ANESTHESIA MANAGEMENT

IN BRONCHOSCOPY
PROCEDURE

Dr.Pandit Sarosa H,SpAn

yogyakarta
 Bronchoscopy

is a technique of visualizing the

inside of the airways for diagnostic
and therapeutic perposes
(an instrument is inserted into the
airways, usually through the nose or
mouth, or occasionally through a
tracheostomy)
 Type of bronchoscope
Rigid ventilating bronchoscope
rigid ventury-effect broncoscope
Flexible fiberoptic bronchoscope
 Indications
Diagnostic
- Atelectasis
- Hemophysis
- Cancer
Therapeutics
- Respiratory toilete
- Remove a foreign
bodies
- Drain on Abscess
- Dilate on airway (stenosis)
Other
- Difficult intubation
 Rigid Bronchoscope
Moderate or massive hemopysis
Large foreign bodies removal
In infants and small children
To by pass the point of airway
obstruction when airway patency is
compromised by a mass
Obtaining large biopsy spacimen
 Fiber Optic
Bronchoscope
Occupies only 10% of cross sectional
area of tracheal
Awake patients can ventilate easily
around scope
Can be done under local or general
anesthesia
For general anesthesia bronchoscope
is introduced through ett
 FOB for difficult
1. Mallampati IV
intubation
2. Temporo maxillary ankylosis
3. Maxillo facial ankylosis
4. Rigid neck
5. Thyroid tumors
6. Giant goiter
7. Le fort II fracture of maxilla
8. Morbid obisity
9. macro glossia
10.Sub mandibulla abces
 Advantages FOB
Improved optical resolution
Improves patient confort
Can be maneuvered into pheripheral zones
of lung
Facilitates intubation in case of difficult
airway
Limitations
needs fragmentation of foreign bodies
before removal
Small size of aspirating channel
 Bronchoscopy - Problems
Competition between bronchopiest and
anesthesiologist for airway control
Airway reactivity and hemodynamic
responses
Emergency procedure in an unprepared,
poor ascessed patients with impaired
respiratory function
Compromised ventilation and gas exchange
 Physiological Changes
Increase in sympathetic activity
tachycardia, hypertension
Changes in cardiac rhythm
Decline in PO2 (average 20 mmHg)
without significant rise in PCO 2 during
FOB
FVS and FEV1 decreases by 13 to 30 %
during FOB
Increase in airway resistance
 Anaesthetic Technique
Choice of anaesthetic technique
depens on
Patients pre operative condition and
preferences
Indication for procedure
Anticipated duration
Anaesthesiologist familiarity
 Techniques of Anaesthesia

Regional anesthesia Airway block

General anaesthesia
Deep inhalational anaesthesia
TIVA
Inhalational & Intravenous agents
NMBA
LMA
 Pre Operative Evaluation
Detailed History
Problems of oxygenation and
ventilation
Conditios associated with increased
risk of pulmonary complications
Assessment of neck and jaw mobility
Presence of wheeze, rales, rhonchi,
stridor
 Anaesthetic Technique
Premedication
Depends on physical status of the
patient, surgical technique
Narcotics-For analgesia, Decrease
cough reflex Provide euphoria
Anti Cholinergics
Benzodiazepine
steroids
TOPICAL ANAESTHESIA
 Anesthetic requirements
To provide anaesthesia & analgesia
Sufficient relaxation
Abolotion of reflexes from respiratory
tract
Maintenance of adequate gas
exchange
Rapid recovery of- consciousness,
respiratory drive, cough reflex
 Bronchoscopy in ICU -
Problems
Patient Related
Decreased or absent pulmonary reserve
Mechanically ventilated for significant
period
Haemodynamic instability
Co morbidities

Procedure Related
Increase in airway resistance, peak airway
pressure, PEEP
Reduction in TV Hypercarbia, Hypoxemia
 Broncoscopy in ICU -
Measures
ETT size should be adequate
Hand ventilation with non
rebreathing circuit with 100% O2
Intermittent suctioning only
Sedation according to patient status
Mechanichal PEEP to be removed
Monitoring cardiovascular status &
oxygen saturation
Serial ABG analyses
 Complication
Complications associated with anaesthesia
Hypoxemia, Hypoventilation
Hypertension, hypotension, tachycardia,
myocardial ischaemia
Arrhytmias related to hypoxia and
hypercarbia
Toxic reaction to local anaesthetics
Auditory awareness
 Complication
Complication arising from procedure
Pneumothorax
Severs hemorhage
Laceration of bronchial wall
Laryngospasm
Bronchospasm
 Messages
Bronchoscopy is highly stimulating
procedure
Adequate plane of anaesthesia needed
till end of procedure
Rapid emergence and recovery of
protective airway reflexes are desirable
Short setting drugs like Propofol,
Rocuronium, Fentanyl, Renifentanil,
Sevoflurane can facilitate these goals