Bronchoscopy (cont.)

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Prior to the procedure, the doctor will discuss the following with the patient:

• The need to do a bronchoscopy
• What doctors hope to achieve (take biopsy and visualize an area)
• The risks of the procedure
• Potential complications

The doctor also will do the following:

• Create an accurate medical history
• Examine the patient's lungs and heart
• Take a chest X-ray
• Perform appropriate blood tests if the patient has a high risk of bleeding or have significant medical problems.

The patient will be asked to fast for at least 6 hours before the procedure.

• The bronchoscopy is performed in one of three areas:
  • A special room designated for bronchoscopies and similar procedures
  • An operating room
  • An intensive care unit
• During the procedure, doctors provide an agent to sedate the patient (such as midazolam (Versed) and /or a narcotic (for example, fentanyl), although the patient remains conscious (so-called conscious sedation "twilight sleep"). Recently, propofol (a short acting , intravenous hypnotic agent) has become more commonly used as an anesthetic agent for bronchoscopies. Lidocaine also can be used to anesthetize the patient's upper airways.
• The patient will be monitored during the procedure with periodic blood pressure checks, respiratory rate, continuous electrocardiogram (ECG, EKG) monitoring of heart and oxygen measurement. Monitoring is extremely important in all forms of anesthesia.
• The doctor can insert a flexible bronchoscope through either the nose or mouth. The patient can be either sitting or lying down.
• Once the bronchoscope is inserted into the patient's upper airway, the doctor will examine the vocal cords. The doctor continues to advance the instrument to the trachea and on down, examining each area as the bronchoscope passes.
• If doctors discover an abnormality, they may sample it, using a brush, a needle, or forceps.
  • Doctors can obtain a specimen of lung tissue (transbronchial biopsy) often using a real-time X-ray (fluoroscopy). This specimen contains actual lung tissue which may include samples of the air sacs, airways, blood vessels, and supporting membranes of the lungs.

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