Bronchoscopic EvaluBronchoscopic Evaluation of the Lungs anation of the Lungs and Tracheobronchial Td Tracheobronchial T

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Rigid BronchoscopyRigid Bronchoscopy

Most commonly in Most commonly in adult: ID 6,7,8 adult: ID 6,7,8 mm, 40 cm in mm, 40 cm in

lengthlength

♦ ♦ Supine position, assistant Supine position, assistant positioning the head, neck is slightly positioning the head, neck is slightly fixed, chin extendedfixed, chin extended

♦♦ Risks: injury to gums, tooth Risks: injury to gums, tooth dislodgement, hypoventilation, dislodgement, hypoventilation, airway bleeding, direct injury to airway bleeding, direct injury to larynx, rupture of the larynx, rupture of the tracheobronchial treetracheobronchial tree

Flexible BronchoscopyFlexible Bronchoscopy

In the early 1970s, fiberoptic In the early 1970s, fiberoptic bronchoscopy was introduced, bronchoscopy was introduced, revolutionizing examination.revolutionizing examination.

Most commonly used: OD 5.9mm, Most commonly used: OD 5.9mm, 2.2 mm working channel, reach to 2.2 mm working channel, reach to

the 4-5order bronchithe 4-5order bronchi..

Anesthetic ConsiderationAnesthetic Consideration

♦♦ Pulse oximeter, cuff BP, ECG monitor, OPulse oximeter, cuff BP, ECG monitor, O2, topical anesthesia, IV sedation2, topical anesthesia, IV sedation

♦♦ 50% of severe complication: 50% of severe complication: oversedatiooversedationn, hypoxia, hypercapnia, respiratory dep, hypoxia, hypercapnia, respiratory depressionression

♦♦ Pre-op opiates: MeperidinePre-op opiates: Meperidine♦♦ Midazolam: 0.07mg/kg, half life 2 hours, Midazolam: 0.07mg/kg, half life 2 hours, liver diseaseliver disease→prolonged sedation→prolonged sedation

♦♦ Topical anesthesia: Topical anesthesia: lidocaine (1%, 2%), tetracaine(0.5, 1, 2 lidocaine (1%, 2%), tetracaine(0.5, 1, 2

%)%)♦♦ Spraying of hypopharynx, additional tSpraying of hypopharynx, additional t

o vocal cord, trachea, tracheobronchiao vocal cord, trachea, tracheobronchial treel tree

♦♦ Injected through cricothyroid membrInjected through cricothyroid membraneane

♦♦ Nasal route: avoid chewing instrumenNasal route: avoid chewing instrumentt

♦♦ Mouth route: Mouth route: ♦♦ Through oral endotracheal tube, laryThrough oral endotracheal tube, lary

ngeal madkngeal madk

Bronchia Biopsy and Bronchia Biopsy and BrushingBrushing

♦♦ Mucosal change of malignanceMucosal change of malignance♦♦ Bleeding: 1/100,000 epinephrine, Bleeding: 1/100,000 epinephrine, Nd:YAG laser photoablation,Nd:YAG laser photoablation,

Transbronchial Biopsy and BrusTransbronchial Biopsy and Brushinghing

Transbronchial Needle AspiratTransbronchial Needle Aspirationion

♦♦ Transbronchial needle aspiration befTransbronchial needle aspiration before brushing, lavageore brushing, lavage

♦♦ At least 15% false-negative rateAt least 15% false-negative rate♦♦ Endobronchial ultrasonography(EUS):Endobronchial ultrasonography(EUS):

assess, localize paratracheal, peribroassess, localize paratracheal, peribro

nchial pathologynchial pathology

Bronchoalveolar lavage (BABronchoalveolar lavage (BAL)L)

♦♦ Material from terminal bronchial, alveMaterial from terminal bronchial, alveolar sacsolar sacs

♦♦ 100-300 ml saline, 40-60% is recovered.100-300 ml saline, 40-60% is recovered.♦♦ Useful in microbiological specimens, Useful in microbiological specimens,

especially in immunosuppressed, fungespecially in immunosuppressed, fungal, bacterial, viral culture specimensal, bacterial, viral culture specimens

ComplicationComplication

♦♦ Bronchospasm, hypoxia, fever, transiBronchospasm, hypoxia, fever, transient decline in pulmonary functionent decline in pulmonary function

♦♦ Careful evaluation and preparationCareful evaluation and preparation♦♦ General anesthesiaGeneral anesthesia♦♦ Pneumothorax: 3% in transbronchial Pneumothorax: 3% in transbronchial

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Foreign Body RetrievalForeign Body Retrieval

Autofluorescence BronchosAutofluorescence Bronchoscopycopy

♦♦ Helium cadmium laser: severe dysplaHelium cadmium laser: severe dysplasia and carcinoma can be easily recognsia and carcinoma can be easily recognizedized

Massive HemoptysisMassive Hemoptysis♦♦ 600 ml in 24 hours600 ml in 24 hours♦♦ Rigid bronchoscope Rigid bronchoscope ♦♦ Airway control, suction, packing with epineAirway control, suction, packing with epine

phrine soaked pledget, fogarty ballonphrine soaked pledget, fogarty ballon♦♦ The site of massive hemoptysis must be locaThe site of massive hemoptysis must be loca

lized: lized: Sugical excisionSugical excision Nd:YAG laser photoablationNd:YAG laser photoablation Endobronchial tamponadeEndobronchial tamponade Bronchial artery embolizationBronchial artery embolization

Interventional Interventional BronchoscopyBronchoscopy

♦♦ Endobronchial electrocauderyEndobronchial electrocaudery♦♦ Nd:YAG laser photoablationNd:YAG laser photoablation♦♦ CryoablationCryoablation♦♦ Photodynamic therapyPhotodynamic therapy♦♦ Placement of radioactive brachytheraPlacement of radioactive brachythera

pypy♦♦ Placement of endobronchial stent: Placement of endobronchial stent: silicone stent, self-expanding metal stentsilicone stent, self-expanding metal stent