Flexible Fiberoptic Bronchoscopy: An Overview

Introduction:

In pulmonology (lung medicine), flexible fiberoptic bronchoscopy is essential for diagnosing and treating various respiratory conditions. It allows doctors to visualize and treat the problem in the airways with precision and minimal invasiveness. This article mainly focuses on flexible fiberoptic bronchoscopy and its complications.

What Is Flexible Fiberoptic Bronchoscopy?

Flexible fiberoptic bronchoscopy is a minimally invasive procedure. During this procedure, a flexible fiberoptic tube called a bronchoscope is inserted through the mouth or nose down the trachea and into the bronchi. This enables the doctors to inspect the airways, collect samples for additional examination, and provide any necessary treatment. Bronchoscopy is a telescope with a long, flexible fiber-optic tube equipped with a small light and camera at the end of the tube. The fiber optic material is made of flexible glass fibers that allow light to be transmitted through the whole length of the telescope. This light illuminates the inside of the airways, making it easier for medical professionals to view the lungs. Flexible fiberoptic bronchoscopy plays an important role in diagnosing various lung conditions, such as

• Hemoptysis (coughing up blood).

• Chest infection.

• Parenchymal lung disease (lung disease affecting the tissue).

• Lung nodules or masses.

• Persistent lung infiltrates.

• Mediastinal lymphadenopathy (enlarged lymph nodes in the chest).

• Suspected lung transplant rejection.

Furthermore, flexible fiberoptic bronchoscopy can be used in the treatment of

• Foreign body aspiration.

• Elimination of endobronchial masses (growth inside airways).

• Airway stenosis (narrowing of airways).

• Lung lavage (washing lungs).

How Is the Preparation Done Before Flexible Fiberoptic Bronchoscopy?

• Blood Tests: Before surgery, blood tests may be done to ensure the patient has no blood clotting issues. Bleeding occasionally happens after bronchoscopy, particularly if tissue samples are obtained.

• Medical History: Inform the doctor if the patient takes any blood-thinning medication, such as Aspirin, Warfarin, Plavix, etc. To lower the risk of bleeding during surgery, one may need to stop taking any blood-thinning medication a few days before the procedure. It is also important to inform the doctor if one has experienced any allergic reaction or complication during any medical procedure. One should also inform the doctor of any medical conditions, such as diabetes mellitus. A patient may need to modify their dose as advised by their physician. For heart problem patients, a doctor performing bronchoscopy may need to consult a cardiologist before performing a procedure.

• Fasting: Before the bronchoscopy procedure, it is important not to eat for at least six hours.

• Removing Mouthpieces: Any denture or other removal device, such as orthodontic appliances, should be removed from the mouth before the procedure.

How Is the Flexible Fiberoptic Bronchoscopy Procedure Done?

• Anesthesia: Intravenous sedatives are commonly administered before the procedure to make the patients feel sleepy and relaxed. A local anesthetic spray is used to numb the back of the throat. This prevents the chances of gagging and coughing during the procedure. But the taste of local anesthetic is usually unpleasant. In most cases, sedatives are administered after the throat has been numbed. In some cases, general anesthesia is given, in which the patient will be unconscious for the entire bronchoscopy procedure.

• Bronchoscope Placement: During the procedure, a flexible bronchoscope equipped with a tiny camera and light is inserted into the mouth or nose. The tiny camera at the bronchoscope's tip displays images on the camera or video screen. After inserting it into the mouth or nose, it is gradually slowed to the back of the throat, the vocal cords, and the airways. In some cases, instruments may be inserted through the bronchoscope to obtain tissue and fluid samples. Other instruments might be used to;

• Remove foreign objects or secretions.

• Treat abnormal growths.

• Place an airway stent.

• Deliver radiation therapy directly to the abnormal area.

What Are the Complications of Flexible Fiberoptic Bronchoscopy?

Bronchoscopy procedures are usually safe, but complications are rare and usually mild. They may result from the procedure or adverse sedative and local anesthetic medicine reactions. The following are some of the complications associated with flexible fiberoptic bronchoscopy.

• Cough and Discomfort: The bronchoscope may cause discomfort when inserted into the throat or nose to reach the lungs. It can also cause coughing by tickling Airways. A local anesthetic spray may be given to the throat to minimize this effect.

• Bleeding: Bleeding can occur, particularly if a biopsy sample is taken during bronchoscopy. Inflammation or disease-related damage to the airway increases the risk of bleeding. Usually, bleeding is not severe and goes away on its own.

• Fever: Fever is usually a common sign after bronchoscopy and does not always indicate infection.

• Myocardial Ischemia: This occurs when the heart muscle does not get enough blood supply, which results in a strain of the heart muscle and causes pain or discomfort. Heart attack is a more serious form of ischemia that damages the heart muscles due to a prolonged lack of blood flow. Individuals with existing hard disease are at increased risk of myocardial ischemia during bronchoscopy procedures. Doctors recommend waiting for at least six weeks after a heart attack before performing the procedure.

• Reduced Oxygen Level: During the flexible fiberoptic bronchoscopy procedure, a probe that fits the finger is used to continuously measure the oxygen levels in the blood. There may be a short drop in blood oxygen levels during the procedure. The drop in oxygen level returns to normal without treatment. Extra oxygen may be administered to keep the blood oxygen level safe.

• Lung Collapse: The airway may be damaged during bronchoscopy, especially if the lung is severely infected or inflamed. If a lung gets punctured during the procedure, it may result in pneumothorax (air leak), which causes the lung to collapse. This complication occurs most often if a biopsy sample is taken during the procedure.

• Death: Death may occur in extremely rare cases.

Conclusion:

Flexible bronchoscopy is a safe diagnostic and therapeutic procedure that plays an important role in managing various lung conditions. It helps doctors to improve patient outcomes and quality of life. With the development of technology, even more efficacy and safety in the diagnosis and treatment of lung disorders are anticipated through continuous improvement in flexible bronchoscopy procedures.