- Spray cetacaine over the patient's tongue and pharynx. Three to four sprays
should suffice. Do not spray cetacaine excessively. I once saw one of my fellows produce
methemoglobinemia in a patient due to excessive use of spray.
- Drip 2 cc's of 2% xylocaine behind the patient's tongue over the epiglottis with
a curved nozzle.
- Soak a cotton swab in 4% xylocaine and hold it on the pyriform fossa for one
minute. Repeat the procedure for the opposite side.
- Wear gloves. Insert your finger beyond the tongue and gently pull the epiglottis
forward. Instruct the patient not to bite your fingers. Position the curved nozzle beyond
the epiglottis and instill 2 cc's of 2% xylocaine into the larynx.
- The patient will cough if the procedure is successful. Instruct the patient to
spit out the excess anesthetic to minimize the dose.
- Allow the patient to lay down and be comfortable. Start an IV line and titrate
versed. I give 1-2 mg at a time, watching the patient's response. Older patients are very
sensitive to versed. Therefore, 1 or 2 mg may suffice. Never push 10 mg in one stroke.
Versed makes the procedure go smoothly and provides amnesia. An excessive dose can induce
respiratory depression. In the past, I used valium with good results. However, I find
versed to be better.
Let me share an anecdote with you. I once got into
trouble with valium. One of my patients stopped breathing after only 2 mg of valium. I has
removed his breathing aids and he could not hear my commands to breath. I quickly
intubated and bagged him for a few minutes. He started respirations on his own and I was
then able to complete the procedure.
Valium induced respiratory depression can be overcome. The patient will respond
to your instructions to take a deep breath. I got into trouble by removing my patient's
- Drape the patient and cover the eyes. I like to wear a surgical scrub suit and
gloves. The procedure cannot be done under sterile conditions. However, it should be done
under clean conditions.
Fiberoptic bronchoscopy can be done easily with topical anesthesia and is the
current standard. Let us discuss, in more detail, anesthetizing the patient for a
bronchoscopy. There are choices to be made for the following:
- Type of anesthesia
- Medications for topical anesthesia
- Mode of delivery of the local anesthesia
- Method of anesthetizing the larynx
The choice of anesthesia used for bronchoscopy are:
- General: General anesthesia may be indicated in children, uncooperative adults
and when performing a rigid bronchoscopy
- Carden, E. Recent improvements in techniques for general anesthesia for
bronchoscopy. Chest 73:697-700, 1978.
If you take care to anesthetize your patient properly, the procedure will go