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The aim of this study was to observe the effect of nasal high-flow humidification oxygen therapy on choking reactions and related respiratory and hemodynamic effects in elderly patients undergoing fiberoptic bronchoscopy.

Abstract Objective To review and analyze the airway and anesthesia management methods for patients who underwent endoscopic closure of tracheoesophageal fistula (TEF) and to summarize the experience of intraoperative airway management. Method We searched the anesthesia information system of the First Affiliated Hospital of Nanjing Medical University for anesthesia cases of TEF from July 2020 to July 2023 and obtained a total of 34 anesthesia records for endoscopic TEF occlusion. The intraoperative airway management methods and vital signs were recorded, and the patients’ disease course and follow-up records were analyzed and summarized. Results The airway management strategies used for TEF occlusion patients included nasal catheter oxygen (NCO, n = 5), high-flow nasal cannula oxygen therapy (HFNC, n = 4) and tracheal intubation (TI, n = 25). The patients who underwent tracheal intubation with an inner diameter of 5.5 mm had stable hemodynamics and oxygenation status during surgery, while intravenous anesthesia without intubation could not effectively inhibit the stress response caused by occluder implantation, which could easily cause hemodynamic fluctuations, hypoxemia, and carbon dioxide accumulation. Compared with those in the TI group, the NCO group and the HFNC group had significantly longer surgical times, and the satisfaction score of the endoscopists was significantly lower. In addition, two patients in the NCO group experienced postoperative hypoxemia. Conclusion During the anesthesia process for TEF occlusions, a tracheal catheter with an inner diameter of 5.5 mm can provide a safe and effective airway management method.

Objective: To review and analyze the airway and anesthesia management methods for patients who underwent endoscopic closure of tracheoesophageal fistula (TEF) and to summarize the experience of intraoperative airway management. Method: We searched the anesthesia information system of the First Affiliated Hospital of Nanjing Medical University for anesthesia cases of TEF from July 2020 to July 2023 and obtained a total of 34 anesthesia records for endoscopic TEF occlusion. The intraoperative airway management methods and vital signs were recorded, and the patients' disease course and follow-up records were analyzed and summarized. Results: The airway management strategies used for TEF occlusion patients included nasal catheter oxygen (NCO, n = 5), high-flow nasal cannula oxygen therapy (HFNC, n = 4) and tracheal intubation (TI, n = 25). The patients who underwent tracheal intubation with an inner diameter of 5.5 mm had stable hemodynamics and oxygenation status during surgery, while intravenous anesthesia without intubation could not effectively inhibit the stress response caused by occluder implantation, which could easily cause hemodynamic fluctuations, hypoxemia, and carbon dioxide accumulation. Compared with those in the TI group, the NCO group and the HFNC group had significantly longer surgical times, and the satisfaction score of the endoscopists was significantly lower. In addition, two patients in the NCO group experienced postoperative hypoxemia. Conclusion: During the anesthesia process for TEF occlusions, a tracheal catheter with an inner diameter of 5.5 mm can provide a safe and effective airway management method. [ABSTRACT FROM AUTHOR]

Abstract Background This study aims to investigate the outcomes of patients who received early fiberoptic bronchoscopic sputum aspiration and lavage after thoracoscopic and laparoscopic esophagectomy due to esophageal cancer. Methods A prospective randomized clinical trial was performed between March 2020 and June 2022. Patients who were scheduled for thoracoscopic and laparoscopic esophagectomy due to esophageal cancer were enrolled. Then, these patients were assigned to the control group (traditional postoperative care) and study group (traditional postoperative care with early bronchoscopic sputum aspiration and lavage). The outcomes, which included the length of hospital stay and medical expenses, and postoperative complications, which included pulmonary infection, atelectasis, respiratory dysfunction and anastomotic leakage, were compared between these two groups. Results A total of 106 patients were enrolled for the present study, and 53 patients were assigned for the control and study groups. There were no statistically significant differences in gender, age, and location of the esophageal cancer between the two groups. Furthermore, the length of hospital stay was statistically significantly shorter and the medical expenses were lower during hospitalization in the study group, when compared to the control group (12.3 ± 1.2 vs. 18.8 ± 1.3 days, 5.5 ± 0.9 vs. 7.2 ± 1.2 Chinese Yuan, respectively; all, P

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]

Background: This study aims to investigate the outcomes of patients who received early fiberoptic bronchoscopic sputum aspiration and lavage after thoracoscopic and laparoscopic esophagectomy due to esophageal cancer. Methods: A prospective randomized clinical trial was performed between March 2020 and June 2022. Patients who were scheduled for thoracoscopic and laparoscopic esophagectomy due to esophageal cancer were enrolled. Then, these patients were assigned to the control group (traditional postoperative care) and study group (traditional postoperative care with early bronchoscopic sputum aspiration and lavage). The outcomes, which included the length of hospital stay and medical expenses, and postoperative complications, which included pulmonary infection, atelectasis, respiratory dysfunction and anastomotic leakage, were compared between these two groups. Results: A total of 106 patients were enrolled for the present study, and 53 patients were assigned for the control and study groups. There were no statistically significant differences in gender, age, and location of the esophageal cancer between the two groups. Furthermore, the length of hospital stay was statistically significantly shorter and the medical expenses were lower during hospitalization in the study group, when compared to the control group (12.3 ± 1.2 vs. 18.8 ± 1.3 days, 5.5 ± 0.9 vs. 7.2 ± 1.2 Chinese Yuan, respectively; all, P < 0.05). Moreover, there were statistically significantly fewer incidences of overall complications in study group, when compared to the control group (20.7% vs.45.2%, P < 0.05). Conclusions: For patients with esophageal cancer, early fiberoptic bronchoscopic sputum aspiration and lavage after thoracoscopic and laparoscopic esophagectomy can shorten the length of hospital stay, and lower the medical expense and incidence of postoperative complications. [ABSTRACT FROM AUTHOR]

Abstract Background Fiberoptic bronchoscopy (FOB) and bronchoscopic biopsy are the established methods for diagnosing and treating sputum crust. However, sputum crust in concealed locations can sometimes be missed or undiagnosed, even with bronchoscopy. Case presentation We present the case of a 44-year-old female patient who experienced initial extubation failure and postoperative pulmonary complications (PPCs) due to the missed diagnosis of sputum crust by FOB and low-resolution bedside chest X-ray. The FOB examination showed no apparent abnormalities prior to the first extubation, and the patient underwent tracheal extubation 2 h after aortic valve replacement (AVR). However, she was reintubated 13 h after the first extubation due to a persistent irritating cough and severe hypoxemia, and a bedside chest radiograph revealed pneumonia and atelectasis. Upon performing a repeat FOB examination prior to the second extubation, we serendipitously discovered the presence of sputum crust at the end of the endotracheal tube. Subsequently, we found that the sputum crust was mainly located on the tracheal wall between the subglottis and the end of the endotracheal tube during the “Tracheobronchial Sputum Crust Removal” procedure, and most of the crust was obscured by the retained endotracheal tube. The patient was discharged on the 20th day following therapeutic FOB. Conclusion FOB examination may miss specific areas in endotracheal intubation (ETI) patients, particularly the tracheal wall between the subglottis and distal end of the tracheal catheter, where sputum crust can be concealed. When diagnostic examinations with FOB are inconclusive, high-resolution chest CT can be helpful in identifying hidden sputum crust.

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]

Background: Fiberoptic bronchoscopy (FOB) and bronchoscopic biopsy are the established methods for diagnosing and treating sputum crust. However, sputum crust in concealed locations can sometimes be missed or undiagnosed, even with bronchoscopy. Case presentation: We present the case of a 44-year-old female patient who experienced initial extubation failure and postoperative pulmonary complications (PPCs) due to the missed diagnosis of sputum crust by FOB and low-resolution bedside chest X-ray. The FOB examination showed no apparent abnormalities prior to the first extubation, and the patient underwent tracheal extubation 2 h after aortic valve replacement (AVR). However, she was reintubated 13 h after the first extubation due to a persistent irritating cough and severe hypoxemia, and a bedside chest radiograph revealed pneumonia and atelectasis. Upon performing a repeat FOB examination prior to the second extubation, we serendipitously discovered the presence of sputum crust at the end of the endotracheal tube. Subsequently, we found that the sputum crust was mainly located on the tracheal wall between the subglottis and the end of the endotracheal tube during the "Tracheobronchial Sputum Crust Removal" procedure, and most of the crust was obscured by the retained endotracheal tube. The patient was discharged on the 20th day following therapeutic FOB. Conclusion: FOB examination may miss specific areas in endotracheal intubation (ETI) patients, particularly the tracheal wall between the subglottis and distal end of the tracheal catheter, where sputum crust can be concealed. When diagnostic examinations with FOB are inconclusive, high-resolution chest CT can be helpful in identifying hidden sputum crust. [ABSTRACT FROM AUTHOR]

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Summary: Objective: To explore the therapeutic effect of systemic administration combined with microwave ablation (MWA) under computed tomography (CT) and fiberoptic bronchoscope for treating lung cancer. Methods: Sixty-six patients with advanced lung cancer admitted to our hospital from February 2019 to February 2020 were collected and divided into control group and experimental group with 33 patients in each group. The control group was treated with systemic administration, and the experimental group was treated with systemic administration combined with MWA under CT and fiberoptic bronchoscope. Overall response rate (ORR), adverse events (AEs) during treatment, and survival analysis were used to evaluate the curative effect of lung cancer treatment in each group. Results: MWA under CT and fiberoptic bronchoscope could safely remove the cancerous tissues by point burning without destroying the adjacent normal tissues with high success rate. The ORR of the control group was 24.4%, and that of the experimental group was 63.6%, which was better than the control group. The AEs occurred during treatment in each group were of level 1 or level 2, and no serious life-threatening AEs occurred. Progression-free survival (PFS) time and overall survival (OS) time in the experimental group were both longer than those in the control group. Patients treated with MWA had a lower risk of disease progression and death than those treated with systemic administration alone. Conclusion: The treatment of lung cancer using systemic administration combined with MWA under CT and fiberoptic bronchoscope is more effective than using systemic administration alone, which can be promoted in clinical treatment.

Abstract Background Flexible scope intubation is an important airway management skill that requires hands-on training in a real airway. We compared flexible scope intubation by trainees between patients in the left lateral and supine positions. Methods Forty patients aged 20 to 80 years with American Society of Anesthesiologists physical status class I to III were scheduled for elective surgery under general endotracheal anesthesia in Ramathibodi Hospital from February 2020 to June 2020. Patients were randomly assigned to be intubated in one of two positions: supine (Group S) or left lateral (Group L). Trainees performed flexible scope intubation in sedated patients under the supervision of an attending anesthesiologist. Intubation success, time to successful intubation, number of attempts, airway adjustment maneuvers, and hemodynamic changes were compared between groups. Results Patient characteristics did not differ between groups except for Mallampati airway classification. The rate of successful intubation on the first attempt and intubation time did not significantly differ between groups. The proportion of patients who required a jaw thrust during intubation was significantly lower in Group L (10.5% vs. 85%; P

Background : Lung recruitment techniques are employed to help in improvement of pulmonary mechanics, facilitate early weaning, and shorten the duration of mechanical ventilation. We are reporting a novel lung recruitment technique employed in four children with left lung atelectasis, who underwent corrective surgery for congenital heart disease. Materials and Methods : From January 2020 to March 2021, four pediatric cardiac patients having left lung atelectasis, undergoing corrective surgery were subjected to lung recruitment technique and had elective endobronchial intubation and suctioning with chest physiotherapy in the form of vibration and percussion. This was done along with intermittent ventilation with 100% oxygen. Results : Successful recruitment of lung segments and clearance of atelectasis were confirmed by auscultation and chest X-ray in all four patients. All the cases were successfully weaned off the ventilator within 24–48 h. One patient had an opposite lung collapse after extubation, which was managed conservatively with chest physiotherapy. Another patient had bradycardia and desaturation during the procedure, which was improved after withdrawing the tube and instituting two lung ventilation with 100% oxygen. Conclusions : This novel lung recruitment technique helps in recruitment of collapsed lung segments and thus helps in early weaning and shortens the duration of mechanical ventilation.

Abstract Background Management of the airway and ventilation in neonates with a tracheoesophageal fistula (TEF) remains a significant challenge. The routine method of intubation involves placement of the tracheal tube tip beyond the fistula opening followed by isolation of the fistula from ventilation using the inflated cuff. When the fistula opening is close to the carina or below the level of the carina, the traditional technique is not suitable for adequate ventilation. Moreover, this method fails to prevent gastric insufflation. Case presentation We herein report a series of 10 newborns with TEFs (1,090–3,080 g) who underwent bronchoscopic insertion of a 5-Fr balloon-tipped bronchial blocker (BTBB) for temporary occlusion of the fistula. In seven newborns, placement of the BTBB was easily and quickly achieved with no incorrect placements. In addition, we successfully utilized the inner hollow cavity of the BTBB for gastric decompression in six neonates with severe gastric distension. However, three failed placements occurred in premature infants (

A GlideScope® and a flexible fiberoptic bronchoscope (FOB) were successfully used in combination, to intubate a 73- year-old female patient in which repeated previous intubation attempts with conventional laryngoscope had failed. GlideScope®, and FOB were used sequentially. She had been scheduled for an elective total thyroidectomy to remove a huge retrosternal goiter. A computed tomography (CT) scan revealed a large necrotic mass (measuring 10 x 16 cm) with heterogeneous enhancement involving the thyroid gland and extending to the anterior mediastinum, causing significant tracheal compression and left deviation. Endotracheal intubation was successfully performed while she was awake using a combination of GlideScope and FOB. The operation lasted for two hours and was uneventful. The patient was then transferred to the intensive care unit (ICU) and kept intubated, sedated, and mechanically ventilated overnight. She was awakened and extubated the following day with no airway complications. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To probe into the treatment efficacy of fiberoptic bronchoalveolar lavage combined with azithromycin in children with Mycoplasma pneumoniae pneumonia. METHODS: A total of 130 children with M. pneumoniae pneumonia admitted into Nanchong Central Hospital from Oct. 2019 to Oct. 2021 were selected to be divided into the observation group and the control group via the random number table, with 65 cases in each group. The control group was treated with azithromycin, while the observation group received fiberoptic bronchoalveolar lavage combined with azithromycin. The clinical efficacy, treatment cost, pulmonary ventilation function indicators [tidal volume (TV), vital capacity (VC), total lung capacity (TLC) and maximal expiratory flow (MEF) ], inflammatory factors [monocyte chemoattractant protein 4 (McP-4), mitogen-activated protein kinase (MAPK) and cysteine leukotriene receptor 1 (CysLTR1)], immune function indicators (CD3+, CD4+, CD8+ and CD4+ / CD8+ ), treatment safety and other indicators were comprehensively evaluated in two groups. RESULTS: The total effective rate in the observation group was 92. 31% ( 60 /65), higher than 78. 46% (51 /65) in the control group, with statistically significant difference ( P < 0. 05). The treatment cost of the observation group was lower than that of the control group, the difference was statistically significant (P<0. 05). After treatment, the levels of TV, VC, TLC and MEF in the observation group were higher than those in the control group, and the levels of MCP-4, MAPK and CysLTR1 were lower than those in the control group, with statistically significant difference (P<0. 05). After treatment, the levels of CD3+, CD4+ and CD4+ / CD8+ in the observation group were higher than those in the control group, and the level of CD8+ was lower than that in the control group, with statistically significant difference (P<0. 05). During the treatment, the incidence of adverse drug reactions in the observation group and the control group was respectively 12. 31% (8/65) and 9. 23% (6/65), and there was no significant difference between two groups ( P > 0. 05). CONCLUSIONS: The treatment efficacy of fiberoptic bronchoalveolar lavage combined with azithromycin in the treatment of M. pneumoniae pneumonia is significant, which can improve the pulmonary ventilation function of children, inhibit the inflammatory response and improve the immune function with mild adverse drug reactions. [ABSTRACT FROM AUTHOR]

Objectives: As the largest cohort of healthcare workers and nurses can practice as psychotherapists to integrate the psychotherapeutic interventions as part of routine care. The present study aims to evaluate the effectiveness of supportive psychotherapy (SPT) on patients who had been scheduled to undergo a fiberoptic bronchoscopy (FOB) procedure. Methods: This study retrospectively analyzed 92 patients who underwent FOB, which was divided into the SPT group and usual-care group based on whether patients were given SPT interventions or not. The Patient Health Questionnaire-9 (PHQ-9) and Hospital Anxiety and Depression Scale (HADS) were used to determine the severity of depression and anxiety, as well as the 36-Item Short-Form Health Survey questionnaire (SF-36) to evaluate the health-related quality of life (HRQoL). Moreover, the patients' satisfaction was assessed based on the Likert 5-Point Scale. Results: The baseline status of anxiety, depression, and HRQoL in patients was similar in the SPT group and the usual-care group with no significant difference. Both PHQ-9 score and HADS-D score in the SPT group after intervention were lower than that in the usual-care group, accompanied by the deceased HADS-A subscale. Moreover, the improved HRQoL was found in the patients undergoing FOB after SPT interventions as compared to those receiving conventional nursing care using the SF-36 score. Additionally, the patient satisfaction in the SPT group was higher than in the usual-care group. Conclusions: The study demonstrated that anxiety and depression, as negative emotions, can be reduced by supportive psychotherapy in patients receiving FOB with improved mental health and satisfaction with nursing care. [ABSTRACT FROM AUTHOR]

Background: Lung recruitment techniques are employed to help in improvement of pulmonary mechanics, facilitate early weaning, and shorten the duration of mechanical ventilation. We are reporting a novel lung recruitment technique employed in four children with left lung atelectasis, who underwent corrective surgery for congenital heart disease. Materials and Methods: From January 2020 to March 2021, four pediatric cardiac patients having left lung atelectasis, undergoing corrective surgery were subjected to lung recruitment technique and had elective endobronchial intubation and suctioning with chest physiotherapy in the form of vibration and percussion. This was done along with intermittent ventilation with 100% oxygen. Results: Successful recruitment of lung segments and clearance of atelectasis were confirmed by auscultation and chest X-ray in all four patients. All the cases were successfully weaned off the ventilator within 24-48 h. One patient had an opposite lung collapse after extubation, which was managed conservatively with chest physiotherapy. Another patient had bradycardia and desaturation during the procedure, which was improved after withdrawing the tube and instituting two lung ventilation with 100% oxygen. Conclusions: This novel lung recruitment technique helps in recruitment of collapsed lung segments and thus helps in early weaning and shortens the duration of mechanical ventilation. [ABSTRACT FROM AUTHOR]

Aim: In this prospective, randomised, clinical study; we aimed to compare the effects of endotracheal intubation (ETI) via direct laryngoscope (DLS) and fiberoptic bronchoscope (FOB) on intraocular pressure (IOP) and hemodynamic data of non-ophthalmic patients. Materials and Methods: Fifty-four adult patients undergoing non-ophthalmic surgeries performed in the supine position under general anesthesia requiring orotracheal intubation were included into the study. The patients were randomly and prospectively divided into 2 groups: Group DLS (n=27) and Group FOB (n=27). Mean arterial pressure (MAP), Heart rate (HR), IOP were measured at before induction (basal), post-induction and 1st, 2nd, 3rd, and 5th minutes of intubation. Results: There was no statistically significant difference in distribution of patient characteristics. Duration of intubation was significantly longer in Group FOB (p<0.001). There was no statistically significant difference in MAP and HR when groups compared each other. Statistically significant increase was found in IOP at 1st minute of intubation in Group DLS when compared with Group FOB (p<0.001). No significant difference was found in terms of IOP in other time periods. Conclusion: We thought that endotracheal intubation by FOB could be more useful with respect to endotracheal intubation by DLS in patients with high IOP due to significantly less rise caused in IOP when performed by experienced anesthesiologists. [ABSTRACT FROM AUTHOR]

Background: Management of difficult airway remains a cornerstone of anesthesiology requiring constant probe into newer devices challenging set gold standards. Hence, we compared the effectiveness of intubating laryngeal mask airway (ILMA) with flexible fiberoptic bronchoscope (FOB) in anticipated difficult airway. Aims: The aim of this study was to compare and evaluate ILMA and FOB for tracheal intubation in patients with anticipated difficult airway. Settings and Design: The study design involves comparative randomized study. Materials and Methods: Fifty patients undergoing elective surgery under general anesthesia with anticipated difficult airway (Modified Mallampati Class III/Wilson’s Score 6‑7) were divided into Group I (ILMA) and Group F (FOB). Primary outcomes, i.e., ease of intubation (number and duration of attempts) and success rate; and secondary outcomes, i.e., hemodynamic parameters and adverse events were noted. Results: Both the groups were comparable in age, gender distribution, body mass index, and type of surgery. The number of attempts required and hemodynamics changes were similar in both groups. ILMA required lesser time, i.e., 59.76 s versus FOB, i.e., 109.88 s in the first attempt (DA1) and 62.67 s for Group I versus 120.86 s for Group F in the second attempt (DA2), being statistically significant. ILMA showed higher adverse event rate versus FOB; however, the difference was statistically insignificant. Conclusions: ILMA is an effective alternative to FOB in patients with anticipated difficult airway with respect to ease of intubation, with similar hemodynamic stability, success rate, and adverse events. [ABSTRACT FROM AUTHOR]

Abstract Background Most patients with congenital tracheal stenosis (CTS) develop respiratory symptoms early in life. CTS remaining undiagnosed until adulthood is rare. Case presentation A 51-year-old female was scheduled for cardiovascular surgery. She had undergone laparoscopic surgery 3 years earlier and was found to have a difficult airway. Postoperatively, she was diagnosed with CTS. For the current cardiovascular surgery, combined use of a McGRATHTM MAC videolaryngoscope and fiberoptic bronchoscope allowed sufficient visualization of the glottis and trachea, resulting in successful intubation. Conclusions CTS patients have a high probability of difficult intubation. Our experience suggests the efficacy of combined use of a videolaryngoscope and fiberoptic bronchoscope for airway management in CTS patients.

Abstract Background Foreign body ingestion is a common emergence in gastroenterology. Foreign bodies are most likely to be embedded in the esophagus. The sharp ones may penetrate the esophageal wall and lead to serious complications. Case presentation A 72-year-old Chinese female was admitted to our hospital with a 4-day history of retrosternal pain and a growing cough after eating fish. Chest computed tomography scan indicated that a high-density foreign body (a fish bone) penetrated through the esophageal wall and inserted into the left main bronchus. First, we used a rigid esophagoscope to explore the esophagus under general anesthesia. However, the foreign body was invisible in the side of the esophagus. Then, the fiberoptic bronchoscopy was performed. We divided the fish bone, which traversed the left main bronchus, into two segments under holmium laser and removed the foreign body successfully. The operation time was short and there were no complications. The patient was discharged 1 week postoperatively and was symptom free even under a liquid diet. Conclusions There are several challenges in the management of this rare condition. We applied the technique of interventional bronchoscopy to the management of esophageal foreign body flexibly in an emergency. A surgery was avoided, which was more invasive and costly.

To explore the therapeutic effect of systemic administration combined with microwave ablation (MWA) under computed tomography (CT) and fiberoptic bronchoscope for treating lung cancer. Sixty-six patients with advanced lung cancer admitted to our hospital from February 2019 to February 2020 were collected and divided into control group and experimental group with 33 patients in each group. The control group was treated with systemic administration, and the experimental group was treated with systemic administration combined with MWA under CT and fiberoptic bronchoscope. Overall response rate (ORR), adverse events (AEs) during treatment, and survival analysis were used to evaluate the curative effect of lung cancer treatment in each group. MWA under CT and fiberoptic bronchoscope could safely remove the cancerous tissues by point burning without destroying the adjacent normal tissues with high success rate. The ORR of the control group was 24.4%, and that of the experimental group was 63.6%, which was better than the control group. The AEs occurred during treatment in each group were of level 1 or level 2, and no serious life-threatening AEs occurred. Progression-free survival (PFS) time and overall survival (OS) time in the experimental group were both longer than those in the control group. Patients treated with MWA had a lower risk of disease progression and death than those treated with systemic administration alone. The treatment of lung cancer using systemic administration combined with MWA under CT and fiberoptic bronchoscope is more effective than using systemic administration alone, which can be promoted in clinical treatment. [ABSTRACT FROM AUTHOR]

Background: Flexible scope intubation is an important airway management skill that requires hands-on training in a real airway. We compared flexible scope intubation by trainees between patients in the left lateral and supine positions. Methods: Forty patients aged 20 to 80 years with American Society of Anesthesiologists physical status class I to III were scheduled for elective surgery under general endotracheal anesthesia in Ramathibodi Hospital from February 2020 to June 2020. Patients were randomly assigned to be intubated in one of two positions: supine (Group S) or left lateral (Group L). Trainees performed flexible scope intubation in sedated patients under the supervision of an attending anesthesiologist. Intubation success, time to successful intubation, number of attempts, airway adjustment maneuvers, and hemodynamic changes were compared between groups. Results: Patient characteristics did not differ between groups except for Mallampati airway classification. The rate of successful intubation on the first attempt and intubation time did not significantly differ between groups. The proportion of patients who required a jaw thrust during intubation was significantly lower in Group L (10.5% vs. 85%; P < 0.01). Blood pressure and oxygen saturation declined in both groups after intubation. The relative risk of desaturation in patients in the left lateral position compared with the supine position was 0.44 (0.1649–1.1978). Conclusion: The rate of successful flexible scope intubation on the first attempt and intubation time did not differ between the groups. The proportion of patients who required a jaw thrust maneuver was significantly lower in patients in the left lateral position. Trial registration: https://www.thaiclinicaltrials.org/ (TCTR20200208001) on 08/02/2020. [ABSTRACT FROM AUTHOR]

Objective: The present study aims to compare the detection rates of different diagnostic methods for primary peripheral lung cancer (PPLC). Methods: The detection rate and patient information were collected from a total of 359 cases of PPLC or a suspected diagnosis of lung cancer; among these, 186 cases were simultaneously treated with fibreoptic bronchoscopy, brush inspection and flush inspection, and 173 cases underwent a computed tomography (CT)-guided percutaneous lung biopsy (PNB). The positive detection rates of the different methods were compared. Results: In the detection of peripheral lesions (diameter of <5 cm), the CT-PNB had the significantly highest detection rate, followed by the combined basic method (fibreoptic bronchoscopy + brushing + flushing). The independent use of the three basic sampling methods showed a significantly lower detection rate compared with the combined use. Conclusion: In the diagnosis of peripheral lung cancer, the CT-PNB had the best detection rate; hence, it could be used in clinical practice for the diagnosis of such lesions. [ABSTRACT FROM AUTHOR]

Introduction: We aimed to compare the procedural time, efficacy, and incidence of complications of ultrasonography and fiberoptic bronchoscope-guided percutaneous dilatational tracheostomy (PDT). Methods: The study population included the patients admitted to the department of anesthesiology and critical care. In this prospective observational study, we randomly divided 60 participants into two groups. In the ultrasound (US)-guided group, ultrasonography was used for PDT. While in the FOB guided group, we used the fiberoptic bronchoscope (FOB). We compared efficacy parameters and complications between the two groups. The mean values were compared between study groups using an independent sample t-test. Categorical outcomes were compared using the chi-square test. P-value < 0.05 was considered statistically significant. Results: Compared with the bronchoscopy group, the US group had a significantly shorter PDT operation time (11.8 ± 2.5 versus 15.43 ± 3.27 mins, P < 0.001). FOB group had fewer puncture attempts than the US group. FOB group had more central punctures than the US group (p < 0.001). Among PDT complications, bleeding happened in two patients (6.67%) in the FOB group and tracheal tube cuff puncture was observed in 8 (26.67%) patients in the US group. Conclusion: The US-guided PDT consumes less time for the procedure compared to bronchoscope-guided PDT. FOB was more effective in terms of parameters like the number of needle puncture attempts, the accuracy of the puncture site, the incidence of the posterior tracheal wall hit compared to US-guided PDT. Complications like bleeding were present in FOB.

ObjectiveThe present study aims to compare the detection rates of different diagnostic methods for primary peripheral lung cancer (PPLC).MethodsThe detection rate and patient information were collected from a total of 359 cases of PPLC or a suspected diagnosis of lung cancer; among these, 186 cases were simultaneously treated with fibreoptic bronchoscopy, brush inspection and flush inspection, and 173 cases underwent a computed tomography (CT)-guided percutaneous lung biopsy (PNB). The positive detection rates of the different methods were compared.ResultsIn the detection of peripheral lesions (diameter of

Background: Management of the airway and ventilation in neonates with a tracheoesophageal fistula (TEF) remains a significant challenge. The routine method of intubation involves placement of the tracheal tube tip beyond the fistula opening followed by isolation of the fistula from ventilation using the inflated cuff. When the fistula opening is close to the carina or below the level of the carina, the traditional technique is not suitable for adequate ventilation. Moreover, this method fails to prevent gastric insufflation.Case Presentation: We herein report a series of 10 newborns with TEFs (1,090-3,080 g) who underwent bronchoscopic insertion of a 5-Fr balloon-tipped bronchial blocker (BTBB) for temporary occlusion of the fistula. In seven newborns, placement of the BTBB was easily and quickly achieved with no incorrect placements. In addition, we successfully utilized the inner hollow cavity of the BTBB for gastric decompression in six neonates with severe gastric distension. However, three failed placements occurred in premature infants (<2,000 g) because the narrow cricoid cavity was too small to accommodate a 2.8-mm fiberoptic bronchoscope and a BTBB. The procedure was well tolerated by all infants, and no significant adverse events occurred.Conclusions: Our findings illustrate that BTBBs can provide durable blockage of the fistula opening and should be considered as a treatment modality for infants with large carinal TEFs. Moreover, BTBB placement is neither arduous nor time-consuming. The hollow center, small round balloon, and 30-degree angled tip of the BTBB make this device feasible for clinical application, especially for neonates with severe gastrointestinal distension. [ABSTRACT FROM AUTHOR]

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Abstract By combining video laryngoscopy and fiberoptic bronchoscopy, awake intubation can be performed more safely.

Abstract Background Stenotrophomonas maltophilia (SMA) is present in hospital environments and has been one of the pathogens that cause nosocomial contamination and infections. To investigate the occurrence of Stenotrophomonas maltophilia (SMA) in bronchoscope lavage fluid (BALF) among 25 cases treated in the Division of Infection and to trace the contamination source and transmission route. Methods 25 cases of SMA positive BALF occurring from May 11 to August 10, 2018 were tested for drug sensitivity. Environmental hygiene conditions were investigated to identify the source of contamination and the route of transmission. Results BALF associated SMA was in all cases sensitive to minocycline, levofloxacin and chloramphenicol and resistant to ceftazidime and imipenem. 92.3% of samples were sensitivity to compound sulfamethoxazole. Investigation of environmental hygiene parameters revealed SMA growing on the inner wall of the fiberoptic bronchoscope as a likely source of contamination. Conclusion Incomplete cleaning and sterilization of the fiberoptic bronchoscope led to SMA nosocomial contamination. Strict sterilization procedures are required to prevent and control nosocomial contamination.

Objective　To observe the effect on two kinds of tracheal intubation guiding equipment (video laryngoscope andfiberoptic bronchoscope) for awake orotracheal intubation. Methods　Sixty patients with difficult airway requiring conscious intubation were randomly divided into two groups, respectively with UE video laryngoscope（groupⅠ) and fiberopticbronchoscope (FOB) (groupⅡ). Heart rate (HR), mean arterial pressure (MAP), the change of hemodynamic at four time points were recorded： 5 min after enteringthe room (T0), sprayed local anesthetic on the endotracheal tube or sprayed local anesthetic via FOB (T1), the endotracheal tube entered the trachea (T2), the patient’ s reactionto the completion of three minutes of intubation (T3) . Results　Compared with T0, the HR and MAP in groupⅠat T2 were both higher (P < 0.05), Compared with T0, the HR and MAP in groupⅡat T2 were both significantly higher (P < 0.01), there were no significant differences between the two groups at T0, T1, T2, and T3 (P > 0.05), There were significant differences between the two groups intubation time (P < 0.05), Similarly there were no significant differences between the two groups in patient’ s reaction and satisfaction (P > 0.05). Conclusion　UE video laryngoscope can be widely used in the case of awake orotracheal intubation with stable hemodynamics, safe and comfortable, and convenient operation. [ABSTRACT FROM AUTHOR]

bjective To study the role of atropine in spontaneous breathing painless fiberoptic bronchoscopy. Methods Forty cases of patients scheduled for receivepainless fiberoptic bronchoscopy were randomly divided into 2 groups，with 20 cases in each group.The patients in the control group （group C） were gven the intravenous anesthesia with sufentanil 0.1 μg/kg，dexmedetomidine 0.2 μg/kg，propofol 1 mg/kg，remifentanil 0.2 μg/kg，propofol 1 mg/kg，then endotracheal fiberoptic bronchoscopy were conducted cooperating with the endotracheal surface anesthesia.An extra propofol 0.4 mg/kg was given when choking cough or body moving occurred.The patients in the observation group （group S） were given atropine 0.006 mg/kg intravenous injection，the subsequent processing was the same as for group C. The changes of vital signs at different points during the perioperative period，the time of operation，anesthesia recovery and leaving operation room，the excellent and good rate for anesthesia，the number of cases of propofol supplementation and use of vasoactive drugs，the incidence of intraoperative respiratory adverse events and postoperative adverse events were observed and compared between the two groups. Results The levels of HR，MAP and SpO2 had no significant different between the two groups on T1 （P > 0.05），those of group S were significantly higher than group C on T2 （P < 0.05），the levels of HR and MAP on T2 were significantly lower than those on T1 in group C （P < 0.05），the rate of excellent and good of anesthesia of group S was significantly higher than that of group C （P < 0.05），the time of anesthesia recovery and leaving the operation room of group S were significantly lower than that of group C （ P < 0.01），the number of cases of intraoperative propofol supplementation and use of vasoactive drugs of group S were significantly lower than those of group C （P < 0.05），the incidence of intraoperative respiratory adverse events of group S was significantly lower than that of group C （P < 0.05). Conclusion Atropine can improve the safety of the anesthesia of preserving spontaneous breathing for painless fiberoptic bronchoscopy. [ABSTRACT FROM AUTHOR]

Difficult airway still is one of the dreaded crises in anesthesia. A well-formulated plan with all the necessary equipment should be ready when such situations are anticipated, but unanticipated difficulties can arise, and managing such cases is a nightmare for the anesthesiologist. Most hospitals in the developing countries are not equipped technically with all the modern equipment and gadgets as far as anesthesia is concerned. In a resource-constrained area, the skill and innovative ideas of the anesthesiologist often emerge as an alternative option in dealing with such cases. Here, we describe two cases of difficult intubation by conventional approach, which were managed successfully using a pediatric gastroscope and a flexible cystoscope as an alternative to fiberoptic bronchoscope.

BACKGROUND: Patients with cervical spinal cord injury will have serious complications in the early stage, of which respiratory complications are the most common. Therefore, respiratory tract management is particularly important for the rehabilitation of patients with cervical spinal cord injury. OBJECTIVE: To introduce the neuroanatomical and pathological features of cervical spinal cord injury, and to summarize the multiple treatments of respiratory complications in patients with cervical spinal cord injury and the application of fiberoptic bronchoscopy in patients with cervical spinal cord injury in recent years. METHODS: By inputting the key words of "cervical spinal cord injury, pulmonary infection, respiratory tract management, antibiotics, nerve transfer, tracheotomy, mechanical ventilation, fiberoptic bronchoscope, pneumonia" in Chinese and "cervical spinal cord injury, fibrobronchoscopy, bronchoalveolar lavage, tracheotomy, pneumonia" in English, we searched the CNKI, Wanfang, SinoMed, PubMed, and Web of Science for the related literature on the application of fiberoptic bronchoscopy in spinal cord injury in recent years. Through the preliminary screening of reading titles and abstracts, the articles with low relevance to the topic were excluded, and a total of 57 articles were included for review. RESULTS AND CONCLUSION: (1) At present, the treatment strategies of respiratory complications in patients with cervical spinal cord injury include supine position and use of abdominal band, respiratory training, mechanically assisted cough, mechanical ventilation, tracheotomy, diaphragm pacemaker, nerve transfer technique, fibrobronchoscopic sputum suction and bronchoalveolar lavage, and antibiotics use. (2) At present, the positive effects of early tracheotomy, non-invasive ventilation and auxiliary cough on patients with high spinal cord injury have been gradually recognized by the academic circles, which can improve the respiratory function of patients, while posture, respiratory training, and auxiliary cough have been widely used in clinical practice and achieved satisfactory results. (3) In recent years, bronchofiberscope suction and bronchoalveolar lavage have been widely used in the treatment of patients with pulmonary infection, and have a good therapeutic effect. For patients with cervical spinal cord injury with respiratory complications, fiberoptic bronchoscopy and bronchoalveolar lavage can also improve dyspnea and pulmonary function, which may become a new direction of diagnosis and treatment of cervical spinal cord injury patients. [ABSTRACT FROM AUTHOR]

Background: Most patients with congenital tracheal stenosis (CTS) develop respiratory symptoms early in life. CTS remaining undiagnosed until adulthood is rare. Case presentation: A 51-year-old female was scheduled for cardiovascular surgery. She had undergone laparoscopic surgery 3 years earlier and was found to have a difficult airway. Postoperatively, she was diagnosed with CTS. For the current cardiovascular surgery, combined use of a McGRATHTM MAC videolaryngoscope and fiberoptic bronchoscope allowed sufficient visualization of the glottis and trachea, resulting in successful intubation. Conclusions: CTS patients have a high probability of difficult intubation. Our experience suggests the efficacy of combined use of a videolaryngoscope and fiberoptic bronchoscope for airway management in CTS patients. [ABSTRACT FROM AUTHOR]

Abstract Background Conventional transbronchial needle aspiration (C-TBNA) is a unique technique that allows the sampling tissue from beyond the endobronchial tree, such as enlarged lymph nodes, peribronchial, or submucosal lesions. However, it remains underutilized and even unavailable in many countries and centers around the world including Egypt. Objective This study aimed to implement bronchoscopic C-TBNA service in a tertiary care chest hospital with special emphasis on the diagnostic yield, complications encountered, and learning experience. Patients and methods This cohort study was conducted on 60 patients with bronchoscopic nonvisible extraluminal lesions who have sought bronchoscopic C-TBNA service at the Bronchoscopy Unit of both Ain Shams University Hospital and Giza Chest Hospital during the period from June 2016 to February 2018. Results The overall C-TBNA had a diagnostic yield of 88.3% in which 68.3% were malignant and 20% had sarcoidosis without serious complications recorded except for minor non-life-threatening bleeding in 21.7% of cases. After 6 months of C-TBNA learning experience, the diagnostic yield showed improvement in physicians without previous C-TBNA experience, but without reaching a statistical significance. Also, there were significant reduction in both duration and complications of C-TBNA. Conclusion Implementing C-TBNA service in a tertiary care chest hospital in bronchoscopically nonvisible extraluminal lesions seems to be a safe, easy technique with high diagnostic yield and its learning performance was able to be improved over time.

Intubasi nasotrakeal adalah salah satu metode yang umum digunakan pada operasi intraoral dan maksilofasial yang memiliki keunggulan untuk menyediakan akses yang lebih baik. Hal yang menjadi perhatian utama ketika memasukkan endotracheal tube (ETT) adalah penempatan yang tepat dan sesuai sehingga menghindari komplikasi akibat malposisi ETT. Fiberoptic bronchoscope (FOB) adalah cara yang paling pasti untuk menilai penempatan ujung ETT karena menyediakan visualisasi secara langsung sehingga dapat mengukur penempatan ETT yang ideal, tetapi FOB tidak selalu tersedia di rumah sakit. Penelitian ini bermaksud menilai kesesuaian Chula formula, yaitu rumus yang menggunakan tinggi badan untuk menempatkan ETT pada posisi yang tepat. Penelitian ini merupakan penelitian analitik yang dilakukan secara prospektif pada 59 subjek penelitian di RSUP Dr. Hasan Sadikin Bandung pada bulan Juli sampai Agustus 2018. Subjek diintubasi nasotrakeal dengan kedalaman ETT dihitung menggunakan Chula formula, kemudian jarak ujung ETT ke carina dinilai menggunakan FOB. Hasil uji statistik dengan Guilford dan Spearman didapatkan nilai r 0,933 dan p 0,0001 yang menunjukkan kesesuaian yang sangat kuat pada Chula formula untuk menempatkan ETT pada kedalaman yang tepat. Simpulan, Chula formula dapat memprediksi kedalaman ETT dengan tepat pada intubasi nasotrakeal. Chula Formula as a Predictor for Correct Endotracheal Tube Placement for Nasotracheal Intubation Nasotracheal intubation is a common method which provides better access for intraoral and maxillofacial operations. The main concern when inserting an endotracheal tube (ETT) is the correct and appropriate placement as there are many complications develop due to ETT malposition. A Fiberoptic Bronchoscope (FOB) is the best way to assess the placement of the tip of the ETT for it provides a direct visualization to measure the ideal ETT placement; however, it is not always readily available in hospitals. This study aims to assess the compatibility of Chula formula, a formula that utilizes height to determine the correct ETT placement. This study was a prospective analytical study on 59 research subjects in Dr. Hasan Sadikin General Hospital Bandung from July to August 2018. The subjects were nasotracheally intubated with the ETT depth measured using the Chula formula, afterwards the distance from the tip of the ETT to the carina was assessed using an FOB. The results from Guilford and Spearman’s were an r value of 0.933 and a p value of 0.0001, showing a statistically significant conformation of the Chula formula in correct ETT placement. It is concluded that Chula formula can be used as a predictor for correct ETT placement in nasotracheal intubation.

Abstract Background Hypoxia is a major concern and cause of morbidity or mortality during tracheal intubation after anesthesia induction in a pathological obese patient with obstructive sleep apnea (OSA). We introduce a case using Supraglottic jet oxygenation and ventilation (SJOV) to promote oxygenation/ventilation during fiberoptic intubation in a paralyzed patient with morbid obesity and OSA. Case presentation A 46-year-old man weighting 176 kg with BMI 53.7 kg/m2 was scheduled for gastric volume reduction surgery to reduce body weight under general anesthesia. SpO2 decreased during induction, and two hand pressured mask ventilation partial failed. We then placed WEI Nasal Jet Tube (WNJ) in the patient’s right nostril to provide SJOV. Then fiberoptic bronchoscopy guided endotracheal intubation was performed via mouth approach, and vital signs were stable. The operation was successfully completed after 3 h. Patient recovered smoothly in hospital for 8 days and did not have any recall inside the operating room. Conclusion SJOV via WNJ could effectively maintain adequate oxygenation/ventilation during long time fiberoptic intubation in an apnea patient with morbid obesity and OSA after partial failure of two hand pressured mask ventilation, without obvious complications. This may provide a new effective approach for difficult airway management in these patients.

Abstract Background A fiberoptic bronchoscope (FOB) is commonly used to identify the proper placement of a double-lumen endotracheal tube (DLT) for good lung isolation during thoracic surgery. We hypothesized that the FOB-guided method for DLT placement composed of tracheal intubation under initial guidance by a FOB via the bronchial lumen and subsequent selective left-bronchial intubation could be used to reduce the incidence of DLT malposition and reduce the time required for completion of DLT placement and confirmation of proper DLT position during intubation using a left-sided DLT, in comparison to the conventional method under direct laryngoscopy using a Macintosh laryngoscope. Methods/design In this randomized controlled pilot trial, 50 patients, aged 18–70 years, scheduled for elective thoracic surgery will be recruited and randomly assigned to two groups according to the method of DLT placement: a FOB-guided method (F) group and a conventional method (C) group. Regardless of the group, the DLT placement processes will be followed by subsequent confirmation processes, using a FOB. If the DLT is misplaced, the position would be corrected. The primary outcome is the incidence of DLT malpositioning observed via a FOB during confirmation after DLT placement. The secondary outcomes consist of the time required to achieve the entire DLT intubation process, which is the sum of the duration of DLT placement and the duration of confirmation of the proper position, the incidence of failed tracheal intubation on the first and second attempt, and complications associated with the intubation process. Discussion This pilot study was designed as the first randomized controlled trial to confirm our hypothesis. This should provide information for a further full-scale trial, and the outcomes of the study should provide clinical evidence on the usefulness of the FOB-guided method for DLT placement, in comparison to the conventional method. Trial registration Clinical Research Information Service; CRIS, ID: KCT0002663. Retrospectively registered on 24 January 2018.

Abstract Background In intubation using fiberoptic bronchoscope (FOB), partial or complete obstruction of upper airway makes the FOB insertion difficult. Thus, maneuvers to relieve such obstructions are recommended. There have been no studies to determine whether the sniffing or neutral position is superior for this purpose. Therefore, this study was performed to examine the effects of these two positions including vocal cord view. Methods Fifty-four patients scheduled to receive general anesthesia by orotracheal intubation were eligible for inclusion in the study with informed consent. After confirmation of proper head positioning depending on the group, the view of the vocal cord was acquired in each position. Images were reviewed using the percentage of glottic opening (POGO) score. Results A total of 106 images of vocal cords from 53 patients were obtained. The mean of difference of POGO score was 11.09, higher for the neutral position and standard deviation was 23.73 (p = 0.002). Neutral position increased POGO score in 31 patients and decreased POGO score in 13 patients compare to sniffing position (p = 0.017). There were no significant differences between the two head positions with regard to intubation time or degree of convenience during intubation. Conclusions Neutral position improved the view of glottic opening than sniffing position during oral fiberoptic intubation. However, there was no difference in the difficulty of tube insertion between the two positions. Trial registration Clinical Trials.gov identifier: NCT02931019, registered on October 12, 2016.

Airway devices were first used in children since 1940 and thereafter an increasingly large number of paediatric airway devices have come into our armamentarium. To control and protect the airway in children during anaesthesia, in intensive care unit or in emergency department either tracheal intubation is performed under direct or indirect visualization of vocal cords with the help of laryngoscopes or video-laryngoscopes respectively or it can be done blindly or by using special instruments such as fiberoptic laryngoscope, lighted stylet or Bullard laryngoscope to name a few. Airway also can be maintained with the help of Laryngeal mask airways, oropharyngeal and nasopharyngeal airways. Updating our information and knowledge regarding these developments is pivotal to our practice of paediatric anaesthesia. With a thorough search of books, MEDLINE, MEDNET, clinical trials.gov.in, this article aims at focusing and understanding a brief basis of paediatric devices and their use.

Awareness and the management of the difficult airway in children are crucial. Although the incidence of difficult intubation in children is believed to be lower than in adults, there is insufficient data regarding it. The aim of this study was to determine what airway management techniques are being applied in the difficult airway situation, by a group of experienced Consultant Anesthetists, in a large pediatric center. The study conducted over a 2-year period, in a large pediatric hospital. For a 2-year period beginning from September 2014, consultant anesthetists completed pro-forma following all pediatric anesthesia procedures in which tracheal intubation was difficult. The collected information included: patient demographics; airway assessment; anesthetic technique and airway management strategies employed; and reasons of failure in intubation attempts. There were 50 cases which were assessed as difficult intubation, and 80% of the cases had an anticipated difficult intubation report with 40% having a history of previous difficult intubation. Fiberoptic Bronchoscope (FOB) was the first-choice rescue technique in 84% of the patients; 92% of oral FOB and 71% of nasal FOB were successful. Six cases required surgical airway as surgical tracheostomy. This study created a screenshot of the various methods used when we were faced with a difficult airway management in pediatric population. Fiberoptic intubation remains overall the best method whereas no method was 100% successful. The majority of the patients had anticipated difficult airway, which opportunely allows planning for surgical airway with other teams such as Ear-Nose Throat and pediatric surgery. [Med-Science 2018; 7(4.000): 769-72]

Background: Foreign body ingestion is a common emergence in gastroenterology. Foreign bodies are most likely to be embedded in the esophagus. The sharp ones may penetrate the esophageal wall and lead to serious complications.Case Presentation: A 72-year-old Chinese female was admitted to our hospital with a 4-day history of retrosternal pain and a growing cough after eating fish. Chest computed tomography scan indicated that a high-density foreign body (a fish bone) penetrated through the esophageal wall and inserted into the left main bronchus. First, we used a rigid esophagoscope to explore the esophagus under general anesthesia. However, the foreign body was invisible in the side of the esophagus. Then, the fiberoptic bronchoscopy was performed. We divided the fish bone, which traversed the left main bronchus, into two segments under holmium laser and removed the foreign body successfully. The operation time was short and there were no complications. The patient was discharged 1 week postoperatively and was symptom free even under a liquid diet.Conclusions: There are several challenges in the management of this rare condition. We applied the technique of interventional bronchoscopy to the management of esophageal foreign body flexibly in an emergency. A surgery was avoided, which was more invasive and costly. [ABSTRACT FROM AUTHOR]

Introduction: For successful pulmonary segmentectomy, the identification of boundaries between segments is important. Previous measures include tracing the intersegmental vessels by staining with a dye via the affected pulmonary artery or bronchus and inflating with oxygen via a high frequency ventilator. However, problems with these methods have been reported. Aim: We developed a novel method using a manual jet ventilator (MJV) and investigated its efficacy in identification of the pulmonary intersegmental plane. Material and methods: Patients underwent MJV for pulmonary segmentectomy in the period from January 2013 to December 2017 at our institution. The patients' characteristics, resected segments, availability of clear resection planes, and complications associated with MJV from medical records were investigated. A questionnaire survey was conducted with the surgeons on the effectiveness of lung segment identification using MJV. Results: Of 199 cases of planned pulmonary segmentectomy, 171 cases with descriptions of identified intersegmental planes were analyzed. Of these, 152 (89%) cases showed a clear boundary. There were 19 cases where the exact boundaries were not clearly identified, but segmentectomy was still performed. Furthermore, we found that identification of the right upper lobes was difficult (p = 0.0028). A subjective questionnaire was answered by the 12 surgeons who performed the procedures. All 12 responded that MJV was very effective or effective regarding clarity, safety, shorter identification time, and shorter resection time. Conclusions: MJV enabled surgeons to more easily and safely identify the pulmonary intersegmental plane, thereby suggesting that MJV has clinical significance during pulmonary segmentectomy. [ABSTRACT FROM AUTHOR]

Objective To investigate the optimal intubation guidance method and the choice of phenylephrine administration approaches for patients with three-vessel coronary heart disease undergoing off-pump coronary artery bypass grafting（CABG）. Methods Sixty patients scheduled for off-pump CABG（49 males and 11 females, aged 52 to 75 years, ASAⅡ-Ⅲ） were randomly allocated into four groups, with 15 in each group: group L（intubation with visual laryngoscope + intravenous injection of phenylephrine）, group LP（intubation with visual laryngoscope + continuous intravenous pumping of phenylephrine）, group F（fiberoptic bronchoscope-guided intubation + intravenous injection of phenylephrine）, and FP group（fiberoptic bronchoscope-guided intubation + continuous intravenous pumping of phenylephrine）. The heart rate（HR）, MAP, and RPP（RPP=SBP×HR） were recorded before anesthesia induction（T0）, immediately before intubation（T1）, 1 minute after intubation（T2）, 3 minutes after intubation（T3）, 5 minutes after intubation（T4） as well as arterial lactic acid and time from anesthesia induction to intubation, and phenylephrine usage; plasma norepinephrine（NE） concentrations were measured at T0, T1 and T3. Results Compared with T1, the MAP, HR, and RPP of patients in the group L and LP group increased significantly at T2 and T3（all P<0.05）. The time from anesthesia induction to intubation was significantly shorter and the dosage of phenylephrine was less in the LP group and FP group than in the group L and group F（all P<0.05）. The interplasma concentration of NE in the group L and LP group increased significantly at T3 as compared with that at T1. Conclusions Intubation with visual laryngoscope can cause the elevation of blood pressure, heart rate and myocardial oxygen consumption in patients with three-vessel coronary heart disease. The stimulation of intubation guided by fiberoptic bronchoscope is small and does not increase myocardial oxygen consumption. Intermittent injection of phenylephrine can prolong anesthesia induction time, which is not good for patients. This method of intubation guided by fiberoptic bronchoscope combined with continuous intravenous pumping of low-dose phenylephrine can maintain hemodynamics smooth, and is especially suitable for three-vessel coronary heart disease patients with poor myocardial oxygen reserve. [ABSTRACT FROM AUTHOR]

Huge goitor can lead to tracheal compression and hence difficulty in intubation. This is compounded by severe obesity. Failed tracheal intubation in difficult intubation is a serious event that may lead to increased patient morbidity and mortality. Current intubation rescue techniques and combination of different rescue techniques may increase the success rate of difficult intubation. In a 47-year-old female patient, with severe obesity and a huge goiter, our attempts at intubation using direct laryngoscope, video laryngoscope, and awake fiberoptic bronchoscope had failed. We succeeded by applying video laryngoscope to improve visualization of the airway and fiberoptic bronchoscope as a stylet for endotracheal tube.