Flexible Bronchoscopy

Anesthesia Implications

Position: Supine, arms at side on armboards
Time: 5-30 min (very short)
Post-op Pain: Zero
Maintenance Paralytic: Yes

General anesthetic with paralysis is the preferred approach. MACs or LMAs are rarely utilized because of the risk of laryngospasm and bronchospasm.

ETT should be as large as possible to accomodate the bronchoscope. However, you should never force the tube. Typical is 9.0mm for males and 8.5mm for females.
8.0mm is the bare minimum to allow entry unless a pediatric bronchoscope is available.

Because of the size of the tube, it is advisable to use an LTA kit and decadron.

Give a dose of Robinul where not contraindicated. This will help dry up secretions.

Standard wake-up. Be mindful of the potential of bleeding from biopsied sites. Closely watch SpO2 and airway patency postoperatively and have suction close by.

Pro Suggestions – I also use LTA kit on the cords when I DL up front. More recently I’ve decided to add a second dose of lidocaine at the end (often via ETT). Usually 1-1.5 mg/kg at the end. Sometimes I’ll give half the dose IV and the other half ETT. More often, I’ll give the entire dose via ETT Since I’ve implemented lidocaine up front and at the end, PACU has been reaching out to my saying that they love taking my bronch patients because the lack of that abysmal post-bronch coughing fit