality on a scale of 1 to 3, and the findings were correlated among modalities. Mean follow-up was 11.1 months (range: 3 to 47 mo). Postintubation injury was the most frequent cause of stenosis in 16 patients (80%). Mean stenosis grade±SD was 2.0±0.92 for SP, 2.3±0.86 for FB, and 2.54±0.68 for HCT3D. A significant correlation was found between HCT3D and FB (r=0.76, P<0.01). There was no correlation between SP and FB (r=0.46, P=0.2) or between SP and HCT3D (r=0.68, P=0.13). Treatment was conservative in 8 patients. Eighteen tracheal dilatation procedures were performed in 7 patients (mean: 2.5 dilatations/patient, range: 1 to 6; mean free time between dilatations 109.7±81 d, range: 6 to 210 d). Tracheoplasty was carried out in 7 patients, with tracheal anastomosis in 4 patients and thyroid-tracheal anastomosis in 3 patients. Tracheostomy was required in 1 patient with scleroma. Neither complications nor mortality related to FB was reported. HCT3D has a good correlation with FB. Tracheal dilatation is a viable option for patients who are not surgical candidates and for those with restenosis of tracheal anastomosis.