1)     RECOMMENDATIONS

a)      General Approach

i)        Maintain adequate ventilation and effective anesthesia while allowing for airway study

b)      Pre-anesthetic Medications

i)        Consider an opioid with either benzodiazepine or acepromazine depending on patient status

ii)       Atropine or glycopyrrolate should be given prior to bronchoscopy in order to prevent vagal-vagal bradycardic effect

(1)   When the collection of airway secretions is considered a priority, anticholinergic medications should be postponed until diagnostic sample collection is complete

c)      Induction

i)        Propofol

d)      Maintenance

i)        Propofol - intermittent boluses

e)      Support

i)        Provide oxygen insufflation by passing a red rubber catheter down trachea

(1)   Connect to oxygen source

(a)    1 to 2 liter flow

ii)       Always have appropriate selection of endotracheal tubes in case of emergency

2)     PRECAUTIONS

a)      Pre-anesthetic Medications

i)        Without anticholinergic medications, bronchoscopy can trigger potentially fatal vagal-vagal bradycardic event

(1)   In the event of a bradycardic emergency, atropine is preferred over glycopyrrolate

b)      Induction

i)        Rapid propofol infusion can lead to apnea and hypotension

c)      Maintenance

i)        N/A

d)      Support

i)        Use red rubber catheter to provide tracheal oxygen insufflation during the procedure

ii)       Carefully monitor heart rate, blood pressure, and oxygen saturation