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Dr. Manoj K Goel
Director & Head
Dept of Pulmonology, Critical Care & Sleep Medicine
Fortis Memorial Research Institute,Gurugram(Delhi & NCR)

Details of Procedure:


BBD is generally performed under topical anesthesia and conscious sedation, or under general anesthesia with laryngeal mask ventilation or tracheal intubation.     Bronchoscopy is first performed with a diagnostic bronchoscope  to assess and localize the airway stenosis before balloon dilation.  A flexible, 0.035-inch guidewire  is then inserted through the working channel of the bronchoscope and is passed through the stenosis.   With the guidewire held in place, the bronchoscope is withdrawn.  A balloon catheter  is passsed over the guidewire under the bronchoscopic guidance.  The balloon is passed across the stenotic area and is inflated briefly to dilate the stenosis.   

 

  

Possible risks and complications

 

Every effort will be made to conduct the procedure in such a way as to minimize discomfort and risks.  However, I understand that just as with other types of prodedures, there are inherent potential risks of this procedure.   The incidence of major complications associated with bronchoscopy are 0.8% - 1.3% and balloon dilatation are less than 5%.  The complications include accumulation of air in pleural space, hemorrhage, subcutaneous emphysema, postoperative fever, chest infection, cardiac arrhythmias, hypoxemia, vasovagal attack, myocardial infarction, pulmonacy oedema, bronchospasm, choking, perforation of airway and tracheo-esophageal fistula. Some tears are associated mild chest pain, blood-tinged sputum, or even pneumomediastinum, but these all resolved spontaneously at 24 h The tears themselves heal spontaneously within few days to 1 month. The mortality rate associated with bronchoscopy is  

 

Post procedure course: 

 

1) Postoperative oxygen supplementation may be required in some patients, particularly those with impaired lung function and those who have been sedated.

2) A chest radiograph is carried out post procedure

3) Patients who have had transbronchial biopsies  should observe for  pain chest, breathlessness, haemoptysis, surgical emphysema , excessive cough which can indicate pneumothorax after leaving hospital and they should contact hospital emergency.

4)Patients who have been sedated  are advised to   not  drive, sign legally binding documents, or operate machinery for 24 hours after the procedure.

5) It is preferable that day case patients who have been sedated should be accompanied home and that higher risk patients such as the elderly or those from whom transbronchial biopsy specimens have been taken should have someone to stay with them at home overnight.

 

 

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