A Randomized Controlled Trial Comparing a Mapleson Circuit with Nasal Trumpet to Standard Oxygen Supplementation during EBUS Bronchoscopy under Monitored Anesthesia Care

Estimation of the median effective dose and the 95% effective dose of alfentanil required to inhibit the bronchoscopy reaction during painless bronchoscopy with i-gel supraglottic airway device: an Up-and-Down Sequential Allocation Trial

Background

In practice, the optimal dose of alfentanil that should be used when painless bronchoscopy is performed is unknown. The purpose of this study was to investigate the effective dose of alfentanil in suppressing bronchoscopy responses to painless bronchoscopy with an i-gel supraglottic airway device.

Methods

Patients aged 18-70 years, with American Society of Anesthesiologists (ASA) physical status I-II, who planned to undergo painless bronchoscopy were recruited for this study. Alfentanil was administered intravenously 2 minutes before propofol administration. The response to bronchoscopy was measured, including oxygen saturation (SPO₂) and changes in respiratory rhythm. The median effective dose of alfentanil (ED₅₀) required to alleviate responses to the bronchoscopy was calculated using Dixon's up-and-down method in the female and male groups. Probit analysis was used to generate a dose-response curve in each group.

Results

A total of 48 patients were recruited for the study including 25 females and 23 males. The ED₅₀ of alfentanil for suppressing responses to painless bronchoscopy in females and males was 13.68±4.75 and 17.96±3.45 µg/kg, respectively. The difference was not statistically significant between the two groups (P=0.078). Probit analysis showed the ED₅₀ of alfentanil in female bronchoscopy was 12.4 µg/kg [95% confidence interval (CI): 4.5 to 17 µg/kg]. In men, the ED₅₀ of alfentanil was 16.4 µg/kg (95% CI: 12.1 to 20.1 µg/kg). According to the probit analysis, the 95% effective dose (ED₉₅) of alfentanil was 22.4 µg/kg (95% CI: 17.5 to 67.3 µg/kg) in female bronchoscopy. In men, the ED₉₅ of alfentanil was 23.3 µg/kg (95% CI: 19.8 to 46.2 µg/kg).

Conclusions

Our data suggest that there were no obvious differences between men and women in the effective dose of alfentanil in painless bronchoscopy.

[Painless fiberoptic bronchoscopy in patients with COVID-19: analysis of 33 cases]

OBJECTIVE

To investigate the necessity, safety and feasibility of painless fiberoptic bronchoscopy in patients with coronavirus disease 2019 (COVID-19).

OBJECTIVE

We retrospectively analyzed the clinical characteristics of 33 patients diagnosed with COVID-19 who received painless fiberoptic bronchoscopy in Wuhan First Hospital. The general demographic and clinical data of the patients including age, gender, and ASA classification were collected. The patients received intravenous anesthesia with topical airway anesthesia with lidocaine. The changes in the vital signs of the patients were recorded before, during and after the procedure. The cough intensity of the patients during bronchoscopy were evaluated, and the adverse reactions within 24 h after the procedure were observed. The health status of the medical staff carrying out the procedure was also monitored.

OBJECTIVE

The 33 patients with ASA class Ⅱ to Ⅳ included 19 male and 14 female patients with an average age of 63.58±11.85 years. The lowest SpO₂ of the patients during bronchoscopy was (94.8±4.3)%, which was significantly lower than that before the procedure [(99.1±1.3)%, P < 0.05] but was restored to more than 95% after such treatment as holding the jaw to open the airway or face mask positive-pressure ventilation. Bronchoscopy was completed successfully in all the patients, and 28 patients (84.85%) had mild cough during the procedure. None of the patients had obvious complications related to anesthesia. While performing the procedure, all the medical staff used third-level protection and facial protection with powered air-purifying respirators (PAPR), and the patients' face were covered with single-use sterile medical plastic curtains that were originally intended for collecting flushing fluid during arthroscopic procedures. No medical personnel was diagnosed with COVID-19 at the end of the study.

OBJECTIVE

For patients with COVID-19, painless techniques can be valuable during bronchoscopy, and this procedure can be safe and feasible under third-level protection.