This video is an introduction to operative direct laryngoscopy and bronchoscopy (DLB) and demonstrates how to perform a safe and comprehensive exam in the operating room.
Authors: Alexander Moushey1; Taher Valika, MD2; Erik H. Waldman, MD3; Sarah E. Maurrasse, MD3
Voiceover: Vidal Maurrasse
1Yale School of Medicine, New Haven, CT
2Department of Surgery, Division of Pediatric Otolaryngology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine
3Department of Surgery, Section of Pediatric Otolaryngology, Yale School of Medicine, Yale New Haven Children’s Hospital
Laryngoscopy and Bronchoscopy is an examination of the larynx, trachea, and mainstem bronchi through a rigid lighted telescope. This procedure is typically performed in the operating room under general anesthesia.
The purpose of a diagnostic DLB is to look for pathology and provide a detailed airway assessment. Interventional DLB can also be used to remove airway foreign bodies, to biopsy airway lesions, to secure a difficult airway, and to perform a wide variety of airway procedures.
Bronchoscopy can be performed with a Hopkins rod telescope alone, or it can be sheathed in a rigid ventilating bronchoscope. The purpose of a rigid bronchoscope is to be able to ventilate the patient while performing bronchoscopy, to serve as a port for instruments, and to provide a protective sheath for the telescope in certain scenarios.
-Acute pulmonary illness, such as viral URI or pneumonia
-Poor pulmonary reserve (relative contraindication)
-Unstable cervical spine
Table setup for a diagnostic DLB should include:
-De-fog and moist gauze to clean the telescope
-Laryngoscope blade or suspension laryngoscope
-Topical lidocaine on an atomizer to anesthetize the larynx
-Right angle probe
-Age-appropriate uncuffed endotracheal tube and 2 sizes smaller
-Hopkins rod telescope and camera head
Please see our video "Direct Laryngoscopy and Bronchoscopy: Purpose & Setup" for additional information.
Varies depending on the indication for DLB
Right and left mainstem bronchi
Ability to directly visualize the entire airway and obtain dynamic information about airway pathology and obstruction
Loss of airway
Damage to lips, teeth, tongue
Thank you to Vidal Maurrasse (firstname.lastname@example.org) for providing voiceover.