Use Of Rigid Bronchoscopy Research Articles

Exposure of personnel to sevoflurane during paediatric anaesthesia: influence of professional role and anaesthetic procedure

Background and objective: This study was performed to determine the individual exposure of paediatric operating theatre personnel to sevoflurane and to evaluate the impact of inhalation induction and various airway approaches on exposure to airborne sevoflurane. Methods: Mean individual environmental (workplace air) exposure to sevoflurane and a biomarker of exposure (urinary sevoflurane) were monitored in 36 subjects (10 anaesthetists, 10 surgeons, 12 nurses and 4 auxiliary personnel) working in two paediatric operating rooms. Results: Environmental and urinary values were significantly greater in anaesthetists compared with other groups, with median values of 0.65 ppm (interquartile range 1.36; 95th percentile 4.36) for breathing zone sevoflurane and 2.1 μgL−1 urine (interquartile range 2.6; 95th percentile 7.6) for urinary sevoflurane. Anaesthetists exceeded the 2 ppm maximum allowed environmental concentration recommended by the National Institute for Occupational Safety and Health in 4 of 22 cases (18.1%). A positive correlation was found between the number of patients undergoing inhalational induction each day and mean values of breathing zone and urinary sevoflurane. An increase in the number of daily laryngeal mask insertions, or the use of rigid bronchoscopy, are statistically related to higher environmental and urinary values (P < 0.01 and <0.00001 for breathing zone sevoflurane, P < 0.05 and <0.01 for urinary sevoflurane, respectively). Conclusions: Anaesthesia with sevoflurane can pose a hazard of chronic exposure with anaesthetists having the highest risk. Endotracheal intubation offers considerable protection against exposure. Routine anaesthesia using a standard facemask, a laryngeal mask or rigid bronchoscopy are risk factors for increased anaesthetic exposure.

Pulmonary Osteosarcoma

Although osteosarcoma commonly metastasizes to the lungs, endobronchial lesions are very rare. We present a 54-year-old woman with symptomatic endobronchial involvement caused by advanced pulmonary metastatic osteosarcoma. Successful palliative management was achieved with the use of rigid bronchoscopy and laser therapy. Rigid bronchoscopy with laser therapy has not been reported previously as a therapeutic modality for endobronchial osteosarcoma. A literature review of osteosarcoma metastatic to the lung is provided, and alternative management options are discussed.

Aspirated Foreign Body in a Laryngectomized Patient: Case Report and Literature Review

The presence of a permanent tracheal stoma in a laryngectomized adult is a predisposing factor for foreign-body aspiration, as are conditions that impair normal protective airway mechanisms. Such an aspiration can cause significant morbidity if it is not properly managed. The use of rigid bronchoscopy to remove an aspirated object can be difficult in these patients, and a high percentage of them require thoracotomy, especially for the removal of sharp objects. An emphasis on patient education regarding the handling of objects around the stoma in laryngectomized adults is key to preventing aspiration and its complications.

ROLE OF BRONCHOSCOPY IN MODERN MEDICAL INTENSIVE CARE UNIT

This article gives a broad overview of the increasingly important applications of bronchoscopy, flexible (FOB) and rigid (RB), in a modern medical intensive care unit. Special emphasis is made to bronchoscopy use in mechanically ventilated patients. Therapies such as endobronchial stenting and Nd:YAG laser are being used to improve respiratory failure and facilitate weaning from mechanical ventilation. Practical applications of recent advancements in technology (endobronchial stenting, laser therapy, and so forth), the increasing use of rigid bronchoscopy, and the new generation of flexible bronchoscopes like battery bronchoscopes, and ultra-thin bronchoscopes, are also discussed. The risks, potential benefits, complications, and suggested technique of performing bronchoscopy in mechanically ventilated patients are reviewed.

Pediatric foreign body aspiration.

1. Joshua D. Rovin, MD* 2. Bradley M. Rodgers, MD† 1. 2. *Division of Pediatric Surgery, Children’s Medical Center, University of Virginia Health Sciences Center, Charlottesville, VA. 3. 4. †Editorial Board. After completing this article, readers should be able to: 1. Delineate the signs and symptoms of foreign body aspiration. 2. Explain the process of evaluating for suspected foreign body aspiration. 3. Describe the possible radiographic manifestations of foreign body aspiration. 4. Explain the management of foreign body aspiration in children. 5. Delineate the potential late complications of foreign body aspiration. Aspiration of foreign bodies by children can lead to serious illness and sometimes even death. According to National Safety Council statistics, in 1995, mechanical suffocation accounted for 5% (167) of all unintentional deaths among children in the United States younger than 4 years of age. Most of these deaths occurred in children younger than 1 year of age (81 deaths, accounting for 10% of all unintentional deaths in children younger than 1 year of age). Fortunately, the number of deaths has decreased over the past decade, which has been attributed to better education of the public and stricter guidelines for toy manufacturers. Nevertheless, foreign body aspiration continues to account for a significant number of preventable childhood deaths. Younger children are at the highest risk for accidental foreign body aspiration. This increased incidence has been attributed to several factors among younger children, including that they: 1) have the tendency to put small objects into their mouths; 2) often cry, shout, run, and play with objects in their mouths; and 3) do not have molars to chew certain foods adequately. Most studies show that fewer than 15% of foreign body aspirations occur among children older than 5 years of age. Boys comprise more than 50% of all cases of foreign body aspiration. By far, the objects aspirated most frequently are organic or food matter. In North America, peanuts are most common (Table 1⇓ ). View this table: Table 1. Commonly Aspirated Foreign Bodies Unlike aspiration in adults, there is only a …