B Bronchoscopy
Bronchoscopy permits direct inspection of the larynx, trachea, and bronchi. Indications include collection of secretions for cytologic or bacteriologic examination, tissue biopsy, location of bleeding and tumors, removal of a foreign body, and implantation of radioactive gold seeds for tumor treatment. A common indication for bronchoscopy is suspicion of bronchial neoplasm.
2. Preoperative assessment
a) History and physical examination
(1) Respiratory: Evaluate for chronic lung disease, wheezing, atelectasis, hemoptysis, cough, unresolved pneumonia, diffuse lung disease, and smoking history.
(2) Cardiac: Question underlying dysrhythmias because they may arise with stimulation from the scope or could be a sign of hypoxemia during the procedure.
c) Preoperative medications and intravenous (IV) therapy
(1) The patient may already be taking sympathomimetic bronchodilators and aminophylline. The patient may benefit from administration of an inhaled bronchodilator preoperatively.
(5) Topical anesthesia involves 4% lidocaine using a nebulizer to anesthetize the airway by spraying the palate, pharynx, larynx, vocal cords, and trachea.
3. Room preparation
a) Monitoring equipment is standard: An arterial line is used if thoracotomy is planned or the patient is unstable.
