Flexible Fiberoptic Bronchoscopy Research Articles

A novel combined approach to placement of a double lumen endobronchial tube using a video laryngoscope and fiberoptic bronchoscope: a retrospective chart review

BackgroundThe objective of this study was to evaluate a modern combined video laryngoscopy and flexible fiberoptic bronchoscope approach to placement of a double lumen endobronchial tube and further characterize potential strengths and weaknesses of this approach.MethodsRetrospective chart review was conducted at our single institution, academic medical center, tertiary-care hospital. Patients aged 18 years of age or older were evaluated who underwent thoracic surgery and one-lung ventilation with placement of a double lumen endobronchial tube using a novel combined video laryngoscopy and flexible fiberoptic bronchoscope approach. No interventions were performed.ResultsDemographics and induction and intubation documentation were reviewed for 21 patients who underwent thoracic surgery and one-lung ventilation with placement of a double lumen endobronchial tube using a novel combined video laryngoscopy and flexible fiberoptic bronchoscope approach. First pass success using the combined approach was 86% (18/21). The five patients with an anticipated difficult airway had successful double lumen endobronchial tube placement on the first attempt. There were no instances of desaturation during double lumen endobronchial tube placement. No airway complications related to double lumen endobronchial tube placement were recorded.ConclusionUse of a combined approach employing video laryngoscopy and a flexible fiberoptic bronchoscope may represent a reliable alternative approach to placement of double lumen endobronchial tubes.

Can concurrent use of king vision video laryngoscope and fiberoptic bronchoscope improve efficacy and safety of awake intubation in patients with limited mouth opening? - A case report

Securing the airway by endotracheal intubation in a patient with a restrictive mouth opening poses a challenge to anesthesiologists. Awake tracheal intubation using flexible fiberoptic bronchoscopy is the gold standard in the anesthetic management of patients with restricted mouth openings. Awake video laryngoscopy (VL) is being increasingly used for the management of the anticipated difficult airways. We report a case of temporomandibular joint ankylosis with restrictive mouth opening posted for laparoscopic nephrectomy managed by awake intubation with the combined use of king vision VL (KVVL) and fiberoptic bronchoscope (FOB). KVVL provided an improved and clear view of the airway structures and FOB helped in guiding and maneuvering the tube safely into the larynx. The combined use of KVVL and FOB enhanced the effectiveness and safety of the procedure.

Floyd Type II Congenital Tracheal Agenesis in a Preterm Neonate: A Rare Case Report

Tracheal agenesis is a rare and life-threatening airway malformation, and currently, there is no curative treatment available. The described case involves a preterm male newborn at 30 weeks of gestational age who could not be intubated during resuscitation, despite multiple attempts. However, the baby could be ventilated after oesophageal intubation. Tracheal stenosis/ atresia was suspected, and airway evaluation was performed using a thin, flexible fiberoptic bronchoscope. No tracheal opening could be identified, and upon introducing the bronchoscope into the oesophagus, a triluminal opening was found, through which the scope could not be further navigated. To further delineate the anatomy, a Contrast-enhanced Computed Tomography (CECT) thorax was performed, revealing the absence of a tracheal lumen and the communication of both bronchi at the carina with the oesophagus. Unfortunately, the baby succumbed to the illness after three days. Tracheal agenesis is an anatomical malformation that typically presents as respiratory distress and the absence of an audible cry at birth. Attempts to establish a definite airway are unsuccessful, which may result in early neonatal death. Oesophageal intubation may temporarily establish ventilation until palliative surgery is performed.

Effect of different doses of dexmedetomidine as an adjuvant to lignocaine nebulization: A comparative study during awake flexible fiberoptic bronchoscopy.

Mild to moderate sedation during bronchoscopy is essential for patient safety, comfort during and after the procedure, and to facilitate the performance of the bronchoscopist. Dexmedetomidine is a highly selective, centrally acting α-2 agonist used to provide conscious sedation during various procedures. The aim of this study was to compare the efficacy of three different doses of dexmedetomidine nebulization as an adjuvant to lignocaine during bronchoscopy. Ninety American Society of Anesthesiologists physical status I/II patients, aged from 18 to 60 years, scheduled for an elective bronchoscopy, were recruited. They were divided into three groups: 30 patients in each group. Group I: The patient was nebulized with a mixture of 4 ml of 4% lignocaine and dexmedetomidine 0.5 μg/kg. Group II: The patient was nebulized with a mixture of 4% lignocaine, 4 ml, and dexmedetomidine, 1 μg/kg. Group III: The patient was nebulized with 4% lignocaine 4 ml and dexmedetomidine 1.5 μg/kg. The mean cough score was (1.17 ± 0.37), (1.40 ± 0.49), and (1.70 ± 0.75) in group III, group II, and group I, respectively. A significant difference was found between the groups. Patients were more comfortable with a statistically significant difference in the comfort score in group III as compared to group II and group I. Dexmedetomidine nebulization in a dose of 1.5 μg/kg (compared to 1 μg/kg or 0.5 μg/kg) as an adjuvant to lignocaine, provides better bronchoscopy conditions and patient satisfaction.

Carcinoid tumorlet/typical carcinoid of the lung: An incidental bronchoscopic finding and cytological dilemma

Carcinoid tumors of the lung are low-grade neuroendocrine tumors with the potential to progress to high-grade tumors. Diagnosing a typical carcinoid of the lung/tumorlet is a tough nut to crack, especially in their early stages when there is no well-defined lesion in the imaging. Besides, differentiating a carcinoid from low-grade adenocarcinomas of the lung cytologically is quite challenging due to their similar morphology. We report a case of typical carcinoid of lung/tumorlet in a 42-year-old male who presented with hemoptysis. Flexible fibreoptic bronchoscopy revealed a bump in the right middle bronchus. Bronchial biopsy showed a cellular smear with a monotonous round to oval bland-looking cells distributed in singles and in acini, having a high nuclear-cytoplasmic ratio, scant cytoplasm, regular round nuclei, and inconspicuous nucleoli. No atypical mitotic figures or necrosis were seen. With these features, a cytological diagnosis of a typical carcinoid was made. Biopsy was not attempted again due to the small size of the lesion and inaccessibility. Serum chromogranin levels were elevated, confirming the diagnosis. The PET scan was unremarkable. The patient was referred to medical oncology for further management. This report will create awareness about diagnosing early carcinoid/tumorlet, especially with the increasing use of bronchoscopy and cytological diagnostic caution of overdiagnosis of malignancy.

Management of iatrogenic airway bleeding with flexible bronchoscopy: Evidence or experience-based?

Iatrogenic bleeding during bronchoscopy may lead to early termination, insufficient sample collection, decreased diagnostic accuracy, and even death. Unlike rigid bronchoscopy, the management of bleeding during flexible fiberoptic bronchoscopy does not allow the use of methods such as cautery, direct pressure, etc. and is usually limited to the application of liquids. The management of endobronchial bleeding usually depends on two main mechanisms: 1) vasoconstriction; 2) enhancing coagulation to form fibrin clots. The data on cold saline, the most widely recognized agent, is based on case reports and the experience of centers, not randomized controlled trials. Vasoconstrictor agents consist of adrenaline, vasopressin analogues, phenylephrine, and xylometazoline hydrochloride. However, there are only a limited number of randomized controlled trials on adrenaline, and information on the remaining substances is limited to retrospective studies, case reports, and expert opinions. The endobronchial administration of tranexamic acid, which inhibits fibrin degradation, has been the subject of very few studies. Despite its documented efficacy, information regarding its dosage, frequency of use, and safety is lacking. Although Ankaferd Blood Stopper, which binds erythrocytes to the vascular endothelium, has been shown to be effective in controlling bleeding related to dental procedures, the gastrointestinal tract, and operations, only one retrospective study found it to be effective against endobronchial bleeding that could not be controlled with cold saline and adrenaline. Although there are a variety of agents that centers use in their routine procedures, there is not yet a consensus on the efficacy, dose, frequency, and safety of any of them.

An international RAND/UCLA expert panel to determine the optimal diagnosis and management of burn inhalation injury

BackgroundBurn inhalation injury (BII) is a major cause of burn-related mortality and morbidity. Despite published practice guidelines, no consensus exists for the best strategies regarding diagnosis and management of BII. A modified DELPHI study using the RAND/UCLA (University of California, Los Angeles) Appropriateness Method (RAM) systematically analysed the opinions of an expert panel. Expert opinion was combined with available evidence to determine what constitutes appropriate and inappropriate judgement in the diagnosis and management of BII.MethodsA 15-person multidisciplinary panel comprised anaesthetists, intensivists and plastic surgeons involved in the clinical management of major burn patients adopted a modified Delphi approach using the RAM method. They rated the appropriateness of statements describing diagnostic and management options for BII on a Likert scale. A modified final survey comprising 140 statements was completed, subdivided into history and physical examination (20), investigations (39), airway management (5), systemic toxicity (23), invasive mechanical ventilation (29) and pharmacotherapy (24). Median appropriateness ratings and the disagreement index (DI) were calculated to classify statements as appropriate, uncertain, or inappropriate.ResultsOf 140 statements, 74 were rated as appropriate, 40 as uncertain and 26 as inappropriate. Initial intubation with ≥ 8.0 mm endotracheal tubes, lung protective ventilatory strategies, initial bronchoscopic lavage, serial bronchoscopic lavage for severe BII, nebulised heparin and salbutamol administration for moderate-severe BII and N-acetylcysteine for moderate BII were rated appropriate. Non-protective ventilatory strategies, high-frequency oscillatory ventilation, high-frequency percussive ventilation, prophylactic systemic antibiotics and corticosteroids were rated inappropriate. Experts disagreed (DI ≥ 1) on six statements, classified uncertain: the use of flexible fiberoptic bronchoscopy to guide fluid requirements (DI = 1.52), intubation with endotracheal tubes of internal diameter < 8.0 mm (DI = 1.19), use of airway pressure release ventilation modality (DI = 1.19) and nebulised 5000IU heparin, N-acetylcysteine and salbutamol for mild BII (DI = 1.52, 1.70, 1.36, respectively).ConclusionsBurns experts mostly agreed on appropriate and inappropriate diagnostic and management criteria of BII as in published guidance. Uncertainty exists as to the optimal diagnosis and management of differing grades of severity of BII. Future research should investigate the accuracy of bronchoscopic grading of BII, the value of bronchial lavage in differing severity groups and the effectiveness of nebulised therapies in different severities of BII.Graphical

Bronchus compression is a predictor for reobstruction in coarctation with hypoplastic arch repair.

The surgical treatment of coarctation of aorta with hypoplastic aortic arch (CoA/HAA) was challenging to achieve long-lasting arch patency. We reviewed early and late outcomes in our centre and identified predictors for arch reobstruction. A retrospective analysis of medical records was performed to identify CoA/HAA patients who underwent primary arch reconstruction via median sternotomy between 2011 and 2020. Preoperative aortic arch geometry was analysed with cardiac computed tomographic angiography. Bedside flexible fibre-optic bronchoscopy was routinely performed after surgery in intensive care unit. There were 104 consecutive patients (median age 39.5 days) who underwent extended end-to-end anastomosis, extended end-to-side anastomosis and autograft patch augmentation. Early mortality was 3.8% and overall survival was 94.1% [95% confidence interval (CI) 89.6-98.8%] at 1, 3 and 5 years. Reobstruction-free survival was 85.1% (95% CI 78.4-92.3%) at 1 year, 80.6% (95% CI 73.1-88.9%) at 3 years and 77.4% (95% CI 69.2-86.6%) at 5 years. Preoperative aortic arch geometric parameters were not important factors for reobstruction. Nineteen patients (18.3%) were detected with left main bronchus compression (LMBC) on flexible fibre-optic bronchoscopy. Cardiopulmonary bypass time [P < 0.001, hazard ratio (95% CI): 1.02 (1.01-1.03)] and postoperative LMBC [P = 0.034, hazard ratio (95% CI): 2.99 (1.09-8.23)] were independent predictive factors on multivariable Cox regression analysis of reobstruction-free survival. Aortic arch can be satisfactorily repaired by extended end-to-end anastomosis, extended end-to-side anastomosis and autograft patch augmentation via median sternotomy in CoA/HAA. Cardiopulmonary bypass time and postoperative LMBC detected by flexible fibre-optic bronchoscopy are significant predictors for long-term arch reobstruction.

Changing trend of airway management in patients with temporomandibular joint ankylosis; A 9 year retrospective appraisal in Sokoto, Northwest Nigeria

Study objectiveTemporomandibular joint ankylosis (TMJA) presents a serious airway management challenge as rigid laryngoscopy is not possible. Administration of anesthesia to these patients requires flexible fibreoptic bronchoscope, trained personnel and monitoring facilities. These equipment and trained personnel are not readily available in resource limited countries. The main objective of this article is to report the changing trends of airway management in patients with TMJA in our centre over the last 9 years. DesignThis was a retrospective study conducted from January 2014 to December 2022. The period of review was grouped into 3 yearly periods (2014–2016, 2017–2019 and 2020–2022). SettingDepartment of Oral and Maxillofacial Surgery, Usmanu Danfodiyo University Teaching Hospital and Noma Children Hospital, Sokoto, Nigeria. Patients A total of 117 patients were studied. Data retrieved include gender, age, etiology of ankylosis, duration of ankylosis, type of airway management and complications. Interventions Type of airway management. Conducted includeBlind nasal tracheal intubation, awake flexible fibreoptics, sleeping flexible fibreoptics and tracheostomy. MeasurementsAnesthetic chart, age, duration and laterality of TMJA. Main resultsA total of 117 TMJA patients (56 males and 61females) were recruited into the study. Age ranged from 5 to 40 years. Mean ± SD 16.5(7.85). Bulk of the patients were between age 1–30 years. During the 2014–2016 review, tracheostomy was the main airway management procedure in 20 (17.1%) patients, while only 1 (0.8%) case of blind nasal tracheal intubation was observed. In the 2020–2022 review, most of the airway management was awake fibre-optics in 48 (41.0%) patients and sleeping fibre-optics in 27 (23.1%) patients. Only 2 (1.7%) cases of death was observed in the tracheostomy subjects. ConclusionAirway management in TMJA patients have evolved over the years in our centre. Surgical airway management which has many shortcomings is no longer encouraged because of improved facilities and personnel.

Indications and findings of flexible bronchoscopy in trauma field in Korea: a case series

Purpose: Since its implementation, flexible fiberoptic bronchoscopy (FBS) has played an important role in the diagnosis and treatment of tracheobronchial tree and pulmonary disease. Although FBS is often performed by endoscopists, it has also been performed by surgeons, albeit rarely. This study investigated FBS from the surgeon’s perspective.Methods: This retrospective study included patients who underwent FBS performed by a single thoracic surgeon between March 2017 and December 2021. Accordingly, the epidemiology, purpose, results, and complications of FBS were analyzed.Results: A total of 47 patients received FBS, whereas 13 patients underwent repeat FBS. Their mean age was 60.7 years. The main organs injured involved the chest (n=22), brain (n=9), abdominal organ (n=7), cervical spine (n=4), extremities (n=4), and face (n=1). The average Injury Severity Score was 22.5. Indications for FBS included atelectasis or haziness on chest x-ray (n=34), pneumonia (n=17), difficult ventilator management (n=7), percutaneous dilatory tracheostomy (n=3), blood aspiration (n=2), foreign body removal (n=2), and intubation due to a difficult airway (n=1). The findings of FBS were mucous plugs (n=36), blood and blood clots (n=16), percutaneous dilatory tracheostomy (n=2), foreign bodies (n=2), granulation tissue at the tracheostomy site (n=2), tracheostomy tube malposition (n=1), bronchus spasm (n=1), difficult airway intubation (n=1), and negative findings (n=5). None of the patients developed complications. Conclusions: FBS is an important modality in the trauma field that allows for the possibility of diagnosis and therapy. With sufficient practice, surgeons may safely perform FBS at the bedside with relative ease.

Optimal intervention: Flexible Fiberoptic Bronchoscopy’s Role in Chronic Aspiration Foreign Body Removal

Foreign body aspiration in the lower airway is prevalent among children under 5 years old and rare among adults, except in cases of neurodegenerative or neuromuscular conditions. This condition is linked to substantial morbidity, necessitating awareness of potential complications. Flexible bronchoscopy stands as a primary method for foreign body removal. We present a case of a 56-year-old male who aspirated a denture 15 years ago. Recent symptoms encompassed persistent hemoptysis, worsening over two weeks, accompanied by mucopurulent sputum, fever, chest pain, and dyspnea. Physical examination indicated shortness of breath with positive rhonchi. X-ray revealed tubular opacities and atelectasis. Two days post-admission, flexible bronchoscopy exposed moderate mucopurulent secretion in both bronchial trees, with multifocal hyperemic edematous mucosal changes in the right bronchial tree. A denture was successfully extracted from the lower left lobe during the procedure. Treatment included antibiotics, bronchodilators, and mucolytics. Flexible fiberoptic bronchoscopy's adaptability allows local anesthesia usage, reducing costs and risks. The integration of high-definition imaging in flexible bronchoscopes enhances airway visualization and foreign body localization, ensuring precise and safe removal.

A Comparative Study between Nebulized Ketamine, Nebulized Dexmedetomidine and Topical Lidocaine as Premedications for Flexible Fiberoptic Bronchoscopy in Pediatrics

Abstract Background Flexible fiberoptic bronchoscopy remains an invaluable tool in the evaluation and management of infant and pediatric respiratory disease. Anesthetic strategies in pediatric fiberoptic bronchoscopy should aim at minimizing respiratory complications as oxygen desaturation, hypoxemia, cough, bronchospasm and airway trauma. Objective To compare between the efficacy and safety of nebulized ketamine, nebulized dexmedetomidine and topical lidocaine as premedication for flexible fiberoptic bronchoscopy in pediatrics regarding the incidence of moderate to severe cough. Patients and Methods This prospective randomized clinical study was conducted in Ain shams University, Pediatric endoscopy unit on 186 children aged 2 to 8 years and classified according to the American Society of Anesthesiologists (ASA) physical status I or II and scheduled for flexible fiberoptic bronchoscopy (either diagnostic or therapeutic). The included patients were divided into 3 equal groups. Group D (Dexmedetomidine group) received nebulized dexmedetomidine 30 minutes before procedure (2 mic/kg), Group K (Ketamine group) received nebulized ketamine 30 minutes before procedure (2 mg/kg), and Group L (lidocaine group) received topical lidocaine 2% (3 mg/kg). Results Mean heart rate was insignificantly different at baseline among the three groups. Heart rate before induction, 15 minutes after induction and in PACU was significantly lower in group D compared with group K and group L (P &amp;lt; 0.001) and significantly higher in group K compared with group L (P &amp;lt; 0.001). Mean arterial blood pressure at baseline, before induction, 15 minutes after induction, and in PACU were insignificantly different among the three groups. Mean propofol requirements in group L were significantly higher compared with group D, and group K (p &amp;lt; 0.001) but insignificantly different between group D and group K. Conclusion Incidence of moderate to severe cough was less with nebulized dexmedtomidine and nebulized ketamine compared with topical lidocaine. There were no significant differences between nebulized dexmedtomidine and nebulized ketamine with regards to the incidence of moderate to severe cough. There was an insignificant difference between dexmedetomidine and ketamine in the incidence of moderate to severe cough, but it was significantly different between dexmedetomidine and lidocaine, and group ketamine and group lidocaine.

A RETROSPECTIVE ANALYSIS OF PEDIATRIC CASES UNDERGOING FIBEROPTIC BRONCHOSCOPY UNDER GENERAL ANESTHESIA: A FIVE-YEAR EXPERIENCE AT A SINGLE CENTER

The use of the laryngeal mask (LMA) during flexible fiberoptic bronchoscopy (FOB) is more advantageous compared to other airway devices. In this study, the use of LMA for airway maintenance in FOB in pediatric patients was planned to be reviewed in the light of the literature by evaluating the postoperative complications encountered with the demographics of the patients, the duration of anesthesia, and bronchoscopic diagnoses. Between January 2017 and January 2022, the files of pediatric patients who underwent FOB were reviewed retrospectively. The patients' demographics, the airway device used for airway maintenance in FOB (LMA, endotracheal tube, tracheal tube), bronchoscopy indications, bronchoscopic diagnoses, duration of anesthesia, post-procedure hypoxia, laryngospasm, and the number of patients requiring bronchospasm were all recorded. The study included 162 pediatric patients ranging in age from 0 to 17. The median age was 6.9 years old (interquartile range 0-17 years old), and the median weight was 24.5 kg (interquartile range 2.5-89). The patient group having thoracic CT abnormalities and requiring an operation to support the diagnosis was the most prevalent FOB indication (n=37, 22.8%). In all, 28 patients (17.3%) experienced temporary hypoxia, whereas 62 patients (38.3%) experienced bronchospasm. In pediatric patients, FOB via LMA is a safe method. Appropriate equipment, experienced personnel, good patient selection, and adequate follow-up of the patient after bronchoscopy are among the most important factors in the prevention and reduction of complications.

Reliability of Flexible Fiberoptic Bronchoscopy in Patients with Low Oxygen Saturation

Reliability of Flexible Fiberoptic Bronchoscopy in Patients with Low Oxygen Saturation

Retrospective study of congenital airway malformations detected by flexible fiberoptic bronchoscopy in Alexandria University Children’s Hospital

BackgroundCongenital airway malformations affect the quality of life and increase the family burden. The care of children who have these lesions requires considerable expenditures of time and other resources within a tertiary care center.AimThis work aims to determine the incidence of congenital airway malformations in children with airway-related manifestations detected by flexible fiberoptic bronchoscopy at the bronchoscopy unit of Alexandria University Children Hospital during the period from 1st of January 2019 to 31st of December 2019.Patients and methodsThis retrospective study includes symptomatic children who underwent flexible fiberoptic bronchoscopy from 1st of January 2019 to 31st of December 2019.ResultsThe incidence of congenital airway malformations in the studied population was 32%. The mean age of patients at time of diagnosis was 7 months and the most common congenital anomaly was laryngomalacia.ConclusionWe concluded that congenital airway malformations are not uncommon in newborns and their early detection can be beneficial for optimum management.

The role of smear microscopy of induced sputum and bronchoalveolar lavage in the diagnosis of pulmonary tuberculosis in patients with initial smear-negative: A prospective study

Several studies have compared the diagnostic value of sputum induction (SI) with flexible fiberoptic bronchoscopy (FOB) in diagnosing pulmonary tuberculosis; however, these investigations yield an inconsistent conclusion. This study aims to evaluate the role of acid-fast bacilli (AFB) testing of SI and bronchoalveolar lavage (BAL) samples in suspected pulmonary tuberculosis cases. A prospective study was conducted at the Department of Pulmonary in Cho Ray Hospital (Ho Chi Minh City, Vietnam) between October 2020 and May 2021. The study comprised 60 patients hospitalized with suspected pulmonary tuberculosis who had at least one negative AFB result from spontaneous sputum or gastric lavage. All participants underwent AFB testing of SI and BAL samples on the same day. Among 60 patients, 25 (41.7%) were diagnosed with pulmonary tuberculosis. Of the patients with pulmonary tuberculosis, 13 had positive AFB results, including four cases with both positive AFB SI and positive AFB BAL results. The sensitivity of AFB SI was significantly lower compared to that of AFB BAL (16% vs. 52%, p = 0.0027). The most common complication associated with the SI method was cough (15%). The proportion of patients able to provide sputum using the SI method was significantly higher than those with spontaneous sputum (p = 0.0499, McNemar test). SI is a safe and effective method for collecting respiratory specimens, even from patients unable to expectorate spontaneous sputum. FOB should be reserved for suspected cases of pulmonary tuberculosis that are negative for AFB in spontaneous sputum, SI, and gastric lavage.

Bronchoscopic Assessment of Radiologically Detected Lung Lesion

Background: Radiologically detected lung lesions are very common in regular clinical practice. It is very important to diagnose radiologically detected lung lesions early. Flexible fiber-optic bronchoscopy is an excellent minimally invasive and safe investigation for early diagnosis of lung diseases. Methods: Data were collected using a semi-structured questionnaire from the patients who had lesion on chest x-ray that were not in the peripheral part and advised for bronchoscopy. Patients were followed up after getting their histopathology. Statistical analysis using SPSS16.0 was carried out thereafter. Results: Mean age of the respondents was 56.8 years with age ranging from 25 to 85 years. 82% of the patients were male. Male-female ratio was 4.5:1. Endobronchial growth was found in maximum 46% patients during bronchoscopy, followed by 22% showing inflammatory lesion. In 20% of the patients, bronchoscopy findings showed normal findings and 12% patients showed inconclusive results. In subsequent biopsy and histopathology, maximum 55.88% showed non-neoplastic lesion. Among the non-neoplastic lesions 26.47% showed non-specific inflammation.20.58% showed tuberculosis, 5.88% showed sarcoidosis and 2.94% showed aspergilloma. 35.29% cases showed neoplastic lesion, 2.94% showed inconclusive results, 2.94% showed normal results and 2.94% showed inadequate sample. 58.33% cases were squamous cell carcinoma, 25% cases were adenocarcinoma, 8.33% showed small cell carcinoma and 8.33% showed mixed cell type of carcinoma. Conclusion: Fiberoptic bronchoscopy can be successfully employed for the diagnosis of lung diseases, including malignancies and granulomatous lesions.It is extremely useful in finding specific etiologies of various lung diseases. J MEDICINE 2023; 24(2): 106-111

Compare Indications and Findings of Fiberoptic Bronchoscopy in Children Before and During the COVID-19 Outbreak

Background: The coronavirus disease 2019 (COVID-19) dramatically impacts healthcare delivery. Pulmonary diagnostic procedures have had frequent disruptions during this pandemic. Objectives: This study aimed to discover how the COVID-19 pandemic affected pediatric flexible fiberoptic bronchoscopy. Methods: This retrospective cross-sectional study was carried out on pediatric patients who underwent fiberoptic bronchoscopy at a tertiary pediatric hospital affiliated to Tehran University of Medical Sciences. Procedural analysis was done from 20 March 2019 to 20 February 2020 (the pre-pandemic period) and 20 March 2020 to 20 February 2021 (during the pandemic period). The two groups were compared with regard to bronchoscopic indications and findings. Results: Our results from the data registry showed that within (group 1), 290 patients vs. 241 patients from 20 March 2020 till 20 February 2021 (group 2) were admitted to the operation room at least once for bronchoscopy procedures. Although the findings of foreign body aspiration in bronchoscopy were more frequent in group 2, this difference was not significant in the two groups (P = 0.055). The number of cases without abnormality in group 2 was significantly less than in group 1 (P = 0.006). The prevalence of Laryngomalacia was also significantly higher in group 2 (P = 0.000). Conclusions: Our results confirmed the reduction of bronchoscopy in children after the COVID-19 epidemic. However, there was no change in the immediate indications for bronchoscopy, and this pandemic had the most significant impact on elective bronchoscopy.

Evaluating efficacy and safety of sub-anesthetic dose esketamine as an adjuvant to propofol/remifentanil analgosedation and spontaneous respiration for children flexible fibreoptic bronchoscopy: a prospective, double-blinded, randomized, and placebo-controlled clinical trial.

Background: Flexible fiberoptic bronchoscopy (FFB) for children is widely performed under sedation. Currently, the optimal sedation regimen remains unclear. Esketamine is an N-methyl-D-aspartic acid (NMDA) receptor antagonist, which has stronger sedative and analgesic effects and exerts less cardiorespiratory depression than other sedatives. The purpose of this study was to evaluate whether a subanesthetic dose of esketamine as an adjuvant to propofol/remifentanil and spontaneous ventilation compared with control reduces the procedural and anesthesia-related complications of FFB in children. Materials and methods: Seventy-two children ≤ 12years of age who were scheduled for FFB were randomly assigned, in a 1:1 ratio, to the esketamine-propofol/remifentanil (Group S, n = 36) or to the propofol/remifentanil group (Group C, n = 36). All children were retained spontaneous ventilation. The primary outcome was the incidence of oxygen desaturation (respiratory depression). Perioperative hemodynamic variables, blood oxygen saturation (SPO2), end-tidal partial pressure of carbon dioxide (PetCO2), respiratory rate (R), and the Bispectral index (BIS), induction time, procedural time, recovery time, the time to the ward from the recovery room, consumption of propofol and remifentanil during the procedure and the appearance of adverse events, including paradoxical agitation following midazolam administration, injection pain, laryngospasm, bronchospasm, PONV, vertigo, and hallucination were also compared. Results: The incidence of oxygen desaturation was significantly lower in Group S (8.3%) compared to Group C (36.1%, p = 0.005). The perioperative hemodynamic profile including SBP, DBP, and HR were more stable in Group S than that in Group C (p < 0.05). Consumption of propofol and remifentanil was lower in Group S than in Group C (p < 0.05). Furthermore, PAED scores, cough scores and injection pain were lower in the Group S than in Group C (p < 0.05). The recovery time of Group S was slightly longer than that of Group C (p < 0.05). Nobody happened paradoxical agitation following midazolam administration, PONV, vertigo, and hallucinations in both groups (p > 0.05). Conclusion: Our findings indicate that a subanesthetic dose of esketamine as an adjuvant to propofol/remifentanil and spontaneous respiration is an effective regimen for children undergoing FFB. Our findings will provide a reference for clinical sedation practice during these procedures in children. Clinical Trail Registration: Chinese clinicaltrials.gov registry (identifier: ChiCTR2100053302).

Diagnostic Accuracy of Auscultation During General Anesthesia by Taking Fiberoptic Bronchoscopy as Gold Standard

Objective: To evaluate the diagnostic accuracy of auscultation in the detection of inappropriate positioning of endotracheal tube, in patients undergoing elective surgeries, by taking fiberoptic bronchoscopy as gold standard. Study design: cross sectional study Place and duration: Department of anesthesia, Nishtar Hospital, Multan Methodology: A total of 205 patients admitted in general surgery ward were included in the study. The pre-operative assessment was done one day before surgery. The level of difficulty of intubation was assessed during pre-operative assessment. SPSS version 23 was used for data analysis. Tests of significance chi square and t-test were applied. P-value &lt; 0.05 was taken as statistically significant. Results: Therefore, the estimated sensitivity was 72.03%. The estimated specificity was 65.6%. Positive predictive value was 73.9% and negative predictive value was 63.3%. Two hundred and five patients were included in this study of both genders. Gender distribution revealed as n=144 (70.2%) males and n=61 (29.8%) females. The mean age of the patients was 38.92±10.61years. ASA status I and II observed as n=121 (59.0%) and n=84 (41.0%), respectively. Mallampati grading I and II observed as n=127 (62.0%) and n=78 (38.0%), respectively. Laryngoscopy grading I and II observed as n=135 (65.9%) and n=70 (34.1%), respectively. Practical Implication: The main objective of this study was to evaluate the relative diagnostic accuracy of auscultation during GA. Therefore, we evaluated each technique's sensitivity, specificity, (PPV), (NPV) and overall accuracy in detecting incorrect endotracheal tube positioning. Conclusion: The five point auscultation technique is a reliable method of confirmation of endotracheal intubation, as verified by flexible fiberoptic bronchoscope. Keywords: Auscultation, Fiberoptic bronchoscopy, General analgesia, Diagnostic accuracy, sensitivity.