Technique

Resuscitation equipment should be at hand.

Continuous pulse oximetry is essential and supplementary oxygen is given if haemoglobin saturation falls below 90%.

Short-acting sedation is given intravenously:

• midazolam
• fentanyl

Local anaesthetic (2% lignocaine) is sprayed over the nasal and oropharyngeal cavities.

In patients who are not intubated the bronchoscope is inserted through either:

• the nose
• a mouthgard

The naso- and oropharynx and vocal cords are inspected. The cords are anaesthetised with lignocaine and the bronchoscope gently advanced during inspiration.

The trachea, carina and bronchi may be further anaesthetised with lignocaine, up to a total of 12 ml of 2% lignocaine.

The bronchial tree may be inspected to the subsegmental level.

Attention is paid to:

• mucosal abnormalities
• anatomical abnormalities
• signs of external compression