Overview of Bronchoscopy
A bronchoscopy is a very useful procedure for doctors and other medical professionals who treat patients suffering from lung diseases. A bronchoscopy helps to better diagnose and manage these diseases. This tool was first introduced by a doctor named Shigeto Ikeda back in 1966. Since then, the technique of a flexible bronchoscopy has become of great importance in the field of lung diseases. There is another type of bronchoscopy known as a rigid bronchoscopy, which is extremely useful for treatments.
Anatomy and Physiology of Bronchoscopy
A flexible bronchoscope is a special medical tool that doctors use to look inside your airways. This device is equipped with a camera, light source, and fiber optics, which helps provide very clear images in real time. This means the doctor can see everything live as it is happening.
This tool can be used to examine areas starting from your mouth or nose down to small air passages in your lungs called the sub-segmental bronchi. Doctors can use more advanced techniques, like endobronchial ultrasound, to take a closer look at structures within the chest, like lymph nodes, and the edges of the lung.
In simpler terms, this tool helps doctors see the inside of your airways and lungs so they can identify what may be causing breathing problems or other respiratory issues.
Why do People Need Bronchoscopy
If someone is coughing up blood, constantly coughing without known reason, experiences trouble breathing, has enlarged lymph nodes around their lungs or heart, or has lung diseases, they might require a diagnostic test called bronchoscopy. This test also assists in detecting the stage of lung cancer or checking out conditions such as pneumonia and long-term lung collapse.
Potentially, doctors also use bronchoscopy for therapeutic purposes such as retrieving foreign bodies from the airways and placing stents in the windpipe or airways in case of narrowing. It is also used to handle tumors, manage persistent air leak from the lung or an abnormal connection between air tubes and the thin space between the lungs and chest wall (bronchopleural fistula), aiding in difficult intubations (inserting a tube into a person’s windpipe), and in treating asthma. Yet bronchoscopy doesn’t efficiently stop bleeding in the lungs, although it can help by isolating the bleeding area.
Despite its wide application, bronchoscopy may not be the best tool for diagnosis or treatment of certain diseases and conditions. For instance, it may not be very effective in diagnosing or managing conditions including cystic fibrosis, tuberculosis, certain lung or heart diseases, or lymph gland diseases. Furthermore, it fails to yield good results when it comes to investigating a build-up of fluid around the lungs or lymph node enlargement due to conditions like chronic obstructive pulmonary disease, idiopathic pulmonary fibrosis, or tumor of the lymphatic system (Lymphoma).
When a Person Should Avoid Bronchoscopy
A bronchoscopy, a procedure where a doctor looks inside your lungs using a special tube, should not be done if the dangers are greater than the possible benefits. Each case is evaluated individually by a lung specialist known as a pulmonologist. Reasons you might not be able to have this procedure could include:
– If you have severe baseline hypoxia, a condition where your body or a region of your body is deprived of adequate oxygen.
– If your body’s vital functions are unstable, a condition known as hemodynamic instability.
– If you recently had a heart attack.
– If you have a severe bleeding disorder which further increases the risk of the procedure.
– If you’re not able to cooperate during the procedure.
– If the person doing the procedure doesn’t have enough experience, the risk could be higher too.
Remember that these are only possible reasons and the final decision is always made by your doctor based on your specific condition.
Equipment used for Bronchoscopy
A flexible bronchoscope is a special tool that helps doctors to look inside your airways. It has fiber optic cables that carry light and video back to a monitor, allowing the doctor to see what’s happening inside your body. The bronchoscope can be moved in different directions with a small lever, which helps the doctor to fully explore and evaluate your airways.
Just like other tools, bronchoscopes come in different sizes and have different features – it’s not one-size-fits-all! That’s why the doctor picks the most suitable one for your situation.
When the doctor is using the bronchoscope, they can also use other tools to take tissue samples. For example, they might use a pair of biopsy forceps, a special needle, or a bronchial brush.
There are also other tools that can be used for treatment, like balloons, laser fibers, and probes for electrocautery and cryotherapy. Electrocautery is a way to use electricity to manage bleeding, and cryotherapy is a technique that uses cold temperatures for treatment.
In recent years, bronchoscopy has made great progress and now includes things like endobronchial ultrasound (where they use sound waves to produce images from inside the airway), radial probe ultrasound, confocal endomicroscopy, narrow band imaging, autofluorescence (using natural light from tissues), and electromagnetic navigational bronchoscopy.
Preparing for Bronchoscopy
Before any medical procedure, it’s important that doctors get permission from the patient or from the person who can make medical decisions for the patient. This is known as obtaining ‘informed consent’. The doctor will also need to do a careful check-up and ask questions about the patient’s medical history to make sure that the procedure is necessary and safe for the patient. Importantly, patients should not eat or drink anything for six to eight hours before the procedure.
Doctors will also need to maintain a steady check on the patient’s body parameters (like pulse and blood pressure) and have a way to give medication intravenously (that’s through a needle into a vein) ready before starting the procedure.
They will also review what medications the patient takes and any allergies they may have. Additionally, they will need to look at any recent laboratory results. Sometimes an ECG (a test that checks how your heart is working) may be done as well. Before the procedure starts, everyone involved takes a ‘time out’ to double-check everything.
For comfort during the procedure known as bronchoscopy (which involves looking into your lungs with a special instrument), patients are often given sedatives – these are medicines that help you relax or sleep. The type and amount of sedative used will depend on the doctor’s choice and these include drugs like benzodiazepines, opioids, or dexmedetomidine. Sometimes, for some procedures, patients may require deep sedation or even general anesthesia, which means they will be unconscious for the procedure.
No matter the type or level of sedation used, it’s crucial that doctors are aware of any potential side effects of these medicines, and they are ready to handle any conditions that might arise in patients because of these medications.
How is Bronchoscopy performed
Your doctor may use a device called a bronchoscope to take a very close look at your airways. This tool can be inserted into your nose or mouth or through a tube that helps you breathe. It can even be threaded through a mask over your windpipe. The bronchoscope is gently moved down to the vocal cords. The doctor will examine the appearance and movement of the cords.
As the bronchoscope continues to move down past the vocal cords, the entire inside of the airways will be carefully inspected. The doctor will look for any abnormal tissues, mucosal abnormalities that might indicate disease, or any areas of narrowing or partial collapse. The bronchoscope can take photos or capture video footage to help the doctor refer back to their observations in the future. Great care is taken to avoid touching the inside lining of the airways to prevent discomfort. Depending on the reason you’re undergoing the procedure, specific tools are used for tasks like collecting tissue samples or removing tumours.
Once the procedure is complete, your airways will be checked again to make sure no bleeding is happening. In some cases, you might need a chest x-ray afterwards to check for problems like a collapsed lung (known as pneumothorax).
Your doctor will carefully monitor you before, during, and after the procedure. If everything goes smoothly and no complications occur, you should be able to go home on the same day. A follow-up visit will be scheduled and, as a safety measure, you’ll be advised not to drive or operate heavy machinery for the rest of the day after your procedure. This is because the medications you received may affect you for several hours and could impair your ability to perform these tasks safely.
Possible Complications of Bronchoscopy
Medicines used during procedures can sometimes cause problems:
* An overdose of local anesthetics, which are used to numb a specific area of the body, can cause issues with the central nervous system. This could lead to nerve damage, seizures, or even a coma.
* Methemoglobinemia, a condition where the blood is not able to carry enough oxygen, can occur.
* Some sedatives, which are medicines used to calm you or help you sleep, can result in low blood pressure or slow heart rate.
* General anesthetics, which are used to put you in a sleep-like state before surgery, may cause a rapid rise in body temperature, long-lasting muscle paralysis, or severe allergic reaction.
Some complications could happen during the procedure itself:
* Bleeding: Generally, bleeding from the procedure stops on its own. Your doctor will carefully check for this. If severe bleeding occurs, they will quickly provide treatment.
* Lung collapse: 1-3% of patients may experience pneumothorax, or a collapsed lung, after lung biopsies. Small lung collapses might heal on their own, but larger ones need treatment including placing a tube in the chest cavity and under-care at the hospital.
Fast treatment is a must for “tension pneumothorax,” a severe form of lung collapse, that can affect your heart’s ability to pump blood. Most lung collapses develop within an hour of the procedure but they can be delayed up to 24 hours. Your doctor will guide you on how to watch for signs at home and when to follow up.
Problems with heart rhythm can also happen, especially in people who already have heart disease. Other potential complications can include damage to the vocal cords, air buildup in the center of the chest (pneumomediastinum), low oxygen levels in the blood (hypoxia), and very rarely, a risk of death.
What Else Should I Know About Bronchoscopy?
Bronchoscopy is a useful method to diagnose and treat different types of diseases that affect the airways and lungs. This involves a doctor inserting a small tube with a light and camera into your airways through your nose or mouth. This allows the doctor to visually examine your airways and lungs.
As technology progresses, bronchoscopy not only will maintain its present role in medical practice, but its applications will extend. We can expect it to become an even more effective less invasive diagnostic and treatment tool. This means it can help diagnose conditions and deliver treatments without the need for more intrusive procedures.