Bronchoscopy Flashcards
When would the use of a rigid bronchoscope be
preferable over a flexible/fiberoptic scope?
Rigid bronchoscopes are preferred over flexible scopes when
the patient has massive hemoptysis, foreign bodies, vascular
tumors, if the patient is a small child, or endobronchial resection
is anticipated.
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 1057.
List situations in which a flexible/fiberoptic scope is
preferable over a rigid bronchoscope.
When a patient has pneumonia and selective cultures need to
be obtained, for the positioning of double-lumen tubes, if the
patient has limited mobility of the neck, for the use of difficult
intubations, if bronchial blockade is needed, if endotracheal
tube position needs to be checked, if the patient has peripheral
and upper lobe lesions, or if the amount of hemoptysis is limited
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 1057.
For what disorders/symptoms must a patient be
evaluated prior to the performance of a
bronchoscopy?
Hemoptysis, coughing, chronic lung disease, bronchospasm,
respiratory obstruction, and the inability to adequately clear
secretions.
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 1056-1057.
How is the anesthesia source connected to a rigid
bronchoscope?
Through a side arm provided on the rigid scope.
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philade
List complications associated with rigid
bronchoscopy.
Hemorrhage, damage to the teeth, tracheal or bronchial
perforation, bronchospasm, barotrauma, and subglottic edema.
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 1058.
Is the incidence of complications higher with a rigid
or fiberoptic bronchoscope?
Rigid bronchoscopy is associated with a higher incidence of
complications.
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 1058.
What are the disadvantages to the use of local
anesthesia during the performance of a
bronchoscopy?
Lack of cooperation by the patient, the poor tolerance of
bleeding by an awake patient.
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 1057.
What are the advantages to using local anesthesia
for patients undergoing a bronchoscopy?
The patient remains awake and breathing spontaneously.
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 1057.
How is apneic oxygenation performed during a rigid
bronchoscope?
A small catheter is inserted just above the carina, and oxygen is
insufflated at a rate of 10 to 15 L/min.
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 1057
What is the other use for the suction channel on the
adult fiberoptic bronchoscope?
The suction channel can also be used to oxygenate and
ventilate the patient.
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 1058.
What is the average decline in PaO2 seen in
patients who have undergone a fiberoptic
bronchoscopy? How long is this decline seen?
A decline of 20 mm Hg is typically seen for 1 to 4 hours
following the procedure.
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 1058.
What is the disadvantage to the apnea and
intermittent ventilation technique used during a rigid
bronchoscopy?
The possibility of a leak around the brochoscope can lead to
hypoventilation and an increase in CO2.
Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s
Clinical Anesthesiology. 5th ed. New York, NY: McGraw-Hill;
2013: 567.
What are the advantages of the Sanders Injection
System of oxygenation during a rigid bronchoscope?
Since there is no requirement for an eyepiece on the rigid
scope, continuous ventilation is possible. (During the apneic
and intermittent ventilation technique, ventilation is only
possible when the eyepiece is in place.) The duration of the
bronchoscopy is reduced, but, the effectiveness of the
technique allows the procedure to be extended if necessary.
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 1058.
What are three disadvantages to using the Sanders
Injection System during rigid bronchoscopy?
Variable FiO2 levels occur as a result of the entrainment of air
from the oxygen jet. Assessment of adequate ventilation may
be difficult. If the patient has poor lung compliance, inadequate
ventilation may occur.
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 1058.
Why should PEEP be discontinued prior to the
passage of a fiberoptic bronchoscope?
The bronchoscope itself causes a PEEP effect, which could
lead to barotrauma in ventilated patients in which PEEP is
already applied.
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 1058.
