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At least 433 records · Page 24Linked to original sources
PubMed2002

Bronchoscopy training: is simulated surgery effective?

Intensive surgical skills courses have become an essential part of surgical skill acquisition for surgeons in training. There is a need to monitor the value of these courses in terms of skill attainment. The aim of this study was to determine the effectiveness of skills-laboratory-based training in rigid bronchoscopy and bronchial foreign body removal. Bronchoscopies were recorded, analysed and categorized by a single observer according to time to completion and four predetermined parameters of surgical error. An overall quality score was obtained by simple summation of the number of errors and determined as acceptable or unacceptable (scoring 0 or 1 respectively). The data was analysed using a t-test for paired groups. P < 0.05 was considered to be significant. In total, 20 trainee otolaryngologists performed 80 separate bronchoscopies. The time to complete the task pre versus post training showed significant improvement; P < 0.001. The overall quality score pre training was 66 and post training 17; P < 0.001. We conclude that intensive surgical simulation-based courses appear to be an effective means of training surgical trainees in surgical skill proficiency.

Animals↗
PubMed1999

Remifentanil vs. fentanyl during interventional rigid bronchoscopy under general anaesthesia and spontaneous assisted ventilation.

The treatment of tracheo-bronchial diseases with rigid bronchoscopy requires general anaesthesia without tracheal intubation. Spontaneous assisted ventilation is a safe modality of ventilation. In this study the use of remifentanil and fentanyl is compared during rigid bronchoscopy with spontaneous assisted ventilation. Ninety high-risk patients received fentanyl or remifentanil with propofol for general anaesthesia. During the maintenance fentanyl was delivered at 6.1 +/- 4.6 micrograms kg-1 h-1 and remifentanil at 0.15 +/- 0.07 microgram kg-1 min-1. The same degree of intra-operative respiratory acidosis with similar good operating conditions resulted in both groups. Patients treated with remifentanil recovered more quickly compared with those in the fentanyl group (3.8 +/- 2 vs. 10.4 +/- 9.2 min, P < 0.001). In conclusion, the use of remifentanil during rigid bronchoscopy under general anaesthesia with spontaneous assisted ventilation is safe and assures good operating conditions. Moreover, remifentanil permits a more rapid recovery than fentanyl. The dose of remifentanil is higher than previously described for spontaneously breathing patients.

Anesthesia, General↗
PubMed2000

Remifentanil and propofol for sedation in children and young adolescents undergoing diagnostic flexible bronchoscopy.

Flexible fibreoptic bronchoscopy (FOB) has become a useful diagnostic and therapeutic procedure in children. We investigated 26 patients (3-14 years) for FOB using a new sedation strategy. All patients received oral premedication and inhalation of topical anaesthetic. Sedation for bronchoscopy was achieved with a continuous infusion of remifentanil and intermittent boluses of propofol. Propofol injection was repeated if sedation was inadequate. Sedation could be successfully performed in all children without adverse effects. Endtidal CO2 concentration and arterial oxygen saturation remained stable throughout the study. All children were awake 5+/-1.3 min after stopping remifentanil infusion. Sedation with remifentanil/propofol is a new sedation strategy for diagnostic flexible paediatric bronchoscopy in children with spontaneous ventilation.

Adolescent↗
PubMed2003

Severe bronchial synechia after removal of a long-standing bronchial foreign body: a case report to support control bronchoscopy.

The authors report the case of a child who had severe bronchial synechia of the left main bronchus after removal of a pistachio shell embedded in granulation tissue. Histology finding of the removed granulation tissue at initial bronchoscopy showed an Actinomyces bacterial invasion. It was decided not to treat this local contamination and to perform a control bronchoscopy to verify the disappearance of local bacterial invasion. The control bonchoscopy performed 4 weeks after the foreign body (FB) removal disclosed a large central left main bronchus synechia producing a 70% reduction of the lumen, although the child had become asymptomatic except for a slight residual cough. The resection of the synechia restored a normal bronchial lumen. The performance of a systematic control bronchoscopy after removal of long standing FB is discussed and recommended.

Actinomycosis↗
PubMed2000

Sedation in outpatient bronchoscopy.

Bronchoscopy is a procedure that is likely to provoke anxiety as the patient is surrounded by monitoring and bronchoscopy equipment, and care is administered by strangers who perform intimate, invasive, and sometimes, painful procedures. Sedation is needed, therefore, to allay anxiety and reduce stress, improve patient comfort and co-operation, provide amnesia and facilitate the bronchoscopic procedure. In this review we try to summarize the current knowledge on currently used sedation protocols with special reference to the commonly used pharmacological agents. We believe sedation should be used routinely in fiberoptic bronchoscopy in order to achieve a safe and pleasant procedure for both the patient and the pulmonologist.

Adrenergic alpha-Agonists↗
PubMed1998

Comparison of virtual and fiberoptic bronchoscopy.

Preoperative diagnostic procedures in the treatment of non-small-cell lung carcinoma (NSCLC) include fiberbronchoscopy (FBS) and CT scanning of the thorax and abdomen. The introduction of double-detector helical computed tomography has led to improved image resolution which allows three-dimensional reconstruction of the bronchial tree. A special computer simulation provides a virtual endoscopic view into the inner surface of the bronchial system. In order to determine whether the so-called virtual bronchoscopy (VBS) accurately reflects the anatomic situation of the bronchial tree, neoplastic lesion, and postoperative control of sleeve resections, we performed a virtual bronchoscopy in 24 patients with NSCLC and in 6 patients following sleeve resections and compared the results with the findings of fiberoptic bronchoscopy. An anatomic computer simulation of the bronchial tree was created in 100% of the investigated patients. Central tumor stenosis or occlusion was visualized by VBS as well as by FBS. In peripheral tumorous lesions VBS revealed the correct diagnosis in only 75%. VBS, however, enables viewing beyond the stenosis. FBS remains the gold standard in the endoscopic diagnostic procedures, showing not only airway patency but also mucosal changes in the vicinity of the tumorous lesion. VBS, however, gives further information about the poststenotic area in occlusive main bronchus stenosis. Furthermore, adequate control investigation of airway patency in patients following sleeve resections or stent implantation can be performed by VBS.

Bronchoscopy↗
PubMed1983

Comparison of flexible fiberoptic bronchoscopy and scalene lymph node biopsy in the diagnosis of sarcoidosis.

The diagnostic accuracy achieved by taking bronchial mucosal and lung biopsies through flexible fiberoptic bronchoscopes was compared with scalene lymph node biopsy in 55 patients with sarcoidosis. The diagnostic yield with flexible fiberoptic bronchoscopy was 62 per cent in the whole material and increased to 76 per cent in patients with stage II sarcoidosis. Scalene lymph node biopsy was positive in 80 per cent. Flexible fiberoptic bronchoscopy is a useful method for obtaining biopsy material in sarcoidosis, especially in stage II sarcoidosis. We consider flexible fiberoptic bronchoscopy and scalene lymph node biopsy the methods of choice in the diagnosis of sarcoidosis.

Adult↗
PubMed1987

[Bronchography during flexible bronchoscopy. Indications and results in bronchiectasis].

The radiological imaging of the respiratory tract by bronchography has apparently lost in importance since the introduction of newer imaging methods. Indications for and results of bronchography, performed after bronchoscopy with a flexible bronchoscope under local anesthesia, were analysed in 115 patients. In 68 the bronchography had been performed because of suspected bronchiectasis, in the others because of hemoptysis, cough or infiltration of unclear etiology. In 43% of patients who had undergone bronchography bronchiectasis was indeed found, in 47% there were isolated or additional changes in the bronchial system. In 70% the examination had furthered the diagnosis. The described method of bronchography was not significantly more uncomfortable than flexible bronchoscopy alone. Combined bronchoscopy and bronchography is thus a valuable procedure in the diagnosis of pneumonological abnormalities.

Adolescent↗
PubMed2006

Thin-section axial multidetector computed tomography and multiplanar reformatted imaging of children with suspected foreign-body aspiration: Is virtual bronchoscopy overemphasized?

PURPOSE: To determine the added value of multidetector computed tomography (MDCT)-assisted virtual bronchoscopy (VB) to axial MDCT and multiplanar reformatted (MPR) imaging with respect to conventional bronchoscopy in the evaluation of children with suspected foreign-body aspiration (FBA). MATERIAL AND METHODS: Twenty-one consecutive children (14 male, seven female, age 8 months-7 years, mean age 3.5 years) presenting with the suspicion of FBA were examined with 16-slice MDCT using 100-120 kV, 30-50 mA, 1-mm section thickness, 1.2 pitch ratio, and 0.6-1.0-mm reconstruction interval. Before CT examinations, chest radiographies were also obtained in all cases. VB and MPR imaging were carried out after MDCT examinations. RESULTS: Nine foreign bodies were identified by gold-standard conventional bronchoscopy. VB, thin-section axial MDCT, and MPR images identified eight of nine foreign bodies. CT scans with MPR images and VB did not reveal a chronic foreign body; and, in one patient, endobronchial mucous was diagnosed as the foreign body. The sensitivity, specificity, and accuracy of thin-section axial MDCT and MPR images alone in the diagnosis of FBA were 88.9%, 91.7%, and 90.5%, respectively. Results were the same as those obtained when VB was also included. CONCLUSION: MDCT with VB and axial/MPR images provide equally valuable information in children with suspected foreign-body aspiration and prevent unnecessary conventional bronchoscopic examinations. However, VB increases total examination time and cost, and it does not provide additional information over MPR images in the evaluation of foreign-body aspiration.

Bronchi↗
PubMed1978

Effect of age on amnesia and sedation induced by flunitrazepam during local anaesthesia for bronchoscopy.

Bronchoscopy was undertaken in 79 outpatients using local anaesthesia plus an i.v. injection of flunitrazepam 0.01 mg kg-1. The co-operation of the patients and the ease of bronchoscopy were good regardless of the age of the patient. There was an increase in amnesia for the bronchoscopy with increasing age, but the most distinct difference between different age groups was that the amnesic action of flunitrazepam was evident earlier and persisted longer in patients of more than 60 yr. Eye co-ordination and ability to stand steadily and walk on a line returned to normal more slowly in patients more than 60 than in those less than 60 yr, but no differences in recovery were noted between patients less than 40 and those of 40--59 yr, or between those 60--69 and those more than 70 yr.

Adult↗
PubMed1982

Plasma concentrations of lignocaine and its metabolites during fibreoptic bronchoscopy.

Lignocaine metabolites are known to have both antiarrhythmic and toxic effects. Large plasma concentrations of these metabolites have been reported following endotracheal instillation of lignocaine. We measured plasma lignocaine monoethylglycinexylidide (MEGX), and glycinexylidide (GX) concentrations for up to 4h after fibreoptic bronchoscopy. The total dose of lignocaine required to suppress coughing varied between 230 mg and 364 mg. Small therapeutic lignocaine concentrations occurred transiently in nine of 19 patients after the bronchoscopy examination had finished. Only one patient achieved a plasma lignocaine concentration in the range of minor toxicity. Metabolite peaks occurred later and were of much smaller magnitude. They were unlikely to contribute to prophylaxis of cardiac arrhythmia or to toxicity. It would seem to be safe to use topical lignocaine in doses greater than the currently recommended maximum (200 mg) in conscious patients during fibreoptic bronchoscopy.

Aged↗
PubMed1996

Sevoflurane-nitrous oxide or halothane-nitrous oxide for paediatric bronchoscopy and gastroscopy.

We have studied 120 infants and children, in three age groups (3-11 months, 1-5 yr and 6-15 yr), to compare anaesthesia with sevoflurane or halothane for bronchoscopy or gastroscopy, or both. Premedication or i.v. anaesthetic agents were not used. Patients were allocated randomly to receive either 7% sevoflurane or 3% halothane in 66% nitrous oxide in oxygen for induction of anaesthesia. The same inspired mixture was continued during bronchoscopy while the concentration of the inhalation agent was reduced by 50% during gastroscopy. Induction times were shorter for infants than for children and shorter for sevoflurane than for halothane. Cardiac arrhythmias were significantly more frequent during halothane than during sevoflurane anaesthesia. Physiological and psychomotor recovery were more rapid after sevoflurane than after halothane. At 24-h follow-up, children who received sevoflurane had significantly less nausea and vomiting. We conclude that sevoflurane was superior to halothane for paediatric bronchoscopy and gastroscopy.

Adolescent↗
PubMed1987

Airway obstruction by vascular anomalies. Importance of telescopic bronchoscopy.

This review of 28 cases of airway obstruction by vascular anomalies in the past 6 years emphasizes the importance of these anomalies as causes of obstruction, stridor, and apnea in infants as well as the important contribution of telescopic bronchoscopy to the recognition of these lesions, especially compression of the trachea by the innominate artery. There were 20 patients with compression by the innominate artery; four were surgically corrected. Seven vascular ring anomalies were all corrected by operation as was an enlarged left atrium and malformed mitral valve in one patient. Vascular anomalies caused 26% of the obstructive airway lesions in a series of infants who had bronchoscopy for obstruction, stridor, or apnea. Failure to diagnose and treat these entities may result in progressive respiratory embarrassment and even death. Barium esophagogram and aortic arch arteriogram, the traditional modalities for diagnosing vascular rings, may fail to identify tracheal compression by enlarged cardiac chambers or the more common "anomalous" innominate artery. Telescopic bronchoscopy will identify tracheal compression by the innominate artery; furthermore, it will identify the area of compression by the vascular ring. Observation of the compressed area during corrective surgery ensures that the operative manipulations are appropriate and successful in relieving the obstruction. This observation can be facilitated by televised monitoring and videotaping.

Airway Obstruction↗
PubMed1980

Helium-oxygen mixtures during bronchoscopy.

Fiberoptic bronchoscopy in mechanically ventilated patients has been limited to endotracheal tubes of 8.0--8.5 mm diameter. When performed through smaller tubes, pressures exceeding ventilator limits may occur, alveolar ventilation may become impaired, or progressive hyperinflation from airway obstruction during expiration may result. In this study, the efficacy of a 70% helium-30% oxygen ventilating gas mixture was compared to 30% oxygen in air in a laboratory mechanical lung analog and during 15 bronchoscopies in 7 intubated patients. One patient with a 7.5 mm tube was studied. With the helium-oxygen mixture, ventilator pressures were not exceeded, alveolar ventilation was uncompromised, and hyperinflation did not occur. Bronchoscopy may be safely performed through endotracheal tubes smaller than 8.0 mm using a helium-oxygen mixture.

Air↗
PubMed2000

Correlation of findings on direct laryngoscopy and bronchoscopy with presence of extraesophageal reflux disease.

OBJECTIVE: To determine the correlation between findings at direct laryngoscopy and bronchoscopy and presence of extraesophageal reflux disease (EERD). STUDY DESIGN: Retrospective chart review METHODS: Operative notes of 155 children undergoing direct laryngoscopy and bronchoscopy between 1996 and 1999 for airway symptoms for whom there was a suspicion of EERD were examined. Gastroesophageal reflux disease (GERD) was considered present if at least one test was positive (including upper GI series, pH probe, gastric scintiscan, or esophageal biopsy). RESULTS: A total of 130 (84%) patients had GERD diagnosed. Ninety percent had at least one laryngotracheal abnormality: 83% had an abnormal larynx and 66% had an abnormal trachea. Laryngeal abnormalities in GERD included postglottic edema, 69%; arytenoid edema, 30%; large lingual tonsil, 16%; vocal fold edema, 12%; vocal fold nodule, 12%; ventricular obliteration, 5%; and hypopharyngeal cobblestoning, 3%. Tracheobronchial abnormalities in GERD included tracheal cobblestoning, 33%; blunting of carina, 12.5%; subglottic stenosis, 11%; increased secretions, 11%; and generalized edema or erythema, 5%. The best sensitivity or specificity was obtained by combining postglottic edema, arytenoid edema, and vocal fold edema, resulting in a sensitivity of 75% and a specificity of 67%. Positive predictive value was 100% for the combination of postglottic edema and any vocal fold or ventricular abnormality. CONCLUSION: Laryngoscopy and bronchoscopy can reveal findings with a high positive predictive value for the presence of GERD. Endoscopy of the upper airway in children with clinical signs and symptoms of EERD is a promising tool for diagnosis.

Bronchi↗
PubMed2005

Sedative drug requirements during bronchoscopy are higher in cystic fibrosis after lung transplantation.

BACKGROUND: We noted that patients with cystic fibrosis tended to need higher doses of sedatives during bronchoscopy. We undertook this study to assess the sedative drug doses administered during bronchoscopy in lung transplant recipients and to assess if there is a change in the dosage requirements over time following lung transplantation. METHODS: In all, 773 transbronchial biopsy procedures performed via flexible bronchoscopy were analyzed in 140 consecutive lung transplant recipients. Conscious sedation was achieved with intermittent boluses of intravenous midazolam and fentanyl. Intravenous propofol boluses of 10 to 30 mg were administered when optimal sedation was not achieved with midazolam doses of 0.20 to 0.25 mg/kg and fentanyl 2 to 2.5 micrograms/kg. RESULTS: Mean doses of midazolam and fentanyl administered were 0.15+/-0.07 mg/kg (range 0.02 to 0.44 mg/kg) and 1.8+/-0.8 micrograms/kg (range 0.1 to 6.67 micrograms/kg) respectively. Midazolam and fentanyl doses administered to patients with cystic fibrosis were the highest compared to those with other disease types (P<0.0001). Examining the sedative doses administered over time following transplantation, there was a significant linear (P<0.001) and quadratic (P=0.0023) effect of time for midazolam and a significant linear (P=0.003) and a trend (P=0.08) for a quadratic effect for fentanyl. Propofol was effectively used in seven lung transplant recipients in whom adequate sedation could not be achieved with high doses of midazolam and fentanyl. CONCLUSIONS: There is an increase in sedative drug requirement with time for both midazolam and fentanyl after transplantation, which is significantly higher in patients with cystic fibrosis.

Adolescent↗
PubMed2004

Three-dimensional path planning for virtual bronchoscopy.

Multidetector computed-tomography (MDCT) scanners provide large high-resolution three-dimensional (3-D) images of the chest. MDCT scanning, when used in tandem with bronchoscopy, provides a state-of-the-art approach for lung-cancer assessment. We have been building and validating a lung-cancer assessment system, which enables virtual-bronchoscopic 3-D MDCT image analysis and follow-on image-guided bronchoscopy. A suitable path planning method is needed, however, for using this system. We describe a rapid, robust method for computing a set of 3-D airway-tree paths from MDCT images. The method first defines the skeleton of a given segmented 3-D chest image and then performs a multistage refinement of the skeleton to arrive at a final tree structure. The tree consists of a series of paths and branch structural data, suitable for quantitative airway analysis and smooth virtual navigation. A comparison of the method to a previously devised path-planning approach, using a set of human MDCT images, illustrates the efficacy of the method. Results are also presented for human lung-cancer assessment and the guidance of bronchoscopy.

Algorithms↗
PubMed1991

The haemodynamic effects of bronchoscopy. Comparison of propofol and thiopentone with and without alfentanil pretreatment.

The haemodynamic response to bronchoscopy under general anaesthesia was investigated. Forty patients were allocated at random to receive either thiopentone or propofol; half the patients in each group received in addition 18 micrograms/kg of alfentanil one minute before induction of anaesthesia. The heart rate, noninvasive blood pressure and Holter ECG was monitored in all patients. Significant increases in heart rate (p less than 0.05), systolic and diastolic arterial pressures (p less than 0.01) occurred in the thiopentone only group, following bronchoscopy. Systolic and diastolic arterial pressure decreased in patients receiving thiopentone plus alfentanil, following induction of anaesthesia and laryngoscopy (p less than 0.05). No significant haemodynamic changes were seen in either of the groups which received propofol. ST segment changes on subsequent Holter analysis were seen in four patients, but there were no significant differences between the groups. Anaesthesia with propofol alone provides adequate haemodynamic stability for bronchoscopy and the addition is superfluous.

Aged↗