What Is a Bronchoscopy?

• Bronchoscopy is a procedure that is performed by lung specialists (pulmonologists or thoracic surgeons) to diagnose or treat a variety of lung-related diseases.
• There are two types of bronchoscopes - flexiblefiberopticand rigid.
• Bronchoscopy is relatively safe.
• Bronchoscopy is performed in various settings, including same-dayoutpatientbronchoscopy suite,operating room,hospitalward, and/orintensive careunit.

Bronchoscopy can be used fordiagnosisor treatment. (The lists below are not meant to be all-inclusive, but are intended to provide a greater awareness and knowledge regarding the indications for bronchoscopy.)

Bronchoscopy is used to make adiagnosismost commonly for these conditions:

1. persistent or unexplainedcough;
2. blood in thesputum(coughed upmucusmaterial from thelungs);
3. abnormalchest x-raysuch as a mass,nodule, orinflammationin the lung; or
4. evaluation of a possible lunginfection.

Bronchoscopy is used fortreatment:

1. to remove foreign bodies in theairway;
2. to place astent(a tiny tube) to open a collapsed airway due to pressure by a mass ortumor; or
3. to remove a mass or growth that is blocking the airway.

Complications of bronchoscopy are relatively rare and most oftenminor. It is important to realize that all procedures may involve risk or complications from both known and unforeseen causes, because individual patients vary in theiranatomyand response to medications. Therefore, there is no guarantee that a procedure can be free of complications.

The following is a list of some potential complications:

• Nosebleeding (epistaxis)
• Vocalcordinjury
• Irregularheartbeats
• Lack ofoxygento the body's tissues
• Heart injury due to medications or lack of oxygen
• Bleeding from the site ofbiopsy
• Punctured lung (pneumothorax)
• Damage toteeth(from rigid bronchoscopy)
• Complications from pre-medications or general anesthesia

• Usually, patients undergoing bronchoscopy should take nothing bymouthafter midnight prior to the procedure.
• Routine medications should be taken with sips ofwaterexcept for those drugs that can enhance the risk of bleeding. These medications are aspirin products, blood thinners such aswarfarin(Coumadin), and non-steroidalanti-inflammatory products such asibuprofen. (These drugs must be discontinued at varying numbers of days before the procedure, depending on themedication. Patients must consult their doctors for the appropriate schedule in their particular situation.)
• Thedoctorwill also want to know of any drugallergiesormajordrug reactions that the patient may have experienced.

• As the patient arrives in the bronchoscopy suite (or if the patient is already in the hospital), anintravenouscatheter(IV) will be started for administration of medication and fluid.
• The patient is then connected to a monitor for continuous monitoring of theheart rate,blood pressure, and oxygen level in the blood.
• If needed, supplemental oxygen will be supplied either through a 1/4-inchtube inserted into the nostrils (cannula) or a facemask.
• Medication is then given through the IV to make the patient feel relaxed and sleepy for the flexible fiberoptic bronchoscopy.
• If rigid bronchoscopy is to be performed, an anesthesiologist will be present to induce and monitor the general anesthesia.
• Patients will be lying on their back with oxygen supplemented through the mouth or the nose.
• Prior to theinsertionof the flexible bronchoscope, a local anesthesia withtopicallidocaineis given in the nose and to the back of thethroat. The flexible bronchoscope can be introduced either through the mouth or the nose.
• 有些病人可能需要一个特殊的管称为endotracheal tubeto be inserted through the mouth, passing the vocal cord, and into the trachea to protect and secure the airway.
• Once the bronchoscope is in the airway, an additional topicalanestheticwill be sprayed into the airway for local anesthesia to minimize discomfort and coughing spells.
• The rigid bronchoscope is inserted by mouth only. This is usually done after the patient is under general anesthesia.
• Flexible bronchoscopy rarely causes any discomfort orpain. Patients may feel the urge tocoughbecause of thesensationof a foreign object in the "windpipe." This feeling can be minimized by pre-procedural medication given for relaxation and local anesthesia with lidocaine. The procedure usually takes between 15 to 60 minutes.

If a specific area needs to be more thoroughly evaluated or an abnormality is detected during the procedure, samples can be collected by several methods listed below:

1. Washing— Squirts ofsaltwater (saline) are injected through the bronchoscope into the area of interest and the fluid is then suctioned back. Thisprocessis repeated several times to obtain adequate samples, which are then submitted to the laboratory foranalysis.
2. Brushing —A soft brush is inserted through the bronchoscope to the area of interest. Cells around the airway are collected by brushing up and down the airway. The samples are also sent to the laboratory for analysis.
3. Needle aspiration— A small needle is inserted into the airway and through the wall of the airway to obtain samples outside of the airway for analysis under amicroscope.
4. Forceps biopsy—Forcepsmay be used to biopsy either a visiblelesionin the airway or a lung lesion. Abnormal tissue that is visible in the airway is usually easily biopsied. However, a mass that is in the lung tissue isdeepwithin the lung and usually requires a biopsy using specialx-rayguidance (fluoroscopy). Specimens obtained are sent to apathologistfor inspection under a microscope.

• After the bronchoscopy procedure, patients are taken to an observation area for monitoring for one to two hours until any medication given adequately wears off and patients are able to swallow safely.
• Afamily成员或必须把病人带回家被一个朋友r the outpatient procedure.
• Patients are not allowed to drive or operate heavy machinery for therestof the day because their reflexes and judgment may be impaired.
• Some patients may cough up dark-brown blood for the next one to two days after the procedure. This is expected and should not be alarming.
• However, if there is persistent bright red blood in the sputum, the doctor must be consulted immediately.
• A follow-up visit with the doctor is scheduled to review the laboratory results, which are typically available within one week.

• The bronchoscope is now being used with lasers to help remove and destroy tumor in the lungs.
• Sometimes, probes can be passed through the scope to freeze bleeding sites or to shrink tumors.
• Some newer technologies are on the horizon and may play a future role in the management ofasthmaandemphysema.
• There isdatato suggest that warming the linings of the airways can reduceasthmaattacks.
• Studies are also now underway investigating one-way valves placed in the upperlobeairways in patients with emphysema.
• The hope is that this investigationaltherapywill simulate the benefits seen in emphysema patients that receivelung volume reduction surgery.