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Paediatric bronchoscopy
  1. Keith G Brownlee,
  2. David C G Crabbe
  1. St James’s University Hospital, Leeds
  1. Dr Keith G Brownlee, St James’s University Hospital, Leeds LS9 7TF.

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Bronchoscopy first saw clinical application in 1897 when Killian removed a pork bone from the right main bronchus of a German farmer. The early clinical applications of bronchoscopy were limited to the removal of foreign bodies. As illumination and optical technology improved, notably the Hopkins rod and lens system, wider applications became realised. Wood and Flink first described use of the flexible bronchoscope in children in 1978.1 Fibreoptic bronchoscopes small enough for use in children became widely available in 1981. Since then the rise in flexible bronchoscopy has been relentless. While the experienced bronchoscopist can probably accomplish most procedures with either a flexible or a rigid bronchoscope, the two instruments have complimentary roles. What does bronchoscopy involve and what can bronchoscopy achieve in the paediatric age group?

The rigid bronchoscope

Ventilating bronchoscopes are available in a variety of sizes and lengths from 2.5 mm internal diameter upwards (Karl Storz GmbH). Safe examination of the tracheobronchial tree from the premature neonate onwards is possible. A variety of telescopes fit down the bronchoscope allowing inspection of all lobar bronchi. Ventilation through the bronchoscope alongside the telescope maintains oxygenation and, under appropriate conditions, spontaneous respiration through the bronchoscope allows assessment of the degree of airway collapse in tracheomalacia or bronchomalacia.

The principal advantage of the rigid bronchoscope is complete control of the airway. The bronchoscope functions as a rigid endotracheal tube. The clarity of vision achieved by the Hopkins rod lens telescope exceeds that of the flexible bronchoscope. The comparatively large diameter of the instrument channel and the superb array of baskets, forceps, and grabbers available enables a wide range of therapeutic procedures to be performed. In the event of significant haemorrhage or tenacious secretions, the telescope can be withdrawn and suction catheters passed directly down the bronchoscope while maintaining oxygenation and control of the …

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