Fiberoptic bronchoscopy guidelines for the anesthesiologist

Fiberoptic bronchoscopy is a widely performed procedure that is generally considered to be safe. The first performed bronchoscopy was done by Gustav Killian in 1897; however, the development of flexible fiberoptic bronchoscopy was accomplished by Ikeda in 1964(1). Flexible fiberoptic bronchoscopy is a key diagnostic and therapeutic procedure(2). It is estimated that more than 500,000 of these procedures are performed each year by pulmonologists, otolaryngologists, anesthesiologists, and cardiothoracic and trauma surgeons(3). Despite the widespread practice of diagnostic flexible bronchoscopy, there are no firm guidelines that assure a uniform acquisition of basic skills and competency in this procedure, nor are there guidelines to ensure uniform training and competency in advanced diagnostic flexible bronchoscopic techniques(4). The purpose of this review is to provide an update on 1) tracheobronchial anatomy, 2) flexible fiberoptic bronchoscopy exam, 3) training and competence on fiberoptic bronchoscopy, and 4) application of flexible fiberoptic bronchoscopy in thoracic anesthesia.