In a 3‑year‑old boy with an aspirated airway foreign body undergoing rigid bronchoscopy, which complication is most likely—laryngospasm, pneumonia, pneumothorax, sepsis, or vocal‑cord paralysis?

Most Likely Complication of Rigid Bronchoscopy for Foreign Body Removal in a 3-Year-Old

Laryngospasm is the most likely complication of rigid bronchoscopy for foreign body removal in this 3-year-old child with an aspirated hotdog piece.

Rationale for Laryngospasm as the Primary Risk

While the provided guidelines focus extensively on transbronchial biopsy complications (where pneumothorax is the major concern at ~3% incidence), foreign body removal via rigid bronchoscopy carries a distinctly different complication profile 1. The key distinction is that:

• Transbronchial biopsy involves peripheral lung tissue sampling with forceps penetration into lung parenchyma, creating pneumothorax risk 1
• Foreign body removal involves instrumentation of the central airways (trachea and mainstem bronchi) without parenchymal violation 2, 3, 4, 5

Evidence-Based Complication Profile

Actual Complications from Foreign Body Bronchoscopy

Large pediatric series demonstrate the following complication patterns:

• Laryngospasm and airway reactivity are the predominant anesthetic/periinterventional complications during rigid bronchoscopy for foreign body removal 2, 4
• Respiratory distress requiring intervention occurred in multiple studies, with hypoxia developing in patients requiring mechanical ventilation 5
• Overall complication rate: 7.6% periinterventional complications in one series of 287 children, with anesthetic adverse events at 0.7% 2
• Pneumothorax occurred in only 2 of 548 patients (0.4%) in one large series—a rare event in foreign body removal 5

Why Other Options Are Less Likely

Pneumothorax is uncommon in foreign body removal because:

• The procedure does not involve peripheral lung tissue penetration 3, 5
• Incidence is <1% in foreign body series versus 3% in transbronchial biopsy 1, 5

Pneumonia is a consequence of delayed diagnosis (>24 hours), not an acute procedural complication 2, 4

Sepsis is not a recognized acute complication of bronchoscopy 2, 3, 4, 5

Vocal cord paralysis is not reported as a complication in pediatric foreign body bronchoscopy series 2, 3, 4, 5

Clinical Context Supporting Laryngospasm Risk

This specific case has multiple risk factors:

• Age 3 years: Young children have hyperreactive airways and increased laryngeal sensitivity 2
• Recent aspiration event (30 minutes ago): Acute airway irritation and inflammation increase reactivity 4
• Organic foreign body (hotdog): These cause more mucosal inflammation and edema than inorganic objects 3, 4
• Moderate distress with tachypnea (RR 32): Indicates existing airway irritability 2

Critical Management Points

Preventing Laryngospasm

• Experienced anesthesiologist with pediatric airway expertise is mandatory 2
• Adequate depth of anesthesia before instrumentation 2
• Topical lidocaine to vocal cords may reduce reactivity 2

Common Pitfalls to Avoid

• Inadequate anesthetic depth during scope insertion increases laryngospasm risk 2
• Delayed diagnosis (>24 hours) increases all complications due to mucosal inflammation and granulation tissue formation 2, 4
• Multiple previous bronchoscopies significantly predict complications 4
• Prolonged procedure duration correlates with higher complication rates 4