Rigid Bronchoscopy and Mediastinoscopy in Severe COPD

You are a staff anaesthetist at a major metropolitan hospital. You have been asked to review a patient who is on your list in seven days' time. He is a 73-year-old man who was admitted five days ago with an exacerbation of chronic obstructive pulmonary disease (COPD) secondary to a viral illness. During his admission a CT chest was performed that showed a mediastinal mass, which now requires a tissue diagnosis. The location of the lesion is not amenable to a CT guided biopsy, and a flexible bronchoscopy failed to yield a specimen for diagnosis. He has been booked by a cardiothoracic surgeon for a rigid bronchoscopy and mediastinoscopy. Medical History Severe chronic obstructive pulmonary disease Type 2 diabetes mellitus Hypertension Ischaemic heart disease, medically managed. Medications Aspirin 100 mg once daily Prednisolone 30 mg once daily (day 5 of 5 – day course) Ramipril 5 mg once daily Rosuvastatin 20 mg once daily Sitagliptin/ metformin 50 mg/1000 mg once daily Tiotropium-olodaterol inhaler one puff bd