Bronchoscopic Procedures

  • Gordon N. FinlaysonEmail author
  • Tawimas Shaipanich
  • Chris Durkin


Diagnostic flexible bronchoscopy is safely performed outside of the operating room with light to moderate sedation and topical anesthesia. Rigid bronchoscopy is typically performed in patients with central airway obstruction and major comorbidities. Primary concerns include the risk of complete airway obstruction and inability to ventilate or dynamic hyperventilation with hemodynamic compromise. A fluid transition between ventilation strategies is often required for these procedures. Extracorporeal membrane oxygenation may be implemented when conventional approaches are not feasible or deemed safe. Multimodal techniques employed by interventional bronchoscopists to acutely re-establish patency of obstructed central airways include stenting, laser, endobronchial electrosurgery, argon plasma coagulation, and balloon bronchoplasty. Major intraoperative complications associated with these techniques include hemorrhage, airway trauma, perforation, fire, systemic gas embolism, and dissemination of postobstructive pneumonia. Alternative indications for these procedures include treatment of low-grade malignancies and carcinoma in situ. These lesions may also respond to brachytherapy, cryotherapy, or photodynamic therapy. Interventional bronchoscopy is an evolving field with expanding applications with both diagnostic and therapeutic modalities covering benign and malignant pulmonary disease. Future indications may include endobronchial valve insertion for persistent air leaks and lung volume reduction in COPD as well as bronchial thermoplasty for treatment-resistant asthma.


Central airway obstruction Diagnostic bronchoscopy Interventional Bronchoscopy Airway stenting Endobronchial ultrasound Endobronchial valve Airway foreign body 

Supplementary material


  1. 1.
    Limper AH, Prakash UB. Tracheobronchial foreign bodies in adults. Ann Intern Med. 1990;112(8):604–9.PubMedCrossRefGoogle Scholar
  2. 2.
    Conacher ID, Curran E. Local anaesthesia and sedation for rigid bronchoscopy for emergency relief of central airway obstruction. Anaesthesia. 2004;59(3):290–2.PubMedCrossRefGoogle Scholar
  3. 3.
    Chadha M, Kulshrestha M, Biyani A. Anaesthesia for bronchoscopy. Indian J Anaesth. 2015;59(9):565–73.PubMedPubMedCentralCrossRefGoogle Scholar
  4. 4.
    Ernst A, Simoff M, Ost D, Goldman Y, Herth FJ. Prospective risk-adjusted morbidity and mortality outcome analysis after therapeutic bronchoscopic procedures: results of a multi-institutional outcomes database. Chest. 2008;134(3):514–9.PubMedCrossRefGoogle Scholar
  5. 5.
    Perrin G, Colt HG, Martin C, Mak MA, Dumon JF, Gouin F. Safety of interventional rigid bronchoscopy using intravenous anesthesia and spontaneous assisted ventilation. A prospective study. Chest. 1992;102(5):1526–30.PubMedCrossRefGoogle Scholar
  6. 6.
    Metzner J, Posner KL, Domino KB. The risk and safety of anesthesia at remote locations: the US closed claims analysis. Curr Opin Anaesthesiol. 2009;22(4):502–8.PubMedCrossRefGoogle Scholar
  7. 7.
    Folch E, Mehta AC. Airway interventions in the tracheobronchial tree. Semin Respir Crit Care Med. 2008;29(4):441–52.PubMedCrossRefGoogle Scholar
  8. 8.
    Brodsky JB. Bronchoscopic procedures for central airway obstruction. J Cardiothorac Vasc Anesth. 2003;17(5):638–46.PubMedCrossRefGoogle Scholar
  9. 9.
    Pinsonneault C, Fortier J, Donati F. Tracheal resection and reconstruction. Can J Anaesth. 1999;46(5):439–55.PubMedPubMedCentralCrossRefGoogle Scholar
  10. 10.
    Mason RA, Fielder CP. The obstructed airway in head and neck surgery. Anaesthesia. 1999;120(4):1152–6.Google Scholar
  11. 11.
    Hnatiuk OW, Corcoran PC, Sierra A. Spirometry in surgery for anterior mediastinal masses. Chest. 2001;120(4):1152–6.CrossRefGoogle Scholar
  12. 12.
    Ernst A, Feller-Kopman D, Becker HD, Mehta AC. Central airway obstruction. Am J Respir Crit Care Med. 2004;169(12):1278–97.PubMedCrossRefGoogle Scholar
  13. 13.
    Walser EM. Stent placement for tracheobronchial disease. Eur J Radiol. 2005;55(3):321–30.PubMedCrossRefGoogle Scholar
  14. 14.
    Lee KS, Lunn W, Feller-Kopman D, Ernst A, Hatabu H, Boiselle PM. Multislice CT evaluation of airway stents. J Thorac Imaging. 2005;20(2):81–8.PubMedCrossRefGoogle Scholar
  15. 15.
    Burke AJ, Vining DJ, McGuirt WF, Postma G, Browne JD. Evaluation of airway obstruction using virtual endoscopy. Laryngoscope. 2000;110(1):23–9.PubMedCrossRefGoogle Scholar
  16. 16.
    Baroni RH, Ashiku S, Boiselle PM. Dynamic CT evaluation of the central airways in patients undergoing tracheoplasty for tracheobronchomalacia. Am J Roentgenol. 2005;184(5):1444–9.CrossRefGoogle Scholar
  17. 17.
    Conacher ID. Anaesthesia and tracheobronchial stenting for central airway obstruction in adults. Br J Anaesth. 2003;90(3):367–74.PubMedCrossRefGoogle Scholar
  18. 18.
    Wood D. Airway stenting. Chest Surg Clin N Am. 2003;13(2):211–29.PubMedCrossRefGoogle Scholar
  19. 19.
    Ho AM, Dion PW, Karmakar MK, Chung DC, Tay BA. Use of heliox in critical upper airway obstruction. Physical and physiologic considerations in choosing the optimal helium:Oxygen mix. Resuscitation. 2002;52(3):297–300.PubMedCrossRefGoogle Scholar
  20. 20.
    Stephens KE, Wood DE. Bronchoscopic management of central airway obstruction. J Thorac Cardiovasc Surg. 2000;119(2):289–96.PubMedCrossRefGoogle Scholar
  21. 21.
    Vonk-Noordegraaf A, Postmus PE, Sutedja TG. Tracheobronchial stenting in the terminal care of cancer patients with central airways obstruction. Chest. 2001;120(6):1811–4.PubMedCrossRefGoogle Scholar
  22. 22.
    Hautmann H, Gamarra F, Henke M, Diehm S, Huber RM. High frequency jet ventilation in interventional fiberoptic bronchoscopy. Anesth Analg. 2000;90(6):1436–40.PubMedCrossRefGoogle Scholar
  23. 23.
    Smith IJ, Sidebotham DA, McGeorge AD, Dorman EB, Wilsher ML, Kolbe J. Use of extracorporeal membrane oxygenation during resection of tracheal papillomatosis. Anesthesiology. 2009;110(2):427–9.PubMedPubMedCentralGoogle Scholar
  24. 24.
    Zhou YF, Zhu SJ, Zhu SM, An XX. Anesthetic management of emergent critical tracheal stenosis. J Zhejiang Univ Sci B. 2007;8(7):522–5.PubMedPubMedCentralCrossRefGoogle Scholar
  25. 25.
    Vourc'h G, Fischler M, Michon F, Melchior JC, Seigneur F. Manual jet ventilation v. high frequency jet ventilation during laser resection of tracheo-bronchial stenosis. Br J Anaesth. 1983;55(10):973–5.PubMedCrossRefGoogle Scholar
  26. 26.
    Vaitkeviciute I, Ehrenwerth J. Con: bronchial stenting and laser airway surgery should not take place outside the operating room. J Cardiothorac Vasc Anesth. 2005;19(1):121–2.PubMedCrossRefGoogle Scholar
  27. 27.
    Wahidi MM, Herth FJ, Ernst A. State of the art: interventional pulmonology. Chest. 2007;131(1):261–74.PubMedCrossRefGoogle Scholar
  28. 28.
    Barbaro RP, Odetola FO, Kidwell KM, Paden ML, Bartlett RH, Davis MM, Annich GM. Association of hospital-level volume of extracorporeal membrane oxygenation cases and mortality. Analysis of the extracorporeal life support organization registry. Am J Respir Crit Care Med. 2015;191(8):894–901.PubMedPubMedCentralCrossRefGoogle Scholar
  29. 29.
    Kim CW, Kim DH, Son BS, Cho JS, Kim YD, Hoseok I, Ahn HY. The feasibility of extracorporeal membrane oxygenation in the variant airway problems. Ann Thorac Cardiovasc Surg. 2015;21(6):517–22.PubMedPubMedCentralCrossRefGoogle Scholar
  30. 30.
    McLenon M, Bittle GJ, Jones K, Menaker J, Pham SM, Iacono AT, et al. Extracorporeal lung support as a bridge to airway stenting and radiotherapy for airway-obstructing pancoast tumor. Ann Thorac Surg. 2016;102(1):e7–9.PubMedCrossRefGoogle Scholar
  31. 31.
    Willms DC, Mendez R, Norman V, Chammas JH. Emergency bedside extracorporeal membrane oxygenation for rescue of acute tracheal obstruction. Respir Care. 2012;57(4):646–9.PubMedCrossRefGoogle Scholar
  32. 32.
    Ko M, dos Santos PR, Machuca TN, Marseu K, Waddell TK, Keshavjee S, Cypel M. Use of single-cannula venous-venous extracorporeal life support in the management of life-threatening airway obstruction. Ann Thorac Surg. 2015;99(3):e63–5.PubMedCrossRefGoogle Scholar
  33. 33.
    Natt B, Knepler J Jr, Kazui T, Mosier JM. The use of extracorporeal membrane oxygenation in the bronchoscopic management of critical upper airway obstruction. J Bronchol Interv Pulmonol. 2017;24(1):e12–4.CrossRefGoogle Scholar
  34. 34.
    Hong Y, Jo KW, Lyu J, Huh JW, Hong SB, Jung SH, et al. Use of venovenous extracorporeal membrane oxygenation in central airway obstruction to facilitate interventions leading to definitive airway security. J Crit Care. 2013;28(5):669–74.CrossRefGoogle Scholar
  35. 35.
    Guha A, Mostafa SM, Kendall JB. The montgomery t-tube: Anaesthetic problems and solutions. Br J Anaesth. 2001;87(5):787–90.PubMedCrossRefGoogle Scholar
  36. 36.
    Dumon JF. A dedicated tracheobronchial stent. Chest. 1990;97(2):328–32.PubMedCrossRefGoogle Scholar
  37. 37.
    Saito Y. Endobronchial stents: past, present, and future. Semin Respir Crit Care Med. 2004;25(4):375–80.PubMedCrossRefGoogle Scholar
  38. 38.
    Stehlik L, Hytych V, Letackova J, Kubena P, Vasakova M. Biodegradable polydioxanone stents in the treatment of adult patients with tracheal narrowing. BMC Pulm Med. 2015;15:164.PubMedPubMedCentralCrossRefGoogle Scholar
  39. 39.
    Finlayson GN, Brodsky JB. Anesthetic considerations for airway stenting in adult patients. Anesthesiol Clin. 2008;26(2):281–91.PubMedCrossRefGoogle Scholar
  40. 40.
    Zakaluzny SA, Lane JD, Mair EA. Complications of tracheobronchial airway stents. Otolaryngol Head Neck Surg. 2003;128(4):478–88.PubMedCrossRefGoogle Scholar
  41. 41.
    Bolliger CT, Sutedja TG, Strausz J, Freitag L. Therapeutic bronchoscopy with immediate effect: laser, electrocautery, argon plasma coagulation and stents. Eur Respir J. 2006;27(6):1258–71.PubMedCrossRefGoogle Scholar
  42. 42.
    Grillo HC. Stents and sense. Ann Thorac Surg. 2000;70(4):1142.PubMedCrossRefGoogle Scholar
  43. 43.
    Grewe PH, Müller KM, Lindstaedt M, Germing A, Müller A, Mügge A, Deneke T. Reaction patterns of the tracheobronchial wall to implanted noncovered metal stents. Chest. 2005;128(2):986–90.PubMedCrossRefGoogle Scholar
  44. 44.
    Thornton RH, Gordon RL, Kerlan RK, LaBerge JM, Wilson MW, Wolanske KA, et al. Outcomes of tracheobronchial stent placement for benign disease 1. Radiology. 2006;240(1):273–82.PubMedCrossRefGoogle Scholar
  45. 45.
    Eller RL, Livingston WJ, Morgan CE, Peters GE, Sillers MJ, Magnuson JS, Rosenthal EL. Expandable tracheal stenting for benign disease: worth the complications? Ann Otol Rhinol Laryngol. 2006;115(4):247–52.PubMedCrossRefGoogle Scholar
  46. 46.
    Makris D, Marquette CH. Tracheobronchial stenting and central airway replacement. Curr Opin Pulm Med. 2007;13(4):278–83.PubMedCrossRefGoogle Scholar
  47. 47.
    Urschel JD. Delayed massive hemoptysis after expandable bronchial stent placement. J Laparoendosc Adv Surg Tech A. 1999;9(2):155–8.PubMedCrossRefGoogle Scholar
  48. 48.
    Hung WT, Liao SM, Su JM. Laryngeal mask airway in patients with tracheal stents who are undergoing non-airway related interventions: report of three cases. J Clin Anesth. 2004;16(3):214–6.PubMedCrossRefGoogle Scholar
  49. 49.
    Davis N, Madden BP, Sheth A, Crerar-Gilbert AJ. Airway management of patients with tracheobronchial stents. Br J Anaesth. 2006;96(1):132–5.PubMedCrossRefGoogle Scholar
  50. 50.
    Yan Y, Olszewski AE, Hoffman MR, Zhuang P, Ford CN, Dailey SH, Jiang JJ. Use of lasers in laryngeal surgery. J Voice. 2010;24(1):102–9.PubMedCrossRefGoogle Scholar
  51. 51.
    Van Der Spek AF, Spargo PM, Norton ML. The physics of lasers and implications for their use during airway surgery. Br J Anaesth. 1988;60(6):709–29.CrossRefGoogle Scholar
  52. 52.
    Cortese DA. Rigid versus flexible bronchoscope in laser bronchoscopy pro rigid bronchoscopic laser application. J Bronchol Interv Pulmonol. 1994;1(1):72–5.Google Scholar
  53. 53.
    Moghissi K, Dixon K, Hudson E, Stringer M, Brown S. Endoscopic laser therapy in malignant tracheobronchial obstruction using sequential nd YAG laser and photodynamic therapy. Thorax. 1997;52(3):281–3.PubMedPubMedCentralCrossRefGoogle Scholar
  54. 54.
    Geffin B, Shapshay SM, Bellack GS, Hobin K, Setzer SE. Flammability of endotracheal tubes during nd-yag laser application in the airway. Anesthesiology. 1986;65(5):511–5.PubMedCrossRefGoogle Scholar
  55. 55.
    Lee P, Kupeli E, Mehta AC. Therapeutic bronchoscopy in lung cancer. Laser therapy, electrocautery, brachytherapy, stents, and photodynamic therapy. Clin Chest Med. 2002;23(1):241–56.PubMedCrossRefGoogle Scholar
  56. 56.
    Tellides G, Ugurlu BS, Kim RW, Hammond GL. Pathogenesis of systemic air embolism during bronchoscopic nd:YAG laser operations. Ann Thorac Surg. 1998;65(4):930–4.PubMedCrossRefGoogle Scholar
  57. 57.
    Lobraico RV, Schifano MJ, Brader KR. A retrospective study on the hazards of the carbon dioxide laser plume. J Laser Appl. 1988;1(1):6–8.CrossRefGoogle Scholar
  58. 58.
    Garden JM, O'Banion MK, Shelnitz LS, Pinski KS, Bakus AD, Reichmann ME, Sundberg JP. Papillomavirus in the vapor of carbon dioxide laser-treated verrucae. JAMA. 1988;259(8):1199–202.PubMedCrossRefGoogle Scholar
  59. 59.
    Baggish MS, Poiesz BJ, Joret D, Williamson P, Refai A. Presence of human immunodeficiency virus DNA in laser smoke. Lasers Surg Med. 1991;11(3):197–203.PubMedCrossRefGoogle Scholar
  60. 60.
    Barlow DE. Endoscopic applications of electrosurgery: a review of basic principles. Gastrointest Endosc. 1982;28(2):73–6.PubMedCrossRefGoogle Scholar
  61. 61.
    Coulter TD, Mehta AC. The heat is on: impact of endobronchial electrosurgery on the need for nd-yag laser photoresection. Chest. 2000;118(2):516–21.PubMedCrossRefGoogle Scholar
  62. 62.
    Boxem TV, Muller M, Venmans B, Postmus P, Sutedja T. Nd-YAG laser vs bronchoscopic electrocautery for palliation of symptomatic airway obstruction: a cost-effectiveness study. Chest. 1999;116(4):1108–12.PubMedCrossRefGoogle Scholar
  63. 63.
    Ernst A, Silvestri GA, Johnstone D. Interventional pulmonary procedures: guidelines from the american college of chest physicians. Chest J. 2003;123(5):1693–717.CrossRefGoogle Scholar
  64. 64.
    Grund KE, Storek D, Farin G. Endoscopic argon plasma coagulation (APC) first clinical experiences in flexible endoscopy. Endosc Surg Allied Technol. 1994;2(1):42–6.PubMedGoogle Scholar
  65. 65.
    Sheski FD, Mathur PN. Endobronchial electrosurgery: argon plasma coagulation and electrocautery. Semin Respir Crit Care Med. 2004;25(4):367–74.PubMedCrossRefGoogle Scholar
  66. 66.
    Morice RC, Ece T, Ece F, Keus L. Endobronchial argon plasma coagulation for treatment of hemoptysis and neoplastic airway obstruction. Chest. 2001;119(3):781–7.PubMedCrossRefGoogle Scholar
  67. 67.
    Reddy C, Majid A, Michaud G, Feller-Kopman D, Eberhardt R, Herth F, Ernst A. Gas embolism following bronchoscopic argon plasma coagulation: a case series. Chest. 2008;134(5):1066–9.PubMedCrossRefGoogle Scholar
  68. 68.
    McArdle JR, Gildea TR, Mehta AC. Balloon bronchoplasty: its indications, benefits, and complications. J Bronchol Interv Pulmonol. 2005;12(2):123–7.Google Scholar
  69. 69.
    Vergnon JM, Huber RM, Moghissi K. Place of cryotherapy, brachytherapy and photodynamic therapy in therapeutic bronchoscopy of lung cancers. Eur Respir J. 2006;28(1):200–18.PubMedCrossRefGoogle Scholar
  70. 70.
    Schumann C, Hetzel M, Babiak AJ, Hetzel J, Merk T, Wibmer T, et al. Endobronchial tumor debulking with a flexible cryoprobe for immediate treatment of malignant stenosis. J Thorac Cardiovasc Surg. 2010;139(4):997–1000.PubMedCrossRefGoogle Scholar
  71. 71.
    Mohamed AS, El-Din MAA. Fiberoptic bronchoscopic cryo-ablation of central bronchial lung cancer. Egypt J Chest Dis Tuberc. 2016;65(2):527–30.CrossRefGoogle Scholar
  72. 72.
    Inaty H, Folch E, Berger R, Fernandez-Bussy S, Chatterji S, Alape D, Majid A. Unimodality and multimodality cryodebridement for airway obstruction. A single-center experience with safety and efficacy. Ann Am Thorac Soc. 2016;13(6):856–61.PubMedCrossRefGoogle Scholar
  73. 73.
    Browning R, Parrish S, Sarkar S, Turner JF. First report of a novel liquid nitrogen adjustable flow spray cryotherapy (SCT) device in the bronchoscopic treatment of disease of the central tracheo-bronchial airways. J Thorac Dis. 2013;5(3):E103–6.PubMedPubMedCentralGoogle Scholar
  74. 74.
    Browning R, Turner JF, Parrish S. Spray cryotherapy (SCT): institutional evolution of techniques and clinical practice from early experience in the treatment of malignant airway disease. J Thorac Dis. 2015;7(Suppl 4):S405–14.PubMedPubMedCentralGoogle Scholar
  75. 75.
    Rafanan AL, Mehta AC. Adult airway foreign body removal. What’s new? Clin Chest Med. 2001;22(2):319–30.PubMedCrossRefGoogle Scholar
  76. 76.
    Swanson KL. Airway foreign bodies: What’s new? Semin Respir Crit Care Med. 2004;25(4):405–11.PubMedCrossRefGoogle Scholar
  77. 77.
    Zur KB, Litman RS. Pediatric airway foreign body retrieval: surgical and anesthetic perspectives. Paediatr Anaesth. 2009;19(Suppl 1):109–17.PubMedCrossRefGoogle Scholar
  78. 78.
    McKenna RJ. Endobronchial valves for the treatment of emphysema. Semin Thorac Cardiovasc Surg. 2008;20(4):285–9.PubMedCrossRefGoogle Scholar
  79. 79.
    Valipour A, Slebos DJ, Herth F, Darwiche K, Wagner M, Ficker JH, et al. Endobronchial valve therapy in patients with homogeneous emphysema. Results from the IMPACT study. Am J Respir Crit Care Med. 2016;194(9):1073–82.PubMedCrossRefGoogle Scholar
  80. 80.
    Hopkinson NS. Bronchoscopic lung volume reduction: indications, effects and prospects. Curr Opin Pulm Med. 2007, Mar;13(2):125–30.PubMedCrossRefGoogle Scholar
  81. 81.
    Sciurba FC, Ernst A, Herth FJ, Strange C, Criner GJ, Marquette CH, et al. A randomized study of endobronchial valves for advanced emphysema. N Engl J Med. 2010, Sep 23;363(13):1233–44.PubMedCrossRefGoogle Scholar
  82. 82.
    Klooster K, ten Hacken NH, Hartman JE, Kerstjens HA, van Rikxoort EM, Slebos D-J. Endobronchial valves for emphysema without interlobar collateral ventilation. N Engl J Med. 2015;373(24):2325–35.PubMedCrossRefGoogle Scholar
  83. 83.
    Sciurba FC, Criner GJ, Strange C, Shah PL, Michaud G, Connolly TA, et al. Effect of endobronchial coils vs usual care on exercise tolerance in patients with severe emphysema: the RENEW randomized clinical trial. JAMA. 2016;315(20):2178–89.PubMedCrossRefGoogle Scholar
  84. 84.
    Deslée G, Mal H, Dutau H, Bourdin A, Vergnon JM, Pison C, et al. Lung volume reduction coil treatment vs usual care in patients with severe emphysema: the REVOLENS randomized clinical trial. JAMA. 2016;315(2):175–84.PubMedCrossRefGoogle Scholar
  85. 85.
    Travaline JM, McKenna RJ, De Giacomo T, Venuta F, Hazelrigg SR, Boomer M, et al. Treatment of persistent pulmonary air leaks using endobronchial valves. Chest. 2009;136(2):355–60.PubMedCrossRefPubMedCentralGoogle Scholar
  86. 86.
    Ingenito EP, Wood DE, Utz JP. Bronchoscopic lung volume reduction in severe emphysema. Proc Am Thorac Soc. 2008;5(4):454–60.PubMedPubMedCentralCrossRefGoogle Scholar
  87. 87.
    Shah PL, Slebos DJ, Cardoso PF, Cetti E, Voelker K, Levine B, et al. Bronchoscopic lung-volume reduction with exhale airway stents for emphysema (EASE trial): randomised, sham-controlled, multicentre trial. Lancet. 2011;378(9795):997–1005.PubMedCrossRefGoogle Scholar
  88. 88.
    Bel EH. “Hot Stuff” bronchial thermoplasty for asthma. Am J Respir Crit Care Med. 2006;173:941–2.PubMedCrossRefGoogle Scholar
  89. 89.
    Cox G. New interventions in asthma including bronchial thermoplasty. Curr Opin Pulm Med. 2008;14(1):77–81.PubMedCrossRefGoogle Scholar
  90. 90.
    Lee P, Mehta AC, Mathur PN. Management of complications from diagnostic and interventional bronchoscopy. Respirology. 2009;14(7):940–53.PubMedCrossRefGoogle Scholar
  91. 91.
    Burns DM, Shure D, Francoz R, Kalafer M, Harrell J, Witztum K, Moser KM. The physiologic consequences of saline lobar lavage in healthy human adults. Am Rev Respir Dis. 1983;127(6):695–701.PubMedGoogle Scholar
  92. 92.
    Hariri LP, Applegate MB, Mino-Kenudson M, Mark EJ, Bouma BE, Tearney GJ, Suter MJ. Optical frequency domain imaging of ex vivo pulmonary resection specimens: obtaining one to one image to histopathology correlation. J Vis Exp. 2013;71:e3855.Google Scholar
  93. 93.
    Hariri LP, Mino-Kenudson M, Applegate MB, Mark EJ, Tearney GJ, Lanuti M, et al. Toward the guidance of transbronchial biopsy: identifying pulmonary nodules with optical coherence tomography. Chest. 2013;144(4):1261–8.PubMedPubMedCentralCrossRefGoogle Scholar
  94. 94.
    Strumpf IJ, Feld MK, Cornelius MJ, Keogh BA, Crystal RG. Safety of fiberoptic bronchoalveolar lavage in evaluation of interstitial lung disease. Chest. 1981;80(3):268–71.PubMedCrossRefGoogle Scholar
  95. 95.
    Pingleton SK, Harrison GF, Stechschulte DJ, Wesselius LJ, Kerby GR, Ruth WE. Effect of location, ph, and temperature of instillate in bronchoalveolar lavage in normal volunteers. Am Rev Respir Dis. 1983;128(6):1035–7.PubMedGoogle Scholar
  96. 96.
    Wardlaw AJ, Collins JV, Kay AB. Mechanisms in asthma using the technique of bronchoalveolar lavage. Int Arch Allergy Appl Immunol. 1987;82(3–4):518–25.PubMedCrossRefGoogle Scholar
  97. 97.
    Klech H, Pohl W. Technical recommendations and guidelines for bronchoalveolar lavage (BAL). Eur Respir J. 1989;2(6):561–85.Google Scholar
  98. 98.
    Schreiber G, McCrory DC. Performance characteristics of different modalities for diagnosis of suspected lung cancer: summary of published evidence. Chest. 2003;123:115S–28S.PubMedCrossRefGoogle Scholar
  99. 99.
    Colt HG, Prakash UB, Offord KP. Bronchoscopy in north america: survey by the american association for bronchology, 1999. J Bronchol Interv Pulmonol. 2000;7(1):8–25.Google Scholar
  100. 100.
    Sheski FD, Mathur PN. Endobronchial ultrasound. Chest. 2008;133(1):264–70.PubMedCrossRefGoogle Scholar
  101. 101.
    Krasnik M, Vilmann P, Larsen SS, Jacobsen GK. Preliminary experience with a new method of endoscopic transbronchial real time ultrasound guided biopsy for diagnosis of mediastinal and hilar lesions. Thorax. 2003;58(12):1083–6.PubMedPubMedCentralCrossRefGoogle Scholar
  102. 102.
    Herth FJ, Lunn W, Eberhardt R, Becker HD, Ernst A. Transbronchial versus transesophageal ultrasound-guided aspiration of enlarged mediastinal lymph nodes. Am J Respir Crit Care Med. 2005;171(10):1164–7.PubMedCrossRefGoogle Scholar
  103. 103.
    Kennedy MP, Jimenez CA, Morice RC, Eapen GA. Ultrasound-guided endobronchial, endoscopic, and transthoracic biopsy. Semin Respir Crit Care Med. 2008;29(4):453–64.PubMedCrossRefGoogle Scholar
  104. 104.
    Kucera F, Wolfe GK, Perry ME. Hemomediastinum after transbronchial needle aspiration. Chest. 1990;3:466.Google Scholar
  105. 105.
    Epstein SK, Winslow CJ, Brecher SM, Faling LJ. Polymicrobial bacterial pericarditis after transbronchial needle aspiration. Case report with an investigation on the risk of bacterial contamination during fiberoptic bronchoscopy. Am Rev Respir Dis. 1992;146(2):523–5.PubMedCrossRefGoogle Scholar
  106. 106.
    Simpson FG, Arnold AG, Purvis A, Belfield PW, Muers MF, Cooke NJ. Postal survey of bronchoscopic practice by physicians in the United Kingdom. Thorax. 1986;41(4):311–7.PubMedPubMedCentralCrossRefGoogle Scholar
  107. 107.
    Ernst A, Eberhardt R, Wahidi M, Becker HD, Herth FJ. Effect of routine clopidogrel use on bleeding complications after transbronchial biopsy in humans. Chest. 2006;129(3):734–7.PubMedCrossRefGoogle Scholar
  108. 108.
    Papin TA, Grum CM, Weg JG. Transbronchial biopsy during mechanical ventilation. Chest. 1986;89(2):168–70.PubMedCrossRefGoogle Scholar
  109. 109.
    O'Brien JD, Ettinger NA, Shevlin D, Kollef MH. Safety and yield of transbronchial biopsy in mechanically ventilated patients. Crit Care Med. 1997;25(3):440–6.PubMedCrossRefGoogle Scholar
  110. 110.
    Rose DD. Review of anticholinergic drugs: their use and safe omittance in preoperative medications. AANA J. 1984.Google Scholar
  111. 111.
    Corallo CE, Whitfield A, Wu A. Anticholinergic syndrome following an unintentional overdose of scopolamine. Ther Clin Risk Manag. 2009;5(5):719–23.PubMedPubMedCentralCrossRefGoogle Scholar
  112. 112.
    Simmons ST, Schleich AR. Airway regional anesthesia for awake fiberoptic intubation. Reg Anesth Pain Med. 2002;27(2):180–92.PubMedGoogle Scholar
  113. 113.
    Kundra P, Kutralam S, Ravishankar M. Local anaesthesia for awake fibreoptic nasotracheal intubation. Acta Anaesthesiol Scand. 2000;44(5):511–6.PubMedCrossRefGoogle Scholar
  114. 114.
    Mostafa SM, Murthy BVS, Hodgson CA, Beese E. Nebulized 10% lignocaine for awake fibreoptic intubation. Anaesth Intensive Care. 1998;26(2):222.PubMedGoogle Scholar
  115. 115.
    Chung DC, Mainland PA, Kong AS. Anesthesia of the airway by aspiration of lidocaine. Can J Anaesth. 1999;46(3):215–9.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Gordon N. Finlayson
    • 1
    Email author
  • Tawimas Shaipanich
    • 2
  • Chris Durkin
    • 3
  1. 1.Department of Anesthesiology, Division of Critical CareVancouver General Hospital, University of British ColumbiaVancouverCanada
  2. 2.Interventional Pulmonology, Respiratory Medicine, and Integrative OncologySt Paul’s Hospital, BC Cancer Agency and University of British ColumbiaVancouverCanada
  3. 3.Department of Anesthesiology, Pharmacology and TherapeuticsUniversity of British Columbia; Vancouver General HospitalVancouverCanada

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