About Procedures

Bronchoscopy is a procedure during which an examiner uses a viewing tube to evaluate a patient's lung and airways including the voice box and vocal cord, trachea, and many branches of bronchi. Bronchoscopy is usually performed by a pulmonologist or a thoracic surgeon. Although a bronchoscope does not allow for direct viewing and inspection of the lung tissue itself, samples of the lung tissue can be biopsies through the bronchoscope for examination in the laboratory.

There are two types of bronchoscopes - a flexible fibre optic bronchoscope and a rigid bronchoscope. Since the 1960s, the fiber optic bronchoscope has progressively supplanted the rigid bronchoscope because of overall ease of use. In addition, patients typically do not require general anaesthesia for fibre optic bronchoscopy while a rigid bronchoscopy requires additional medical personnel to perform the procedure because general anaesthesia is required. During the bronchoscopy, the examiner can see the tissues of the airways either directly by looking through the instrument or by viewing on a TV monitor.

Depending on the indication the examiner will choose between the flexible fiber optic bronchoscope and the rigid bronchoscope. For example, if a patient were coughing up large amounts of blood, a rigid bronchoscope is used since it has better optics for viewing and large suction channel.

What should a patient expect during bronchoscopy?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 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 fibre optic bronchoscopy. If rigid bronchoscopy is to be performed, an anaesthesiologist will be present to induce and monitor the general anaesthesia.

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 anaesthesia 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. Depending on the doctor, 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 anaesthetic will be sprayed into the airway for local anaesthesia to minimise discomfort and coughing spells. The rigid bronchoscopy is inserted by mouth only. This is usually done after the patient is under general anaesthesia.          

What is a Bronchoscopy?