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Background: The airway should be thoroughly and accurately evaluated before anesthesia induction and endotracheal intubation. Awake direct laryngoscopy (ADL) can provide rapid, accurate, and intuitive airway assessment, especially for suspected difficult airways, and sometimes eliminates the need for fiberoptic intubation in some suspicious difficult airway cases. However, an optimal regimen has not been determined. Methods: In this double-blind, controlled study, prior to ADL, 60 patients scheduled for general anesthesia were randomly allocated to receive 0.75 μg/kg of dexmedetomidine (Dex group, n = 20), 0.15 mg/kg of nalbuphine (Nal group, n = 20), or a placebo (control group, n = 20) intravenously over 10 min. At the same time, all study subjects received nebulized lidocaine for 15 min. The primary outcome was patient tolerance as assessed by a 5-point ADL comfort score, while secondary outcomes included satisfaction, coughing, pain, nausea and vital signs. Results: Patients undergoing ADL in the Nal group had higher tolerance scores than those in the control and Dex groups [4 (3,4) vs. 3 (2,2.75), P < 0.017, and 4 (3,4) vs. 2 (2,2,75), P < 0.001, respectively] and higher satisfaction [7 (6,8) vs. 4 (3,5.75), P < 0.017, and 7 (6,8) vs. 5.5 (5,6), P < 0.001, respectively]. Additionally, the Nal group had significantly fewer adverse events, such as pain and nausea than the control and Dex groups. The sedation score and peripheral oxygen and saturation were significantly higher in the Nal group than in the Dex group, with no difference between the Nal and control groups (P < 0.001, P = 0.159, respectively). Conclusions: Intravenous nalbuphine in combination with lidocaine aerosol inhalation significantly improved patient tolerance and satisfaction while reducing nausea, coughing, pain, sedation, and SpO2 levels during ADL. Highlights: • Awake direct laryngoscopy (ADL) allows rapid and accurate assessment of suspicious airways prior to the induction of anesthesia. • The combination of nalbuphine and lidocaine resulted in higher tolerability, comfort, and satisfaction than dexmedetomidine combined with lidocaine or lidocaine alone during ADL. • Nalbuphine combined with lidocaine could be safer than dexmedetomidine combined with lidocaine in terms of maintaining higher SpO2 levels and reducing the risk of loss of consciousness during anesthesia. [ABSTRACT FROM AUTHOR]

Summary Introduction Methods Results Conclusions Flexible bronchoscopes have become essential in the operating theatre environment and in critical care. This narrative review compared single‐use and reusable flexible bronchoscopes with a focus on safety, efficacy, cost‐effectiveness and environmental impact.We searched MEDLINE, Embase and PubMed databases for studies related to flexible bronchoscopes for airway management or use in critical care. Human or animal studies of any design assessing single‐use and reusable flexible bronchoscopes were included and qualitatively synthesised. We also searched manufacturer websites for relevant data.We included 52 studies and data from six manufacturer websites. There was mixed evidence for safety, and data on usability also showed significant heterogeneity, with different parameters, manufacturers and models examined. Neither single‐use nor reusable flexible bronchoscopes appeared convincingly superior to the other for safety or usability. Cost analyses showed that the rate of use of flexible bronchoscopes per year, along with several other factors, affects cost‐effectiveness for each institution, though the risk of cross‐contamination is an advantage of single‐use devices. However, sufficient evidence on the rate of bronchoscopy‐induced infection in the operating theatre and critical care environment is lacking. Due to the risk of cross‐contamination, single‐use flexible bronchoscopes must be sterilised or incinerated after use, and completely recyclable single‐use models are not currently available.Further research is required on safety, usability and life cycle assessment in the operating theatre and critical care environment, as well as on the rate of bronchoscopy‐induced infection. Future comparative studies, including new manufacturers and designs, may lend further insights. [ABSTRACT FROM AUTHOR]

Background: Patients with mediastinal lymph node enlargement (MLNE) are diagnosed depending on lymph node biopsy. Whereas, how to obtain larger tissue masses from mediastinal lymph nodes and improve the diagnostic yield of the disease remains to be investigated. Objectives: Aiming to assess the diagnostic value of endobronchial ultrasound-guided intranodal forceps biopsy via transbronchial laser photoablation (EBUS-IFB-TLP) in patients with MLNE. Design: A prospective, self-controlled study. Methods: This study was conducted on 67 MLNE patients requiring a lymph node biopsy for diagnosis at the Henan Provincial People's Hospital and the Fuwai Central China Cardiovascular Hospital in China, from January 2020 to December 2022. Each patient underwent endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA group) and EBUS-IFB-TLP (EBUS-IFB-TLP group) on the same mediastinal lymph node for biopsies. The operation time, diagnostic efficiency, and complication rates of the two biopsy methods were compared. Results: The number of diagnosed patients in the EBUS-IFB-TLP and the EBUS-TBNA groups was 65 (97.0%) and 57 (85.1%), respectively (p = 0.021). In the EBUS-IFB-TLP group, 28 cases (96.6%) were diagnosed with lung cancer and were classified into different epithelial types. In the EBUS-TBNA group, there were 27 cases (93.1%) diagnosed with lung cancer, of which 26 (89.7%) were classified into different epithelial types. There were 37 (97.4%) and 30 (78.9%) non-lung cancer patients diagnosed in the EBUS-IFB-TLP and EBUS-TBNA groups, respectively (p = 0.039), while 27 cases (96.4%) of sarcoidosis in the EBUS-IFB-TLP group and 20 cases (71.4%) of sarcoidosis in the EBUS-TBNA group were diagnosed (p = 0.016). The percentages of intraoperative mild to moderate bleeding complications were 23.9% (16/67) and 14.9% (10/67) in the EBUS-IFB-TLP and in the EBUS-TBNA groups, respectively (p = 0.109). Conclusion: This study demonstrated that EBUS-IFB-TLP could be a feasible and effective method in the diagnosis of patients with MLNE, presenting an analogous safety profile compared with EBUS-TBNA. Further studies are needed to verify the diagnostic performance of EBUS-IFB-TLP for MLNE. Plain language summary: A new way of obtaining a larger biopsy sample in patients with enlarged lymph nodes in the chest Why was the study done? Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) allows doctors to look at a patient's lungs using a tiny camera (called a bronchoscope). A needle is found at the tip of the bronchoscope and is used to take samples (biopsies) from the lymph nodes in the chest. Lymph nodes are small structures that help filter foreign substances in the body, for example cancer cells. The enlarged (big) lymph nodes are often caused by cancer. Researchers are still trying to work out how to obtain large samples from the lymph nodes which could lead to a better diagnosis. What did the researchers do? We explored a new method called endobronchial ultrasound-guided intranodal forceps biopsy based on transbronchial laser photoablation (EBUS-IFB-TLP) to be used in diagnosing patients who have enlarged lymph nodes. EBUS-IFB-TLP is performed under the guidance of endndobronchial ultrasound, the laser fiber is inserted through the bronchoscope to act on the airway wall, creating a hole in the target lymph node, a biopsy forcep was inserted into the lymph node through the biopsy hole. We used both methods on each patient in this study and compared them. What did the researchers find? More patients were diagnosed with enlarged lymph nodes when using the EBUS-IFB-TLP method, but there were milder to moderate bleeding complications. What do the findings mean? This study shows that EBUS-IFB-TLP could be use in the diagnosis of enlarged lymph nodes. [ABSTRACT FROM AUTHOR]

Background: Self-expandable metallic stents (SEMS) are increasingly used in the management of both malignant and nonmalignant airway stenosis. There are multiple stents available in the market; however, the current literature on the efficacy and safety of newly available 3rd generation SEMS (Bonastent) is extremely limited and only has data from single center studies. Objectives: To report the efficacy and early (<7 days) and late (⩾7 days) complications in patients with central airway obstruction (CAO) treated with Bonastent placement at two institutions. Design: We performed a retrospective analysis of data of consecutive patients who underwent therapeutic bronchoscopy and Bonastent placement at two tertiary care university hospitals between January 2019 and November 2023. Methods: Bonastent deployment was performed in the operating room. Stents were deployed using rigid or flexible bronchoscopy under direct visualization with a flexible bronchoscope and in conjunction with fluoroscopic guidance. We then analyzed the effectiveness, short-term, and long-term complications of Bonastent placement. Results: A total of 107 Bonastents® were placed in 96 patients. The most common etiology of CAO was malignancy, 92.7% (n = 89), followed by excessive dynamic airway collapse (EDAC) and post-intubation tracheal stenosis. Seventy-three patients (76%) had improvement in symptoms or imaging within 7 days of stent placement, including successful liberation from mechanical ventilation in a patient with CAO. Early complications occurred in seven patients (two-airway bleeding, two-mucus plugging that improved with airway clearance, two-stent migrations, and one-cough). Late complications occurred in 23 patients (1-stent migration requiring revision bronchoscopy and replacement of airway stent, 11-mucus plugging, 6-granulation tissue, 2-pneumonia, 1-cough, 1-tumor ingrowth/stent fracture, 1-airway emergency due to excessive granulation tissue obstructing the distal end of the stent and had a failed cricothyroidotomy leading to death). Overall, the early complication rate was 7.3% (7/96) and late complication rate was 23.9% (23/96). Conclusion: Our study is the first multicenter study that found a good safety profile with a low complication rate after tracheobronchial Bonastent placement with improvement in symptoms soon after stent placement. [ABSTRACT FROM AUTHOR]

As the demand for advanced bronchoscopic procedures increases, prolonged sedation with adequate oxygenation has become essential. Traditionally, these procedures require an anesthesiologist to provide (positive‐pressure or jet) ventilator support. However, recent innovations have enabled advanced bronchoscopy under high‐flow endotracheal oxygenation and deep sedation without these requirements. Following oropharyngeal lidocaine anaesthesia, deep sedation was induced using fentanyl and remimazolam. Thereafter lidocaine was instilled into the larynx, trachea, and main bronchi using a flexible bronchoscope with a spray catheter. Finally, either an uncuffed endotracheal tube (Case 1) or a rigid bronchoscope (Case 2) was inserted, and advanced bronchoscopic procedures, such as cryobiopsy and stent insertion, were successfully performed without a ventilator or an anesthesiologist. Our novel technique is expected to facilitate the easier and adequate performance of advanced high‐level bronchoscopic procedures by pulmonologists, even in resource‐limited settings. [ABSTRACT FROM AUTHOR]

Bleeding mitigation is an important part of any transbronchial lung cryobiopsy (TBLC) procedure, either for interstitial lung disease (ILD) or peripheral pulmonary lesions (PPL). The two‐scope technique has been previously described for ILD and PPL‐TBLC, but it has its own limitations and technical and logistical complexities. In this case series, we describe a modified two‐scope technique that enhances the conventional two‐scope technique by maintaining a small equipment footprint and longer bronchoscopic vision without the need for intra‐procedure switching of bronchoscopes. Three cases of PPLs were navigated by standard radial endobronchial ultrasound and biopsied with the 1.1 mm flexible ultrathin cryoprobe. All cases achieved a conclusive diagnosis with adequate specimens for immunohistochemical staining and molecular analysis; only Grade 1 bleeding reported in two cases. The challenges and limitations of this modified two‐scope technique were also explored in this series. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusion Healthcare systems contribute 5%–10% of the global carbon footprint. Given the detrimental impact of climate change on population health, health systems must seek to address this environmental responsibility. This is especially relevant in the modern era of minimally invasive procedures (MIP) where single‐use instruments are increasingly popular. We compared the environmental footprint of single‐use versus multi‐use instruments in MIP.We conducted a systematic review across five databases to identify relevant original studies, following the PRISMA guidelines. We extracted environmental impact data and performed a quality assessment of included studies.We included 13 studies published between 2005 and 2024. Eight employed Life Cycle Analysis (LCAs), which is the gold standard methodology for studies evaluating environmental impact. The instruments studied included laparoscopy systems, endoscopes, cystoscopes, bronchoscopes, duodenoscopes, and ureteroscopes. Six studies, including three high quality LCAs and one fair quality LCA, showed that single‐use instruments have a significantly higher environmental footprint than their multi‐use counterparts. Six studies suggested a lower environmental footprint for single‐use instruments, and one study presented comparable results. However, these studies were of poor/fair quality.Although our systematic review yielded mixed results, all high quality LCAs suggested multi‐use instruments may be more environmentally friendly than their single‐use counterparts. Our findings are limited by inter‐study heterogeneity and methodological quality. There is an urgent need for additional research employing gold standard methodologies to explore the interplay between environmental impact and operational factors such as workflow efficiency and cost‐benefit ratio to allow health systems to make more informed decisions. [ABSTRACT FROM AUTHOR]

Apparently, understanding airway management status may help to reduce risk and improve clinical practice. Given these facts, our team conducted a second survey on the current status of airway management for mainland China following our 2016 national airway survey. The national survey was conducted from November 7 to November 28, 2022. An electronic survey was sent to the New Youth Anesthesia Forum, where Chinese anesthesiologists completed the questionnaire via WeChat. A total of 3783 respondents completed the survey, with a response rate of 72.14%. So far, in 2022, 34.84% of anesthesiologists canceled or delayed surgery at least once due to difficult airway. For the anticipated difficult airway management, 66.11% of physicians would choose awake intubation under sedation and topical anesthesia, while the percentage seeking help has decreased compared to the 2016 survey. When encountering an emergency, 74.20% of respondents prefer to use the needle cricothyrotomy, albeit less than a quarter have actually performed it. Anesthesiologists with difficult airway training experience reached 72.96%, with a significant difference in participation between participants in Tier 3 hospitals and those in other levels of hospitals (P < 0.001). The videolaryngoscope, laryngeal mask, and flexible intubation scope were equipped at 97.18%, 95.96%, and 62.89%, respectively. Additionally, the percentage of brain damage or death caused by difficult airways was significantly decreased. The study may be the best reference for understanding the current status of airway management in China, revealing the current advancements and deficiencies. The future focus of airway management remains on training and education. [ABSTRACT FROM AUTHOR]

Difficult airway management represents a challenge. Guidelines recommend choosing the airway technique based on physicians' skills, equipment, available devices and context. A man with acute respiratory failure needed an emergent intubation. He was obese with Mallampati score 4, Cormack-Lehane grading 4, macroglossia, reducedmouth opening, stocky and wide neck, and deviated laryngotracheal axis due to expanding neck hematoma. After endotracheal intubation failure, the anesthetist placed a second-generation laryngeal mask airway and started ventilation. In the next step, definite airway was provided by an endotracheal tube placed through the mask under flexible fiberscope vision. Supraglottic airway devices are recommended in cases of unanticipated difficult intubation after endotracheal intubation failure. They are used to ensure satisfactory oxygenation and occasionally to guide the endotracheal tube. Fiberscope is useful to ensure vision of larynx and trachea in these scenarios. This is a unique case of emergency and difficult airway management using this combined approach. [ABSTRACT FROM AUTHOR]

A novel detachable bronchoscope with a 3D printed micro-transmission is investigated. The micro-transmission controls the motion of the tip of the bronchoscope and is embedded in one end of the flexible insertion section of the bronchoscope. The micro-transmission allows manipulation of the distal end through the translation of guide nuts that are connected to the tip of the bronchoscope through so-called "angulation" wires. The displacement of the guide nuts on the left and right-handed screw sections and the control of the distal end of the bronchoscope are investigated. The maximum tensile force on the angulation wire before failure is determined experimentally for different screw pitches. [ABSTRACT FROM AUTHOR]

Massive haemoptysis is a life‐threatening condition whose cause needs to be identified rapidly so that prompt interventions can ensue. Bronchial occlusion with endobronchial Watanabe spigots (EWSs) may be useful when endovascular treatment or surgery proves to be difficult. An 84‐year‐old woman developed massive haemoptysis during percutaneous mitral valve repair for refractory heart failure due to severe mitral regurgitation (MR). Interventional radiology (IVR) and surgery were contraindicated, and bronchial occlusion with EWSs was attempted to control bleeding. The bleeding was so persistent that it was difficult to secure the visual field without aspiration with a bronchoscope. Herein, we report a two‐scope technique, also used in cryobiopsy of peripheral lung lesions, to control bleeding and perform bronchial occlusion with EWSs. [ABSTRACT FROM AUTHOR]

Background and Objective: Next‐generation sequencing (NGS) analysis is considered standard for lung cancer diagnosis in clinical practice. Little is known about the feasibility of NGS using tumour tissue sampled with a 1.1 mm‐diameter cryoprobe. We aimed to investigate the suitability of specimens obtained by transbronchial cryobiopsy (TBC) using a 1.1 mm‐diameter cryoprobe for NGS analysis. Methods: Patients with lung cancer who underwent TBC using a 1.1 mm‐diameter cryoprobe for NGS testing between October 2020 and April 2023 were enrolled. A 4.0‐ or 3.0 mm‐diameter bronchoscope with radial probe endobronchial ultrasound and virtual bronchoscopic navigation was used to detect peripheral lung lesions. All procedures were performed under fluoroscopic guidance. Data were analysed retrospectively. Results: A total of 56 patients underwent TBC using a 1.1 mm cryoprobe for NGS testing, during the study period. Most patients (98%) were in the advanced stage of lung cancer (recurrent or inoperable disease of stages III or IV). The diagnostic yield of NGS for DNA and RNA sequencing was 95% each (53 of 56). Moderate bleeding was noted in three patients (5%) and none of the study patients developed life‐threatening complications, such as pneumothorax or lung infection. Conclusion: TBC using a 1.1 mm‐diameter cryoprobe is a useful and safe tool for NGS analysis, for both DNA and RNA sequencing. [ABSTRACT FROM AUTHOR]

This study aimed to establish an exposure method that can induce homogeneous lesions with minimal inter-individual variability. The distribution of lesions induced by bleomycin (BLM) administration was also analyzed. C57BL mice were intrabronchially administered 20 µL of BLM (3 mg/mL) using a bronchoscope in the left or right bronchus. The mice were sacrificed 14 days after administration, and their lungs were evaluated histopathologically. BLM-induced inflammatory lesions were widely observed in the lungs. In the left bronchus-treated group, lesions were uniformly observed throughout the lobe, and no individual differences were noted. Meanwhile, in the right bronchus-treated group, individual differences in the distribution of the pulmonary lesions were observed. The distribution of lesions differed among the four lobes of the right lung owing to their anatomical features. Administration into the left bronchus is recommended for highly homogeneous lung exposure and for establishing models that contribute to highly accurate toxicity and efficacy evaluations. [ABSTRACT FROM AUTHOR]

Background: Frequent repairs of pediatric flexible bronchoscopes can lead to a huge financial burden for the hospital. This study aimed to investigate the common causes of the failures in pediatric flexible bronchoscopes and propose the measures to prevent the failures. Methods: This was a retrospective study. We collected repair information of the pediatric flexible bronchoscopes reprocessed in the Department of Sterile Processing at a hospital between September 1, 2018 and September 1, 2022 in order to investigate the causes and possible factors associated with the failures in pediatric flexible bronchoscopes. Results: The Department of Sterile Processing staff reprocessed the pediatric flexible bronchoscopes 4280 times. A total of 29 failures were identified. The failure rate was 0.678%. The average repair cost was USD7246.60. The common failures in the pediatric flexible bronchoscopes included dim video image, black dots, improper video image display or no image during angulation adjustment, and pressure marks in the insertion tube. The failure rates in flexible electronic bronchoscopes and small-diameter flexible bronchoscopes were 65.5% and 93.1%, respectively. The failure rate in the pediatric flexible bronchoscopes reprocessed by the staff members with less work experience was 75.9%. Conclusion: The failure rate in the pediatric flexible bronchoscopes was not high but the repair costs were extremely high. The types and size of the flexible bronchoscopes and work experience of the staff members responsible for bronchoscope reprocessing were the possible factors associated with the failure rate in the pediatric flexible bronchoscopes. It is advisable to further optimize the central workflow and management mode for reprocessing the pediatric flexible bronchoscopes, thereby extending their useful life and reducing costs. [ABSTRACT FROM AUTHOR]

Background: Maxillofacial surgery patients frequently pose challenges to airway management due to anatomical and functional constraints. While fiber-optic-aided nasotracheal intubation is considered the gold standard, not all medical facilities have access to fiber-optic bronchoscopes, particularly in low-resource settings. In such situations, awake nasal tracheal intubation is often the safest approach for managing patients with known or suspected difficult airways. Aims and Objectives: (1) To assess the technique of capnography-assisted airway management by awake blind nasal intubation (ABNI) in maxillofacial surgeries. (2) To find out any complications encountered by the technique of capnography-assisted airway management by ABNI in maxillofacial surgeries. Materials and Methods: 40 patients undergoing various maxillofacial surgeries and in whom blind nasotracheal intubation was attempted were included in this study. The institutional ethical committee approved the study, and informed consent was obtained from all the patients. The number of attempts for ABNI, successful versus failed ABNI, and complications encountered were studied. SSPS 21.0 software was used for statistical analysis. Results: There were 23 (57.50%) males and 17 (42.50%) females. There was a male preponderance, with the M: F ratio being 1:0.73. The mean age of the patients was 40.97±8.92 years. In 36 (90%) of the patients, the intubation could be successfully done. In 19 (47.50%) patients, blind nasal intubation was successfully done in the first attempt; 2 attempts were required in 15 (37.50%) patients, and 3 attempts were required in 2 (5%) patients. Epistaxis (10%) and sore throats (7.5%) were the most common complications in the studied cases. Conclusion: Capnography-assisted ABNI is an effective technique for airway control in patients undergoing maxillofacial surgeries with an acceptable complication rate. [ABSTRACT FROM AUTHOR]

Supraglottic masses can be an anaesthesiologist's nightmare due to the difficult airway scenario and bleeding risk during airway manipulation. Awake fibreoptic intubation is the primary method to secure the airway in such cases. However, most practising anaesthesiologists are not experts at handling the fibreoptic scope, especially in cases with a floppy supraglottic mass where it becomes difficult to displace the mask with the thin flexible bronchoscope. A hybrid technique of intubation in supraglottic masses using Bonfils rigid scope and C-MAC is often described but frequently not available. Here we describe a case of an elderly patient in their 80s presenting with a floppy supraglottic mass where an awake fibreoptic bronchoscope failed to secure the airway. Without access to a rigid Bonfils scope, we intuitively used a C-MAC to visualize the larynx and a yankauer suction catheter to displace the mass and perform a bougie-guided endotracheal intubation. [ABSTRACT FROM AUTHOR]

The article provides a review of the year 2023 for the journal LUNG. The journal experienced growth and progress, with a rise in impact factor and strong numbers of article downloads. The field of cough was a focus, with articles covering various aspects of cough and antitussive drug development. Other topics covered in the journal included sarcoidosis, bronchiectasis, obstructive airways disease, lung cancer, COVID-19, pulmonary infectious diseases, lung transplantation, critical care, and preclinical and translational research. The editorial team is motivated to continue improving the journal and expanding its readership. [Extracted from the article]

The unequal distribution of medical resources and scarcity of experienced practitioners confine access to bronchoscopy primarily to well-equipped hospitals in developed regions, contributing to the unavailability of bronchoscopic services in underdeveloped areas. Here, we present an artificial intelligence (AI) co-pilot bronchoscope robot that empowers novice doctors to conduct lung examinations as safely and adeptly as experienced colleagues. The system features a user-friendly, plug-and-play catheter, devised for robot-assisted steering, facilitating access to bronchi beyond the fifth generation in average adult patients. Drawing upon historical bronchoscopic videos and expert imitation, our AI–human shared control algorithm enables novice doctors to achieve safe steering in the lung, mitigating misoperations. Both in vitro and in vivo results underscore that our system equips novice doctors with the skills to perform lung examinations as expertly as seasoned practitioners. This study offers innovative strategies to address the pressing issue of medical resource disparities through AI assistance. The unequal distribution of medical resources means that bronchoscopic services are often unavailable in underdeveloped areas. Here, the authors present an AI co-pilot bronchoscope robot that features a user-friendly plug-and-play catheter and an AI-human shared control algorithm, to enable novice doctors to conduct lung examinations safely. [ABSTRACT FROM AUTHOR]

Background: Pharyngeal flap (PF) is a commonly used surgical technique in the treatment of velopharyngeal insufficiency (VPI), but it still faces limitations that have not been overcome. The present study aims to objectively analyze the results of PF combined with velar muscle repair, which aimsto transform the static structure of PF into a dynamic one, addressing one of itslimitations. Patients and Methods: Patients were divided into two groups based on the surgical technique: Group 1: the traditional PF group and Group 2: PF with radical intravelar veloplasty (PF‑RIVVP) group. Acoustic evaluation of the velopharyngeal unit (VFU) and nasality level was conducted using a nasometry device during the preoperative period and at 1‑year postoperative follow‑up. Direct anatomical evaluation of the VFU was performed using a flexible fiberoptic endoscope. Student’s t‑test and Chi‑square test were used for statistical analysis. Results: The mean preoperative nasalance score was 56.5 ± 11.0 in Group 2 and 59.9 ± 10.3 in Group 1. The postoperative mean nasalance score was 29.2 ± 3.1 in Group 2 and 35.3 ± 3.1 in Group 1. Although no statistically significant difference was observed in the mean preoperative nasalance scores, a statistically significant difference wasfound in the postoperative scores(P < 0.001). Furthermore, nasopharyngoscopic evaluation revealed a superior velopharyngeal movement in Group 2. Conclusion: Through the objective evaluation techniques, the present study demonstrates that PF combined with velar muscle repair provides an enhanced velopharyngeal function in the treatment of VPI compared to the traditional technique. [ABSTRACT FROM AUTHOR]

The treatment of mediastinal tumor has always been a clinical difficulty due to its complex anatomical location and many important organs. Compared with traditional local treatment, endobronchial ultrasound guided laser multi)point ablation of mediastinal tumors has many advantages, including real-time monitoring of ablation range and effect, avoidance of damage to normal tissue and organs, few side effects and good tolerance. This article describes the standard operating procedure for endobronchial ultrasound guided laser multi-point ablation of mediastinal tumors. [ABSTRACT FROM AUTHOR]

Systemic application of effective antifungal drugs is the basic treatment for pulmonary mycosis, meanwhile, drug spraying under bronchoscope is one of the most important treatment options for tracheal, bronchial and pulmonary mycosis. Compared with bronchoscopic drug injection, indwelling guided drug injection cannula through nasal suspension with or without anchoring has more advantages in the treatment of pulmonary mycosis, including the ability to connect to a syringe pump for continuous and slow injection of drugs, which can avoid repeatedly performing bronchoscopy. This article describes the standard operating procedure of indwelling nasal cannula with or without anchoring for the treatment of pulmonary mycosis. [ABSTRACT FROM AUTHOR]

Background & Aims: Post-operative sore throat is one of the minor complications after general anaesthesia with endo tracheal intubation. Although short lasting and selflimiting, it creates an uncomfortable situation for patient. Diffusion of Nitrous Oxide (N20) into endotracheal tube (ETT) cuffs and increase intra cuff pressure causes this. Different inflating agents have been studied to see the incidence of intra cuff pressure changes. This study was performed to see the post extubation tracheal mucosal changes and post-operative sore throat after using N20 in Oxygen as ETT cuff with direct visualization of the tracheal mucosa just after tracheal extubation. Methods: Institutional ethical committee approval and informed written consent were obtained, 50 patients, undergoing elective surgery under general anaesthesia, were enrolled. Patients were randomly allocated in two groups of 25. In Group A, the ETT cuff was inflated with air, in Group B, cuff was inflated with 67% N, 0 in oxygen. The cuff pressure was kept around 30 cm H, 0 and was measured every 10 minutes. The condition of the trachea was seen using fibreoptic bronchoscope and a grading was done. All the data was collected & statistical analysis performed. Results: The frequencies of pain, difficulty in swallowing, and hoarseness of voice at the recovery room within the first two hours after anaesthesia were lowest in Group B than Group A and significantly reduced within 24 hours. Perioperatively cuff pressure change in group A was significantly high and in group B it was minimum. Bronchoscopic view of larynx and trachea showed 64 % normal. 22% was erythematous, 10% was oedematous in group B. In group A it was 28%, 46% and 24%. Conclusions: It is evident, that N, 0 in 0, filled ETT cuff reduces the incidence of postoperative sore throat. It is proposed that the difference was produced due to no or minimum diffusion of N, 0 in N, 0 with 0, filled ETT cuff, subsequently no significant intra cuff pressure changes per operatively. [ABSTRACT FROM AUTHOR]

Purpose: The process of infection by bacteria and viruses involves invasion, establishment, growth, and parasitization. Poor oral hygiene and dysbiosis are significant risk factors for pneumonia. The aim of this study was to evaluate bacterial transport into the trachea during intubation for orthopedic surgery and the impact of oral hygiene treatment. Methods: The study cohort included 53 patients with fracture who underwent surgical procedures under general anesthesia and were divided into two groups: an oral hygiene treatment (OHT) group (n = 27) and a control group (n = 26). Before intubation, the OHT group underwent preoperative oral hygiene treatment. Microbiological culture was used for detection and counting of bacteria from the oropharynx, trachea, and tip of the endotracheal tube (ETT). Results: Patients in the OHT group had a lower pathogen detection rate and lower degree of bacterial colonization in the oropharynx, trachea, and ETT tip. Conclusion: Preoperative oral hygiene treatment is able to reduce bacterial transport and colonization during orthopedic surgery, thus providing an important adjunct to pre-anesthesia care. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the effects on the dislocation and misalignment of the cuffed end of a double-lumen endobronchial tube (DLT) when a patient moves from a horizontal to a lateral position without fixation. A total of 148 patients who had undergone video-assisted thoracoscope surgery were enrolled and randomly divided into two groups: a group in which the periportal end of the DLT was fixed with tape (group I; n = 74) and a group in which the periportal end of the DLT remained unfixed (group II; n = 74). Both groups were given an intravenous induction for double-lumen endobronchial intubation and then moved from a horizontal position to a lateral position, after which the alignment of the bronchial cuffed end of the DLT was assessed using a fiberoptic bronchoscope. After lateral position, the dislocation rate of group I and group II was 44.6% and 20.2%, and the misalignment rate was 27.0% and 8.1%, respectively, the incidence of dislocation and misalignment was significantly lower in group II than in group I after the change to a lateral position (p < 0.05). After lateral position, the total rate of airway injury was 25.7% in group I and 5.4% in group II, the incidence of airway injury was significantly lower in group II than in group I (p < 0.05), as was the incidence of sore throat, hoarseness, and cough on postoperative day 1 (p < 0.05). The average outward dislocation of the periportal end of the DLT in group II was 1.5 cm. A DLT without periportal fixation is less likely to be displaced and poorly aligned when the patient moves from a horizontal to a lateral position, which could facilitate intra-operative management and reduce the incidence of postoperative complications. Through a randomized controlled trial, this study innovatively found that no double-lumen endobronchial tube (DLT) peripheral tape binding can prevent the dislocation and misalignment of the DLT bronchial cuffed end in patients undergoing thoracic surgery from horizontal to lateral position. [ABSTRACT FROM AUTHOR]

Background Endobronchial ultrasound (EBUS) is widely used to diagnose lung cancer. Monitored anesthesia care (MAC) can enhance patient comfort and procedural conditions during EBUS. EBUS under MAC is usually safe but can lead to various complications. Case A 34-year-old male who had increased sputum for two months showed an enlarged paratracheal lymph node and planned for lymph node biopsy by EBUS. During EBUS under MAC, an unexpected oxygen saturation decline required intervention. After intubation, copious frothy fluid was suctioned from the bronchi, and oxygenation was recovered. A narrowed trachea and the EBUS bronchoscope might have resulted in upper airway obstruction, and suction performed under these conditions might have caused pulmonary edema. The patient received non-invasive ventilation and high-flow nasal cannula and recovered without complications. Conclusions When there is an expected risk of upper airway obstruction during EBUS, careful preoperative evaluation and preparation are essential to prevent negative pressure pulmonary edema.

The article discusses the use of the supraglottic jet oxygenation and ventilation (SJOV) technique in airway management for various medical procedures. It has been found to be effective in preventing or treating hypoxia and hypoventilation, particularly in obese patients or at high altitudes. The technique has a high success rate and minimal side effects, making it valuable in non-operating room settings. Further research is needed to explore its potential use in emergency and critical medicine. The document provides a list of references that support the effectiveness and safety of the SJOV technique in improving oxygenation and ventilation during procedures such as bronchoscopy and gastrointestinal endoscopy. [Extracted from the article]

The article focuses on the evolution of bronchial blockers in anaesthesia, highlighting their role in lung isolation and ventilation during thoracic surgery. Topics include the historical development of bronchial blockade techniques, the shift from "side-by-side" placement to co-axial insertion with single-lumen endotracheal tubes, and a case report illustrating the continued relevance of "side-by-side" positioning in certain clinical scenarios.

Background Direct insertion of a double-lumen tube (DLT) using a flexible fiberoptic bronchoscope (FOB) is an option for DLT intubation. The difficult process of fiberoptic intubation is that the different properties of polyvinyl chloride and silicone DLTs may affect railroading differently. Therefore, we aimed to compare intubation using polyvinyl chloride and silicone DLTs over an FOB. Methods Patients aged 19–75 years who required one-lung ventilation under general anesthesia were enrolled in this study. After induction of anesthesia, the anesthesiologist intubated the DLT using FOB. The primary outcome was the difficulty of railroading over the flexible FOB scaled into five grades (I, II-1, II-2, III, and IV). Additionally, the intubation time and mucosal damage were recorded. Results A total of 46 patients participated in this study, 23 each in the silicone and polyvinyl groups. The difficulty of railroading over the FOB was significantly different between the two groups (P < 0.001). In the silicone group, the grades of difficulty in railroading were limited to I and II-1; 20 patients (87%) presented no difficulty in advancing the tube. In contrast, in the polyvinyl group, 13 patients (57%) had scores of II-2 and III. Both the intubation time and mucosal damage were significantly better in the silicone group than in the polyvinyl group. Conclusions Intubation using a silicone DLT over an FOB was easier and faster than that with a polyvinyl chloride DLT with lesser trauma around the glottis.

The occurrence of unexpected difficult airway management (DAM) during endotracheal intubation (ETI) attempts represents a life-threatening scenario. The management of such challenges may improve with training in simulated DAM scenarios. Moreover, simulation allows investigation at the potential value of new devices and techniques for DAM. The combined use of laryngoscopy with fiberoptic bronchoscope (CLBI) has been proposed in this regard, but its performance by novices facing DAM remain unexplored. We performed a randomized crossover simulation study evaluating the performance of ninety-six anesthesiology residents during ETI with four approaches: direct laryngoscopy (DL), Glidescope®, McGrath® and CLBI. Increased difficulty was produced by placement of a cervical collar. Residents had maximum of 3 attempts per device/technique (up to 60 seconds per attempt). The main outcomes were success rate (SR) and corrected time-to-intubation (cTTI, with 60 seconds added for each failed attempt). Subgroup analyses were performed separating residents according to their experience (junior, n = 60; senior, n = 36). The CLBI had significantly lower SR at both 1st and 3rd attempt (31% and 64%, respectively) as compared to DL (93% and 98%), Glidescope® (70% and 86%) and McGrath® (58% and 84%), with all p < 0.001. Moreover, CLBI had significantly longer cTTI (158.5 seconds; (54.3; 180)) than other devices: Glidescope® (37.6 seconds; (24.7; 88.2)), McGrath® (39.3 seconds; (20.6; 105.1)), and DL (19 seconds; (15.4; 27.2)), all p < 0.002. CLBI and McGrath® were the only approaches performing better in senior as compared to junior residents. In a DAM simulated setting, anesthesiology residents had lower SR and longer cTTI with the CLBI as compared to direct and video-laryngoscopy. [ABSTRACT FROM AUTHOR]

When health care management considers implementing a new technology such as a medical device, it is crucial to take workflow, clinical outcome, economy, and environmental impacts into consideration in the decision-making process. This study outlines the knowledge status of this complex challenge via a systematic literature review (SLR). The SLR found 133 of 1570 screened publications that covered relevant frameworks for choosing hospital equipment (i.e., related economics, life cycle assessment, waste generation and health issues). Yet, just five publications addressed choosing single-use vs. reuse of tubes or similar types of equipment by economic and environmental considerations through a systematic quantitative approach. The SLR reveals few publicly available peer-reviewed studies for the optimal sustainable choice of equipment. This study assesses environmental impacts of carbon dioxide (CO2) emissions as CO2-equivalents and resource consumption of a single-use double-lumen tube (DLT) combined with a reusable bronchoscope were compared to a single-use DLT with an integrated single-use camera. Camera DLTs exclude or minimize the need for a bronchoscope to verify correct tube placement during one-lung ventilation. The life cycle assessment shows that the materials and energy used and needed for personnel protective equipment and cleaning of the reusable bronchoscope contribute significantly to CO2-equivalent emissions. To ensure the sustainable choice of equipment this aspect must not be overlooked. Secondly, future reuse of plastic waste materials from the use can contribute significantly to better environmental performance. [ABSTRACT FROM AUTHOR]

Optimal material resource planning is crucial to run safe and cost-efficient hospital services. In this article, we investigate a real problem in hospitals, motivated by an environmental and economically inefficient use of disposable, single-use, endoscopes. We develop a mathematical model and create a decision support tool to determine when reusable, multi-use, bronchoscopes should be sent for inspection including information to what extent single-use bronchoscopes can cover the remaining demand. The results show that the proposed approach can contain operational costs which consist of costs for buying single-use devices, inspection costs and reprocessing costs, i.e., sterilization of reusable devices. Our tool can assist hospitals to predict when reusable bronchoscopes should undergo inspection and whether the current inventory of reusable devices is sufficient to cover the demand. Finally, we evaluate the impact of variation in demand on total costs. [ABSTRACT FROM AUTHOR]

We have developed a 0.97 mm diameter ultra-thin optical fiberscope that can access the peripheral lung fields of human lungs and evaluated this fiberscope in resected human lungs for evaluation of the peripheral airways including the alveoli. Keywords: alveolus; bronchoscopy; desiccator; peripheral airways; ultra-thin fiberscope EN alveolus bronchoscopy desiccator peripheral airways ultra-thin fiberscope 881 884 4 08/21/23 20230901 NES 230901 DATA AVAILABILITY STATEMENT The data that support the findings of this study are available from the corresponding author upon reasonable request. This ultra-thin fiberscope, called the Laser eYe Ultra-thin fiberscope (LYU), can access the peripheral lung field. Observation of peripheral airways using ultra-thin fiberscope. [Extracted from the article]

Hirayama disease is a rare neurological disorder, characterized by muscular atrophy of the distal upper extremities. The occurrence of spastic quadriparesis and autonomic dysfunction is rarely reported and has important perioperative considerations during cervical spine surgery for the treatment of this disorder. The role of the anesthesiologist is vital in the thorough assessment of the patient for the involvement of the pyramidal tract, autonomic dysfunction, gastroparesis, hyperreactive airway disease, and documentation of neurological deficits. Intraoperative concerns include safe manipulation of the airway during mask ventilation and the use of a flexible fibreoptic bronchoscope during endotracheal intubation to prevent neck flexion. It is also essential to avoid drugs, leading to histamine release. The use of multimodal monitoring including bispectral index and neuromuscular monitoring is crucial to prevent delayed recovery. Anticipation and management of exaggerated hypotension in response to anesthetic induction agents and prone position is the key to a successful outcome in patients with autonomic dysfunction. [ABSTRACT FROM AUTHOR]

The article discusses the importance of assessing facemask ventilation in anesthesia. The facemask is a crucial tool used to deliver anesthetic gases to patients, and it is often the first device used by an anesthesiologist. Proper facemask ventilation is essential for airway management and resuscitation. The article highlights various techniques and factors that can affect the effectiveness of facemask ventilation, including mask design, size, and the skill of the practitioner. The article suggests the need for standardized grading systems and further research to improve facemask ventilation techniques. [Extracted from the article]

Key message: Plastic bronchitis is characterized by sputum obstructing the bronchus and causing atelectasis. Bronchoscopic removal of the clogged bronchial cast is typically performed, but small‐diameter bronchoscopes with narrow suction ports cannot achieve adequate suction. Suction using a bronchoscope as a guide sheath may be effective for treating plastic bronchitis in children. [ABSTRACT FROM AUTHOR]

Background: Although fiberoptic-guided endotracheal intubation using a supraglottic airway device (SAD) is a good alternative for the management of difficult airways, its learning curve for residents has not been evaluated in pediatric patients. We aimed to train residents using a pediatric manikin and obtain learning curves to evaluate the efficiency of the training. Methods: We conducted a single-armed prospective study with anesthesiology residents. Plain endotracheal tube (ETT) intubation guided by a fiberoptic bronchoscope through Ambu® AuraGainTM was demonstrated in a pediatric manikin to the participants before training. The procedure was divided into four steps: SAD insertion, vocal cord identification, carina identification, and ETT insertion into the trachea. The results and elapsed procedure times of each trial were recorded. The learning curves for the participants were constructed and analyzed using the cumulative sum method. Results: All the 30 participants acquired proficiency at the end of practice between eight and 25 trials. The overall success rate for the procedure was 92.8%, and above 80% for all participants. Mean ± standard deviation procedure time was 71.3 ± 50.7 s. The 4th step accounted for 86.2% and 48.0% of the total failures and procedure time, respectively. The procedure time rapidly decreased in the 2nd trial; a modest decline was observed thereafter. Conclusions: Trainees can obtain proficiency for fiberoptic-guided intubation through SAD within 25 times when using pediatric manikin. Effect of the training on performance in actual clinical situation should be studied. [ABSTRACT FROM AUTHOR]

Pediatric respiratory emergencies of airway foreign body (FB) are a common cause of visits to the emergency department (ED) and respiratory failure is a major cause of cardiopulmonary arrest. The purpose of this study is to evaluate the literature and update our current understanding of pediatric respiratory tract FBs in children by clearly considering the aspect of the complications and related factors. A systematic search of PubMed and Embase yielded a total of 2035 studies related to the respiratory tract FB in children. After screening the abstracts, 118 articles were included for analysis. However, 56 articles were excluded due to the published data more than 10 years. Meanwhile, 6 articles were duplicated and 3 articles were the secondary data. Thus, 53 full text articles were assessed for eligibility. Then, 46 full text articles were excluded due to irrelevant contents. Finally, there were 7 qualitative articles in this systematic review. Most children with FBs in the aerodigestive tract are 1–3 years of age. Most FBs are organic, especially seeds. The most commonly obstructed airway is the right primary bronchus. The most common and severe complications are pneumonia, pulmonary atelectasis, lung consolidation, pneumothorax, bronchiectasis, and death. The main device for the removal of FBs from the airways is a rigid bronchoscope. Duration of diagnosis is major factors that related with severe complication. FBs obstructive conditions in respiratory tract of children are serious and life-threatening conditions. The likelihood of death depends on the location of the obstruction, the nature of FB, time to removal, and initial resuscitation. Moreover, even after a FB has been removed, complications can lead to death. Educating parents and immediate treatment is very important. Rapid diagnosis is important factor to prevent complication. [ABSTRACT FROM AUTHOR]

Cholangioscopy remains a key tool for the assessment of clearance of the biliary system in the management of hepatolithiasis either in laparoscopic or open common bile duct exploration. A fiber optic bronchoscope (Ambu® aScope™ 2, Ambu UK Ltd, Cambridgeshire, UK), from the anesthesia cart, can be utilized in place of a specific choledochoscope for the same. A middle-aged male patient was planned for open common bile duct exploration and bilioenteric anastomosis for choledocholithiasis and hepatolithiasis, not amenable for endoscopic clearance. After choledochotomy and stone clearance, a sterile pediatric fiber optic bronchoscope, selected from the anesthesia cart, was utilized as a choledochoscope for intraoperative cholangioscopy and complete stone clearance was assured. The biliary system was explored up to tertiary biliary radicals as well as distal common bile duct up to the duodenum. Bilioenteric anastomosis was done after assurance of complete stone clearance. The patient was discharged on postoperative day 4. Fiber optic bronchoscope can be used for intraoperative cholangioscopy as a makeshift choledochoscope as good resource utilization with minimal logistic issues. [ABSTRACT FROM AUTHOR]

Background: Endotracheal intubation with a flexible bronchoscope is a well-recognized airway management technique that anesthesiologists must master. Skill acquisition and knowledge must reach an appropriate level before trainees perform independent practice on patients. There are a paucity of evidence-based outcome measures of trainee competence in performing flexible bronchoscopy. The objectives of this study were to 1) construct a learning curve for flexible bronchoscope-guided orotracheal intubation for anesthesiology residents using the CUSUM method and 2) determine the number of procedures required to achieve proficiency. Methods: This study included 12 first-year anesthesiology residents with no previous experience with flexible bronchoscopic intubation. Trainees attended theoretical and simulation training and performed flexible bronchoscope-guided orotracheal intubation in adult patients with normal airways under general anesthesia. Number of intubation attempts, intubation success rate, time to intubation, and incidence of dental and mucosal injuries were recorded. The cumulative sum (CUSUM) method was used to evaluate the learning curve of flexible bronchoscope-guided orotracheal intubation. Results: Trainees performed flexible bronchoscope-guided orotracheal intubation on 364 patients. First-attempt intubation success occurred in 317 (87.1%) patients. Second-attempt intubation success occurred in 23 (6.3%) patients. Overall, the flexible bronchoscope-guided orotracheal intubation success rate was 93.4% (range, 85.3% to 100%). The mean number of orotracheal intubation procedures per trainee was 31 ± 5 (range, 23 to 40). All trainees crossed the lower decision boundary (H0) after 15.1 ± 5.6 procedures (range, 8 to 25 procedures). There was a significant decrease in median intubation time [39s (IQR: 30, 50) vs. 76s (IQR: 54, 119)] (P < 0.001) after crossing the lower decision boundary (H0) compared to before. There were no dental, mucosa, arytenoid or vocal cord trauma events associated with intubation. Conclusions: Learning curves constructed with CUSUM analysis showed that all trainees (anesthesiologist residents) included in this study achieved competence (intubation success rates ≥ 80%) in flexible bronchoscope-guided orotracheal intubation. Trainees needed to perform 15 (range, 8 to 25) procedures to achieve proficiency. There was wide variability between trainees. Trial registration: Trial registration: Chinese Clinical Trial Register, ChiCTR 2000032166. [ABSTRACT FROM AUTHOR]

Objectives: The regulatory role of integrin β4 (ITGB4) in asthmatic children infected with Mycoplasma pneumoniae (MP) was analyzed, and its potential molecular mechanisms and function were studied.Methods: We collected epidemiological data from 70,455 asthmatic children. The immunofluorescence assay was used to test 9 index IgMs against respiratory tract pathogens for 736 serum samples. Then, 98 children with severe asthma were treated via fiberoptic bronchoscope examination. During the surgery, the patients' lavage fluid was collected. Additionally, differences in transforming growth factor-beta (TGF-β) expression between the MP-infected and noninfected groups were examined. Experiments were performed using white blood cell counting methods and flow cytometry for 98 asthmatic children.Results: We tested 736 specimens, and the percentages of MP, RSV, and ADV infections were 50.27%, 11.68%, and 10.05%, respectively. The percentage of eosinophils was increased significantly in the AS-I-MP group, and their TGF-β expression levels were increased, which was related to tissue fibrosis. Furthermore, MP infection exacerbated the decreasing trend of ITGB4 expression in patients' blood compared with the noninfected group.Conclusions: There might be a chain reaction from MP infection to an increase in ITGB4, a decrease in TGF-β, a large accumulation of eosinophils and the development of asthma in children. [ABSTRACT FROM AUTHOR]

Simulators aid airway training and also familiarization with new devices and techniques. Direct laryngoscopy (DL) is the most used method for endotracheal intubation (ETI), followed by video-laryngoscopy (VLS). The combined use of laryngoscopy with fiberoptic bronchoscope (combined laryngo-bronchoscope intubation, CLBI) has been proposed but its performances in novices and the best timing for introduction during training remain not explored. We performed a randomized, crossover study evaluating the CLBI approach in simulated normal airway scenario. Ninety-six anesthesia residents performed ETI with four approaches: DL, Glidescope®, McGrath® and CLBI. Residents were allowed maximum 3 attempts (up to 60 seconds each). Main outcomes were success rate (SR) and time-to-intubation corrected for SR (cTTI). Subgroup analysis was performed separating residents according to their experience (junior, n = 60; senior, n = 36). At first attempt, DL had higher SR (97%) than CLBI (50%, p < 0.001), Glidescope® (84%, p = 0.01) and McGrath® (67%, p < 0.001). After 3 attempts, ETI failure was higher for CLBI (19%) than with Glidescope® (2%, p < 0.001) or DL (1%, p < 0.001). CLBI showed longer cTTI (72(112) sec) than other devices (all p < 0.001: Glidescope® 25(23) sec, McGrath® 30(67) sec, DL 15(9) sec). The CLBI was the only approach performing better in senior as compared to junior residents (p = 0.03). In a normal airway simulation scenario, anesthesiology residents had lower SR and longer cTTI with CLBI technique as compared to DL and VLS. Our results suggest that CLBI could be introduced at senior stage of training, after DL and fiberoptic bronchoscope skills have been consolidated. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to perform a systematic review, meta-analysis and cost-consequence analysis of the single-use bronchoscope, Ambu aScopeTM 5 Broncho, in relation to reusable flexible bronchoscopes (RFB) available within three high procedure volume university hospitals and academic institutions in the USA. Methods: The primary outcome was incremental cost and the secondary outcome was incremental cross-infection risk of use for both the single-use flexible bronchoscope (SUFB) and RFBs. Cost estimates included capital, repair, and reprocessing costs derived from a prospective observational micro-costing approach within three large university hospitals and academic institutions. All costs were valued in 2022 US dollars (USD). A meta-analysis based on literature covering cross-contamination and infection from 2010 to 2020 investigated cross-infection risk following bronchoscopy procedures with RFBs. Capital costs were discounted at 3% over 5–8 years. All parameters were evaluated using both univariate deterministic and probabilistic sensitivity analyses. Results: In high-volume hospitals, RFBs were cost minimizing compared to SUFBs. Probabilistic sensitivity analysis showed that RFBs were cost saving in 88% of iterations. Univariate analyses illustrated sensitivity of the base-case result to the procedure volume. Data from sensitivity analyses suggest that the two interventions are cost neutral at a break-even point of 756 procedures per year or 46 procedures per bronchoscope per year. Conclusion: Assuming equivalent clinical performance, single-use flexible bronchoscopes are not cost minimizing when including the costs associated with cross-infection in high-volume US university hospitals and academic institutions. Overall, the benefits of conversion from RFBs to SUFBs are dependent on the annual procedure volume of individual hospitals, expected cross-infection risk, and purchase price of the aScope 5 Broncho. [ABSTRACT FROM AUTHOR]

Physicians use an endoscopic navigation system during bronchoscopy to decrease the risk of getting lost in complex tree-structure like bronchus. Most existing navigation systems based on the camera pose estimated from bronchoscope tracking and/or deep learning. However, bronchoscope tracking-based method exists tracking error, and the pre-training of the model needs massive data. This paper describes an improved bronchoscope tracking procedure by adopting image domain translation technique to improve tracking performance. Specifically, our scheme consists of three modules, an RGB-D image domain translation module, an anatomical structure classification module and a structure-aware bronchoscope tracking module. The RGB-D image domain translation module translates a real bronchoscope (RB) image to its corresponding virtual bronchoscope image and depth image. The anatomical dependency module classifies the current scene into two categories: structureless and rich structure. The bronchoscope tracking module uses a modified video-CT bronchoscope tracking approach to estimate camera pose. Experimental results showed that the proposed method achieved higher tracking accuracy than the current state-of-the-art bronchoscope tracking methods. [ABSTRACT FROM AUTHOR]

We propose a spatio-temporal mixing kinematic data estimation method to estimate the shape of the colon with deformations caused by colonoscope insertion. Endoscope tracking or a navigation system that navigates physicians to target positions is needed to reduce such complications as organ perforations. Although many previous methods focused to track bronchoscopes and surgical endoscopes, few number of colonoscope tracking methods were proposed because the colon largely deforms during colonoscope insertion. The deformation causes significant tracking errors. Colon deformation should be considered in the tracking process. We propose a colon shape estimation method using a Kinematic Spatio-Temporal data Mixer (KST-Mixer) that can be used during colonoscope insertions to the colon. Kinematic data of a colonoscope and the colon, including positions and directions of their centerlines, are obtained using electromagnetic and depth sensors. The proposed method separates the data into sub-groups along the spatial and temporal axes. The KST-Mixer extracts kinematic features and mix them along the axes multiple times. We evaluated colon shape estimation accuracies in phantom studies. The proposed method achieved 11.92 mm mean Euclidean distance error, the smallest of the previous methods. Statistical analysis indicated that the proposed method significantly reduced the error compared to the previous methods. [ABSTRACT FROM AUTHOR]

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Background: Although transbronchial diagnostic procedures are sometimes difficult to perform because of the patient's respiratory or general conditions, endoscopic ultrasound with bronchoscope-guided fine-needle aspiration (EUS-B-FNA), a known transesophageal diagnostic procedure, might be useful for such cases. We conducted this prospective three-center observational study to evaluate the safety and efficacy of EUS-B-FNA in suspected lung cancer patients with poor respiratory or general conditions. Methods: Patients with suspected lung cancer with respiratory failure, Eastern Cooperative Oncology Group performance status of 2 or higher, or severe respiratory symptoms, were enrolled. The primary endpoints were the diagnostic yield of lung cancer and its safety, and the secondary endpoints were the success rate of molecular and programmed death ligand 1 (PD-L1) analyses, and the 6-month survival rate in patients with lung cancer. Results: We enrolled 30 patients, of which 29 were included in the analysis. Among them, 26 were eventually diagnosed with lung cancer. The diagnostic yield for lung cancer was 100% (26/26). There were no adverse events associated with EUS-B-FNA requiring procedure discontinuation. The success rates of molecular analysis for EGFR, ALK, ROS-1, and BRAF were 100% (14/14), 100% (11/11), 100% (9/9), and 75% (6/8), respectively. The success rate of the PD-L1 analysis was 100% (15/15). The 6-month survival rate in patients with lung cancer was 53.8% (95% confidence interval [CI]: 33.4–76.4), and the median overall survival (OS) was 196 days (95% CI: 142–446). Conclusions: EUS-B-FNA is a safe and effective diagnostic method, even in patients with suspected lung cancer with poor respiratory or general conditions. Trial registration: This clinical trial was registered at https://www.umin.ac.jp/ctr/index.htm (UMIN000041235, approved on 28/07/2020). [ABSTRACT FROM AUTHOR]

Background: Hajdu-Cheney syndrome (HCS) is an extremely rare disorder characterized by progressive acro-osteolysis. A unique facial structure and deformity of the cervical spine are associated with a difficult airway. Although several reports describe general anesthesia with orotracheal intubation for patients with HCS, there have been no reports of nasotracheal intubation with a risk of skull base fracture. We describe nasotracheal intubation for oral surgery in a patient with HCS. Case presentation: A 13-year-old girl with HCS was scheduled for dental surgery. Preoperative computed tomography revealed no abnormalities including fractures in the skull base or cervical spine. After confirming a lack of vocal cord paralysis by bronchofiberscopic inspection from the nose, general anesthesia was induced with sevoflurane, remifentanil, and rocuronium. Fiber-optic nasotracheal intubation was successfully performed without complications such as depletion of oxygen saturation and massive epistaxis, and the surgery was completed uneventfully. She was discharged the day after surgery with no anesthesia-related complications. Conclusions: We were able to safely manage the airway of a patient with HCS by nasotracheal intubation under general anesthesia. [ABSTRACT FROM AUTHOR]

Background: Data regarding the risk of infection related to reusable bronchoscopes, the global drive toward disposable technology and the COVID-19 pandemic have led to an increase in the use and production of single use or disposable bronchoscopes. An in-depth comparison of all available devices has not been published. Methods: A benchtop comparison of the Ambu®aScopeTM, Boston Scientific® EXALTTM Model B, the Surgical Company Broncoflex© Vortex, Pentax® Medical ONE Pulmo™, and Vathin® H-SteriscopeTM (all 2.8 mm inner dimension other than the Pentax single-use flexible bronchoscope (3 mm)) was undertaken including measurement of maximal flexion and extension angles, thumb force required and suction with and without biopsy forceps. Thereafter, preclinical assessment was performed with data collected including experience, gender, hand size, and scope preference. Results: The Vathin single-use flexible bronchoscope had the biggest range of tip movement from flexion to extension with and without forceps. The Boston single-use flexible bronchoscope required the maximal thumb force but had the least reduction of tip movement with forceps. The Boston single-use flexible bronchoscope significantly outperformed all other scopes including the standard Pentax scope and was the only scope capable of suctioning pseudo-mucus around the forceps. Although there was no significant difference in preference in the overall group, females and those with smaller hand size preferred the Pentax and males the Broncoflex single-use flexible bronchoscope. Conclusions: Currently available single-use flexible bronchoscopes differ in several factors other than scope sizes and monitor including suction, turning envelope, and handle size. Performance in the clinical setting will be key to their success. [ABSTRACT FROM AUTHOR]