Chest

Chest

Volume 79, Issue 3, March 1981, Pages 316-321
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Clinical Investigations
Commentary
Complications of Bronchoscopy: Comparison of Rigid Bronchoscopy Under General Anesthesia and Flexible Fiberoptic Bronchoscopy Under Topical Anesthesia

https://doi.org/10.1378/chest.79.3.316Get rights and content

A prospective study of 4,595 bronchoscopic procedures performed over four years (1975 to 1978) on 2,143 patients with various bronchopulmonary diseases is described. Of the 4,595 procedures, 1,146 were performed with a flexible fiberoptic bronchoscope (Olympus BF-5B2 or BF-B2) under topical anesthesia with tetracaine and procaine, and 3,449 procedures were performed with a rigid bronchoscope under general intravenous anesthesia with hexobarbital (Evipan) using a modified Sanders' technique to ventilate the patients. Complications occurred in 235 procedures (5.1 percent). Major complications that threatened the patient's life and required intensive medical treatment, surgical intervention, or resuscitative measures occurred in 51 procedures (1.1 percent); deaths occurred after 6 procedures (0.1 percent). A comparison of the complications of rigid bronchoscopy and flexible fiberoptic bronchoscopy revealed significantly higher rates of complications of fiberoptic bronchoscopy attributable to toxic effects of tetracaine and of complications of rigid bronchoscopy associated with insufficient general anesthesia. With rigid bronchoscopy, the number of major complications induced by diagnostic manipulations through the bronchoscope and the total number of major complications were significantly higher than with flexible fiberoptic bronchoscopy.

Section snippets

MATERIALS AND METHODS

We have made a prospective analysis of complications of 4,595 bronchoscopic procedures performed in our clinic during four years (1975 to 1978) in 2,143 patients with various diseases of the bronchopulmonary system. A total of 1,146 of the procedures were carried out with a bronchofiberscope (Olympus BF-5B2 or BF-B2) (in most cases by the transnasal approach) under topical anesthesia with a 1 percent tetracaine solution and a 10 percent procaine solution; the remaining 3,449 procedures were

Complications of FFB Under Topical Anesthesia

These occurred in 62 procedures (5.4 percent of all FFB procedures). Fifty-nine of these complications (5.1 percent) were classified as minor. Twenty-five of the minor complications (2.2 percent) were related to anesthesia and included dizziness, nausea, and tachycardia (13 procedures), vomiting and hypotonia (3), psychomotor excitation (2), fainting (1), laryngospasm (1), and bronchospasm (1). These complications were considered as a reaction to tetracaine. The remaining four minor

DISCUSSION

The capabilities of bronchoscopy have greatly increased over the past decade or so because of the development of bronchofiberscopes and other flexible instruments, improved roentgenologic techniques, and the Venturi method of ventilation that has eliminated the competition between the endoscopist and the anesthesiologist for the possession of the bronchial tree during bronchoscopy under general anesthesia.

As bronchoscopic techniques increase in number, become more invasive, and have more and

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Manuscript received December 26, 1979; revision accepted March 10.

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Copyright © 1981 The American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.