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At least 487 records · Page 27Linked to original sources
PubMed1996

In vivo direct measurement of the bronchodilating effect of sevoflurane using a superfine fiberoptic bronchoscope: comparison with enflurane and halothane.

OBJECTIVES: Although volatile anesthetics have been shown to have spasmolytic effects on constricted airways, most previous studies were performed to assess bronchodilation with indirect methods such as measurement of airway resistance, whose reliability is controversial. As the authors have developed a new direct method using a superfine fiberoptic bronchoscope (SFB) and confirmed the accuracy of this method, this study assessed the spasmolytic effect of sevoflurane (S) as compared with enflurane (E) and halothane (H). DESIGN: Open-labeled, randomized study. SETTING: The study protocol was approved by the Animal Care Committee in a school of medicine. PARTICIPANTS: Twenty-two mongrel dogs. INTERVENTIONS: The dogs were anesthetized with pentobarbital, IV, paralyzed with pancuronium, and the lungs were mechanically ventilated. The endotracheal tube had an additional lumen to insert the SFB (outer diameter 2.2 mm). The tip of the SFB was located between a second and third bronchial bifurcation to continuously monitor the bronchial cross-sectional area (BCA) of third or fourth generation bronchi. The BCA was printed out by videoprinter at the end of expiration and was calculated on a Macintosh IIci computer using an NIH (National Institutes of Health) image program. Bronchoconstriction was produced with histamine (HA: 10 micrograms/kg + 500 micrograms/kg/hr). In the first protocol, 4 mongrel dogs were used to assess the accuracy of the new method. BCA was measured 30 and 60 minutes after the placement of the SFB and also 30 and 60 minutes after the start of the histamine (HA) infusion. Arterial blood (4 mL) was collected at 30 and 60 minutes after placement of the SFB to measure the plasma concentration of catecholamines with gas chromatographic mass spectrometry. In the second protocol, 18 dogs were randomly allocated to 3 groups of 6 each: group S, group E, and group H. Thirty minutes after the start of the HA infusion, the dogs subsequently inhaled the following concentrations of S, E, or H for 15 minutes: 0.2, 0.4, 0.8, and 1.6 minimum alveolar concentrations. The BCA was assessed before and 30 minutes after the start of HA and at the end of the inhalation period of each concentration. MEASUREMENTS AND MAIN RESULTS: In the first study, no significant differences in the BCA were found between 30 and 60 minutes after the placement of the SFB and between 30 and 60 minutes after the start of HA. The plasma concentrations of norepinephrine and epinephrine changed from 138 +/- 45 and 162 +/- 18 to 188 +/- 48 and 136 +/- 18 pg/mL, respectively. In the second study, all volatile anesthetics significantly increased the BCA in a dose-dependent manner. There was no significant difference among the three groups. CONCLUSION: As the BCA did not change in the first study, the tip of the SBF could be well fixed, and the 30-minute interval is long enough for the HA infusion to produce stable bronchoconstriction. The plasma catecholamine concentrations suggest that the pentobarbital anesthesia was deep enough to inhibit the direct irritant effect of the endotracheal tube and the SFB on the airway. This new direct method indicates that S dilates HA-constricted proximal airway with the same potency as E and H.

Anesthetics, Inhalation↗
PubMed1998

Airway compression in children due to congenital heart disease: value of flexible fiberoptic bronchoscopic assessment.

OBJECTIVE: To evaluate the frequency and severity of airway compression due to congenital heart disease in children and validate the use of the fiberoptic bronchoscope to assess them. DESIGN: A retrospective study. SETTING: A single-institutional study in a university hospital. PARTICIPANTS: Seventy-two children with congenital heart disease. INTERVENTIONS: Airway endoscopy was performed in an awake child in cases of clinical and/or radiologic respiratory signs or in cases of preoperative assessment of a cardiac abnormality that is known to accompany airway compression. MEASUREMENTS AND MAIN RESULTS: Endoscopy was well tolerated; 71% of the children had endoscopic abnormalities and 50% had airway compression. The locations of these compressions are the same as those described in the literature in the cases of vascular rings and left-to-right shunts. The other endoscopic findings were laryngeal and bronchial abnormalities, tracheobronchial malacia, respiratory signs of gastroesophageal reflux, and positive bacteriologic sputum samples. CONCLUSION: Endoscopy in an awake patient is the only way to evaluate the functional component of a compression due to malacia; the resulting collapse of the airway can cause trapping of air and secretions. Furthermore, fiberoptic bronchoscopy offers a complete examination of the airways and can help detect airway abnormalities that are potential causes of complications. Fiberoptic bronchoscopy is a suitable and well-tolerated examination that is easy to perform at the bedside of the child. This technique optimizes the preoperative assessment of children with congenital heart disease.

Adolescent↗
PubMed2003

Significance of early bronchoscopic airway abnormalities after lung transplantation.

Abnormal bronchoscopic allograft airway appearance with erythema, friability and sloughing-presumed to be ischemic-has been described early after lung transplantation, but its association with post-operative spirometry or other outcomes is largely unknown. We conducted a prospective cohort study to assess the impact of such airway changes in all lung transplant recipients from January 1997 to July 2000. Twenty-four (59%) of 41 patients were classified as having ischemic-appearing airways. Timing and value of peak pulmonary function tests, mortality, incidence of infection, rejection, anastomotic stricture and bronchiolitis obliterans syndrome were not significantly different when compared to patients with normal-appearing airways over a mean follow-up period of 761.2 +/- 412.4 days.

Bronchoscopy↗
PubMed1988

Use of bronchoscopic CO2 laser in palliation of obstruction tracheobronchial malignancy.

A review of 15 patients, who underwent 34 CO2 laser bronchoscopic procedures, over a 2-year period, is presented. All had malignancies of the tracheobronchial tree and underwent laser surgery to palliate breathlessness or haemoptysis. Partially obstructing and more proximal tumours proved more easily manageable. One quarter of the patients required repeat procedures and there were two deaths in the early post-operative period. The indications for such surgery, the technique and its limitations, and the palliation obtained are discussed.

Aged↗
PubMed2003

'Iron lung': distinctive bronchoscopic features of acute iron tablet aspiration.

Three confirmed cases of acute iron tablet-induced necrosis due to a fulminant chemical burn injury to the tracheobronchial tree as a result of accidental inhalation and/or aspiration of iron tablets are described. Although histological confirmation has been relied upon for diagnosis, the distinctive bronchoscopic features may allow prompt recognition and treatment by bronchoscopists to prevent this potentially fatal condition.

Aged↗
PubMed2002

Cytological examination of the whole endobronchial brush in bronchoscopic diagnosis of lung cancer.

The combination of cytological and histological techniques has significantly increased the accuracy of fibreoptic bronchoscopy (FOB) in the diagnosis of lung cancer. We tested the hypothesis that cytological examination of material obtained from the whole endobronchial brush might increase the diagnostic yield in patients where conventional brush specimens were negative. Fifty patients who had undergone FOB for suspected lung cancer were studied prospectively. Bronchial lavage, bronchial biopsy and conventional brushing were performed. The whole endobronchial brush was then cut off the end of its wire and transported in a universal pot containing Shandon cytospin collection fluid. The material was dislodged from the whole brush using a vortex and the remaining fluid was centrifuged at 2,000 r.p.m. The fluid concentrate was used to maketwo cytopsin preparations. Papanicolaou stain was used. Fifty patients were studied, of which thirty-nine (78%) had endoscopicaly visible tumour. Of those, bronchial biopsy conventional brushing lavage and whole brush were positive for malignant cells in 31 (79.4%), 29 (74.3%), 21 (53.8%), and 16 (41%) of cases, respectively. A diagnosis of lung cancer was confirmed in 35 (89.7%) cases of endoscopicaly visible tumour. Conventional brushing was positive in two out of 11 (18.2%) cases with no visible tumour. Whole brush analysis was not positive in any of the cases with negative conventional brushings and was the least sensitive test in detecting malignancy Whole endobronchial brush analysis has no advantage in bronchoscopic diagnosis of patients with suspected lung cancer.

Biopsy↗
PubMed1999

[Obturating endobronchial lipoma--bronchoscopic therapy].

We report on the case of a 77-year old man in whom a lipoma caused occlusion of the lingular bronchus with consecutive dystelectasis. The lipoma was resected via the bronchoscope with a hot snare. The incidence, clinical characteristics and treatment of endobronchial lipomas are described.

Aged↗
PubMed1990

Bronchoscopic and cytopathological findings of tracheobronchial involvement in esophageal carcinoma.

To evaluate the usefulness of bronchoscopic and cytopathologic examinations for tracheobronchial involvement of esophageal carcinoma, we reviewed 14 cases of esophageal carcinoma suspected of tracheobronchial invasion. Two cases underwent bronchoscopy for postoperative respiratory symptoms, and both revealed endotracheal tumor growth and proved positive at brush cytology and biopsy. Among nine cases submitted to preoperative examination, bronchoscopy showed only protrusion in four cases, and redness with mucosal protrusion in five cases. Two of the latter evidenced cancer cells on brushing specimen, and their prognosis was poor. The remaining three cases underwent bronchoscopy for preoperative severe respiratory symptoms. Tumor growth was noted in two of them, and cytology or biopsy was positive. We conclude that bronchoscopy for tracheobronchial involvement of esophageal carcinoma plays a major role in the diagnosis of extra-esophageal extension. Because of the anatomical situation, biopsy is sometimes difficult. Brush cytology is important in the case of mucosal protrusion and redness.

Aged↗
PubMed1983

Bronchoscopic photography of a bronchial carcinoid tumor associated with unilateral hypoperfusion of the lung.

A patient with a bronchial carcinoid-producing unilateral hypoperfusion of the lung is described. Bronchoscopic photographs show the adenoma to assume different intrabronchial positions during inspiration and expiration. Although patent during inspiration, the lumen was effectively occluded during expiration. The adenoma exhibited a ball-valve movement which is speculated to be the initial mechanism of hypoperfusion in this setting.

Bronchial Neoplasms↗
PubMed1982

[Fibre-bronchoscopic laser coagulation in the treatment of recurrent pulmonary haemorrhages (author's transl)].

Recurrent episodes of severe lung haemorrhages were successfully treated by laser coagulation in a 76-year-old woman with central squamous-cell carcinoma of the lung. The combination of flexible bronchoscope and laser coagulation made it possible to obtain selective haemostasis as far as the subsegments, with minimal stress to the patient. Laser coagulation is an important alternative in the palliative treatment of recurrent haemorrhages of the lung.

Aged↗
PubMed1986

Placement of double-lumen endobronchial tubes. Correlation between clinical impressions and bronchoscopic findings.

Double-lumen endobronchial tubes were placed "blindly" in 23 patients undergoing thoracotomy. Clinical criteria suggested satisfactory positioning in all cases; however, subsequent fibreoptic bronchoscopy revealed malposition in 48%. Bronchoscopic findings included the inability to view the bronchial cuff, narrowing of the bronchial lumen of the tube at the level of the cuff and herniation of the cuff over the carina. The potential hazards associated with these findings are discussed.

Adult↗
PubMed1983

Acquired laryngeal deviation associated with cervical spine disease in erosive polyarticular arthritis. Use of the fiberoptic bronchoscope in rheumatoid disease.

Cervical spine disease in patients with erosive polyarticular arthritis often presents difficulties in endotracheal intubation at the time of surgery. After extensive experience with the use of the fiberoptic bronchoscope in such situations, the authors have identified a previously unrecognized and unanticipated tri-plane deviation in which the larynx is displaced caudally, deviated to the left, rotated to the right, and anteriorly angulated. A review of 710 consecutive fiberoptic intubations identified 15 arthritis patients with laryngeal deviation. Documentation was available in seven patients showing that the larynx was initially in a normal position, but was progressively displaced as the cervical spine disease worsened. Vertical penetration of the dens was the most significant underlying pattern of cervical spine disease. Computerized tomography with multiplanar reconstruction elucidated two patterns of deformity but was not necessary to detect the laryngeal deviation. One cause of the deviation was a scoliotic deformity of the trachea and larynx secondary to shortening of the neck resulting from the vertical penetration. The second mechanism was a rotational deformity of the cervical spine occurring from asymmetric bony erosions. Knowledge of this deformity permits it to be easily predicted preoperatively so that appropriate management can be planned.

Adolescent↗
PubMed1998

A bronchoscopic, computer-assisted examination of the changes in dimension of the infant tracheal lumen with changes in head position: implications for emergency airway management.

BACKGROUND: Resuscitation guidelines caution against extreme extension or flexion of an infant's head because tracheal obstruction may occur. No data support this recommendation. The authors therefore examined the dimensions of the tracheal lumen in neutral, extended, and flexed head positions in infants undergoing general endotracheal anesthesia for elective surgery. METHODS: Eighteen healthy full-term infants were studied. A flexible fiberoptic bronchoscope was passed through a previously inserted endotracheal tube and positioned above the cricoid cartilage. Video recordings were taken in each of three head positions. Recordings were analyzed by an investigator blinded to head position. A computer-digitized technique was used to measure anterior-posterior and lateral dimensions and cross-sectional area. Data were analyzed using paired t tests and sign tests. RESULTS: No significant differences in mean tracheal dimensions with changes in head position were found. No infant had complete tracheal obstruction. Infants were equally as likely to have a small increase as they were to have a small decrease in tracheal dimension with changes in head position. CONCLUSIONS: Despite the belief that infants and neonates have obstruction at the level of the trachea with extreme positions of the head, the authors were unable to demonstrate this phenomenon.

Airway Obstruction↗
PubMed1984

Indications, results, and complications of bronchoscopic carbon dioxide laser therapy.

A carbon dioxide laser coupled with a rigid ventilating bronchoscope has been used to treat 94 patients with symptomatic obstructing lesions of the trachea and main stem bronchi. Fifty-nine patients had malignant disease and 35 had benign disease. The results in the 35 patients with benign disease have been good except for patients with airway deformity who required subsequent reconstruction. The results in the 59 patients with malignant disease have been satisfactory. Six patients died in the immediate postoperative period, five died within 30 days of treatment, and of the remaining, 24 are alive with an average life span of 14.3 months.

Airway Obstruction↗
PubMed2001

Bronchoscopic invasive diagnostic techniques in the cancer patient.

The cancer patient often presents with fever and pulmonary infiltrates, in particular during the course of chemotherapy or after bone marrow transplantation. In these conditions, specific diagnoses are mainly related to an infective cause, but noninfectious processes, malignant or not, are also found alone or in combination with infection. Identification of the pulmonary process can be achieved by bronchoscopic techniques, including bronchoalveolar lavage (BAL) and transbronchial biopsy (TBB). BAL may help identify opportunistic organisms but also bacterial pneumonia, provided quantitative cultures are performed, and TBB has been shown to increase the diagnostic yield of BAL. These two procedures should then be combined, provided there is no contraindication.

Biopsy↗