Page 2154 - Cote clinical veterinary advisor dogs and cats 4th

1074 Bronchoscopy

Pearls RELATED CLIENT EDUCATION AUTHOR: Aida I. Vientós-Plotts, DVM
Ideally suited for diffuse small airway disease SHEET EDITORS: Leah A. Cohn, DVM, PhD, DACVIM; Mark S.
Thompson, DVM, DABVP
VetBooks.ir disease (e.g., bacterial pneumonia) in stable Consent to Perform Bronchoalveolar Lavage
(e.g., feline asthma) and productive alveolar
cats or small dogs. Interstitial lung disease is
(BAL)
less amenable to diagnosis by BALF but occa-
sionally can be diagnostic (e.g., blastomycosis,
pulmonary lymphoma).

Bronchoscopy Client Education
Sheet

Difficulty level: ♦♦♦ • Intubation is rarely used for the procedure; an upper airways during insertion of the scope.
anesthesia T-piece is required if the scope will Guarded catheters may be used for decreas-
Overview and Goal be passed through the tube; jet ventilation ing the potential for BAL contamination,
To view and assess the anatomy (mucosal, can be used if available. although catheter cost limits their use.
structural) and function (dynamic collapse) • Provide oxygen before, during, and after the • Pulmonary barotrauma (tracheobronchial
of the airways from larynx to distal bronchi procedure; insufflate oxygen through the or lung rupture) is possible if the oxygen
and to obtain samples from the distal airways endoscope channel or a 3-8 Fr sterile urinary insufflation rate exceeds the ability of the gas
for analysis catheter passed alongside the scope during to exit the lungs; this is of concern in smaller
the procedure; use a sterile endotracheal tube animals when the bronchoscope diameter
Indications or a face mask for oxygen administration is close to the tracheal size and pressure
• Diagnostic: evaluation of lower airway before and after. builds up in the lungs as active insufflation
and parenchymal disease (culture/cytologic • Topical 2% lidocaine if needed to decrease continues.
examination, biopsy) and documentation of pharyngeal/laryngeal/tracheal sensation, • Airway collapse during recovery can result
airway caliber disorders (malacia, collapse, excessive coughing, and movement in severe hypoxemia; anticipate when active
compression, bronchiectasis, bronchial • Doxapram HCl 2.2 mg/kg IV once to assist expiratory effort is noted before anesthesia;
stenosis, torsion) with the evaluation of intrinsic laryngeal slow recovery from anesthesia and topical
• Therapeutic: foreign body/secretion removal function prior to bronchoscopy, if functional lidocaine sprayed on the tracheobronchial
laryngeal exam is indicated mucosa help minimize this concern.
Contraindications • Electrocardiogram (ECG), oximetry, blood
• Major: severe hypoxemia, unstable cardiac pressure (BP) cuff, and other monitoring Procedure
arrhythmias, heart failure equipment • Sternal recumbency is recommended in cats
• Minor: significant resting expiratory effort, and dogs.
bronchomalacia, inexperience Anticipated Time • Topical 1%-2% lidocaine may be applied to
A complete bronchoscopy and BAL procedure the pharyngeal/laryngeal mucosa to minimize
Equipment, Anesthesia can be completed within 10-20 minutes by an laryngospasm or excessive coughing.
Equipment: experienced endoscopist; initial setup as well as • Provide oxygen as already outlined.
• Flexible endoscope: 3-5 mm in diameter, animal recovery time is additional. • Evaluate the oropharyngeal/laryngeal region;
55-85 cm long doxapram HCl (2.2 mg/kg IV once) to
• Mouth gag, sterile gauze, suction capabilities Preparation: Important stimulate and confirm normal intrinsic
• Sterile saline Checkpoints laryngeal motion if indicated.
○ Preloaded in 3 or 4 10-20 mL syringes • The bronchoscopist must have a good • Insert the bronchoscope into the airways,
for bronchoalveolar lavage (BAL) understanding of normal bronchial mucosa noting changes in shape (stenosis, stricture),
○ For rinsing and cleaning and lung anatomy to diagnose subtle airway dynamic caliber (malacia, collapse), and
• Sterile, water-soluble lubricant abnormalities. mucosa (secretions, erythema, edema,
• Forceps: if foreign body removal or mucosal • The bronchoscope should be cleaned and masses).
biopsy is required ready for use. • In the normal animal, the dorsal tracheal
Anesthesia: • Ensure all supplies and equipment are avail- membrane is taut so that there is little if
• Pre-treatment with a bronchodilator is recom- able before starting the procedure; anesthetic any redundancy (no visible protrusion or
mended, especially in small dogs and all cats; monitoring and image capture equipment collapse into the airway).
use injectable terbutaline 0.01 mg/kg SQ at should be turned on and ready to use. • The healthy tracheobronchial mucosa is a
least 15 minutes before the procedure. • Antibiotics should be discontinued at least 5 smooth, light pink surface with a rich supply
• Intravenous (IV) catheter for administra- days before the procedure for optimal culture of submucosal capillaries; if these capillaries
tion of a short-acting, injectable anesthetic results. are not visible, mucosal edema or cellular
protocol: atropine 0.02-0.04 mg/kg IM or • Thoracic radiographs are useful to help infiltration may be present.
glycopyrrolate 0.01-0.02 mg/kg IM; in addi- identify specific lung regions for examination • Healthy mucosa has a slightly glistening
tion, butorphanol 0.05-0.1 mg/kg IM and and for BAL. appearance; mucosal edema is readily
diazepam 0.1 mg/kg IV, followed by propofol apparent because it imparts a gelatinous
3-6 mg/kg, slow IV titrated to effect, with Possible Complications and appearance to the mucosal surface.
repeated miniboluses of propofol (1 mg/kg) Common Errors to Avoid • The clinician should examine the carina
as needed over the duration of the procedure • Contamination of the BAL sample is possible for abnormalities (widening, compression,
to maintain anesthetized state. if care is not taken to avoid touching the mucosal infiltration) before evaluating

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