Tuesday, December 28, 2010

Bronchoscopy

Bronchoscopy is of two types:
1. Rigid .
2. Flexible fibre optic.
RIGID BRONCHOSCOPY
Indications
A. Diagnostic
[ . To find out the cause for wheezing, haemoptysis,
or unexp lained cough persisting for more than
4 weeks.
2. When X- ray chest sho ws:
(a) Atelectasis of a segment, lobe or entire lung
(b) Opacity localised to a segment or lobe of lung
(c) Obstructive emphysema-to exclude foreign body
(d) Hilar or mediastinal shadows
3. Vocal cord palsy.
4. Collection of bronchial secretions for culture and
sensitivi ty tests, acid fas t bacilli, fun gus, malignant
cells.
8. Therapeutic
1. Removal of foreign bod ies.
2. Removal of retained secretions or mucus plug in
cases of head injuries, chest trauma, thoracic or
abdomi nal surge ry, or comatosed patients.
Anaesthesia
General anaesthesia with no endotracheal tube or with
only a small bore catheter is often preferred. It can also
be done under topical surface anaesthes ia.
Position
Same as fordirect laryngoscopy.
Technique
There are two methods to in trod uce bronc hoscope:
1. Direct method. Here bronchoscope is introduced
directly through the glottis.
2. Through laryngoscope. Here glo ttis is first exposed
with the help of a spatular type laryngoscope and
then the bronchoscope is introduced through the
laryngoscope into the trachea. Laryngoscope is then
withdrawn. This me thod is useful in infan ts and
young children, and in ad ults who have short neck
and thick tongue.
Details of Technique
l. A piece of ga uze is placed on the upper teeth for the ir
protect ion aga inst injury.
2. Proper-sized bronchoscope is lu bricated with a swab
of autoclaved liquid paraffin or gelly. It is held by the shaft
in surgeon's right hand in a pen- like fashion. Fingers of
the left hand are used to retract the upper lip and guide
the bronchoscope.
3. Now looking through the scope, tip of epiglottis is
identified first and the scope passed behind it and the
epiglottis lifted forward to expose the glottiS. Now bronchoscope
is rotated 90° clockwise so that its bevelled tip
is in the axis of glottis to ease its entry into the trachea.
Once trachea is entered, scope is rotated back to the original
position.
4. Bronchoscope is grad ually advanced and the entire
tracheobronchial tree examined. Axis of bronchoscope
should be made to correspond with axes of the trachea
and bronchi. To ac hieve this, head and neck are flexed
to the left when examining the right bronchial tree and
vice versa.
Openi ngs of all the segmental bronchi in both the
lungs are examined seriatim.
5. Direct vision, right angled and retrograde telescopes
can be used for magnification and detailed examination.
6. Biopsy of the les ion of susp icious area can be taken.
7. Secretions can be collected for exfoliative cytology,
or bacteriologic examination.
Post-operative Care
1. Keep the patient in humid atmosphere.
2. Watch for respiratory distress. This could be due to
laryngeal spasm or subglottic oedema if the proced ure
had been unduly prolonged or the bronchoscope
introduced repeatedly. Inspiratory stridor and suprasternal
retraction will ind icate need for tracheostomy.
Complications
1. Injury to teeth and li ps.
2. Haemorrhage from the biopsy site.
3. Hypox ia and cardiac arrest.
4. Laryngeal oedema.
Precautions During Bronchoscopy
l. Select proper size of bronchoscope according to
patient's age (see Table A 1).
2. Do not force bronchoscope thro ugh closed glott is.
3. Repeated removal and introduction of bronchoscope
should be avoided.
4. Procedure shou ld not be prolonged beyond 20 minutes
in infants and children, otherwise it may cause
subglottic oedema in pos t-operati ve period.
FLEXIBLE FIBRE OPTIC BRONCHOSCOPY
These days, flexible fibre optic bronchoscopy has
replaced rigid bronchoscopy for diagnostic procedures
particularly in adults. It provides magnification and better
illumination, and because of the smaller size, permits
examination of subsegmental bronchi. It is also easy to
use ll1 patients with neck or jaw abnormalities where rigid
bronchoscopy may almost be impossible technically.
This procedure can be performed under topical anaesthesia
and is very useful for bedside examination of the critically
ill patients. The suction/biopsy channel provided
in the fibrescope helps to remove secretions, inspissated
plugs of mucus or even small foreign bodies. Flexible
bronchoscope can also be easily passed through endotracheal
tube or the tracheostomy opening. However, it has
limited utiltty in children because of the problems of
ventilation.

4 comments:

  1. Wow how nicely it is emoted in one frame fabulous blog keep writing this it helps a lot to gain information if you are searching for Ear Correction Cost in Lucknow then Area Cat will help you to find the best surgeon in your nearest locality with surgeons contact details.

    ReplyDelete
  2. I have been in the tinnitus community for a while now and I have experience what you are going though with tinnitus , I do know people that have got
    tinnitus from having their implants done. Ringing in the ear after an implant can go away on its own, but that is BS of what the mouth and jaw specialist said. I have definitely seen and heard of a connection between tinnitus and teeth and mouth. There is a treatment for ringing ears and if you are
    interested you can contact Dr William herbal remedies that what I take that stop the ringing in my ear that was really driving me crazy, don't Lose hope .,I have found a solution for my fellow citizens . If you haven't I would suggest trying Dr William herbal supplement. Again, this is a thing that takes time and usually requires time and patience for it to work WITH no side effects. But I'm not hear to sell you the product, I'm only hear to tell you that it works, but it is a journey and can be difficult. I hope at this point in want away on it own. Good luck . his email address drwilliams098765@gmail.com for advice and for his product

    ReplyDelete
  3. Find The Best Best ENT Specialist in Lahore. Get Online Appointment ENT Surgery Offers Treatment Of Disorders Of Ear, Nose And, Throat When Medicines And Non-invasive Treatment Approaches Fail To Recuperate.Prof. Dr. Ayub is best ENT specialist in Lahore and a best cosmetic surgeon in Lahore he is also known as best ENT doctor surgeon specialist and consultant.

    ReplyDelete
  4. COMPLETE CURE TO TINNITUS: I had tinnitus in both ears for fifteen years with a high pitched two tone sound, the noises are constant and have learned to ignore the ringing. Later, another sound was added, a deep tone that has a sporadic rhythm, that mimics human speech. It varies from soft and muted, to painfully clear, and loud. Have try sound machines, ear plugs, my hearing aid, and medication all to no avail rather I have a difficult time sleeping. Lately I was directed to a Doctor called William on internet who provided solution to the problem. Do not be discourage, dr williams product is a permanent cure to Tinnitus. Contact him with this email (drwilliams098675@gmail.com)

    ReplyDelete