George Schiffman, MD, FCCP
Dr. Schiffman received his B.S. degree with High Honors in biology from Hobart College in 1976. He then moved to Chicago where he studied biochemistry at the University of Illinois, Chicago Circle. He attended Rush Medical College where he received his M.D. degree in 1982 and was elected to the Alpha Omega Alpha Medical Honor Society. He completed his Internal Medicine internship and residency at the University of California, Irvine.
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
In this Article
- What is bronchoscopy?
- What are the indications for bronchoscopy?
- What are the potential complications of bronchoscopy?
- How does a patient prepare for bronchoscopy?
- What should a patient expect during bronchoscopy?
- What can a patient expect after a bronchoscopy?
- What's new in bronchoscopy?
- Bronchoscopy At A Glance
- Find a local Pulmonologist in your town
How does a patient prepare for bronchoscopy?
Usually, patients undergoing bronchoscopy should take nothing by mouth after midnight prior to the procedure. Routine medications should be taken with sips of water except for those drugs that can enhance the risk of bleeding. These medications are aspirin products, blood thinners such as warfarin (Coumadin™), and non-steroidal anti-inflammatory products such as ibuprofen. (These drugs must be discontinued at varying numbers of days before the procedure, depending on the medication. Patients must consult their doctors for the appropriate schedule in their particular situation.) The doctor will also want to know of any drug allergies or major drug reactions that the patient may have experienced.
As the patient arrives in the bronchoscopy suite (or if the patient is already in the hospital), an intravenous catheter (IV) will be started for administration of medication and fluid. The patient is then connected to a monitor for continuous monitoring of the heart rate, blood pressure, and oxygen level in the blood. If needed, supplemental oxygen will be supplied either through a ½ inch tube inserted into the nostrils (cannula) or a facemask. Medication is then given through the IV to make the patient feel relaxed and sleepy for the flexible fiber optic bronchoscopy. If rigid bronchoscopy is to be performed, an anesthesiologist will be present to induce and monitor the general anesthesia.
Patients will be lying on their back with oxygen supplemented through the mouth or the nose. Prior to the insertion of the flexible bronchoscope, a local anesthesia with topical lidocaine is given in the nose and to the back of the throat. The flexible bronchoscope can be introduced either through the mouth or the nose. Some patients may require a special tube called an endotracheal tube to be inserted through the mouth, passing the vocal cord, and into the trachea to protect and secure the airway. Once the bronchoscope is in the airway, an additional topical anesthetic will be sprayed into the airway for local anesthesia to minimize discomfort and coughing spells. The rigid bronchoscope is inserted by mouth only. This is usually done after the patient is under general anesthesia.
Flexible bronchoscopy rarely causes any discomfort or pain. Patients may feel the urge to cough because of the sensation of a foreign object in the "windpipe." Again, this feeling can be minimized by pre-procedural medication given for relaxation and local anesthesia with lidocaine. The procedure usually takes between 15 to 60 minutes. If a specific area needs to be more thoroughly evaluated or an abnormality is detected during the procedure, samples can be collected by several methods listed below:
- Washing - Squirts of salt water (saline) are injected through the bronchoscope into the area of interest and the fluid is then suctioned back. This process is repeated several times to obtain adequate samples, which are then submitted to the laboratory for analysis. Brushing - A soft brush is inserted through the bronchoscope to the area of interest. Cells around the airway are collected by brushing up and down the airway. The samples are also sent to the laboratory for analysis.
- Needle aspiration - A small needle is inserted into the airway and through the wall of the airway to obtain samples outside of the airway for analysis under a microscope.
- Forceps biopsy - Forceps may be used to biopsy either a visible lesion in the airway or a lung lesion. Abnormal tissue that is visible in the airway is usually easily biopsied. However, a mass that is in the lung tissue is deep within the lung and usually requires a biopsy using special x-ray guidance (fluoroscopy). Specimens obtained are sent to a pathologist for inspection under a microscope.
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