Bronchoscopy
This article needs additional citations for verification. (July 2018) |
Bronchoscopy | |
---|---|
ICD-9-CM | 33.21-33.23 |
MeSH | D001999 |
OPS-301 code | 1-62 |
MedlinePlus | 003857 |
Bronchoscopy is an
History
The German
Types
Rigid
The rigid bronchoscope is a hollow metal tube used for inspecting the lower airway.[6] It can be for either diagnostic or therapeutic reasons. Modern use is almost exclusively for therapeutic indications. Rigid bronchoscopy is used for retrieving foreign objects.[7] Rigid bronchoscopy is useful for recovering inhaled foreign bodies because it allows for protection of the airway and controlling the foreign body during recovery.[8]
Massive
Flexible (fiberoptic)
A flexible 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
Flexible bronchoscopy causes less discomfort for the patient than rigid bronchoscopy, and the procedure can be performed easily and safely under moderate sedation. It is the technique of choice nowadays for most bronchoscopic procedures.
Indications
Flexible bronchoscopy plays an important role in the diagnosis, monitoring and therapy of certain pulmonary diseases.[9]
Diagnostic
- To view abnormalities of the airway
- To obtain brushing.
- To evaluate a person who has bleeding in the
Therapeutic
- To remove secretions, blood, or foreign objects lodged in the airway
- strictures
- Stent insertion to palliate extrinsic compression of the tracheobronchial lumen from either malignant or benign disease processes
- For percutaneous tracheostomy
- Tracheal intubation of patients with difficult airways is often performed using a flexible bronchoscope
Interventional bronchoscopy in chronic obstructive airway inflammatory diseases including
Procedure
Bronchoscopy can be performed in a special room designated for such procedures,
A flexible bronchoscope is inserted with the patient in a sitting or supine position. Once the bronchoscope is inserted into the upper airway, the vocal cords are inspected. The instrument is advanced to the trachea and further down into the bronchial system and each area is inspected as the bronchoscope passes. If an abnormality is discovered, it may be sampled using a brush, a needle, or forceps. Specimen of lung tissue (transbronchial biopsy) may be sampled using a real-time X-ray (fluoroscopy) or an electromagnetic tracking system.[11] Flexible bronchoscopy can also be performed on intubated patients, such as patients in intensive care. In this case, the instrument is inserted through an adapter connected to the tracheal tube.
Rigid bronchoscopy is performed under general anesthesia. Rigid bronchoscopes are too large to allow parallel placement of other devices in the trachea; therefore the anesthesia apparatus is connected to the bronchoscope and the patient is ventilated through the bronchoscope.
Recovery
Although most patients tolerate bronchoscopy well, a brief period of observation is required after the procedure. Most complications occur early and are readily apparent at the time of the procedure. The patient is assessed for respiratory difficulty (
Complications and risks
Besides the risks associated with the drugs used, there are also specific risks of the procedure. Although a rigid bronchoscope can scratch or tear
See also
References
- PMID 25965540.
- ^ Kollofrath O. Entfernung Eines Knochenstucks Aus Dem Rechten Bronchus Auf Naturlichem Wege Und Unter Anwendung Der Directen Laryngoskopie. Munch Med Wochenschr 1897;38:1038-1039.
- ^ "Tracheo-bronchoscopy, esophagoscopy, and gastroscopy". St. Louis, Laryngoscope. 1907.
- PMID 5352887.
- ^ Kobayashi T, Koshiishi H, Kawate N, A dela Cruz CM, Kato H (1994). "The Performance of Prototype Videobronchoscopes: The Pentax Eb-Tm1830 and Eb-Tm1530". Journal of Bronchology & Interventional Pulmonology. 1 (2): 160–167.
- PMID 28149583.
- ISBN 978-1-4180-2067-5. Retrieved 30 May 2010.
- ^ Rosbe KW, Burke K (2012). "Chapter 39. Foreign Bodies". In Lalwani A (ed.). CURRENT Diagnosis & Treatment in Otolaryngology—Head & Neck Surgery (3rd ed.). New York, NY: The McGraw-Hill Companies. Retrieved July 16, 2012.
- ^ PMID 22472222.
- PMID 33650526.
- PMID 24992135.