Colposcopy of the bronchi. How is bronchoscopy of the lungs performed? Severe bronchial asthma

Bronchoscopy is a type of diagnostic study based on the endoscopic method of visual examination of the mucous membranes of the tracheobronchial tree. Thanks to such diagnostics, the doctor can assess the condition of the tissues of the bronchi and trachea and give the final result about the state of human health.

For what purposes are diagnostics carried out?

Bronchoscopy for pneumonia is a diagnostic study, which is advisable to carry out to determine the disease and its therapy. In most cases, the examination is carried out to accurately determine the presence or absence of a tumor.

When an X-ray reveals negative processes in the lung tissues, and the patient complains of hemoptysis, then these are important indications for bronchoscopy. In addition, such manipulation will help remove foreign bodies. Bronchoscopy and biopsy are two interrelated concepts in cases where it is necessary to determine the nature of the neoplasm. So, bronchoscopy is performed in the following cases:

• thermal injury – assess the degree of damage to the respiratory system;
• cough - find out the reasons contributing to the formation of a chronic symptom;
• hemoptysis - determine the reasons why blood and mucus are released;
• the presence of foreign bodies in the respiratory system;
• detection of agents of respiratory infections;
• taking tissue for examination;
• assessment of developmental stage;
• correction of therapy.

Now it has become clear what bronchoscopy is and what opportunities it opens up. It allows you to learn as much information as possible about the disease, adjust the treatment, or even carry it out.

IN medicinal purposes, the study is carried out for:

• removal of a foreign object;
• removal of blood and pus;
• administering medications directly to the site of injury;
• eliminating mild collapse;
• regeneration of tracheal patency.

Today, a procedure such as sanitary bronchoscopy plays a very important role. Its essence is that the bronchi are washed with a certain disinfectant solution. The procedure is actively used for purulent lung diseases.

What type of anesthesia is used?

The presented diagnostic method for pneumonia is done under anesthesia. Local anesthesia is used when a flexible device is used in the process. When using rigid models, the procedure is performed under general anesthesia.

If bronchoscopy of the lungs is performed under local anesthesia, then a 2–5% lipocaine solution is used. As a result, the patient feels numbness in the palate, the presence of a lump in the throat, difficulty swallowing and slight congestion in the nasal passages. This type of pain relief may cause severe coughing or vomiting. Before inserting the bronchoscope, the doctor treats the mucous membrane of the larynx, ligaments, trachea and bronchi with an anesthetic spray.

When the procedure is performed under general anesthesia, the diagnosis is most likely carried out in young patients and people with an unstable mental state. While under general anesthesia, the patient sleeps and does not feel any painful or unpleasant sensations.

Types of bronchoscopy

As noted above, modern bronchoscopes come in rigid and flexible types. Each model has its own advantages and scope of use.

If bronchoscopy of the lungs for pneumonia is performed using a flexible bronchoscope (fiber bronchoscope), then the following advantages can be highlighted:

• penetration into the lower sections of the bronchi, which cannot be examined by rigid equipment;
• less trauma to the bronchi;
• the small diameter of the fiber-optic bronchoscope allows it to be used in pediatrics;
• no general anesthesia required.

This type of diagnosis is used in the following cases:

• examination of the lower parts of the trachea and bronchi;
• assessment of the mucous membrane of the respiratory tract;
• removal of small foreign bodies.

The advantages of a rigid bronchoscope include the following:

1. It is widely used for therapeutic activities that cannot be performed using a flexible bronchoscope. It is possible to detect the expansion of the lumen of the bronchi and remove foreign objects obstructing the airways.
2. Thanks to a rigid bronchoscope, it is possible to insert a flexible one for the assessment and examination of thin bronchial walls.
3. Reduce the consequences and pathological processes identified during diagnosis.
4. Resuscitation of patients who have been drowned and... In this case, they remove fluid and mucus from the lungs.
5. The manipulation is carried out under general anesthesia, so the person does not feel any unpleasant symptoms. This is very important for a patient who experiences severe anxiety and fear.

Diagnostics using a hard device is used for the following purposes:

• regeneration of the patency of the bronchi and trachea, which arose due to the presence of scars or tumors, installation of a wall to enlarge and reduce the bronchi;
• elimination of scars, neoplasms, clots of viscous sputum;
• detection of lesions of the respiratory system;
• elimination of bleeding;
• removal of foreign bodies;
• bronchial lavage and administration of medicinal solutions.

Preparatory activities

Before performing bronchoscopy for pneumonia, the following series of recommendations must be followed:

1. Perform chest x-ray and electrocardiography. A test for the presence of urea and gases in the plasma is required for preparatory purposes.
2. Notify the doctor about such ailments as heart attack and ischemic disease hearts. If the patient is taking antidepressants and hormonal drugs, then you should also inform your doctor about this.
3. The procedure should be carried out on an empty stomach. You can eat your last meal the night before, but no later than 21:00.
4. Drinking water before diagnosis is prohibited. Bronchoscopy to determine pneumonia is performed in a specially equipped room and in complete sterility. If this is not observed, then there is a high probability of the body becoming infected. Therefore, before diagnosis, the patient must make sure that all sanitary standards are met in the medical institution.
5. The procedure cannot be performed on a patient who is in an excited state. For these purposes, he is given a sedative injection.
6. You must take a towel with you to the office, as consequences such as hemoptysis may occur. If you have dentures, piercings, or bite plates, they must be removed.

Procedure implementation process

How is bronchoscopy done for pneumonia? Before proceeding to the procedure, the patient must enter the office without outer clothing and with an unbuttoned collar. 45 minutes before the start, the person is administered diphenhydramine, seduxen and atropine, and 25 minutes later - a solution of aminophylline. When bronchoscopy is performed under anesthesia, the patient must inhale a salbutamol aerosol to dilate the bronchi. For local anesthesia, nebulizers are used. With their help, the nasopharynx and oropharynx are treated. Such activities can eliminate the gag reflex.

During the diagnosis, the person must lie or sit. A specialist will indicate the correct position. The examination device is inserted through the nose or mouth, and then the doctor examines all areas of interest.

Together with the doctor, there is a nurse in the office who constantly monitors the patient. If there are signs of difficulty breathing due to swelling of the larynx or laryngospasm, bleeding, bronchospasm, you must immediately notify your doctor.

Consuming food and water is allowed only after the gag reflex is restored. As a rule, a few hours are enough. You must first drink water in small sips or suck on pieces of ice.

The nurse should reassure the patient and explain to him that loss or hoarseness of the voice, painful sensations in the nose will soon disappear. When the gag reflex is restored, the person is given emollient solutions for rinsing and tablets to eliminate a sore throat.

What consequences might arise?

Most often, bronchoscopy for pneumonia does not cause any complications. All the patient may feel is slight numbness and nasal congestion throughout the day. But we should not exclude situations when, after diagnosis, the patient has the following problems:

• damage to the walls of the bronchi;
• development of pneumonia;
• bronchospasms;
• allergy;
• bleeding.

What pathologies can be detected?

During diagnosis, it is possible to identify the following pathological conditions regarding the bronchial wall:

• inflammatory process;
• swelling;
• expansion of submucosal lymph nodes and mouths of mucous glands;
• neoplasms;
• the presence of cartilage in the lumen.

Complications of the trachea include detection of stenosis, compression, and disruption of bronchial branching.

If tissues and cells obtained during bronchoscopy were diagnosed, then it is possible to diagnose:

• interstitial form of pneumonia;
• lung cancer of a bronchogenic nature;

When making a final diagnosis, it is necessary to combine all the data obtained from x-rays, bronchoscopy and cytological examination.

Bronchoscopy - effective method diagnostics various diseases respiratory system. The manipulation itself is not pleasant, but the use of anesthesia allows you to eliminate all painful manifestations during diagnosis. Using bronchoscopy, it is possible not only to assess the condition of the disease, but also to carry out certain therapeutic measures that cannot be carried out in the usual way.

Joseph Addison

With help physical exercise and abstinence, most people can do without medicine.

Bronchoscopy is a method of endoscopic visualization of the mucous membranes of the respiratory tract, carried out using a special device - a bronchoscope. It consists of a long system of flexible or rigid tubes equipped with a light source and a camera. The image from them is displayed on the monitor, and it is possible to record it. The method has proven itself not only as diagnostic; it can also be used to perform some therapeutic procedures.

You will learn about whether preparation for the study is necessary, the methodology for conducting it, as well as the indications and contraindications for this manipulation in our article. But first, we bring to your attention a short historical information and information regarding types of bronchoscopes.

History of bronchoscopy

The doctor inserts a bronchoscope into the airways and, thanks to the optical system at the end of the tube, is able to assess their condition from the inside.

For the first time such a study was carried out in late XIX centuries. Its goal was to remove a foreign body from the tracheobronchial tree. And since both the device and the manipulation technique were imperfect, in order to reduce pain and reduce the risk of injuries and complications, the patient was injected with cocaine.

Only more than half a century later, in 1956, a device that was safe for those being examined was invented - a rigid bronchoscope. And 12 years later, in 1968, a flexible modification of this device appeared. Subsequently, the research technique was improved, and today the doctor has the opportunity to observe on the monitor screen a many times enlarged image of the mucous membrane of the respiratory tract, and the patient can remain conscious during the procedure and experience virtually no discomfort.

Bronchoscopes: types, advantages

There are 2 types of bronchoscopes: fiber-optic bronchoscope (or flexible) and rigid bronchoscope. It cannot be said that one of them is better and the other is worse. Each of the devices is used in certain situations and has its own advantages over its counterpart.

Fiber bronchoscope

It is a smooth, thin, long tube equipped with a light source and a video camera. If necessary, a catheter and some instruments can be inserted into the patient's bronchi through this tube.

It is used primarily for the purpose of diagnosing the condition of the mucous membrane of the trachea and bronchi; it can also be used as a means of removing foreign bodies of small diameter from the respiratory tract.

The main advantage of a flexible bronchoscope is that the risk of injury to the mucous membrane of the respiratory tract when using it is minimal. In addition, due to its small diameter, it penetrates into remote sections of the bronchi and can even be used in pediatrics. The procedure using it does not require putting the patient under anesthesia; often only local application of an anesthetic is sufficient.

Rigid bronchoscope

This device consists of several hollow rigid tubes connected to each other. Their diameter is larger than that of a fiber-optic bronchoscope, so this device does not penetrate into small bronchi. It is also equipped with a photo or video camera, a light source and many devices that allow a number of medical procedures to be carried out during bronchoscopy.

It is used not only for diagnosis, but also for therapeutic manipulation. Using it you can:

• rinse the bronchi with an antiseptic solution, introduce an antibiotic, hormonal or other drug into their lumen;
• remove viscous sputum from the bronchial tree;
• stop the bleeding;
• excise the tumor, scar, that is, restore the functionality of the bronchi;
• normalize bronchial patency by installing a stent.

If, when using a rigid bronchoscope, there is a need to examine bronchi of a smaller diameter, a fiber bronchoscope can be inserted through its tube and the diagnosis can be continued.

This manipulation is performed under general anesthesia (or general anesthesia) - the patient is in a state of sleep and does not experience discomfort associated with the study.

Indications for bronchoscopy

This diagnostic method is used to clarify the diagnosis in the following clinical situations:

• if the patient has an unmotivated persistent cough;
• if the patient has shortness of breath of unknown etiology (when the most common reasons her - COPD - excluded);
• with hemoptysis (blood with sputum);
• if there is a suspicion of the presence of a foreign body in the bronchi;
• if it is suspected in the lumen of the tracheobronchial tree or on, as well as to determine the border of spread lung cancer along the bronchi;
• if the fact of a long-term inflammatory process has been established, the nature of which could not be previously clarified;
• in case of recurrent events in the patient’s history (in order to find their cause and eliminate it);
• if dissemination syndrome is detected on a chest x-ray (multiple foci (suspicion of), cavities or cysts in the lungs);
• for the purpose of taking the contents of the bronchi to determine the sensitivity of its microflora to antibiotics;
• when preparing a patient for lung surgery.

Contraindications for the study

Bronchoscopy. Healthy lungs.

• stenosis (narrowing of the lumen) of the upper respiratory tract II-III degree;
• bronchial asthma in the acute stage;
• severe respiratory failure;
• or suffered by the patient during the last 6 months;
• (sac-like dilatation) of the aorta;
• heavy;
• heavy;
• pathology of the blood coagulation system;
• individual hypersensitivity to anesthetic drugs;
• diseases of the neuropsychic sphere, in particular epilepsy, severe head injury, schizophrenia and others.

Bronchoscopy for any of the above conditions is accompanied by high risk development of complications and worsening of the patient’s condition until his death.

This manipulation should also be delayed during the first phase and third trimester of pregnancy.

It is worth noting that in each specific case, even if there are contraindications, the doctor determines individually whether to perform bronchoscopy or not. If the situation is an emergency and the patient could die without this procedure, the doctor will probably perform it, but will be alert to possible complications and will take steps to prevent them.

Do you need preparation for the study?

Bronchoscopy is an invasive procedure that requires careful preparation for its implementation (this will help increase the information content of the study and reduce the risk of complications).

First of all, the patient must be carefully examined. The required minimum is:

• general blood analysis;
• blood test for coagulation (coagulogram);
• determination of blood gas composition;
• X-ray of the chest organs.

So, based on the data obtained, the doctor will determine whether there are contraindications to the study and, if there are none, he will tell the patient about how the bronchoscopy will proceed and how the patient should behave during the procedure.

The patient, in turn, is obliged to notify the doctor about his existing chronic diseases heart, endocrine and other organs, about a history of allergic reactions (it is very advisable to know what exactly the allergy was to and how it manifested itself), about medications that he takes constantly (probably, taking some of them will have to be temporarily stopped).

• It is important to perform the procedure on an empty stomach, so the patient should not eat for at least 8 hours before the bronchoscopy. This will minimize the risk of food getting into the trachea and bronchi.
• On the day of the study you should stop smoking.
• During bronchoscopy, the patient's intestines must be emptied. To achieve this, on the day of the study, in the morning, he will have to do a cleansing enema or use suppositories (suppositories) with a laxative effect.
• To prevent the patient from having to go to the toilet during the diagnostic process, it is necessary to empty the bladder before starting the diagnostic process.
• If the subject shows excessive anxiety, he may be administered. For the same purpose, the doctor can prescribe tranquilizers and sleeping pills the day before - the patient should be calm and well rested during the procedure.
• After bronchoscopy, the patient may experience short-term hemoptysis, so he should have a towel or napkins with him.

Bronchoscopy technique

The patient is given a bronchodilator to take, the entrance to the pharynx is treated with an anesthetic, and then a bronchoscope is inserted.

Bronchoscopy is performed in a specially designed room in compliance with all sterility rules.

• At the preparatory stage, the patient is administered a drug that dilates the bronchi (Salbutamol, Atropine or others) by inhalation or by subcutaneous injection. This will ensure easy passage of the bronchoscope through the airway.
• The pharyngeal mucosa is treated with a local anesthetic (usually a lidocaine solution is used), which suppresses the gag and cough reflexes, which will allow the doctor to easily insert the tube. At the same time, the patient feels numbness in the palate, as if he has a lump in his throat, his nose is slightly stuffy and it becomes difficult to swallow saliva. If you plan to use a rigid bronchoscope or the procedure is performed on a child or a weakened patient, an anesthetic drug is administered inhalation or intravenously. As a result of its action, the person falls asleep and does not feel anything during the entire procedure.
• During the examination, the patient sits or lies on his back.
• As the doctor inserts the bronchoscope into the airway, the patient is asked to breathe quickly and shallowly (this type of breathing minimizes the risk of a gag reflex).
• The route of insertion of the tube is through any nostril or through the mouth.
• When the tube reaches the glottis, the patient takes a deep breath and the doctor is at his height rotational movements moves the bronchoscope deeper.
• During the examination, the doctor alternately examines the mucous membrane of the larynx, glottis, trachea, bronchi until the second branch. The bronchi located more distally have too small a diameter and are therefore not accessible to research. As the tube moves through the airway, the patient may feel slight pressure in different parts of the airway. The bronchoscope does not interfere with breathing.
• If necessary, the doctor can use special instruments to take a piece of material from the bronchi or wash away their mucous membrane for examination, rinse them with an antiseptic or antibiotic solution, and even remove the polyp.

What's next?

• After the study is completed, the patient is recommended to remain under the supervision of medical personnel for at least an hour.
• He should not eat or smoke for 2 hours - this can cause bleeding.
• If the patient took sedatives before bronchoscopy, he should not drive for 8 hours after taking them. motor vehicle. This is due to the fact that the above drugs often cause drowsiness and reduce reaction speed, which means that the risk of an accident increases sharply.

Are there any complications?

In some cases, complications arise during bronchoscopy. The lion's share of them consists of bleeding (the result of injury to the mucous membrane) or an infectious process (due to non-compliance with the rules of asepsis and antisepsis). Basic clinical manifestations they are the following:

• incessant hemoptysis;
• high body temperature, chills;
• chest pain;
• wheezing heard at a distance;
• nausea, vomiting.

If at least one of these symptoms occurs, you should not waste time; it is important to consult a doctor as soon as possible.

Also complications of bronchoscopy are pneumothorax, mediastinal emphysema (if a lung biopsy was performed through the bronchus), cardiac arrhythmias, hypoxia (in people with insufficient heart and lung function), bronchospasm (in patients suffering from bronchial asthma). These conditions do not develop in a delayed manner, but are noticeable immediately and require emergency medical care for the patient.

What is virtual bronchoscopy

Virtual bronchoscopy is a type of x-ray examination, an option computed tomography, the result of which, using a special program, is converted into a three-dimensional picture of the tracheobronchial tree. The undoubted advantage of this research method is its non-invasiveness (there is no risk of injury to the mucous membrane or the development of bleeding). However, for many reasons, it cannot replace classical bronchoscopy: it is exclusively diagnostic and is used only in certain clinical situations (in particular, for the purpose of diagnosing bronchial tumors and monitoring the rate and nature of their growth). Virtual bronchoscopy, of course, does not allow therapeutic manipulations.

IN modern medicine There are many ways to study the respiratory tract and identify diseases. The question of what bronchoscopy is can be answered as follows: this is a procedure that makes it possible to thoroughly examine the lungs using a special thin hose (bronchoscope). The diagnostic device is equipped with a light and small camera that provides video recording of the organ mucosa. The bronchoscope is carefully moved through the mouth or nose into the throat, trachea and respiratory tract, after which the specialist examines the gaps between the branches of the organ.

Essence of the procedure

There are two types of diagnostic devices: flexible and rigid type. They may vary in width.

The use of a flexible bronchoscope is more common. The instrument is able to move into smaller branches in depth - bronchioles. It is used for the following procedures:

• Organization of oxygen access.
• Collection of fluid secretions and sputum.
• Supplies medicines to the organs.

Bronchoscopy under anesthesia is performed with a rigid type apparatus, which is used to check wide air gaps. Scope of its application:

• Removing excessive fluid and blood secretions.
• Controlling bleeding.
• Freedom from third-party particles (including in children).

Bronchoscopic examination is carried out in the operating room with the introduction of anesthetic substances.

When is the procedure scheduled?

What is bronchoscopy and when is it indicated? The method under consideration is appropriate for the following cases:

• Detection of benign tumors.
• When diagnosing cancer bronchi.
• Detection of blocking processes in the respiratory tract (scientifically called obstruction).
• Places of narrowing of the area in the bronchopulmonary node.
• Diagnosis of inflammatory and infectious processes, including tuberculosis, interstitial diseases.
• Identifying the causes of chronic cough and bleeding.
• Confirmation or exclusion of the diagnosis when spots are reflected on chest X-ray.

Bronchoscopy of the lungs - what is it and how is it done?

Before carrying out this procedure, you must completely free yourself from jewelry, costume jewelry, dentures, contact lenses, and the like. It is advisable to visit the toilet first. Diagnosis is carried out with a minimum amount of clothing on the patient.

When conducting an examination with a flexible bronchoscope, local anesthesia by spraying the drug into the mouth or nose is sufficient. The patient is in a supine or semi-recumbent state. The specialist inserts the device and moves it further through the throat to the organ being examined.

Peculiarities

What is the process of bronchoscopy? The display shows a picture of the area covered with its gradual advancement towards the bronchi and lungs. If the procedure is also aimed at clearing bronchial mucus, a medicinal agent is sprayed at the same time. saline solution to this organ.

When introducing a rigid type bronchoscope, the health worker begins manipulations after the patient has received general anesthesia. The entire operation takes no more than 40-50 minutes. The invasive (alien) nature of the procedure requires a certain short rehabilitation. After bronchoscopy, you need to refrain from eating, water, and cigarettes for 2-3 hours. You should also not drive a vehicle.

Risks and prohibitions

What is bronchoscopy and what are its consequences? This question can be answered almost unequivocally: the manipulation is not pleasant, like most medical studies, but pathological complications occur extremely rarely.

Possible adverse effects:

• The appearance of bleeding most often occurs during a biopsy.
• There is a small percentage of the occurrence of infectious disease.
• Sometimes there is difficulty breathing.
• During the procedure, oxygen levels in the blood may decrease.

Contraindications for bronchoscopy:

• Severe narrowing or blockage of the trachea (stenosis).
• Increased blood pressure in the blood vessels of the lungs (hypertension).
• A hysterical strong cough or severe vomiting.

A patient with a high level carbon dioxide in the blood, a special breathing machine may be needed before manipulation. This technique allows for direct supply of oxygen to the lungs.

Preparatory process

First of all, you need to consult a specialized physician about all possible consequences, objectivity and reliability of the results of this procedure. The specialist must adequately understand the terminology, names of drugs, have an understanding of the patient’s medical history and information about the presence of allergic reactions to drugs.

It is considered absolutely normal to be referred for blood or other tests before diagnosis. This practice is quite common before most diagnostic procedures. 10-12 hours before undergoing bronchoscopy you should stop eating.

Respiratory diseases in modern world meet very often. Various methods are used for their diagnosis and treatment. One of them is bronchoscopy of the lungs - a study during which a specialist examines the mucous membranes of the trachea and bronchi using a special device - a bronchoscope. This is a tube with a video camera at the end. Everything that the device “sees” is displayed on the computer monitor. The accuracy of this study is over 97%.

The procedure is most often used for diagnostic purposes chronic bronchitis, pneumonia, lung cancer, tuberculosis. So, in case of pneumonia, an examination will show whether there is a tumor in the respiratory tract.

Indications for bronchoscopy most often include the following symptoms:

• presence of a foreign body in the respiratory tract;
• hemoptysis;
• cysts in the lungs;
• preparation for surgery;
• prolonged shortness of breath associated with a disease of the respiratory system.

Thus, with the help of such manipulation, not only diseases are diagnosed, but also therapeutic procedures are carried out, for example, foreign bodies are removed from the bronchi, cleansed of pus and thick mucus; washed and administered, if necessary, antibiotic solutions; tissue samples are taken for additional studies (biopsy); expand the lumens of the bronchi and even remove small tumors.

It is for this purpose that bronchoscopes are supplemented with equipment such as a laser for destroying tumors or forceps for taking material.

History of the use of bronchoscopes

The first bronchoscopy of the lungs was performed in 1897, and for 50 years small foreign bodies have been removed using a bronchoscope. Cocaine was most often used as anesthesia because the procedure was very painful. Older bronchoscope models were more likely to injure the airways and cause complications.

The first safe device for patients was invented by Friedel in 1956. It was a rigid bronchoscope. Flexible was invented in 1968. With the development of electronic technologies, it became possible to enlarge the image and obtain a more detailed picture of changes in the lungs.

Types of procedure

Bronchoscopes come in two types: flexible and rigid.

1. Flexible (fiber bronchoscope) is used to diagnose the respiratory tract; visualization of the bronchial mucosa and when removing small foreign bodies. A flexible bronchoscope causes less trauma to the mucous membrane, since it has a small diameter, and is used when examining children.
2. Hard, or rigid, is used to expand the lumen of the bronchi, remove foreign bodies that block the airways. It is used in the resuscitation of drowning people with cystic fibrosis (it is used to remove fluid from the lungs); restore airway patency (in the presence of scars or tumors); when fighting bleeding; bronchial lavage and administration of medicinal solutions.

How is bronchoscopy performed?

The study is carried out in a special room where sterile conditions must be observed. The patient sits or lies on his back. A tube is inserted through the patient's nose or mouth. To suppress the gag reflex that occurs when the bronchoscope is inserted, the patient is asked to breathe quickly and shallowly. There is no need to be afraid that the tubes will stop breathing; they are much smaller than the bronchi and trachea, so they do not interfere with breathing.

The procedure takes place under anesthesia. If the examination is carried out with a flexible bronchoscope, local anesthesia is used using a 2-5% lidocaine solution. At the same time, the palate becomes numb, there is a feeling of a lump in the throat and slight nasal congestion is felt. When the bronchoscope tube is inserted, the mucous membranes are treated with an anesthetic spray.

When using rigid models, general anesthesia is performed, which is recommended not only for children, but also for people with an unhealthy psyche. After all, only during general anesthesia the patient does not experience a feeling of fear. After two hours have passed, you can smoke and eat.

In order to exclude the development of complications, it is better to remain under observation for a while medical workers and, due to the effect of hypnotics on general state, do not drive on the day of the procedure.

Preparing for the study

In preparation for this procedure, studies such as chest X-ray, electrocardiography, and blood tests are most often carried out. Based on the image, the doctor will determine which part of the lungs needs to be examined in more detail; a study of the heart will show the risk of complications.

You must first inform your doctor about any allergies to medications, chronic diseases, or medications you are taking. If it is undesirable to take any medications, the doctor is obliged to warn the patient about this in advance.

Before the study, you need to have a good rest; you may need to take a sedative the day before the procedure.

In order to avoid suffocation from food debris during bronchoscopy, you need to eat no later than 8 hours before the procedure, and smokers should not smoke on the day of the examination.

Before the study, you need to cleanse the intestines with an enema or glycerin suppositories, and it is recommended to urinate immediately before the procedure.

Due to the fact that after the procedure there are cases of hemoptysis, prepare a towel, napkin or diaper for the examination.

Like any other medical examination, bronchoscopy has contraindications. Under no circumstances should the procedure be carried out if:

• exacerbation of bronchial asthma;
• allergies to painkillers;
• myocardial infarction;
• severe arterial hypertension;
• oral diseases;
• consequences of traumatic brain injury, etc.;
• coughing.

Bronchoscopy should be temporarily postponed:

• during pregnancy (2nd and 3rd trimesters);
• during menstruation in women;
• during diabetes mellitus, with alcoholism and enlarged thyroid gland.

What consequences might arise?

This is not to say that pulmonary bronchoscopy does not cause any complications. IN in rare cases After diagnosis, bronchospasms, allergies and bleeding, the development of pneumonia, and, very rarely, damage to the walls of the bronchi were observed. If you follow all the instructions of the doctor conducting the study, undesirable consequences can be avoided.

Bronchoscopy of the lungs is an unpleasant procedure, but it is considered the most effective among the diagnosis of various diseases of the respiratory tract. In addition, anesthesia partially eliminates discomfort during the procedure.

Bronchoscopy as a research method provides not only an assessment of the condition of the disease, but also the opportunity to carry out certain therapeutic measures that cannot be carried out in the usual way.

Bronchoscopy of the lungs is performed for diseases of the pulmonary system, the diagnosis of which requires examination and taking tissue for histological analysis. The procedure can be diagnostic and at the same time therapeutic, performed under local or general anesthesia.

Find the answer

Are you having any problem? Enter “Symptom” or “Name of the disease” into the form, press Enter and you will find out all the treatment for this problem or disease.

To understand how a bronchoscopic examination of the lungs is done, you need to familiarize yourself with the anatomy of the respiratory system.

Indications for bronchoscopy of the lungs

Bronchoscopy is prescribed to clarify the diagnosis:

• Tuberculosis;
• Bronchiectasis (a defect in the bronchi, as a result of which the bronchioles and bronchi have “pockets” in some places, pus, sputum, biological substances accumulate in them, the patient coughs up about 350 milliliters of sputum in the morning);
• Bronchial asthma;
• Protracted bronchitis;
• Hemoptysis;
• Suspicion of lung cancer;
• Sarcoidosis;
• Foreign bodies in the lumen of the bronchi;
• Tracheal diseases.

The method is informative because the doctor receives not just tests, but a real picture of your respiratory tract.

The purposes of bronchoscopy are divided into diagnostic and therapeutic:

• Diagnostic tests include examination and collection of material (for example, targeted biopsy if there is a suspicion of cancer or bronchial asthma).
• Therapeutic - removal of a foreign body, introduction medicinal substances into the bronchi, stopping pulmonary hemorrhage.

Anatomy of the respiratory system

Respiratory system- these are anatomically united organs that perform the function of conducting atmospheric air: the nose and its cavity, trachea, larynx, bronchi, and gas exchange (lungs).

But along with this, the respiratory organs perform our daily functions, the ability to speak (voice formation), charm, and maintain homeostasis in the body.

To understand bronchoscopy, attention is required to the larynx, trachea, and bronchi. The larynx is located in the front of the neck, at the level of 4-6 cervical vertebrae. Front, covered hypoglossal muscles.

This picture can be observed when a person is choking and cannot breathe, not because of a foreign body that has blocked the air supply, but because of a muscle spasm. This condition is called laryngospasm and leads to the death of a person.

The muscles involved in the expansion or contraction of the larynx are innervated by nerves located near the thyroid cartilage and thyroid gland, so it is dangerous to hit a person in the throat.

The thing is that if the ligaments are closed, they are not able to open, since another nerve impulse is needed. They remain in this position forever, due to muscle paralysis (after a strong blow, it is not a fact that the nerves will be able to conduct the impulse).

The trachea is a non-collapsing tube, reminiscent of a vacuum cleaner hose, but cannot stretch throughout the house. At the level of the 5th thoracic vertebra it is divided into 2 parts, the right bronchus and the left.

The right bronchus is considered a continuation of the trachea, while the left one leaves at an obtuse angle. The tracheal rings are made of hyaline cartilage.

The bronchi pass into the bronchi of the first order and further, to the bronchioles, resembling a tree. It is called the bronchial tree.

Manipulation technique

How is bronchoscopy of the lungs done? Translated from Latin broncho (bronchus), skopia (I look), but in medicine it is customary to call this procedure instrumental method research is carried out with an instrument, a bronchoscope, they can be bendable or rigid. The type of bronchoscopy depends on this.

Types of bronchoscopy:

• Rigid bronchoscopy. Performed under general anesthesia, with a rigid bronchoscope, such manipulations are intended to stop pulmonary bleeding and remove foreign bodies. Because it is much easier for doctors to work when the patient is under general anesthesia.
• Soft bronchoscopy. Performed with a bendable bronchoscope, which resembles a gastric tube, for diagnostic purposes. But anesthesia is administered locally, and the patient remains conscious. The type of bronchoscopy is less dangerous compared to the hard one.

Preparation for bronchoscopy is simple. In the evening, on the eve of the procedure, it is forbidden to eat food after 19:00; only water, tea, juice are allowed, but in small quantities. If a person is worried and cannot find a place, it is allowed to take sedatives.

Doctors are required to do a test with an anesthetic, which will be administered before the procedure, to avoid an allergic reaction.

Before the procedure, patients ask: “How will I breathe?” Before the procedure, the oral cavity and larynx are irrigated with an anesthetic (a test is done before this), it will inhibit the gag reflex, you can sit quietly and wait for the end of the procedure.

After the procedure is completed, you should not eat for 2 hours, but then for the next 24 hours, only cool food and drinks are consumed.

Video

Lung Cancer Research

Bronchoscopy and lung biopsy for cancer is a decided invasive method of examination for diagnosis.

In cases of disease, a visual examination of the trachea and bronchi is carried out, taking pieces of tissue and smears for histological and cytological confirmation of the diagnosis of central lung cancer.

During the study, catheterization of smaller bronchi is possible to take material for peripheral tumors. If metastases in regional lymph nodes are suspected during bronchoscopy, a transbronchial puncture is performed.

The essence of the method is to puncture the bronchial wall and take material from the bifurcation, hilar, tracheobronchial and bronchopulmonary lymph nodes. The manipulation is performed under general anesthesia.

Medical procedure for sarcoidosis

Sarcoidosis is a disease connective tissue at which on internal organs“nodules” are formed. During manipulation, “nodules” will be clearly visible, as with cancer; a biopsy is required for an accurate diagnosis.

The examination reveals signs of sarcoidosis changes in the lungs:

• Enlarged lymph nodes;
• Sarcoid plaques;
• Lumps and warts.

In sarcoidosis, changes in the vessels of the bronchial mucosa are detected. They are expanded, compacted and have a more tortuous shape. On the surface of the mucous membrane during the formation of sarcoid granulomas, pale areas devoid of blood vessels, called ischemic spots, are found.

Possible complications and consequences

No one is immune from an accident or a “discovery,” so there will be complications:

• Bleeding associated with damage to the trachea, bronchus or puncture of the lung;
• Swelling of the larynx (this is an allergic reaction);
• Sore throat after the procedure;
• Damage vocal cords, possibly due to the individual anatomical features of the larynx.

Contraindications to the medical procedure

There are contraindications to the bronchoscopy procedure.

Absolute, in which the possibility of consequences outweighs the diagnostic value of the procedure:

• Diseases of cardio-vascular system in the stage of decompensation (aortic aneurysm, acute myocardial infarction, heart defects);
• Obstruction of the bronchial tree, complicated by respiratory failure of the 3rd degree;
• Thrombosis of pulmonary vessels or cerebral vessels.

Relative contraindications, in which bronchoscopy is performed only if there are no other ways to confirm the diagnosis:

• Active pulmonary tuberculosis;
• Severe general condition of the patient (edema, shortness of breath, pneumothorax, high fever);
• Hypertension 3 degrees.

Tasks faced when performing therapeutic bronchoscopy and reasons for performing it

Therapeutic bronchoscopy falls into the category of minor surgical interventions. Accordingly, this procedure can be planned or emergency. It becomes urgent when life-threatening conditions occur - pulmonary hemorrhage, foreign body entry into the bronchial lumen, severe status asthmaticus, etc.

The goals of therapeutic bronchoscopy are:

1. Cleansing and rinsing of the bronchopulmonary tree.
2. Removing blockage of the bronchi and trachea when a foreign body enters using forceps. Occurs more often in children.
3. Drainage of purulent cavities. Pus does not accumulate in the lungs, but is expelled.
4. Administration of drugs to the site of inflammation. For this purpose, antibacterial drugs and antiseptics are used.
5. Removing blockage of the bronchi and trachea from accumulated pus and mucus.
6. Stopping pulmonary hemorrhage by tamponade or administering an adrenaline solution. The solution is injected onto the bleeding vessel.
7. Removal of small tumors in the trachea and bronchi.
8. Restoring the lumen of the trachea after illness.
9. Treatment of fistulas various localizations.
10. Stenting when the airway is compressed by a tumor. The operation involves installing a dilator into the lumen of the bronchus.

Indications for bronchoscopy include:

• Signs of pulmonary hemorrhage;
• Changes in the trachea and bronchi after intubation anesthesia;
• Neoplasms of the bronchi and trachea;
• Severe bronchitis;
• Severe bronchial asthma, uncontrollable drug therapy;
• Complicated pneumonia;
• Pulmonary tuberculosis;
• Cystic fibrosis;
• Severe tracheal stenosis;
• The presence of purulent foci in the lungs - abscesses, cysts;
• Airway obstruction;
• Bronchiectasis.

Anesthesia during bronchoscopy

When performing bronchoscopy under general anesthesia, the anesthesiologist examines the patient on the eve of the procedure and may prescribe premedication. It is done before the operation. The main purpose of premedication is to suppress the cough and gag reflex. For this, atropine is administered. The method of administration and dosage is determined by a specialist! It is permissible to administer antiallergic and sedative drugs.

Anesthesia is aimed at reducing pain patient, preventing the arrest of vital reflexes, good muscle relaxation, adequate ventilation and gas exchange. It is mandatory for both planned and emergency surgery. The attending physician, together with the anesthesiologist, determines the type of anesthesia before the operation, taking into account the volume of the upcoming intervention, the severity of the condition, the age and psychological state of the patient.

It could be local anesthesia or general anesthesia. Topically use lidocaine 2-5% in the form of a spray or solution. It is administered before and during the procedure by irrigating the mucous membrane of the nasopharynx, trachea, and bronchi.

Immediately after administration, the patient may experience a gradually increasing feeling of a warm lump in the throat, a feeling of fullness, numbness of the throat and tongue. This is normal.

Types of general anesthesia during therapeutic bronchoscopy:

1. Intravenous.
2. Mask.

Mask anesthesia is more often used in young children. Nitrous oxide with fluorotane is used. After 3 years, it is permissible to use intravenous anesthesia in combination with a mask one. The type of anesthesia for a child is determined by an anesthesiologist. Parents' wishes are not taken into account.

In the adult population, general anesthesia is indicated for emotional instability. The drugs and dosages used for intravenous anesthesia are selected by the anesthesiologist, taking into account age, body weight, and some objective and laboratory indicators.

In choosing this type of anesthesia, after bronchoscopy, the patient can be transferred to the ward after complete restoration of respiratory reflexes and awakening. Until this moment, the patient should be in the intensive care unit under the careful supervision of specialists.

Bronchoscopy should be performed in the following institutions

1. Multidisciplinary hospitals.
2. Surgical hospitals if they have a thoracic surgery department.
3. Emergency hospitals.

When choosing an institution for an operation, consider the availability of an intensive care unit and a good functional diagnostics department with equipment and staff.

The cost of this procedure varies in different regions. It depends on the following factors:

1. The scope of the upcoming intervention. For example, a bronchoscopy to remove a small tumor in the bronchus and an operation to install a stent in the trachea will have different prices.
2. Type of anesthesia. When using local anesthetics, the price will be lower.
3. The prestige of the medical institution, its technical base and the literacy of its specialists.
4. Adding diagnostic procedures, for example, biopsy of a tumor during its removal.
5. The need for hospital stay.

The price for therapeutic bronchoscopy can be from 1,500 rubles and more.

• You can eat only after the anesthetic drug has worn off;
• Frequently spit out accumulated saliva;
• Stop smoking for at least a day;
• Before eating, take a sip of water to determine any discomfort;
• Limit driving vehicle during the day;
• Alcohol is contraindicated for 24 hours;
• Cancel cold and hot dishes for a day;
• It is not advisable to cough;
• Take medications as prescribed by your doctor;
• Exclude physical exercise;
• Hoarseness of voice and sore throat may bother you for several days;
• If you experience severe pain and excessive hemoptysis, consult a doctor!

Generalized opinion of people who underwent bronchoscopy

The opinion of patients is that this procedure is unpleasant. It is performed quickly, but it must be remembered that bronchoscopy is a minor surgical intervention. As before any operation, there is a lot of fear and anxiety.

Many who have undergone this procedure claim that the idea of ​​bronchoscopy and reality are two different things. Most claim that they did not experience any pain during the operation. Another part of the patients who have experienced unpleasant sensations agree that they can be patient.

The degree of trust in medical personnel is important, so you need to contact doctors in whom you are confident.

The opinions of many people who have undergone therapeutic bronchoscopy are that they feel better after this procedure, and therefore agree to have it repeated if necessary.