Tracheoscopy is an endoscopic manipulation used to examine the inner surface of the lining space of the larynx and trachea. It is a therapeutic and diagnostic procedure. With the help of tracheoscopy, pathology of the respiratory tract is detected, mucus and foreign bodies are removed, instillation of medicines is carried out. The endoscope is inserted transnasally or transorally. The procedure is performed under general anesthesia or local anesthesia.
Tracheoscopy is used in adults and children with various diseases and injuries of the trachea. Depending on the indications, choose a rigid bronchoscope or flexible fiber optics. The wide diameter of the metal bronchoscope and the possibility of ventilation during manipulation makes rigid tracheoscopy more preferable in the following cases:
- In children under 10 years old.
- Removal of a foreign body.
- Stopping massive tracheal bleeding.
- Diagnosis of tracheal neoplasms.
- Resection of endotracheal tumors.
- Identification of tracheal injuries.
- Surgical treatment of stenoses.
- Closure of tracheal fistulas.
Flexible tracheoscopy provides a wider view of the mucous membrane of the respiratory organs and allows you to easily change the angle of view. Indications for this manipulation are:
- The presence of a tracheostomy.
- Impossibility of intubation.
- Control over the performance of tracheotomy.
- The need for aspiration of mucus from the trachea.
Flexible and rigid tracheoscopy are used for the diagnosis of tracheal stenosis and the installation of stents, aspiration of carina lymph nodes affected by tuberculosis. Contrast agents and medications are injected into the trachea through an endoscope. The need to use pharmacological agents has an additional impact on the cost of manipulation.
Tracheoscopy is absolutely contraindicated in the following concomitant pathology:
- Violation of cerebral or coronary circulation.
- Heart failure of the 3rd degree.
- An attack of bronchial asthma.
- 2-3 degree of tracheal or laryngeal stenosis.
- Acute mental disorders.
- Extremely serious condition of the patient.
- Relative contraindications are:
- 2-3 trimester of pregnancy.
- Decompensated diabetes mellitus
- Goiter of the 3rd degree.
- Alcohol dependence syndrome.
Preparation for tracheoscopy
The procedure is prescribed after a preliminary examination of the chest organs. Radiography or CT of the lungs, spirometry are carried out in advance. Within a few days before the manipulation, general clinical testing is carried out, blood type and Rh factor are determined. Special attention is paid to the level of peripheral blood platelets, the coagulogram is evaluated.
On the eve of the procedure, an ECG is performed. Before a rigid tracheoscopy, the patient is examined by an anesthesiologist. With severe anxiety, the patient is prescribed a tranquilizer. Tracheoscopy is performed on an empty stomach. A light snack is allowed no later than 8 hours before the manipulation, smoking is prohibited. Premedication is performed 30 minutes before the procedure, patients with bronchial obstruction receive bronchodilators.
Methodology of conducting
Rigid tracheoscopy is performed in the operating room under general anesthesia. The patient is lying on his back with his head thrown back. Stages of the procedure:
- Introductory anesthesia. The anesthetic is administered intravenously by drip. The patient is ventilated through a mask. The depth of anesthesia is assessed, a muscle relaxant is injected.
- Introduction of the bronchoscope. A protective protector is installed on the upper jaw. The endoscopist starts the bronchoscope behind the glottis into the trachea. A ventilator is connected to the proximal port of the endoscope.
- Manipulation. The condition of the tracheal mucosa is assessed. The necessary endotracheal interventions are carried out.
- Removing the endoscope. The bronchoscope is removed after the restoration of muscle tone and the appearance of spontaneous breathing.
Flexible tracheoscopy is more often performed using local anesthetics. If necessary, general anesthesia is possible. The cost of an anesthetic aid is usually included in the price of the procedure. Tracheoscopy without general sedation is performed on an outpatient basis, usually in a sitting position. The upper respiratory tract is irrigated with a local anesthetic.
The fibrobronchoscope is inserted through the lower nasal passage, mouth or tracheostomy (if any). If necessary, the reflexogenic zones of the respiratory tract are additionally treated with an anesthetic through the working port of the endoscope directly during the procedure. The inner surface of the trachea is examined, the necessary interventions are performed.
Tracheoscopy is usually well tolerated. For several hours after the procedure, there is discomfort in the throat and behind the sternum, there is a hoarseness of the voice. For timely relief of adverse reactions, the patient needs medical supervision within 2 hours. You should not eat or smoke for about 3 hours. During the 8-hour period, you should refrain from driving a vehicle.
According to statistical studies, the frequency of complications for flexible and rigid tracheoscopy is approximately the same. They are observed on average in 5-6% of people who underwent this procedure. Complications of rigid tracheoscopy are usually more severe, sometimes end in the death of the patient. The following types of undesirable consequences are distinguished:
- Toxic effect of drugs. This group includes side effects of drugs for anesthesia and instillation into the trachea, local anesthetics, as well as allergic reactions to these medications.
- Complications of ventilation. Against the background of a ventilator, cardiac arrhythmias sometimes occur up to cardiac arrest. Pneumomediastinum is possible. Upon withdrawal from anesthesia, psychomotor agitation may develop.
- Complications of endoscopy. Transnasal tracheoscopy provokes nosebleeds in 3% of cases. When an endoscope is inserted, laryngeal or bronchospasm is often observed. Rigid tracheoscopy can cause perforation of the tracheal wall. Biopsy is sometimes complicated by tracheal bleeding.