Techniques used to minimize this problem have included avoidance of suction through the bronchoscope prior to BAL, performing the procedure in the supine or slight Trendelenburg position, or discarding the first aliquot of retrieved BAL fluid that has the highest degree of bronchial contamination. buy birth control online
The mode of delivery of topical anesthesia is also important. Coughing is a physiologic protective response to the introduction of a foreign body into the tracheobronchial tree. Topical anesthesia with lidocaine, injected through the FOB over the vocal cords and endobronchially in the awake nonintubated patient, allows for performance of bronchoscopy. Injection of lidocaine, however, carries into the bronchial tree contaminants that have accumulated in the bronchoscope suction channel as it passes through the upper airways and compromises the result of cultures. To avoid this problem, lidocaine should be delivered before bronchoscopy in a high concentration (10 ml of 4 percent nonbacteriostatic solution) via nebulizer or intermittent positive pressure breathing (IPPB), thereby avoiding the need for additional anesthesia before BAL. Lidocaine also has bacteriostatic properties; however, when 1 to 2 ml of a 1 percent solution were used to anesthetize a lobe prior to BAL, the concentration in the BAL effluent was below that reported to inhibit bacterial growth.
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