Bronchoscopy and Biopsy Sample Processing
Bronchoscopy and Biopsy Sample Processing
Flexible bronchoscopy was carried out using standard pediatric techniques. The safety of this procedure in severe asthmatics has been documented. For children < 12 years of age (depending on body size), the Olympus BF-3C20 (Melville, NY) [outer diameter, 3.7 mm] or the BF-3C40 (outer diameter, 3.6 mm) fiberoptic bronchoscopes were used; for adolescents, the Olympus BF-40 (outer diameter, 5.9 mm, suction channel 2.2 mm) was used. Patients underwent conscious sedation using IV narcotics (meperidine and fentanyl) and anxiolytics (midazolam) before and during the procedure Cialis Australia Pharmacy. Local anesthesia was initially induced using nebulized 1% lidocaine and albuterol, 2 mL and 0.5 mL, respectively.
Local anesthesia was maintained throughout the procedure by instillation of 1% lidocaine through the bronchoscope. Lidocaine was titrated to control discomfort and cough and was limited to no more than 5 mg/kg below the vocal cords to protect against lidocaine toxicity. Following sedation and anesthesia, flexible bronchoscopy was undertaken via the nasal route. Inspection of the entire upper and lower airway was done first. The scope was then wedged into a subsegment of the right middle lobe and BAL was carried out using 3 mL/kg total volume (maximum of 150 mL) of sterile normal saline solution in three separate aliquots. Each aliquot was hand aspirated into a large syringe and initially kept separate.
Finally, the bronchoscope was retracted into the lower trachea and the cup biopsy forceps was introduced. Three to six endobronchial samples were obtained from the mainstem carina and from several subsegmental carinae. Minor surface bleeding was encountered and did not require therapy with epinephrine. The scope was then retracted through the upper airway, and the procedure was terminated buy Viagra in Australia. The patient was monitored throughout the sedation until he/she was awake with stable vital signs and receiving oral fluids well. The specimens were processed as follows. The BAL fluid (BALF) was pooled if there was no visible blood contamination of any of the aliquots.