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Gallagher L, Todatry S, Oldenburg K, Misono S, Gray R. Endoscopic treatment of subglottic stenosis with flexible bronchoscopy via laryngeal mask airway. Laryngoscope 2024; 134:2672-2677. [PMID: 38095278 DOI: 10.1002/lary.31229] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 11/22/2023] [Accepted: 11/29/2023] [Indexed: 05/09/2024]
Abstract
OBJECTIVE To evaluate the safety and efficacy of endoscopic treatment of subglottic stenosis with flexible bronchoscopy via laryngeal mask airway (LMA) approach. METHODS The records of all patients who underwent endoscopic surgery for subglottic stenosis (SGS) from November 2019 to January 2023 at an academic medical center were reviewed with attention to demographics, patient comorbidities, airway stenosis characteristics, operative time details, surgical complications, and post-operative course. All patients, >18 years old, with one or more surgeries for SGS using (LMA) for intraoperative airway management were included. Surgeries with suspension microlaryngoscopy were excluded. Patients with glottic stenosis or tracheotomy were excluded. RESULTS Thirty-five patients underwent 52 procedures meeting inclusion criteria. Mean age was 55 years (range 31-78, SD 13.3) and 33 patients (94%) were female. Mean BMI was 30.9 (range 18.4-60.5, SD 8.8). The most common etiology of stenosis was intubation injury in 17 patients (49%), followed by idiopathic in 13 patients (37%). Cotton-Meyer grade 3 (71-99% narrowing) was seen in 25 patients (71%). Mean anesthesia and surgical operative times were 75.9 min (SD 13.5 min) and 39.7 min (SD 11.0 min), respectively. Mean SpO2 nadir was 94.5% (SD 6.3%). No patients required intraoperative change to rigid laryngoscopy, intubation, or tracheotomy. There were no post-operative complications. Mean surgery-free interval was 12.2 months (SD 6.3). CONCLUSION Endoscopic treatment of subglottic stenosis with flexible bronchoscopy and spontaneous ventilation via LMA approach is a safe and effective option, especially in patients with limitations for rigid laryngoscopy and elevated BMI. LEVEL OF EVIDENCE Level Four (case series) Laryngoscope, 134:2672-2677, 2024.
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Affiliation(s)
- Liam Gallagher
- Department of Otolaryngology-Head & Neck Surgery, University of Minnesota, Minneapolis, Minnesota, U.S.A
| | - Soorya Todatry
- Department of Otolaryngology-Head & Neck Surgery, University of Minnesota, Minneapolis, Minnesota, U.S.A
| | - Kirsi Oldenburg
- Department of Otolaryngology-Head & Neck Surgery, University of Minnesota, Minneapolis, Minnesota, U.S.A
| | - Stephanie Misono
- Department of Otolaryngology-Head & Neck Surgery, University of Minnesota, Minneapolis, Minnesota, U.S.A
| | - Raluca Gray
- Department of Otolaryngology-Head & Neck Surgery, University of Minnesota, Minneapolis, Minnesota, U.S.A
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Messina G, Bove M, Natale G, Di Filippo V, Opromolla G, Massimilla E, Forte M, Rainone A, Vicario G, Leonardi B, Fiorelli A, Vicidomini G, Santini M, Pirozzi M, Caterino M, Della Corte CM, Ciardiello F, Fasano M. Ventilation challenge in rigid bronchoscopy: Laser tube as an alternative management in patients with lung cancer and central airway obstruction. Thorac Cancer 2022; 14:24-29. [PMID: 36419381 PMCID: PMC9807437 DOI: 10.1111/1759-7714.14671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Central airway tumors involving the trachea and main-stem bronchi are a common cause of airway obstruction and a significant cause of mortality among the patients of thoracic diseases with respiratory failure. Debulking in rigid bronchoscopy is quick, safe, and effective. It can be complex and hard in patients with severe bronchial or tracheal obstruction and/or with intraluminal bleeding tumors because of inadequate distal airway control. We have used laser tube as a new technique of ventilation for severe central airway obstruction. MATERIALS AND METHODS Forty-six patients with severe airway obstruction undergoing rigid bronchoscopy from September 2020 to June 2022 at the Thoracic Surgery Department of the University L. Vanvitelli of Naples underwent placement of laser tube. RESULTS In all patients who underwent rigid bronchoscopy with the use of the laser tube, a reduction of obstruction of more than 50% was obtained and in all patients no hypoxia (saturation < 88%), nor hypercapnia, nor significant bleeding were reported. DISCUSSION The results of this study suggest that rigid bronchoscopic debulking with the use of laser tube is a safe and effective technique in the management of central airway obstruction. CONCLUSIONS The use of the laser tube allows the monitoring of gas exchange, which controls hypoxemia. Thanks to the double cuff put distally to the tracheal obstruction or in the contralateral bronchus to the obstructed one, the laser tube prevents the flooding of blood from debulking below the stenosis. Rigid bronchoscopy with laser tube will expand its use in the future.
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Affiliation(s)
- Gaetana Messina
- Thoracic Surgery UnitUniversità degli Studi della Campania "Luigi Vanvitelli"NaplesItaly
| | - Mary Bove
- Thoracic Surgery UnitUniversità degli Studi della Campania "Luigi Vanvitelli"NaplesItaly
| | - Giovanni Natale
- Thoracic Surgery UnitUniversità degli Studi della Campania "Luigi Vanvitelli"NaplesItaly
| | - Vincenzo Di Filippo
- Thoracic Surgery UnitUniversità degli Studi della Campania "Luigi Vanvitelli"NaplesItaly
| | - Giorgia Opromolla
- Thoracic Surgery UnitUniversità degli Studi della Campania "Luigi Vanvitelli"NaplesItaly
| | - Eva Massimilla
- Otorhinolaryngology UnitUniversità degli Studi della Campania "Luigi Vanvitelli"NaplesItaly
| | - Mauro Forte
- Anesthesioly and Intensive Care UnitUniversità degli Studi della Campania "Luigi Vanvitelli"NaplesItaly
| | - Anna Rainone
- Thoracic Surgery UnitUniversità degli Studi della Campania "Luigi Vanvitelli"NaplesItaly
| | - Giuseppe Vicario
- Thoracic Surgery UnitUniversità degli Studi della Campania "Luigi Vanvitelli"NaplesItaly
| | - Beatrice Leonardi
- Thoracic Surgery UnitUniversità degli Studi della Campania "Luigi Vanvitelli"NaplesItaly
| | - Alfonso Fiorelli
- Thoracic Surgery UnitUniversità degli Studi della Campania "Luigi Vanvitelli"NaplesItaly
| | - Giovanni Vicidomini
- Thoracic Surgery UnitUniversità degli Studi della Campania "Luigi Vanvitelli"NaplesItaly
| | - Mario Santini
- Thoracic Surgery UnitUniversità degli Studi della Campania "Luigi Vanvitelli"NaplesItaly
| | - Mario Pirozzi
- Oncology, Department of Precision MedicineUniversità della Campania "L. Vanvitelli"NaplesItaly
| | - Marianna Caterino
- Oncology, Department of Precision MedicineUniversità della Campania "L. Vanvitelli"NaplesItaly
| | | | - Fortunato Ciardiello
- Oncology, Department of Precision MedicineUniversità della Campania "L. Vanvitelli"NaplesItaly
| | - Morena Fasano
- Oncology, Department of Precision MedicineUniversità della Campania "L. Vanvitelli"NaplesItaly
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Chen H, Yao Y, Wang S, Liu S, Yang L. Selection of the access channel in bronchoscopic intervention. Expert Rev Respir Med 2022; 16:707-712. [PMID: 35694812 DOI: 10.1080/17476348.2022.2089656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND At present, bronchoscopic intervention has become an important treatment approach for central airway obstruction (CAO). Choosing an appropriate access channel for different patients during this operation has become a research focus. METHODS Data of bronchoscopic interventions in 201 patients with CAO in which one of endotracheal intubation, laryngeal mask, or rigid bronchoscope were used as the only access channel were retrospectively reviewed. RESULTS The total immediate effective rate was 94.1% (398/423), and the main complications related to the access channels included hypoxemia, elevated arterial partial pressure of carbon dioxide, arrhythmia, airway mucosa tear, glottic edema, vocal cord injury, tooth loss, massive bleeding, airway mucosal necrosis, and asphyxia. The incidence of complications was 16.8% (71/423). Glottic edema was the most common complication with an incidence of 7.8% (33/423) and accounted for 46.5% of all complications. Glottic edema only occurred in the laryngeal mask and rigid bronchoscope groups, and the incidence was significantly correlated with the operation time (p < 0.001). Massive bleeding related to the access channel remains the most serious complication. CONCLUSIONS Endotracheal intubation, laryngeal mask, and rigid bronchoscope each have their own advantages and disadvantages. The most appropriate access channel should depend on a comprehensive assessment of the patient.
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Affiliation(s)
- Hui Chen
- Department of Pulmonary and Critical Care Medicine, First Affiliated Hospital of Xi'an Medical University, Xi'an, Shaanxi, China
| | - Yang Yao
- Department of Pulmonary and Critical Care Medicine, First Affiliated Hospital of Xi'an Medical University, Xi'an, Shaanxi, China
| | - Shengyu Wang
- Department of Pulmonary and Critical Care Medicine, First Affiliated Hospital of Xi'an Medical University, Xi'an, Shaanxi, China
| | - Song Liu
- Department of Pulmonary and Critical Care Medicine, First Affiliated Hospital of Xi'an Medical University, Xi'an, Shaanxi, China
| | - Lin Yang
- Department of Pulmonary and Critical Care Medicine, First Affiliated Hospital of Xi'an Medical University, Xi'an, Shaanxi, China
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Chen H, Zhang J, Qiu X, Wang J, Pei Y, Wang Y, Wang T. Choice of bronchoscopic intervention working channel for benign central airway stenosis. Intern Emerg Med 2021; 16:1865-1871. [PMID: 33095412 DOI: 10.1007/s11739-020-02531-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Accepted: 10/07/2020] [Indexed: 12/19/2022]
Abstract
The purpose of this study is to report our experiences over 12 years with bronchoscopic interventions in patients with benign central airway stenosis using three types of working channels (rigid bronchoscope, laryngeal mask, and endotracheal intubation), with a focus on their related advantages, disadvantages, and postoperative complications. We analyzed the clinical data from 273 patients with benign central airway stenosis who underwent a bronchoscopic intervention. The Wilcoxon rank-sum test was used to analyze the immediate results after the first bronchoscopic intervention, and the Chi-square test was used to analyze the correlation between glottic edema and operation time. The 273 patients underwent a total of 479 bronchoscopic interventions, with satisfactory results. The immediate effective rates of the first bronchoscopic intervention by rigid bronchoscope, laryngeal mask, and endotracheal intubation were 91.4%, 91.3%, and 85.2%, respectively. Postoperative complications related to the working channels included hoarseness, glottic edema, pharyngalgia, paresthesia pharynges, cough, and tooth loss. Glottic edema was the most serious complication, and it occurred in 37.7% (23/61) of the rigid bronchoscope group and 9.8% (32/326) in the laryngeal mask group. And the incidence rate was significantly correlated with the operation time (P < 0.01). Therefore, for patients with benign central airway stenosis, the best choice of working channel during an operation should be made by the operation procedure, lesion location, and pathology of the patients. Shortening the operation time was an important factor in preventing glottic edema.
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Affiliation(s)
- Hui Chen
- Department of Respiratory Medicine, Beijing Tian Tan Hospital, Capital Medical University, No. 119, South Fourth Ring West Road, Fengtai District, Beijing, 100070, China
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Xi'an Medical University, Xi'an, China
| | - Jie Zhang
- Department of Respiratory Medicine, Beijing Tian Tan Hospital, Capital Medical University, No. 119, South Fourth Ring West Road, Fengtai District, Beijing, 100070, China.
| | - Xiaojian Qiu
- Department of Respiratory Medicine, Beijing Tian Tan Hospital, Capital Medical University, No. 119, South Fourth Ring West Road, Fengtai District, Beijing, 100070, China
| | - Juan Wang
- Department of Respiratory Medicine, Beijing Tian Tan Hospital, Capital Medical University, No. 119, South Fourth Ring West Road, Fengtai District, Beijing, 100070, China
| | - Yinghua Pei
- Department of Respiratory Medicine, Beijing Tian Tan Hospital, Capital Medical University, No. 119, South Fourth Ring West Road, Fengtai District, Beijing, 100070, China
| | - Yuling Wang
- Department of Respiratory Medicine, Beijing Tian Tan Hospital, Capital Medical University, No. 119, South Fourth Ring West Road, Fengtai District, Beijing, 100070, China
| | - Ting Wang
- Department of Respiratory Medicine, Beijing Tian Tan Hospital, Capital Medical University, No. 119, South Fourth Ring West Road, Fengtai District, Beijing, 100070, China
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Yang M, Wang B, Hou Q, Zhou Y, Li N, Wang H, Li L, Cheng Q. High frequency jet ventilation through mask contributes to oxygen therapy among patients undergoing bronchoscopic intervention under deep sedation. BMC Anesthesiol 2021; 21:65. [PMID: 33653271 PMCID: PMC7921285 DOI: 10.1186/s12871-021-01284-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 02/17/2021] [Indexed: 11/16/2022] Open
Abstract
Background High frequency jet ventilation (HFJV) is an open ventilating technique to maintain ventilation for emergency or difficult airway. However, whether jet ventilation or conventional oxygen therapy (COT) is more effective and safe in maintaining adequate oxygenation, is unclear among patients with airway stenosis during bronchoscopic intervention (BI) under deep sedation. Methods A prospective randomized cohort study was conducted to compare COT (high flow oxygen) with normal frequency jet ventilation (NFJV) and HFJV in oxygen supplementation during BI under deep sedation from March 2020 to August 2020. Patients receiving BI under deep sedation were randomly divided into 3 parallel groups of 50 patients each: the COT group (fractional inspired oxygen (FiO2) of 1.0, 12 L/min), the NFJV group (FiO2 of 1.0, driving pressure of 0.1 MPa, and respiratory rate (RR) 15 bpm) and the HFJV Group (FiO2 of 1.0, driving pressure of 0.1 MPa, and RR of 1200 bpm). Pulse oxygen saturation (SpO2), mean arterial blood pressure and heart rate were recorded during the whole procedure. Arterial blood gas was examined and recorded 15 min after the procedure was initiated. The procedure duration, dose of anesthetics, and adverse events during BI in the three groups were also recorded. Results A total of 161 patients were enrolled, with 11 patients excluded. The clinical characteristics were similar among the three groups. PaO2 of the COT and NFJV groups was significantly lower than that of the HFJV group (P < 0.001). PaO2 was significantly correlated with ventilation mode (P < 0.001), body mass index (BMI) (P = 0.019) and procedure duration (P = 0.001). Multiple linear regression showed that only BMI and procedure duration were independent influencing factors of arterial blood gas PaO2 (P = 0.040 and P = 0.002, respectively). The location of airway lesions and the severity of airway stenosis were not statistically correlated with PaCO2 and PaO2. Conclusions HFJV could effectively and safely improve intra-operative PaO2 among patients with airway stenosis during BI in deep sedation, and it did not increase the intra-operative PaCO2 and the risk of hypercapnia. PaO2 was correlated with ventilation mode, BMI and procedure duration. Only BMI and procedure duration were independent influencing factors of arterial blood gas PaO2. PaCO2 was not correlated with any preoperative factor. Trial registration Chinese Clinical Trial Registry. Registration number, ChiCTR2000031110, registered on March 22, 2020.
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Affiliation(s)
- Mingyuan Yang
- Department of Anesthesiology, Emergency General Hospital, Beijing, 100028, China
| | - Bin Wang
- Department of Anesthesiology, Emergency General Hospital, Beijing, 100028, China
| | - Qingwu Hou
- Department of Anesthesiology, Emergency General Hospital, Beijing, 100028, China
| | - Yunzhi Zhou
- Department of Pulmonary and Critical Care Medicine, Emergency General Hospital, Beijing, China
| | - Na Li
- Department of Anesthesiology, Emergency General Hospital, Beijing, 100028, China
| | - Hongwu Wang
- Department of Pulmonary and Critical Care Medicine, Emergency General Hospital, Beijing, China
| | - Lei Li
- Department of Anesthesiology, Emergency General Hospital, Beijing, 100028, China
| | - Qinghao Cheng
- Department of Anesthesiology, Emergency General Hospital, Beijing, 100028, China.
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Zhu GQ, Wu XM, Cao DH. High frequency jet ventilation at the distal end of tracheostenosis during flexible bronchoscopic resection of large intratracheal tumor: Case series. Medicine (Baltimore) 2020; 99:e19929. [PMID: 32569155 PMCID: PMC7310889 DOI: 10.1097/md.0000000000019929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 02/04/2020] [Accepted: 03/17/2020] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Resection of a large intratracheal tumor with severe obstruction via flexible bronchoscope remains a formidable challenge to anesthesiologists. Many artificial airways positioned proximal to tracheal obstruction can not ensure adequate oxygen supply. How to ensure effective gas exchange is crucial to the anesthetic management. PATIENT CONCERNS Five patients of intratracheal tumor occupying 70% to 85% of the tracheal lumen were scheduled for tumor resection via flexible bronchoscope. DIAGNOSIS The patients were diagnosed with intratracheal tumor based on their symptoms, radiographic findings and tracheoscopy. INTERVENTIONS We describe a technique of high frequency jet ventilation (HFJV) using an endobronchial suction catheter distal to tracheostenosis during the surgery, which ensured the good supply of oxygen. We applied general anesthesia with preserved spontaneous breathing. A comprehensive anesthesia protocol that emphasizes bilateral superior laryngeal nerve (SLN) block and sufficient topical anesthesia. An endobronchial suction catheter was introduced transnasally into the trachea and then advanced through the tracheostenosis with the tip proximal to the carina under direct vision with the aid of fiber bronchoscope. HFJV was then performed through the suction catheter. OUTCOMES The SPO2 maintained above 97% during the surgery. Carbon dioxide retention was alleviated obviously when adequate patency of the trachea lumen achieved about 30 min after the beginning of surgery. HFJV was ceased and all patients had satisfactory spontaneous breathing at the end of the procedure. CONCLUSION HFJV at the distal end of tracheostenosis is a suitable ventilation strategy during flexible bronchoscopic resection of a large intratracheal tumor.
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Affiliation(s)
| | - Xiao-Mai Wu
- Department of Respiratory Medicine, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, China
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Song W, Zha W, Qi X, Jiwang W. Efficacy and safety of flexible endoscopic intervention via laryngeal mask airway for endobronchial hamartoma removal. MINIM INVASIV THER 2020; 30:139-146. [PMID: 32011200 DOI: 10.1080/13645706.2020.1720250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To evaluate the clinical characteristics, efficacy and safety of flexible endoscopic intervention for endobronchial hamartoma. MATERIAL AND METHODS Thirteen patients with endobronchial hamartoma who underwent flexible endoscopic intervention at a single center were analyzed retrospectively. The clinical characteristics and efficacy of flexible endoscopic intervention were described. RESULTS Nine patients were cured after one single flexible endoscopic intervention, three patients underwent second flexible endoscopic interventions due to late tumor recurrence, while one patient who eventually became stable with a 40% stenosis of the airway lumen, received a third intervention because of two relapses. Pneumothorax occurred in one patient who was cured after oxygen therapy. There were no serious complications such as massive hemorrhage, airway perforation, airway ignition and suffocation associated with the therapy. CONCLUSIONS Flexible endoscopic intervention appeared to be safe and effective for the treatment of patients with endobronchial hamartoma.
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Affiliation(s)
- Wei Song
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Wangjian Zha
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Xu Qi
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Wang Jiwang
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
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Saran JS, Kreso M, Khurana S, Nead M, Larj M, Karan S. Anesthetic Considerations for Patients Undergoing Bronchial Thermoplasty. Anesth Analg 2019; 126:1575-1579. [PMID: 28858897 DOI: 10.1213/ane.0000000000002425] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Bronchial thermoplasty (BT) is a novel, Food and Drug Administration-approved nondrug treatment for patients whose asthma remains uncontrolled despite traditional pharmacotherapy. BT involves application of controlled radiofrequency energy to reduce airway smooth muscle in large- and medium-sized airways. Although BT is often performed under general anesthesia, anesthetic management strategies for BT are poorly described. We describe the anesthetic management of 7 patients who underwent 19 BT treatments in a tertiary academic medical center.
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Affiliation(s)
| | | | - Sandhya Khurana
- Pulmonary and Critical Care Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Michael Nead
- Pulmonary and Critical Care Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Michael Larj
- Pulmonary and Critical Care Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York
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Abedini A, Kiani A, Taghavi K, Khalili A, Fard AJ, Fadaizadeh L, Salimi A, Parsa T, Aarabi A, Farzanegan B, Tootkaboni MP. High-Frequency Jet Ventilation in Nonintubated Patients. Turk Thorac J 2018; 19:127-131. [PMID: 30083403 DOI: 10.5152/turkthoracj.2018.17025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Accepted: 04/10/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVES High-frequency jet ventilation (HFJV) is a convenient method for providing ventilation during fiberoptic bronchoscopy. We describe an incipient approach of high-frequency jet ventilation via the working channel of a flexible bronchoscope for nonintubated patients who suffer from hypoxemia during bronchoscopy. The aim of this study was to test the efficacy of this incipient approach and determine the possible complications related to it. MATERIALS AND METHODS Sixteen patients who had oxygen saturation below 70% that did not resolve with nasal oxygen for 20 s during interventional bronchoscopy were included in the study. High-frequency jet ventilation was administrated via the working channel of a bronchoscope for 3 min. Arterial blood gas circumscriptions were compared before and after jet ventilation. RESULTS Oxygen saturation increased to >90% in all patients 30 s after jet ventilation. Mean arterial oxygen saturation pressure increased from 54.84 to 111.98 mmHg with jet ventilation (p=0.0001). Arterial carbon dioxide tension decreased after jet ventilation. The body mass index had no consequential effect on arterial carbon dioxide pressure after jet ventilation in our patients (p=0.1). Complications such as pneumothorax and working channel damage were not observed. CONCLUSION High-frequency jet ventilation via the working channel of the bronchoscope is a novel method that can provide optimal ventilation with minimal complications to nonintubated patients suffering from hypoxemia during bronchoscopy. This method also reduces the duration of bronchoscopy procedures.
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Affiliation(s)
- Atefeh Abedini
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arda Kiani
- Tracheal Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kimia Taghavi
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Khalili
- Tobacco Prevention and Control Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Jahangiri Fard
- Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Lida Fadaizadeh
- Telemedicine Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Salimi
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Tahereh Parsa
- Pediatric Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Akram Aarabi
- Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Behrooz Farzanegan
- Tracheal Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahsa Pourabdollah Tootkaboni
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Özden Omaygenç D, Ünal N, Edipoğlu Sİ, Barca Şeker T, Özgül MA, Turan D, Özdemir C, Karaca İO, Çetinkaya E. Recovery process and determinants of adverse event occurrence in bronchoscopic procedures performed under general anaesthesia. CLINICAL RESPIRATORY JOURNAL 2018; 12:2277-2283. [PMID: 29660267 DOI: 10.1111/crj.12904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 03/21/2018] [Accepted: 04/08/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Regarding the fact that rigid bronchoscopy is generally performed under general anaesthesia and this patient subgroup is remarkably morbid, encountering procedure and/or anaesthesia related complications are highly likely. Here, we aimed to assess factors influencing recovery and detect possible determinants of adverse event occurrence during these operations performed in a tertiary referral centre. METHODS Eighty-one consecutive ASA I-IV patients were recruited for this investigation. In the operating theatre after induction of anaesthesia and advancement of the device, maintenance was provided with total intravenous anaesthesia. Neuromuscular blockage was invariably administered, and patients were ventilated manually. In addition to preoperative demographic and procedural characteristics, perioperative hemodynamic variables, recovery times and observed adverse events were noted. RESULTS Basic demographic properties, ASA and Mallampati scores, and procedure specific variables as lesion localization, lesion and procedure type were comparable among groups assembled with reference to event occurrence. Patients who had experienced adverse event had higher heart rates. Recovery times were comparable between Event (-) and Event (+) groups. Relationship of recovery process were individually tested with all variables and only lesion type was detected to have an effect on respiration and extubation times. Among all parameters only procedural time seemed to be associated with adverse event occurrence (mins, 22.9 ± 11.9 vs 41.6 ± 28.8, P < .001). CONCLUSION Recovery times related with return of spontaneous respiration were significantly lower in procedures performed for treatment of tumoral diseases in this study and procedure length was determined to be the ultimate factor which had an impact on adverse event occurrence.
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Affiliation(s)
- Derya Özden Omaygenç
- Department of Anesthesiology, Yedikule Chest Diseases and Thoracic Surgery Training & Research Hospital, Istanbul, Turkey
| | - Nermin Ünal
- Department of Anesthesiology, Yedikule Chest Diseases and Thoracic Surgery Training & Research Hospital, Istanbul, Turkey
| | - Saadet İpek Edipoğlu
- Department of Anesthesiology, Süleymaniye Obstetrics and Gynecology and Pediatrics Training & Research Hospital, Istanbul, Turkey
| | - Tuğçe Barca Şeker
- Department of Anesthesiology, Yedikule Chest Diseases and Thoracic Surgery Training & Research Hospital, Istanbul, Turkey
| | - Mehmet Akif Özgül
- Department of Chest Diseases, Yedikule Chest Diseases and Thoracic Surgery Ed. & Research Hospital, Istanbul, Turkey
| | - Demet Turan
- Department of Chest Diseases, Yedikule Chest Diseases and Thoracic Surgery Ed. & Research Hospital, Istanbul, Turkey
| | - Cengiz Özdemir
- Department of Chest Diseases, Yedikule Chest Diseases and Thoracic Surgery Ed. & Research Hospital, Istanbul, Turkey
| | - İbrahim Oğuz Karaca
- Department of Cardiology, Istanbul Medipol University Hospital, Istanbul, Turkey
| | - Erdoğan Çetinkaya
- Department of Chest Diseases, Yedikule Chest Diseases and Thoracic Surgery Ed. & Research Hospital, Istanbul, Turkey
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de Lima A, Kheir F, Majid A, Pawlowski J. Anesthesia for interventional pulmonology procedures: a review of advanced diagnostic and therapeutic bronchoscopy. Can J Anaesth 2018; 65:822-836. [PMID: 29623556 DOI: 10.1007/s12630-018-1121-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 01/17/2018] [Accepted: 01/17/2018] [Indexed: 12/11/2022] Open
Abstract
PURPOSE Interventional pulmonology is a growing subspecialty of pulmonary medicine with flexible and rigid bronchoscopies increasingly used by interventional pulmonologists for advanced diagnostic and therapeutic purposes. This review discusses different technical aspects of anesthesia for interventional pulmonary procedures with an emphasis placed on pharmacologic combinations, airway management, ventilation techniques, and common complications. SOURCE Relevant medical literature was identified by searching the PubMed and Google Scholar databases for publications on different anesthesia topics applicable to interventional pulmonary procedures. Cited literature included case reports, original research articles, review articles, meta-analyses, guidelines, and official society statements. PRINCIPAL FINDINGS Interventional pulmonology is a rapidly growing area of medicine. Anesthesiologists need to be familiar with different considerations required for every procedure, particularly as airway access is a shared responsibility with pulmonologists. Depending on the individual case characteristics, a different selection of airway method, ventilation mode, and pharmacologic combination may be required. Most commonly, airways are managed with supraglottic devices or endotracheal tubes. Nevertheless, patients with central airway obstruction or tracheal stenosis may require rigid bronchoscopy and jet ventilation. Although anesthetic approaches may vary depending on factors such as the length, complexity, and acuity of the procedure, the majority of patients are anesthetized using a total intravenous anesthetic technique. CONCLUSIONS It is fundamental for the anesthesia provider to be updated on interventional pulmonology procedures in this rapidly growing area of medicine.
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Affiliation(s)
- Andres de Lima
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Fayez Kheir
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Division of Pulmonary Diseases, Critical Care and Environmental Medicine, Tulane University Health Sciences Center, New Orleans, LA, USA
| | - Adnan Majid
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - John Pawlowski
- Department of Anesthesia, Division of Thoracic Anesthesia, Beth Israel Deaconess Medical Center, Harvard Medical School, 1 Deaconess Road, Boston, MA, 02215, USA.
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Pourciau DC, Hotard DP, Hayley S, Hayley K, Sutton C, McWhorter AJ, Fink DS. Safety and efficacy of laryngeal mask airway ventilation in obese patients with airway stenosis. Laryngoscope 2017; 127:2582-2584. [DOI: 10.1002/lary.26684] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 03/24/2017] [Accepted: 04/24/2017] [Indexed: 11/07/2022]
Affiliation(s)
- D. Cole Pourciau
- Our Lady of the Lake Regional Medical Center; Baton Rouge
- Our Lady of the Lake College Nurse Anesthesia Program
| | | | | | - Kasey Hayley
- Our Lady of the Lake Regional Medical Center; Baton Rouge
| | - Collin Sutton
- Our Lady of the Lake Regional Medical Center; Baton Rouge
- Our Lady of the Lake College Nurse Anesthesia Program
| | - Andrew J. McWhorter
- Department of Otolaryngology-Head and Neck Surgery; Louisiana State University Health Sciences Center; New Orleans Louisiana
| | - Daniel S. Fink
- Department of Otolaryngology-Head and Neck Surgery; University of Colorado School of Medicine; Denver Colorado U.S.A
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