Bronchoscopy

- ARJUN P NAMBIAR
Types of bronchoscopy

 Rigid
 Flexible fiberoptic
Rigid Bronchoscopy
 Indications
 Diagnostic
 Cause for wheezing, hemoptysis or unexplained cough
persisting for more than 4 weeks
 When X-ray chest shows:
 Atelectasis
 Localized opacity
 Obstructive emphysema to rule out foreign body
 Hilar or mediastinal shadows
 Therapeutic
 Removal of foreign bodies
 Removal of retained secretions or mucus plug
Rigid Bronchoscopy
 Anesthesia: General anesthesia with no endotracheal
tube or with only a small-bore catheter is often
preferred. It can also be done under topical surface
anesthesia.
Rigid Bronchoscopy
 Position: (Barking-dog position)
Patient lies supine. Head is elevated by 10-15
cm by placing a pillow under the occiput or by
raising head flap of the operation table. Neck is
flexed on thorax and the head extended on atlanto-
occipital joint.
Rigid Bronchoscopy

 Technique: there are 2 methods to introduce

bronchoscope
 Directmethod: bronchoscope is introduced directly
through the glottis.
 Through Laryngoscope: glottis is first exposed with
the help of a spatular type laryngoscope and then the
bronchoscope is introduced through the laryngoscope
into the trachea. Laryngoscope is then withdrawn.
Useful in infants and young children as well as adults
with short neck and thick tongue.
Rigid Bronchoscopy
 Details of technique:
 Place gauze or dental guard on the upper teeth to protect from injuries
 Hold appropriate sized bronchoscope lubricated with autoclaved liquid
paraffin or jelly by the shaft in the right hand in a pen like fashion. Fingers
of the left hand is used to retract the upper lip and guide the bronchoscope.
 Through the scope, tip of epiglottis is identified and scope is passed behind
it and epiglottis is lifted forwards to expose the glottis. Bronchoscope is
rotated 90º clockwise for the beveled tip is in the axis of glottis to ease its
entry into the trachea after which, scope is rotated back to the original
position.
 Advance bronchoscope and examine tracheobronchial tree, for which axis
of scope should be made to correspond with trachea and bronchi by flexing
head and neck to the opposite side
 Directvision, right angled and retrograde telescopes are used for
magnification and detailed examination.
 Biopsy of the lesion of suspicious area can be taken
 Secretions can be collected for exfoliative cytology or bacteriological
Rigid Bronchoscopy
 Post operative care:
 Keep the patient in humid atmosphere
 Watch for respiratory distress

 Complications:
 Injury to teeth and lips
 Hemorrhage from the biopsy site
 Hypoxia and cardiac arrest
 Laryngeal edema
Rigid Bronchoscopy
 Precautions during bronchoscopy
 Select proper size of bronchoscope according to the
patient’s age
 Do not force bronchoscope through closed glottis
 Repeated removal and introduction of bronchoscope
should be avoided
 Procedure should not be prolonged beyond 20 minutes
in infants and children, otherwise it may cause
subglottic edema in post operative period
Flexible Fiberoptic
Bronchoscopy
Rigid bronchoscopy
Flexible Fiberoptic
bronchoscopy
Thank you.