Diagnostic and Therapeutic Fiberoptic Bronchoscopy

Paul Bigeleisen

BACKGROUND AND EQUIPMENT

Although anesthesiologists frequently use flexible bronchoscopy to assist with difficult intubations and the placement of double lumen endotracheal tubes, they rarely examine the airway distal to the right and left mainstem bronchi. Nonetheless, anesthesiologists and more commonly intensivists, may be called upon to perform some forms of diagnostic or therapeutic bronchoscopy. This chapter summarizes the equipment used in and indications for flexible bronchoscopy that anesthesiologists and intensivists are likely to encounter.

The rigid bronchoscope was invented by Killian in 1897. Machida and the Olympus Corporation produced the first commercially available flexible fiberscope in 1966.¹,² This device used glass fibers to conduct light into the airway and reflected light back to the viewer. In 2001, a new type of flexible scope with a light source in the cable and a digital camera at the tip of the flexible cable was developed.³ The digital image formed by this miniature digital camera was carried back from the airway by copper wire to a viewing screen. This provided a superior image and eliminated the need for glass fibers in the image channel. The resulting image had a higher resolution without the pixilation inherent to the previous generation of fiberoptic scopes.

A flexible bronchoscope consists of a handle with controls attached to a flexible conduit with three channels. One channel is a hollow lumen that can be used to suction sputum, insufflate oxygen, inject saline/local anesthetic, or biopsy tissue. Another channel conveys light from the light source to the tip of the bronchoscope. The third channel returns the image of the airway from the tip of the bronchoscope to the eyepiece or viewing screen. Additional equipment consists of a light source, and a viewing screen or eyepiece (see also Chapter 23).¹,²,³

INDICATIONS

Fiberoptic bronchoscopy is indicated for diagnostic and therapeutic problems of the airway and lungs. The most common diagnostic indications that anesthesiologists and intensivists will encounter are stridor, hoarseness, vocal cord paralysis, and infection. In addition, the fiberscope is usually used to confirm endobronchial tube placement (or diagnose displacement) during surgical procedures requiring lung isolation or single lung ventilation. Less common uses are to diagnose inhalation injury, hemoptysis, lobar collapse, and the identification of foreign bodies and obstructing tumors. Common therapeutic indications are the removal of foreign bodies, pulmonary toilet, bronchoalveolar lavage, and transtracheal percutaneous tracheostomy (see Chapter 39).³

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