Direct Laryngoscopy and Bronchoscopy: Purpose & Setup

This video is an introduction to operative direct laryngoscopy and bronchoscopy (DLB) and will demonstrate 1) How to set up the equipment for a safe and comprehensive DLB and  2) How to assemble a rigid bronchoscope. 

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: -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
Ability to directly visualize the entire airway and obtain dynamic information about airway pathology and obstruction
Airway edema Loss of airway Damage to lips, teeth, tongue Pain Laryngospasm Bronchospasm
Thank you to Vidal Maurrasse (vidal@maurrasse.com) for providing voiceover.

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