Bronchoscopy
Following lung transplantation (either heart-lung, single lung, or bilateral lung), bronchoscopy will be performed at regular intervals after surgery, at occasional times when rejection or infection is suspected, and to follow the adequacy of anti-rejection or anti-infection therapy.
The procedure is done either in the operating room or bronchoscopy suite. It is most often performed by passing a flexible fiber-optic tube (called a bronchoscope) through the nose or mouth down the trachea to the bronchi (See Figure 8).
Each lung is visualized independently by passing the bronchoscope down each bronchi and all segmental and subsegmental bronchi. Samples of lung tissue and cultures can be obtained. All of these samples are useful in determining if there is rejection or infection present.
One of the major advances in the care of the pulmonary transplant patient has been the initiation of routine surveillance bronchoscopies. They facilitate early detection of the two major complications of lung transplantation: infection and rejection.
Bronchoscopy can detect infection and/or lung rejection before the patient experiences any symptoms and long before the chest x-ray demonstrates any abnormality. Early detection results in early treatment, and this usually means earlier resolution of the process.
It is preferred that patients not eat for 8 - 12 hours prior to bronchoscopy to decrease the risk of aspiration of stomach contents during the procedure. Patients are frequently premedicated with atropine (to minimize oral secretions and bronchospasms), morphine (for analgesia and cough suppression), versed and diazepam (for sedation), and lidocaine for local anesthesia.
Following completion of the bronchoscopy, you will remain in a recovery area with nasal O2 running until you are fully awake and your gag reflex has returned.
Because you have been sedated, you must have someone to drive you home.
Your physician will instruct you in any symptoms to report; however, it's not unusual to run a fever for 12 - 24 hours post bronchoscopy.