Direct Laryngoscopy and Bronchoscopy: Purpose & Setup

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

Endotracheal tubes
Laryngoscope
Microlaryngeal suction
Right-angle probe
Rigid bronchoscope
Zero-degree Hopkins rod

Table setup for a diagnostic DLB should include:
-Tooth guard
-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
-Rigid bronchoscope
-Microlaryngeal suction
-Saline

Varies depending on the indication for DLB

Tongue
Epiglottis
Arytenoids
Vocal cords
Interarytenoid area
Subglottis
Trachea
Right and left mainstem bronchi

Airway edema
Loss of airway
Damage to lips, teeth, tongue
Pain
Laryngospasm
Bronchospasm

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