A sedative drug may be injected into your vein to relax you. Sometimes you will not remember having thoracoscopy because of the sedative. You will be given an injection of local anesthetic into the skin and then into the muscle between your ribs. The doctor will make a small cut in the skin, and then place a hollow tube through this cut into space between the lung and chest wall (pleural space). Sometimes a second cut may be needed.

The doctor will then insert a telescopic instrument through the hollow tube.
The doctor will use this instrument to look around the pleural space and/or obtain pleural biopsies by removing small pieces of the lining of the pleural space. This may cause some pain.

If required the doctor may gently spray sterile talc powder into the pleural space. This powder is used to create a sticking reaction between the lung and chest wall which may help prevent future fluid or air building up in the pleural space. At the end of the procedure, you will have a chest tube put into the pleural space through the same incision.

Common risks and complications (more than 5%) include:

Chest pain: The nerves between the ribs are bruised after the procedure, which can cause some persistent pain. This may be controlled with paracetamol.

Fever: This happens if you have had talc sprayed. The fever goes away in a few days.
Increased risk in obese people of wound infection, chest infection, heart and lung complications, and thrombosis.

Uncommon risks and complications (1- 5%) include:

• Air leak from lung. A small hole develops in the lung. This means the chest tube has to stay in longer.
• Subcutaneous emphysema :

Rare risks and complications (less than 1%) include:

• Infection: A small chest tube will be put into the pleural space to drain out the infection.
  This will need antibiotics.
• Bleeding: This can happen after biopsies. Usually, it is minor and settles quickly. Bleeding is more common if you have been taking blood-thinning drugs such as Warfarin, Aspirin, Clopidogrel (Plavix or Iscover), or Dipyridamole (Persantin or Asasantin).
• Heart problems: A brief minor strain may be put on the heart. This can cause the abnormal beating of the heart, fluid to accumulate in the lungs, a heart attack or the heart may stop beating.
• Low oxygen levels. You will be given oxygen.
• Adult Respiratory Distress Syndrome: This can happen after talc is sprayed in the pleural space. The talc powder may cause damage to both lungs which may cause severe breathing difficulty. This may start days after the procedure.
• Death as a result of this procedure is rare.

The bronchoscope is placed through your nose, by the bronchoscopy doctor then advanced slowly down the back of the throat, through the vocal cords and into the airways. If a person has a breathing tube in place, the bronchoscope is passed through this tube.

Your bronchoscopy doctor will be able to see the inside of the airways as the bronchoscope moves down. You may feel like you cannot “catch your breath,” but there is usually enough room around the tube to breathe and get enough oxygen. The doctor can also give you breaks during the

the procedure as needed.
The length of the bronchoscopy varies depending on what needs to be done and why you need it. The doctor can give you an estimate, but usually, it can last from 15 minutes to an hour.

Bronchoscopy is a safe procedure. Serious risks from bronchoscopy, such as an air leak or serious bleeding, are uncommon (less than 5%). The risks associated with the procedure are as follows:

Discomfort and Coughing: While the bronchoscope is passed through your nose and back of your throat into the lungs, it may cause some discomfort. It may also tickle your airways, causing a cough. You will be given medicine to help with this prior to the procedure.

Reduced oxygen: Your oxygen level will be continuously monitored during the procedure using a pulse oximeter, with a sensor clip placed on your finger. The level of oxygen in the blood may fall during the procedure for several reasons. The bronchoscope may block the flow of air into the airway, or small amounts of liquid used during the test may be left behind, causing the oxygen level to drop. This drop is usually mild, and the level usually returns to normal without treatment. If the oxygen level remains low, the doctor will give extra oxygen or stop the test to allow for recovery.

Lung Leak: Rarely, an airway may be injured by the bronchoscope, particularly if the lung is already very inflamed or diseased. The procedure could cause an air leak (pneumothorax) in which air comes out of the lung and gathers in the space around it, which can limit how well the lung expands. This complication is not common and is more likely if a biopsy is taken during bronchoscopy. If there is a large or ongoing air leak, it may need to be drained with a chest tube.

Bleeding: Bleeding can occur after the doctor performs a biopsy. Bleeding can also occur if the airway is already inflamed or damaged by disease. Usually, bleeding is minor and stops without treatment. Sometimes a medication can be given through the bronchoscope to stop bleeding. Rarely, bleeding can lead to severe breathing problems or death.

Infection: While the equipment used is cleaned before and after use, there is a small risk that a germ could be introduced into the airways that could cause infection. If a new infection develops, it would be treated.

Patients vary in how long it takes to wake-up with sedation. If you are in the intensive care unit on a ventilator (respirator; breathing machine), you may already be sedated and will continue to receive medicines to keep you comfortable on the ventilator.

If you are an outpatient or a non-critically ill inpatient, you will need to stay in a recovery area until the sedative has worn off. You will also need to wait until the numbing medicine wears off before drinking any liquids. If you are an outpatient, it is recommended that you bring someone along to drive you home.

It is unlikely that you will experience any problems after the test other than a mild sore throat, hoarseness, cough, or muscle aches. If you feel chest pain or increased shortness of breath or cough up more than a few tablespoons of blood once you leave the hospital, contact your doctor immediately.

Your bronchoscopy doctor can tell you how your airways look right away. Lab results take more time, usually 1–4 days or more depending on the specific test that is being done.