Iotrolan in selective bronchography via the fibreoptic bronchoscope.

Abstract

The standard technique of selective bronchography via the fibreoptic bronchoscope using Dionosil aqueous suspension (Glaxo) as described by Flower and Shneerson (1984) has disadvantages. The medium is a thick suspension and is extremely difficult to inject. Direct injection into the suction channel may cause blockage if the channel is not adequately cleaned. Furthermore, Dionosil may induce chemical pneumonia, lung collapse and compromise of lung function if a large volume is used (Flower & Armstrong, 1986). It also augments the adverse effect of bronchoscopy on arterial oxygen saturation (Goldman et al, 1987). These difficulties have prompted the idea of using a different type of contrast medium that can be injected directly into the suction channel of the bronchoscope without the attendant complications. The physicochemical properties of iotrolan, a non-ionic dimer, suggest that it could be useful in selective bronchography. It is iso-osmolar with blood at a concentration of 240mgIml−1 with a viscosity of 3.9 cP at 37°C. At a concentration of 300 mgl ml−1 it is slightly hyperosmolar (320 m osm kg−1) and the viscosity is 8.1 cP at 37°C. Animal work and clinical evaluation have indicated that this medium is comparable in safety to the other low-osmolar media that are currently in wide clinical use, possibly with better neural tolerance (Hammer & Deisenhammer, 1985). The aim of this study was to assess the safety and efficacy of iotrolan 240 in a group of patients requiring selective bronchography.