Fiberoptic Bronchoscopy
Alexander C. Chen
Daniel J. Brown
General Principles
Fiberoptic bronchoscopy (FOB) was developed by Shigeto Ikeda in the 1960s.
FOB has become a vital procedure for pulmonologists, with nearly 500,000 procedures performed in the United States every year.1
The rise of the field of interventional pulmonology has increased the diagnostic and therapeutic range of the bronchoscope.
As technology has improved, indications for FOB have increased (Table 4-1).
Most contraindications are relative, and potential reward must merit the possible risk (Table 4-2). The major absolute contraindication is a significant increase in intracranial pressure (ICP), as coughing during the procedure can further increase ICP leading to brain herniation.
TABLE 4-1 INDICATIONS FOR FIBEROPTIC BRONCHOSCOPY | ||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
|
TABLE 4-2 RELATIVE CONTRAINDICATIONS TO BRONCHOSCOPY | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|
|
Prebronchoscopy Evaluation
In an American College of Chest Physicians (ACCP) survey, a majority of operators obtain a preprocedure chest radiograph, coagulation studies, and complete blood count. Less than one-half obtain an EKG, arterial blood gas, electrolytes, or pulmonary function tests.2 Routine preprocedure labs are not absolutely indicated unless specific concerns exist.
Cardiac evaluation in patients with known coronary disease undergoing elective bronchoscopy can be considered, and guidelines have been published by the American College of Cardiology/American Heart Association.3
Procedural Medications
Medications are commonly used before and during bronchoscopy to facilitate a safe, comfortable, and successful procedure.
Antisialogogues are used with the intent of drying secretions and reducing the vasovagal response.
Atropine 0.4 mg IM is the antisialogogue most commonly used.
There are no convincing data that antisialogogues are efficacious, and because of the side effects, they are not recommended on a routine basis.4
Benzodiazepines play a central role in providing amnesia and anxiolysis.
Midazolam given parenterally is often used for its fast onset of action and short half-life.4
Lorazepam has been used as a preprocedure medication with improved patient satisfaction at 24 hours versus placebo.
Flumazenil, a competitive inhibitor of the gamma-aminobutyric acid (GABA) receptor, can be used to reverse the sedative effects of benzodiazepines, though it should generally be avoided as it can precipitate withdrawal seizures.
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
