Monday 28 November 2022
Diagnostic and invasive bronchoscopy (Fiberoptic Bronchoscopy)

DIAGNOSTIC AND INVASIVE BRONCHOSCOPY (FIBEROPTIC BRONCHOSCOPY0
Nikos D. Chainis, Pulmonology
Introduction

In late 1890 oGustav Killian using a formula Laryngoscopes able to review the trachea, a little later and managed to remove a foreign body that was plugged in the right bronchial tree. It was the first bronchoscopy and Killian was the ¨ ¨ father of bronchoscopy.



In 1904 tonJackson constructed by the rigid bronchoscope, which became widely used a few years later.

OIkeda in 1968 introduced the inovronchoskopio (flexible bronchoscope)

.

Between 1987 and used the video bronchoscope.
Bronchoscopy

Hvronchoskopisi (direct review of the airways) may be either the rigid or the flexible bronchoscope, each presenting advantages and disadvantages.

The main of them relating to the rigid bronchoscope compared with flexible are:
Rigid bronchoscope
Disadvantages

Done under general anesthesia

Ability to control only the main bronchus

Difficult or impossible to import in stiffening or serious injury of neck

Unable to import into diasolinomenous patients
Advantages

Very good vision

Easier removal of foreign bodies

Effective control of bleeding

FLEXIBLE bronchoscope (FIBER BRONCHOSCOPE)

An overview of the airways to ypotmimatikon level, ie 5 to 6 subdivision. The entrance to vronchoskopiou can be done through:

* Nose
* The oral cavity
* Oral and maxillo-tracheal tube
* Tracheostomy.

Apply mild premedication and local anesthesia. It most often requires hospitalization. But we must always be equipped laboratory. The contraindications are few true and many times not prohibitive, and the complications and just a few more rare: less than 1% (bleeding, pneumothorax, respiratory failure, syncope, cardiac arrhythmias, infections, allergies, laryngeal edema).

Even though complications are rare can not be ignored. It is therefore with increased attention to the account information - any adverse reaction and the usefulness - usefulness (diagnostic or therapeutic).

The complications have to include the effects of drugs used for premedication and local anesthesia (respiratory depression center, tachyarrhythmias, urinary retention, decreased gastro-intestinal mobility, particularly allergy to local anesthetics).

The length ranges from 1 to 30 minutes (mean the effective time of bronchoscopy: entry and exit vronchoskopiou) and depends mainly on the experience of vronchoskopou secondly the cooperation of the patient and the type of materials to be taken. If added and the time needed to prepare the patient (local anesthesia-premedication) and who is about 5-10 minutes, then the total length of the test does not exceed 40 minutes.

1. Premedication

Used various drugs such as diazepam, codeine, morphine, pethidine, fentanyl, etc. which provide analgesia and sedation.

In our laboratory we use often, intramuscular Pethidine (25mg single) or intravenous Midazolam (0,075 mg / kg).

It is also necessary to use an anticholinergic agent is accomplished by reducing secretions and reduction of parasympathetic tone.

It should be noted that it is useful 10 minutes before bronchoscopy be administered either bronchodilation morfiinhaler either mask.

2. LOCAL ANESTHESIA

And here used various drugs including Tetracaine, cocaine, etc.. But what is considered to provide greater security to the lidocaine and therefore widely used in the form ekfenomatos (spray), a solution segel.
Contraindications

The contraindications are separated in absolute and relative.

Absolute:

Refusal of the patient

Inexperience bronchoscopist

Unstable angina - arrhythmia
Related:

Lack of patient cooperation

Recent myocardial infarction

Bleeding

Respiratory failure (particularly respiratory failure yperkapniki)

Uraemia

Pulmonary hypertension

Crisis bronchial asthma

Echinococcus cyst

Age (elderly)
Pre-vronchoskopikos control
General

Download history (allergy, concomitant medication)

Stop medicines (anticoagulants)
Patient Information

In need of examination.

For out how to reduce stress, fear, and to ensure maximum cooperation.
Laboratory Tests

Radiograph or chest CT scan

Electrocardiogram

Arterial blood gases

Spirometry

General blood

Glucose, Urea, electrolytes

PT, aPTT

Hepatitis Markers

AntisomataHIV
PARTICULARS
DIAGNOSTIC

A. Indications related symptoms, history and physical examination:

Chronic cough

Haemoptysis

Inhalation stridor (Wheezing) (in particular localized)

Expiratory wheezing (Stridor)

Hoarseness (impairment-paresis-paralysis of vocal cords)

Chest pain

Syndrome than hollow

Aspiration (stomach contents-foreign body)

Thoracic Trauma

Chemical or thermal burns tracheiovronchikou tree
B. Evidence relating to medical laboratory tests

Positive or suspicious cytology sputum

Pathological chest X-ray

diaphragm paralysis;

-portal lymphadenopathy

mediastinal enlargement;

atelectasis;



-undiagnosed pleural effusion

-cavity

prefabricated-slow pneumonia

-persistent pneumothorax

-benign & malignant tumors

-infections

-diffuse parenchymal disease
C. Entries associated with known diseases of the lungs

Diagnosis and staging of cancer vronchogenous

Monitoring therapeutic efficacy in various diseases (cancer, interstitial lung disease)
OTHER INDICATIONS

Tracheal intubation

Monitoring endotracheal tube

Bronchografy

Lavage (washing vronchokypselidiki) (interstitial lung disease)
THERAPEUTIC

Lavagese:

alveolar-proteinosis

retention of secretions;

mucus plugs;

-aimatopigmata (clots)

Remove foreign body

Control bleeding

Control - drainage of pulmonary abscess

Close vronchoplefrikou, tracheiooisofagikou & vronchooisofagikou fistula

Intratracheal placement - endobronchial prostheses (stents)

Brachytherapy

Laser

Diathermy

Cryotherapy
METHOD OF MAKING MATERIALS TO BE CONSIDERED

Bronchial secretions by suction

Brush cytology (brush) and just protected

Brush microbiological

Forceps (biopsy loop, diavronchiki biopsy)

Diavronchiki by needle aspiration (TBNA)

In conclusion we could say that inovronchoskopisi is a relatively simple method with wide application in the detection-diagnosis and treatment of many diseases of tree tracheiovronchikou and general respiratory system so as to be a valuable tool in daily hospital practice.

 

Diagnostic and Interventional fiberoptic bronchoscopy

by

N.D.Hainis,pneumonologist

Bronchoscopy (examination of the airways under direct visualization) has been applied since the end of the last century . Initially , the rigid bronchoscope was used and since 1968 the flexible one was introduced , which has been used up to now .

The indications that come out of a bronchoscopy are many and include a wide range of respiratory diseases . The method is used mainly as a diagnostic tool but it is used as a therapeutic one .

On the other hand , the contraindications are few and rare , especially when the expert is quite experienced .

In conclusion , we could say that fiberoptic bronchoscopy is a relative simple method applied widely in the detection-diagnosis but also in cure of many diseases of the tracheobronchial tree and generally of the respiratory system , so that it constitutes a valuable tool in the daily hospital practice.

 

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Photos
exophytic mass (main right bronchus)
purulent secretions
ca larynx
foreign body removal