Bronchoscopy




B Bronchoscopy




1. Introduction

    Bronchoscopy permits direct inspection of the larynx, trachea, and bronchi. Indications include collection of secretions for cytologic or bacteriologic examination, tissue biopsy, location of bleeding and tumors, removal of a foreign body, and implantation of radioactive gold seeds for tumor treatment. A common indication for bronchoscopy is suspicion of bronchial neoplasm.

2. Preoperative assessment
a) History and physical examination
(1) Respiratory: Evaluate for chronic lung disease, wheezing, atelectasis, hemoptysis, cough, unresolved pneumonia, diffuse lung disease, and smoking history.

(2) Cardiac: Question underlying dysrhythmias because they may arise with stimulation from the scope or could be a sign of hypoxemia during the procedure.

(3) Gastrointestinal: Assess the patient’s drinking history and nutritional intake.

b) Diagnostic tests
(1) Chest radiography

(2) CT

(3) Pulmonary function test with lung disease

(4) Laboratory tests, including a complete blood count, electrolytes, glucose, and others as indicated by the patient’s medical condition

c) Preoperative medications and intravenous (IV) therapy
(1) The patient may already be taking sympathomimetic bronchodilators and aminophylline. The patient may benefit from administration of an inhaled bronchodilator preoperatively.

(2) Sedatives and narcotics are to be used with caution in patients with poor respiratory reserve.

(3) Cholinergic blocking agents reduce secretions.

(4) IV lidocaine, 0.5 to 1.5 mg/kg, decreases airway reflexes.

(5) Topical anesthesia involves 4% lidocaine using a nebulizer to anesthetize the airway by spraying the palate, pharynx, larynx, vocal cords, and trachea.

(6) One 18-gauge peripheral IV line with minimal fluid replacement is used.

3. Room preparation
a) Monitoring equipment is standard: An arterial line is used if thoracotomy is planned or the patient is unstable.

b) Pharmacologic agents: Lidocaine and cardiac drugs are used.

c) Position: Supine; the table may be turned. One must manage an upper airway that is shared with the surgeon.

4. Anesthetic technique
a) Local infiltration or general anesthesia is used.

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Dec 2, 2016 | Posted by in ANESTHESIA | Comments Off on Bronchoscopy

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