Pulmonary
Bronchoscopy with Conscious Sedation
REASON FOR PROCEDURE: Left upper lobe mass.
The patient was brought from the floor to the Bronchoscopy Suite, where topical anesthesia was obtained by spraying Pontocaine into the left nares and Cetacaine into the posterior pharynx. The nasal passages were inadequate to permit easy passage of the bronchoscope through the left nares and oral intubation was accomplished without difficulty. The structures of the larynx appeared normal. Both vocal chords were normal and moved without any evidence of compromise.
The trachea was normal, but some blood was seen from the distal trachea in the left main stem bronchus. As I descended into the left main stem bronchus, it was apparent that this was coming from the left upper lobe, which was washed. There was endobronchial tumor in the left upper lobe, probably the anterior segment. There was oozing throughout the procedure, worse after brushings were done in the area of the tumor. Because of the oozing, and inability to clearly identify all of the structures, no biopsies were performed.
The structures of the left lower lobe appeared normal, and the right lung was also inspected and it appeared normal. While there was a small amount of oozing at the tumor site, there was generally good hemostasis, and certainly no evidence of brisk bleeding.
The patient tolerated the procedure well.
Prior to the procedure, 2 mg of versed was given intravenously and another 0.5 mg during the procedure in order to achieve conscious sedation. Throughout the procedure she was monitored with continuous pulse oximetry and automated blood pressure monitoring, without any adverse signs noted.