Bronchoscopic Evaluation of the Lungs and Tracheobronchial Tree

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Bronchoscopic Evaluation of the Lungs and
Tracheobronchial Tree
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Rigid Bronchoscopy
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Most commonly in adult ID 6,7,8 mm, 40 cm in
length
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• ? Supine position, assistant positioning the
  head, neck is slightly fixed, chin extended
• ? Risks injury to gums, tooth dislodgement,
  hypoventilation, airway bleeding, direct injury
  to larynx, rupture of the tracheobronchial tree

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Flexible Bronchoscopy

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

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Most commonly used OD 5.9mm, 2.2 mm working
channel, reach to the 4-5order bronchi.
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Anesthetic Consideration

• ? Pulse oximeter, cuff BP, ECG monitor, O2,
  topical anesthesia, IV sedation
• ? 50 of severe complication oversedation,
  hypoxia, hypercapnia, respiratory depression
• ? Pre-op opiates Meperidine
• ? Midazolam 0.07mg/kg, half life 2 hours,
• liver disease?prolonged sedation

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• ? Topical anesthesia
• lidocaine (1, 2), tetracaine(0.5, 1, 2 )
• ? Spraying of hypopharynx, additional to vocal
  cord, trachea, tracheobronchial tree
• ? Injected through cricothyroid membrane

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• ? Nasal route avoid chewing instrument
• ? Mouth route
• ? Through oral endotracheal tube, laryngeal madk

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Bronchia Biopsy and Brushing

• ? Mucosal change of malignance
• ? Bleeding 1/100,000 epinephrine,
• NdYAG laser photoablation,

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Transbronchial Biopsy and Brushing
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Transbronchial Needle Aspiration

• ? Transbronchial needle aspiration before
  brushing, lavage
• ? At least 15 false-negative rate
• ? Endobronchial ultrasonography(EUS)
• assess, localize paratracheal, peribronchial
  pathology

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Bronchoalveolar lavage (BAL)

• ? Material from terminal bronchial, alveolar sacs
• ? 100-300 ml saline, 40-60 is recovered.
• ? Useful in microbiological specimens, especially
  in immunosuppressed, fungal, bacterial, viral
  culture specimens

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Complication

• ? Bronchospasm, hypoxia, fever, transient decline
  in pulmonary function
• ? Careful evaluation and preparation
• ? General anesthesia
• ? Pneumothorax 3 in transbronchial bx

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Foreign Body Retrieval
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Autofluorescence Bronchoscopy

• ? Helium cadmium laser severe dysplasia and
  carcinoma can be easily recognized

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Massive Hemoptysis

• ? 600 ml in 24 hours
• ? Rigid bronchoscope
• ? Airway control, suction, packing with
  epinephrine soaked pledget, fogarty ballon
• ? The site of massive hemoptysis must be
  localized
• Sugical excision
• NdYAG laser photoablation
• Endobronchial tamponade
• Bronchial artery embolization

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Interventional Bronchoscopy

• ? Endobronchial electrocaudery
• ? NdYAG laser photoablation
• ? Cryoablation
• ? Photodynamic therapy
• ? Placement of radioactive brachytherapy
• ? Placement of endobronchial stent
• silicone stent, self-expanding metal stent