Difference between revisions of "Bronchoscopy"
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{{Infobox surgical procedure | {{Infobox surgical procedure | ||
| anesthesia_type = | | anesthesia_type = General or MAC | ||
| airway = | | airway = ETT (use > 8.0 tube) or LMA | ||
| lines_access = | | lines_access = PIV | ||
| monitors = | | monitors = Standard | ||
5-lead ECG | |||
| considerations_preoperative = | | considerations_preoperative = | ||
| considerations_intraoperative = | | considerations_intraoperative = | ||
| Line 18: | Line 19: | ||
!System | !System | ||
!Considerations | !Considerations | ||
|- | |||
|Airway | |||
| | |||
|- | |- | ||
|Neurologic | |Neurologic | ||
| Line 23: | Line 27: | ||
|- | |- | ||
|Cardiovascular | |Cardiovascular | ||
| | |In patients with CAD, the adrenergic response during airway manipulation could precipitate myocardial ischemia. Breakthrough sympathetic responses can be managed with beta blockers or short acting narcotics. | ||
|- | |- | ||
| | |Pulmonary | ||
| | |High incidence of COPD and respiratory disease. Stridor at rest could suggest airway narrowing. | ||
|- | |- | ||
|Gastrointestinal | |Gastrointestinal | ||
| Line 32: | Line 36: | ||
|- | |- | ||
|Hematologic | |Hematologic | ||
| | |Patients with malignancy may have anemia or coagulopathy | ||
|- | |- | ||
|Renal | |Renal | ||
| Line 41: | Line 45: | ||
|- | |- | ||
|Other | |Other | ||
| | |Careful assessment of teeth and documentation of any loose or missing teeth. Inform patients that dental trauma may occur from surgical instrumentation. | ||
|} | |} | ||
| Line 47: | Line 51: | ||
=== Operating room setup<!-- Describe any unique aspects of operating room preparation. Avoid excessively granular information. Use drug classes instead of specific drugs when appropriate. If none, this section may be removed. --> === | === Operating room setup<!-- Describe any unique aspects of operating room preparation. Avoid excessively granular information. Use drug classes instead of specific drugs when appropriate. If none, this section may be removed. --> === | ||
* Have bronchoscopy swivel adapter (allows bronchoscope to be inserted through ETT/LMA) | |||
=== Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. --> === | === Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. --> === | ||
* Glycopyrolate to dry the airway | |||
* Albuterol if wheezing noted pre-operatively | |||
* Avoid sedative premedication in elderly or patients with upper airway obstruction | |||
* Patients with significant respiratory disease may need specialized ventilation techniques, such as jet ventilation, apnea intermittent ventilation, high-flow nasal cannula | |||
* A plan (and backup plan) for securing the airway should be discussed with surgeon prior to induction, particularly if airway is compromised | |||
=== Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. --> === | === Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. --> === | ||
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=== Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. --> === | === Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. --> === | ||
* | |||
* If doing a GA, can use ETT or LMA | |||
** Need large ETT (8.0 or greater) to accommodate bronchoscope | |||
** Succinylcholine or intermediate acting NDMR | |||
** LTA lidocaine | |||
* If doing a MAC, have supplies ready to secure aware if needed | |||
=== Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. --> === | === Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. --> === | ||
* Supine | |||
=== Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. --> === | === Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. --> === | ||
* Consider TIVA with propofol/remifentanyl | |||
** Avoid inhalation agents given the potential for large leaks | |||
* Minimal use of narcotics given brevity of case | |||
* Decadron | |||
=== Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> === | === Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> === | ||
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=== Potential complications<!-- List and/or describe any potential postoperative complications for this case. --> === | === Potential complications<!-- List and/or describe any potential postoperative complications for this case. --> === | ||
* Bleeding from biopsy sites | |||
* Laryngospasm | |||
* Breathing difficulties | |||
* Sore throat | |||
== Procedure variants<!-- This section should only be used for cases with multiple approaches (e.g. Laparoscopic vs. open appendectomy). Otherwise, remove this section. Use this table to very briefly compare and contrast various aspects between approaches. Add or remove rows as needed to maximize relevance. Consider using symbols rather than words when possible (e.g. +, –, additional symbols such as ↑ and ↓ are available using the "Ω" tool in the editor). --> == | == Procedure variants<!-- This section should only be used for cases with multiple approaches (e.g. Laparoscopic vs. open appendectomy). Otherwise, remove this section. Use this table to very briefly compare and contrast various aspects between approaches. Add or remove rows as needed to maximize relevance. Consider using symbols rather than words when possible (e.g. +, –, additional symbols such as ↑ and ↓ are available using the "Ω" tool in the editor). --> == | ||
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|+ | |+ | ||
! | ! | ||
! | !Flexible bronchoscopy | ||
! | !Rigid bronchoscopy | ||
|- | |- | ||
|Unique considerations | |Unique considerations | ||
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|- | |- | ||
|Position | |Position | ||
| | |Supine | ||
| | |Supine | ||
|- | |- | ||
|Surgical time | |Surgical time | ||
| | |10-30 mins | ||
| | |10-30 mins | ||
|- | |- | ||
|EBL | |EBL | ||
| | |Minimal | ||
| | |Minimal | ||
|- | |- | ||
|Postoperative disposition | |Postoperative disposition | ||
| | |PACU | ||
| | |PACU | ||
|- | |- | ||
|Potential complications | |Potential complications | ||
| Line 112: | Line 139: | ||
[[Category:Surgical procedures]] | [[Category:Surgical procedures]] | ||
[[Category:Airway procedures]] | |||
Latest revision as of 00:48, 5 April 2022
Bronchoscopy
| Anesthesia type |
General or MAC |
|---|---|
| Airway |
ETT (use > 8.0 tube) or LMA |
| Lines and access |
PIV |
| Monitors |
Standard 5-lead ECG |
| Primary anesthetic considerations | |
| Preoperative | |
| Intraoperative | |
| Postoperative | |
| Article quality | |
| Editor rating | |
| User likes | 1 |
A bronchoscopy is a procedure that involves examining the tracheobronchial tree for diagnostic and/or therapeutic purposes. The bronchoscope can either be flexible or rigid. Flexible bronchoscopes, which are more commonly used, have multiple ports that allow the proceduralist to visualize, suction, irrigate, and take biopsies. Spontaneous ventilation can be maintained when using a flexible bronchoscope, which affords the possibility of doing this procedure on an awake patient (although a flexible scope can also be introduced via an LMA/ETT). A rigid bronchoscope has a larger working channel, which allows for the introduction of larger instruments for grasping, sampling, or retrieving samples or foreign objects.
Preoperative management
Patient evaluation
| System | Considerations |
|---|---|
| Airway | |
| Neurologic | |
| Cardiovascular | In patients with CAD, the adrenergic response during airway manipulation could precipitate myocardial ischemia. Breakthrough sympathetic responses can be managed with beta blockers or short acting narcotics. |
| Pulmonary | High incidence of COPD and respiratory disease. Stridor at rest could suggest airway narrowing. |
| Gastrointestinal | |
| Hematologic | Patients with malignancy may have anemia or coagulopathy |
| Renal | |
| Endocrine | |
| Other | Careful assessment of teeth and documentation of any loose or missing teeth. Inform patients that dental trauma may occur from surgical instrumentation. |
Labs and studies
Operating room setup
- Have bronchoscopy swivel adapter (allows bronchoscope to be inserted through ETT/LMA)
Patient preparation and premedication
- Glycopyrolate to dry the airway
- Albuterol if wheezing noted pre-operatively
- Avoid sedative premedication in elderly or patients with upper airway obstruction
- Patients with significant respiratory disease may need specialized ventilation techniques, such as jet ventilation, apnea intermittent ventilation, high-flow nasal cannula
- A plan (and backup plan) for securing the airway should be discussed with surgeon prior to induction, particularly if airway is compromised
Regional and neuraxial techniques
Intraoperative management
Monitoring and access
Induction and airway management
- If doing a GA, can use ETT or LMA
- Need large ETT (8.0 or greater) to accommodate bronchoscope
- Succinylcholine or intermediate acting NDMR
- LTA lidocaine
- If doing a MAC, have supplies ready to secure aware if needed
Positioning
- Supine
Maintenance and surgical considerations
- Consider TIVA with propofol/remifentanyl
- Avoid inhalation agents given the potential for large leaks
- Minimal use of narcotics given brevity of case
- Decadron
Emergence
Postoperative management
Disposition
Pain management
Potential complications
- Bleeding from biopsy sites
- Laryngospasm
- Breathing difficulties
- Sore throat
Procedure variants
| Flexible bronchoscopy | Rigid bronchoscopy | |
|---|---|---|
| Unique considerations | ||
| Position | Supine | Supine |
| Surgical time | 10-30 mins | 10-30 mins |
| EBL | Minimal | Minimal |
| Postoperative disposition | PACU | PACU |
| Potential complications |
References
Top contributors: Barrett Larson and Chris Rishel