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Procedures Related to Mechanical Ventilation 473

TABLE 14-3 Medications for Bronchoscopy

Medication (Route) Dosage (Route) Purpose

Lidocaine 5 to 10 mL of 1 to 4% Given 30 to 90 min before procedure to
solution (aerosol) reduce irritation of the mucosal membrane
caused by the insertion tube

Atropine sulfate 0.5 to 1.0 mg (IM) Given before the procedure to reduce vagal
response, oral secretions, and bronchospasm

Morphine sulfate 1.5 to 10 mg (IM) Given before the procedure to provide pain
relief and suppress coughing
Diazepam* 2.5 to 10 mg (IV bolus) Given before and during the procedure as
or 10 to 15 mg (oral) needed to provide sedation

*Sedation may also be induced by using (a) midazolam and fentanyl or (b) fospropofol disodium.
(Data from Bose et al., 2008; Gompertz et al., 1997; Jantz, 2009; Prakash et al., 1991; Williams et al., 1998.)
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channel outlet. A video scope may be fitted onto the eyepiece for video taping of the
procedure. The bending mechanism allows the physician to curve the insertion tube
Lidocaine, atropine up (180°) or down (130°) for viewing of an anatomical structure at different angles.
sulfate, morphine sulfate, and It also helps to direct the tube toward an intended segment or subsegment. The
diazepam are four common
medications for bronchoscopy. channel outlet is used for installation of saline or topical anesthetics, suction, and
for passage of biopsy forceps, cytology brush, or cannula (Olympus America, Inc.).
Depending on the patient requirement and physician preference, four medications
are commonly administered before the procedure. Lidocaine (5 to 10 mL of 1% to
lidocaine: A medication used to
reduce irritation of the mucosal 4% solution) is given to the patient via aerosol 30 to 90 min before the procedure to
membrane caused by the insertion reduce irritation of the mucosal membrane during the procedure. Before the procedure,
tube.
atropine sulfate (0.5 to 1.0 mg) and morphine sulfate (1.5 to 10 mg) are administered
intramuscularly. Atropine reduces vagal response, oral secretions, and bronchospasm.
atropine sulfate: A medication Morphine sulfate provides pain relief and suppresses coughing during the procedure.
used to reduce vagal response,
oral secretions, and bronchospasm Diazepam or a suitable benzodiazepine is given intravenously in bolus to provide seda-
during bronchoscopy. tion. Table 14-3 summarizes the medications for bronchoscopy.

Insertion of Bronchoscope

After testing the bronchoscope assembly, the distal end of the insertion tube is
coated with a water-soluble lubricant and inserted via the nare, mouth (with bit
block), endotracheal tube, or tracheostomy tube. Once the insertion tube enters the
trachea and reaches above the carina, the tube is directed to the intended bronchi
and segments (Figure 14-9).
For patients who are breathing spontaneously and without an artificial airway,
oxygen therapy of up to 6 L/min may be given. If the bronchoscope insertion tube
is inserted via an artificial airway (endotracheal or tracheostomy tube), an aerosol
setup may be used. Adequate SpO may be titrated with a pulse oximeter.
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