Bronchoscopic Evaluation of the Lungs and Tracheobronchial Tree.
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Transcript of Bronchoscopic Evaluation of the Lungs and Tracheobronchial Tree.
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Bronchoscopic EvaluBronchoscopic Evaluation of the Lungs anation of the Lungs and Tracheobronchial Td Tracheobronchial T
reeree
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Rigid BronchoscopyRigid Bronchoscopy
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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
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♦ ♦ 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
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Flexible BronchoscopyFlexible Bronchoscopy
In the early 1970s, fiberoptic In the early 1970s, fiberoptic bronchoscopy was introduced, bronchoscopy was introduced, revolutionizing examination.revolutionizing examination.
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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..
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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
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♦♦ 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
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♦♦ 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
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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,
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Transbronchial Biopsy and BrusTransbronchial Biopsy and Brushinghing
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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
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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
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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
bxbx
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Foreign Body RetrievalForeign Body Retrieval
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Autofluorescence BronchosAutofluorescence Bronchoscopycopy
♦♦ Helium cadmium laser: severe dysplaHelium cadmium laser: severe dysplasia and carcinoma can be easily recognsia and carcinoma can be easily recognizedized
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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
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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