Bronchoscopy is a very important operation for respiratory diseases, and it is essential for the diagnosis and treatment of diseases. However, how to alleviate the pain of patients receiving bronchoscopy diagnosis and treatment, especially to eliminate the patient's fear of re-examination, improve the acceptance of bronchoscopy diagnosis and treatment, minimize the risk of injury and accident in the diagnosis and treatment process, and establish standardized bronchoscopy anesthesia methods and operation specifications are of great significance to improve the diagnosis rate of bronchoscopy.
In 2001, the BTS recommended that all patients with diagnostic bronchoscopy should be sedated, except for contraindications to anesthesia. In China's 2008 "Guidelines for the Application of Diagnostic Flexible Bronchoscopy", it was proposed that patients can be given sedation in the absence of contraindications** to reduce the patient's fear. Since then, the application of sedatives in bronchoscopy has been gradually paid attention to in China, and it has been gradually promoted. In recent years, due to the vigorous development of respiratory intervention, sedation and anesthesia for bronchoscopy have been widely promoted.
Classification of Anesthesia for Bronchoscopy:
Topical anesthesia
Conscious sedation
Moderate sedation
General anesthesia
1. Topical anesthesia.
Scope of application: The patient tolerates it well, and the time is short, and the simple bronchial manipulation technique.
Lidocaine is recommended as a commonly used surface*** The main methods for the use of lidocaine are as follows: spray or nebulized inhalation, endotracheal instillation, gargle, and cricothyroid membrane puncture. Nasal anesthesia is recommended with 2% lidocaine gel. For laryngeal anesthesia, a 1% lidocaine spray is recommended, and lidocaine should be given as a topical surface spray before the bronchoscope passes through the glottis. The total amount of lidocaine should be less than 82 mg/kg。
2. Be sober and sedated.
Scope of application: well tolerated by patients, simple bronchial manipulation techniques.
Advantages: The patient is awake and can cooperate with the doctor to complete the entire examination;
Respiratory depression is not obvious, and artificial airway ventilation such as laryngeal mask and endotracheal intubation is not required;
Without the presence of an anesthesiologist, the respiratory physician can do it on his own.
Operation precautions: some patients are in a state of awakening, the direct stimulation of the airway by tracheoscopic operation, the patient still has a certain degree of cough and other discomfort, which can not achieve the real "bitter" effect, some patients still feel unwell after the examination, some patients are unwilling to accept the examination again, the patient's age liver and kidney function affects the efficacy, and some older patients may have weakened or disappeared spontaneous breathing during the operation. The degree of sedation and analgesia of patients was correlated with age, underlying disease, type and dose of administration, and individualized differences should be paid attention to during the operation.
Commonly used medications: Mida** or fentanyl.
Recommended items: nasopharyngeal airway, oropharyngeal airway.
3. Moderate sedation.
Scope of application: Poor patient tolerance, long operation time bronchial manipulation technique.
Advantages: The patient was asleep during the examination and had no memory of the intraoperative operation, which could significantly improve the patient's inappropriateness;
The use of a small amount of analgesic in intravenous anesthesia relieves irritation from bronchoscopy. Intraoperative cough may occur in some patients, and there is a certain correlation between the time of administration, dose, and age of patients with comorbidities. Moderate sedation can achieve the goal of bronchoscopy.
Precautions for operation: Some patients will have respiratory and circulatory depression during the examination, which requires the anesthesiologist to monitor the whole process and pay attention to individualized differences during the operation. Compared with gastric and colonoscopy, bronchoscopy has two problems: because it is performed in the airway, it interferes with the anesthesiologist's intraoperative airway support, and the anesthesiologist's airway support operation is more complex than that of gastrointestinal endoscopy; Various manipulations in the airway have more adverse irritation to the patient than gastrointestinal endoscopy. Therefore, in order to achieve the best bitter effect and ensure that the patient sleeps quietly during the operation, it is necessary to apply a larger dose of intravenous substance and deeper sedation to achieve the goal, which can easily lead to the inhibition of respiratory circulation.
Concern: for most patients, artificial airway ventilation is generally not necessary because of the short period of arousal and the lack of drug-induced respiratory depression. However, for some patients, such as advanced age, severe underlying cardiac disease, severe respiratory disease, sleep apnea-hypopnea syndrome, hypopituitarism, and the need for muscle relaxants, an artificial airway (laryngeal mask is recommended) is required to ensure adequate ventilation.
Commonly used medications: propofol, remifentanil, or sufentanil.
What to prepare: nasopharyngeal airway, oropharyngeal airway, laryngeal mask, endotracheal intubation.
4. General anesthesia.
Scope of application: endotracheal intubation anesthesia is suitable for long-term diagnosis and treatment operations in the distal trachea and bronchi; Laryngeal mask anesthesia is suitable for subglottic procedures, including trachea and main bronchi; Rigid tracheoscopy is suitable for tracheal obstruction, foreign body removal, massive hemoptysis, etc.
Deep sedation. The patient's spontaneous breathing is completely absent and mechanical ventilation with a laryngeal mask, endotracheal tube, or rigid tracheoscopy is required to maintain the patient's oxygenation and carbon dioxide levels. The anesthesia process is managed by an anesthesiologist.
Problems to be paid attention to: general anesthesia, the need to establish an artificial airway, the anesthesiologist needs to fully evaluate the patient before surgery, and the anesthesiologist needs to manage the whole process.
Medications required: propofol, remifentanil or sufentanil, muscle relaxants, etc.
What you need: laryngeal mask, endotracheal intubation, rigid bronchoscope.
Laryngeal mask. 
Endotracheal intubation. 
Rigid bronchoscope.
The business scope of the Respiratory Interventional Diagnosis and Treatment Center
Diagnosis and treatment of benign and malignant intraluminal lesions: mediastinal lymph node staging of lung cancer, diagnosis and treatment of benign and malignant lesions in the cavity, various advanced techniques in the cavity (ablation, photodynamics, radioactive particles, balloon dilation, stent technology, etc.).
Diagnosis and treatment of pulmonary nodules: transbronchial and percutaneous biopsy techniques for pulmonary nodules, minimally invasive for pulmonary nodules**; Comprehensive evaluation of pulmonary nodules.
Interventional diagnosis and treatment of chronic respiratory diseases: lung volume reduction for COPD, bronchial asthma thermoplasty.
Diagnosis and treatment of pleural diseases: diagnosis of pleural diseases; Pleural disease (refractory pleural effusion, refractory pneumothorax, persistent pleural fistula).
Attendance information
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Specialist clinics are available Monday to Friday mornings.
Respiratory and Critical Care Medicine Specialist Outpatient Clinic:
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Tuesday morning Smoking cessation clinic.
Tuesday afternoon COPD Clinic.
Wednesday morning Pulmonary nodules clinic.
Thursday morning bronchial asthma clinic.
Friday Morning Pulmonary Interstitial Fibrosis Clinic.
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