الفهرس 
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Abstract
Fiberoptic bronchoscopy (FB) is a safe and frequently performed procedure for the diagnosis, and treatment of patients with respiratory diseases Non-invasive diagnostic strategies (as blind catheter aspiration) should be used as first line procedures, when such non-invasive diagnostic techniques fail to identify a responsible organism, bronchoscopy should be considered.
Fiberoptic bronchoscopy can be performed as an outpatient procedure under local lidocaine anaesthesia with or without conscious sedation.
The level of sedation required for Fiberoptic bronchoscopy is typically minimal to moderate depending upon the type of procedure planned and is often performed by a non-anesthesiologist. When greater than moderate sedation is desired, patients with limited cardiovascular or pulmonary reserves, or when a prolonged procedure is anticipated, it is recommended to seek for the experience of an anesthesiologist.
Along with sedation, topical airway anaesthesia is an important component in fiberoptic bronchoscopy as it provides the patient additional comfort and tolerability.
Laryngeal mask is used for diagnostic bronchoscopy under general anaesthesia, allowing spontaneous and controlled ventilation, allow the visualization of the whole respiratory tree from the vocal cords downwards, will not interfere with the scope mobility in contrast to the traditional endotracheal tube which hinders the inspection of the vocal cords and a significant portion of the trachea. Moreover, it has a wider lumen allowing the passage of both the bronchoscope and the air with less increments on airway pressure.
The aim of the work is to compare between bronchoscopy under general anesthesia using laryngeal mask airway and local anesthesia with conscious sedation for the purpose of reaching the best patient comfort and allowing the optimal bronchoscopist maneuvers and find the complications associated with each maneuver.
Fourty ASA ii patients aged between 18 and 60 years old were enrolled in this study, the patients were randomly divided into two equal groups (20 patients in each group):
group I: Local anaesthesia with conscious sedation
group II: General anaesthesia
Inclusion criteria:
Body mass index 25- 35 kg/m2, normo-tensive patients, systolic blood pressure not more than 140 mmHg and diastolic not more than 90 mmHg
Exclusion criteria:
Body mass index more than 35 kg/m2, Poorly controlled arterial hypertension, Liver diseases, Kidney diseases, Heart diseases ischemia Pregnant females.
Anesthetic technique:
Patients in group I received lidocaine nebulizers before the procedure, spray as you go lidocaine during the procedure, plus conscious sedation with midazolam.
Patients in group ii received general anesthesia with propfol (1-2mg/kg), fentanyl (1-2micogram/kg), sevoflurane 2% with or without atracurium(.5mg/kg), laryngeal mask inserted through which bronchoscope passed.
This study concluded that GA was highly significantly associated with fewer symptoms such as cough, choking, shortness of breath, nausea and vomiting, nasal symptoms, and chest pain than LA with conscious sedation by midazolam.
This study showed that patients subjected to GA were highly significantly more accepting to repeat bronchoscopy than those who received LA. Symptoms during bronchoscope insertion were associated with lesser acceptance to repeat bronchoscopy patients who received LA and sedation were significantly more anxious before and during bronchoscopy than patients subjected to GA this study showed that stress response with diagnostic bronchoscopy under local anesthesia of the airway with conscious sedation is more than that with general anesthesia as regard pulse, blood pressure during the whole procedure and till 15 minutes after the procedure.
This study showed that the bronchoscopy time was highly significantly longer in the GA group than in the LA group.
This study concluded that bronchoscopy with local anesthesia and conscious sedation is associated with more desaturation events than that with general anesthesia, as mechanical ventilation with laryngeal mask used to alleviate hypoxia.
In conclusion, GA with laryngeal mask airway provides an almost totally peaceful procedure for both the patient and bronchoscopist, allowing time for meticulous examination and intrabronchial procedures. The only drawbacks are the prolonged recovery time and the increased cost.