BRONCHOSCOPY

2.  Bronchoscopy is a technique of visualizing
the inside of the airways for diagnostic and
therapeutic purposes

3.  Bronchoscope is inserted into the airways,
usually through the nose or mouth, or
occasionally through a tracheostomy. This
allows the practitioner to examine the
patient's airways for abnormalities such as
foreign bodies, bleeding, tumors,
or inflammation. Specimens may be taken
from inside the lungs. The construction of
bronchoscopes ranges from rigid metal tubes
with attached lighting devices to flexible
optical fiber instruments with realtime video
equipment.

4. A German, Gustav Killian,
performed the first
bronchoscopy in 1897. From
then until the 1970s, rigid
bronchoscopes were used
exclusively. Killian used rigid
bronchoscopy to remove a
pork bone. The procedure
was done in an awake patient
using topical cocaine as a
local anesthetic.
HISTORY

5. Killian demonstrates the rigid
bronchoscopy in a cadaver
specimen

6. An American, Chevalier
Jackson, refined the rigid
bronchoscope in the 1920s,
using this rigid tube to visually
inspect the trachea and
mainstem bronchi. The British
laryngologistVictor Negus, who
worked with Jackson, improved
the design of his endoscopes,
including what came to be
called the 'Negus
bronchoscope'
He is sometimes known as the
"father of endoscopy",
although Philipp
Bozzini (1773–1809) is also
often given this sobriquet.

7. A Japanese, Shigeto Ikeda, invented the
flexible bronchoscope in 1966. The
flexible scope initially employed
fiberoptic bundles requiring an external
light source for illumination. These
scopes had outside diameters of
approximately 5 mm to 6 mm, with an
ability to flex 180 degrees and to extend
120 degrees, allowing entry into lobar
and segmental bronchi. More recently,
fiberoptic scopes have been replaced by
bronchoscopes with a charge coupled
device (CCD) video chip located at their
distal extremity.

8. Shigeto Ikeda
regarded as the "father" of
fiberoptic bronchoscopy.
he developed the first flexible
bronchoscope in conjunction with
Machida Endoscope Co. Ltd (later
taken over by Pentax) and Olympus
Optical Co., Ltd. This allowed better
visualisation of the upper
lobe bronchi than is possible with the
rigid bronchoscope. Successive
improvements under his supervision
included the development of video-
bronchoscopy.
His motto was "there is more hope
with the bronchoscope".

9. TYPES
•RIGID
•FLEXIBLE FIBEROPTIC
AND VIDEO
BRONCHOSCOPY

10. RIGID
BRONCHOSCOPE

11.  SURGICAL ASSESMENT OF LUNG
CANCER OPERABILITY
 FOREIGN BODY SUSPECTED AND
REMOVAL
 INSPECTION OF TRACHEAL STENOSIS
 EMERGENCY CONTROL OF PROFUSE
ENDOBRONCHIAL
BLEEDING(HEMOPTYSIS) BY PACKING/
TAMPONADE BY BALOON CATHETER
 PAEDIATRIC BRONCHOSCOPY

12.  IN TREATMENT OF LARGE AIRWAY
TUMOURS BY LASER
 INSPECTION OF SERIOUS CAUSES OF
TRACHEAL NARROWING, WHEREIN A
TRACHEAL DILATOR OR STENTING CAN BE
DONE

15.  WIDE CHANNEL THROUGH WHICH
LARGE BIOPSIES AND FORIGN BODIES
CAN BE MORE EASILY GRASPED AND
REMOVED
 SUPERIOR SUCTION CAPABILITY

16.  LACK OF MANOEUVRABILITY
 REQUIREMENT OF A ANAESTHETIST

17.  The bronchoscope is longer and thinner than a rigid
bronchoscope. It contains a fiberoptic system that
transmits an image from the tip of the instrument to
an eyepiece or video camera at the opposite end.
Using Bowden cables connected to a lever at the
hand piece, the tip of the instrument can be
oriented, allowing the practitioner to navigate the
instrument into individual lobe or segment bronchi.
Most flexible bronchoscopes also include a channel
for suctioning or instrumentation, but these are
significantly smaller than those in a rigid
bronchoscope.

22.  DIAGNOSIS OF LUNG CANCER
 CHEST RADIOGRAPHIC
ABNORMALITY
 HAEMOPTYSIS
 PERSISTENT OR RECURRENT
COUGH
 PARALYSED VOCAL CORD
 POSITIVE SPUTUM
CYTOLOGY

23.  STAGING OF LUNG CANCER
 DIAGNOSIS OF DIFFUSE LUNG DISEASE
 IDENTIFICATION OF INFECTING AGENTS
 IMMUNOCOMPRAMISED
HOST
 IMMUNOCOMPETANT HOST

24.  PERSISTENT COUGH , WITHOUT
HAEMOPTYSIS, IN A WELL PATIENT WITH
CHEST RADIOGRAPHIC FAETURES THAT
ARE EITHER NORMAL OR
UNSUGGESTIVE OF NEOPLASM( WHERIN
CAUSES LIKE SINUSITIS, ASTHMA,
BRONCHITIS HAVE BEEN RULED OUT)BY
HISTORY, PHYSICAL EXAMINATION, PFTS
ETC
 WHEN NO SATISFACTORY EXPLANATION
FOR THE INTRACTABLE COUGH HAS
BEEN FOUND OUT , BRONCHOSCOPY IS
INDICATED

25.  CHEST RADIOGRAPH SHOWS A OPACITY
CONSISTENT WITH A LUNG TUMOUR OR
CHANGES SUGGESTIVE OF BRONCHIAL
OBSTRUCTION , SUCH AS APPEARANCE
OF EARLY VOLUME LOSS OR
UNDOUBTED COLLAPSE, UNRESOLVED
PNEUMONIA OR HEMIDIAPHRAGMATIC
PARALYSIS , RAISING THE POSSIBILITY
OF PHRENIC NERVE INVOLVEMENT BY
TUMOUR

26.  FINDING OF A PARALYSED VOCAL CORD
CALLS FOR A CAREFUL ENDOSCOPIC
INSPECTION OF THE BRONCHIAL TREE,
WHETHER OR NOT POSTEROANTERIOR
AND LATERAL CHEST RADIOGRAPHS
ARE NORMAL

27.  EXPECTORATED SPUTUM MAY CONTAIN
NEOPLASTIC CELLS ON CYTOLOGICAL
EXAMINATION EVEN THOUGH THE
CHEST RADIOGRAPH ITSELF PROVIDES
NO CLEAR LOCALIZING FEATURES
 IF ON EXAMINATION OF THE
OROPHARYNX AND LARYNX FOUND TO
BE NORMAL , BRONCHOSCOPY MAY
FIND TUMOUR (SQUAMOUS CELL
CARCINOMA)

28.  BY TRANSBRONCHIAL LUNG BIOPSY
CARRIED OUT THROUGH FIBREOPTIC
BRONCHOSCOPY IN SARCOIDOSIS AND
LYMPHANGITIS CARCINOMATOSA ETC.

29. • BRONCHOSCOPY MAY BE USED TO
OBTAIN MICROBIOLOGICAL EVIDENCE
OF LOWER RESPIRATORY TRACT
INFECTION BY EXAMINATION OF
1. ASPIRATED BRONCHIAL
SECRETIONS, WASHINGS OR LAVAGE
FLUID
2. ENDOBRONCHIAL BRUSHINGS
3. TRANSBRONCHIAL LUNG
BIOPSY

30.  P.CARINI , CYTOMEGALOVIRUS ,
MYCOBACTERIUM TUBERCULOSIS,
ATYPICAL MYCOBACTERIA,
ASPERGILLOIS COCCIDIODOMYCOSIS
ETC.

31.  INSERTION OF AN ENDOTRACHEAL
TUBE FOR GENERAL ANESTHESIA IN
PATIENTS IN WHOM EXTENTION OF
NECK MAY BE DANGEROUS (ATLANTO –
AXIAL SUBLUXATION )

33.  TAMPONADE OF ENDOBRONCHIAL
BLEEDING, EITHER WITH END OF
BRONCHOSCOPE ITSELF OR BY USING A
FOGARTY OR OTHER PURPOSE –
DESIGNED BALOON CATHETER

34.  REMOVAL OF FOREIGN BODIES

35.  ASPIRATION OF SECRETIONS IN ACUTE
INFLAMATORY LOBAR ATELECTASIS
WHERE PHYSIOTHERAPY HAS PROVED
UNSUCCESFUL IN ACHIEVING THIS END.

36.  RELIEF OF TRACHEOBRONCHIAL
NARROWING BY
 LASER TREATMENT, WHICH
MAY BE ADMINISTERED THROUGH THE
CHANNEL OF A FIBREOPTIC
BRONCHOSCOPE IN THE PALLIATIVE
TREATMENT OF LUNG CANCER
 PLACEMRNT OF STENTS
 DELIVARY OF
ENDOBRONCHIAL RADIOTHERAPY(
BRACHYTHERAPY)

38. BIODEGRADABLE
STENT

40.  CONSENT/ PROCEDURE EXPLANATION
 XYLO TEST DOSE
 BT ,CT ,HIV
 BLOOD GROUPING , PT ,APTT
 NPO
 T. ANXIT 0.5 mg HS
 PRE PROCEDURE NEBULIZATION

41.  SUPPLEMENTAL OXYGEN VIA NASAL
CANNULAE
 MONITOR SATURATION
 PRE MEDICATION
INJ ATROPINE 0.6 mg im (
REDUCE SECRETIONS IN AIRWAYS,
DIMINISH THE CHANCE OF REFLEX
VASOVAGAL PHENOMENON LIKE
BRONCHOCONSTRICTION &
BRADYCARDIA)

42.  SEDATION
INJ MORPHINE 10 mg/5mg im 20-40
MIN BEFORE PROCEDURE ( SENSE OF
EUPHORIA, REDUCE ANXIETY , SUPRESS
COUGHING)
INJ MIDAZOLAM 2.5 mg ( 1mg - > 70
YR OLD, 5mg –YOUNG PTS) SLOW IV
OVER 30 SEC
INJ DIAZEPAM 5 mg IV SLOW (
YOUNG PTS, 2mg IV OLD PTS)
OMIT SEDATIVES IF FEV1 < 1L, IF PaCo2 IS
RAISED , IF PTS RESPIRATORY FUNCTION
GIVES ANY CAUSE FOR CONCERN

43.  TOPICAL ANAESTHESIA
10 mg BENZOCAINE LOZENGE GIVEN AT TIME
OF PRE MEDICATION
4% LIDOCAINE SOLUTION SPRAYED VIA
ATOMIZER INTO PTS MOUTH IN DIRECTION
OF THE FAUCES. PT ASKED TO SAY ‘AAH’ TO
ELEVATE THE SOFT PALATE
TRANSCUTANEOUS CRICOTHYROID
INJECTION WITH 5mL OF 4% LIDOCAINE, BY
PALPATING CRICOID CARTILAGE USING
FOREFINGER IN PTS NECK SLIGHTLY
EXTENDED, IT BEING THE FIRST
PROMINENCE ABOVE THE CARTILAGENOUS
TRACHEAL RING . IMMEDIATELY ABOVE IT
AND BELOW THE NEXT PROMINENCE , IS
THE THYROID CARTILAGE, WHICH IS A
SHALLOW DEPRESSION THAT MARKS THE
CRICOTHYROID MEMBRANE

44. THIS AREA IS WIPED WITH A ALCOHOL
SWAP, PT ASKED TO LOOK AT THE
CEILING AND NOT TO SWALLOW( TO
AVOID MOVT OF LARYNX) A 23 GAUGE
NEEDLE ATTACHED TO LOADED SYRINGE
INSERTED IN MIDLINE, A NO RESISTANCE
FELT AND WITHDRAWAL OF THE PLUNGER
REWARDED BY BUBBLES OF AIR .LOCAL
ANAESTHETIC THEN ADMINISTERED.

45.  PT POSITIONED ON TABLE , OPERATOR
STANDS BEHIND THE PATIENT, AT HEAD
END.

46.  BRONCHOSCOPE LUBRICATED WITH 2%
LIDOCAINE GEL
 ADVANCED VIA EITHER NOSTRIL OR
MOUTH USING A BITE BLOCK

47.  AS INSTRUMENT ADVANCED EPIGLOTTIS
AND LARYNX COME TO VIEW
 POSITION AND MOVEMENT OF VOCAL
CORDS WITH RESPIRATION NOTED , PT
ASKED TO SAY ‘EEEH’, TO OBSERVE THE
FULL APPOSITION OF CORDS
 WHEN PASSED BEYOND VOCAL CORDS,
2.5 ml LIDOCAINE INSTILLED FOLLOWED
BY 5 ml AIR
 PASSING BEYOND , OBSERVE THE
TRACHEA, MAIN CARINA, SUB CARINA,
SEGMENTAL BRONCHI

48.  SAMPLING THROUGH FIBEROPTIC
BRONCHOSCOPE BY
ENDOBRONCHIAL BIPOSY
TRANSBRONCHIAL LUNG
BIOPSY
BRONCHIAL WASHINGS AND
BRONCHOALVEOLAR LAVAGE

50.  PNEUMOTHORAX
 HAEMORRHAGE
 COMPLICATIONS OF SEDATION AND TOPICAL
ANAESTHESIA ( EPILEPTIC SEIZURES,
CARDIAC DYSARRYTHMIAS,
HYPOVENTILATION , LARYNGOSPASM)
 BRONCHOSPASM IN ASTHMATICS
 CVS – MINOR VASOVAGAL EPISODE TO
SERIOUS CARDIAC DYSAARYHTMIAS,
MYOCARDIAL INFARCTION, PULMONARY
EDEMA
 HYPOXAEMIA

51.  UNCOOPERATIVE PATIENT
 UNCORRECTABLE HYPOXAEMIA/
HYPERCAPNIA
 UNSTABLE MYOCARDIUM
 UNCORRECTABLE BLEEDING
TENDENCY
 TRACHEAL STENOSIS
 POORLY CONTROLLED ASTHMA

52.  PROTECTION OF INSTRUMENTS
 PROTECTION OF STAFF
 PROTECTION OF PATIENTS

53.  CROFTON
 FISHMAN
 INTERNET