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PubMed1993

[Pediatric fiber bronchoscopy. Apropos 55 children examined].

We present our experience with 55 children in which we performed flexible fiberoptic bronchoscopy (FFB) using an Olympus BF3C20 instrument and by using sedation and local anaesthesia or laryngeal mask airway. Indications for performing this procedure were stridor, opportunist or recurrent pneumonia, persistent atelectasis, a suspected foreign body, confirmation of endobronchial tuberculosis and evaluation of tracheostomy. In 70% of the cases, the diagnosis was made by the FFB and 14 cases were normal. One child with severe hypoxia presented respiratory arrest and need intubation. Our results suggest that FFB is safe, has advantages over rigid bronchoscopy, avoids general anaesthetic and with laryngeal mask airway is possible to perform in patients of every age.

Adolescent↗
PubMed1993

Topical nasal anaesthesia for fibreoptic bronchoscopy: lignocaine spray or gel?

Lignocaine spray for anaesthetising the nasal mucosa for fibreoptic bronchoscopy often causes discomfort to the patient. We compared two techniques of applying nasal topical anaesthesia using either lignocaine spray (group A: 25 patients) or gel (group B: 30 patients) to assess patients' tolerance to the procedure. Both groups received 100 mg of lignocaine in the nostril, 40-50 mg to oropharynx, 120 mg to vocal cords and 40-100 mg to trachea and bronchi. Throat anaesthesia was the most common unpleasant part experienced by both groups of patients (34.5%), followed by examination of bronchi (30.6%) and nasal anaesthesia (21.8%). Significantly more patients in group A experienced discomfort or pain during nasal anaesthesia as compared to group B (p < 0.001). Patients' tolerance to the bronchoscopy was similar in both groups and the examination was performed satisfactorily in all patients. Thus, lignocaine gel is a simple technique, effective and less irritating as compared to lignocaine spray for topical nasal anaesthesia.

Adolescent↗
PubMed1993

[Results of initial bacteriology of pulmonary tuberculosis among male NTT employees in the Tokyo area--annual transition and influence of fiberoptic bronchoscopy].

A study was made on the annual changes in the positive rate for acid-fast bacilli (AFB) at the initial bacteriological examination of newly detected pulmonary tuberculosis among male NTT (Nippon Telegraph and Telephone Corporation) employees in the Tokyo area during a period of 32 years from 1960 through 1991. The influence on the changes of recent introduction of fiberoptic bronchoscopy for obtaining the specimen was also analyzed, and the following results were obtained. 1. Results obtained by the conventional bacteriological method using expectorated sputum or aspirated gastric juice as the specimens. (1) The annual incidence of bacteriologically positive (smear and/or culture positive) cases constantly decreased and reached the lowest in 1981, then ceased to decline and remained at the level of 1981. (2) The annual ratio of AFB positive by smear and the ratio of smear and/or culture positive cases to the newly detected cases of pulmonary tuberculosis were constant during the entire observation period. (3) The ratio of AFB positive by smear to the newly detected cases annually increased but did not increase when the observation period was limited to within 1976 to 1991. 2. Results obtained by fiberoptic bronchoscopy in combination with conventional bacteriological methods. (1) Both the annual incidence of smear and/or culture positive cases and the ratio of these cases to the newly detected cases of pulmonary tuberculosis showed a tendency to increase in both the 80's and 90's.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1977

Fibreoptic bronchoscopy. Part I: TECHNIQUE AND APPRAISAL.

Fibreoptic bronchoscopy is a simple, useful examination suitable for the investigation of outpatients without general anaesthesia. It considerably extends the range of vision and diagnostic ability that is achieved with a rigid bronchoscope. Further, it lends itself to the diagnosis and management of many medical lung diseases in addition to carcinoma. The applications of fibreoptic bronchoscopy will be discussed in more detail in Part II.

Bronchoscopy↗
PubMed1995

[Pediatric fiber bronchoscopy. Our experience].

Fiberoptic bronchoscopy is at present an indispensable technique in pediatric pulmonology. Sixty-nine such procedures were performed at our center between April 1993 and November 1994 on children under 14 years-old. We used an Olympus BF-3C20 fiberoptic bronchoscope, after providing sedation with diazepam or midazolam, sometimes accompanied by fentanyl and atropine. No intubation was required in 59 cases. In 9 cases intubation was orotracheal. In one patient the tubes were inserted outside the trachea. The indications for bronchoscopy were upper airways disease (16.98%), lower airways disease (75.47%) and exploratory in 7.54%. The endoscopic findings were upper airways disease (8.6%), bronchial disease (52.17%), extrinsic bronchial compression (4.34%) and normal (13.04%). Samples were taken in 52.17%. No important complications occurred but there were slight decreases in oxygen saturation.

Adolescent↗
PubMed1995

Flexible fibreoptic bronchoscopy in 582 children--value of route, sedation and local anesthetic.

The value of route, sedation and local anesthetic was studied in 582 children aged 50 days to 12 years who were subjected to flexible fibreoptic bronchoscopy (FFBS) at the Institutes of Child Health, Madras, during January 1989 to July 1993. Pentax 3.5 mm and Olympus 4.9 mm bronchoscopes were used. Bronchoscopy was performed with sedation and/or local anesthetic through nasal/oral route after premedication with atropine. It was successfully carried out through nasal route in 97.4% and only in 40% through oral route. As nasal route proved advantageous, the oral route was abandoned.

Anesthesia, Local↗
PubMed1996

Rigid bronchoscopy.

Rigid bronchoscopy is indicated for the presence of significant bleeding, a foreign body, or in pediatric patients. A thorough knowledge of endobronchial anatomy and expertise with rigid bronchoscopy is a necessity for the practicing general thoracic surgeon.

Anesthesia↗
PubMed1996

Bronchoscopy in the intensive care unit.

With the prevalence of bronchopulmonary disease in the intensive care unit, bronchoscopy has become an essential tool for the management of patients. This article describes the variety of situations in which bronchoscopy can be of assistance in establishing diagnosis, managing the difficult airway, and supporting the patient's suffering of trauma, hemoptysis, atelectasis, and pneumonia.

Bronchoscopes↗
PubMed1996

[Clinical evaluation of fiberoptic bronchoscopy for the diagnosis of solitary pulmonary nodules 2 cm or less in diameter of chest roentgenogram].

The value of fiberoptic bronchoscopy in the diagnosis of solitary pulmonary nodules was studied. The subjects were 59 patients with chest-roentgenographic evidence of a solitary pulmonary nodule 2 cm or less in diameter. Definitive diagnoses were made in 34 patients (57.6%). Primary lung care was diagnosed 21 of 32 patients (65.6%), pulmonary tuberculosis in 7 of 12 (58.3%), metastatic lung cancer in 3 of 5 (60%), old lesions in 3 of 5 (60%), and pulmonary filariasis in 0 of 1 (0%). The diagnostic sensitivity of transbronchial biopsy was superior to that of curettage, and combining the two techniques further improved the diagnostic yield. Bronchial lavage was not effective for diagnosis of lung cancer, but was effective for diagnosis of pulmonary tuberculosis. Diagnostic yield was less for nodules in upper lobes than for those in other lobes, and most malignant tumors that were not diagnosed from the results of fiberoptic bronchoscopy were in upper lobes. We conclude that combining various fiberoptic bronchoscopic procedures can improve the diagnostic yield in patients with small pulmonary nodules. CT-guided needle biopsy and video-assisted thoracoscopic biopsy are two such procedures. Early diagnosis of small pulmonary nodules requires a skilled bronchoscopist who can choose the most appropriate method for biopsy.

Bronchoscopy↗
PubMed1996

Bronchoscopy in immunocompromised host with pulmonary infiltrates.

Pulmonary complications related to immunosuppression may be secondary to infection, neoplasia, toxic effects of chemotherapy and radiotherapy or the primary disease itself. The diagnostic yield from bronchoscopic studies on immunocompromised hosts (ICH) with pulmonary infiltrates varies widely and the indication and timing for bronchoscopic procedures remain uncertain. We prospectively studied 60 consecutive ICH with pulmonary lesions over a 12-month period. Bronchoscopic studies were performed as soon as pulmonary lesions were detected and within 72 hours of antimicrobial treatment. The patients were divided into two groups: E (40 patients) and L (20 patients) were bronchoscoped on average 1.6 days (SD 0.8) and 16.7 days (SD 10.8) respectively after clinical detection and antimicrobial treatment. A total of 131 bronchoscopic procedures were performed. These included bronchoalveolar lavage 60, bronchoscopic lung biopsy 47, bronchial biopsy 8, brushing 8 and washing 8. Diagnostic yields for bronchoscopically obtained fluid and tissue histology were 45% and 49% respectively. Both complement each other resulting in a higher diagnostic yield of about 70% of the patients in both groups. Procedural complications were minor (13% of cases) and mortality was zero. Infections accounted for approximately two-thirds of the pulmonary lesions. Patients bronchoscoped earlier received less antimicrobial empiric therapy and had shorter hospitalisation. Despite delayed bronchoscopy in ICH in the late group, bronchoscopic results influenced in 85% of patients. However, based on earlier use of appropriate therapy, shorter hospitalisation and decreased costs, we recommend early bronchoscopy when response to empiric treatment has been unsatisfactory.

Adolescent↗
PubMed1997

Cardiovascular consequences of fibreoptic bronchoscopy.

Fibreoptic bronchoscopy (FOB) is now commonly performed, and the number of elderly patients undergoing the procedure is increasing. Problems with oxygenation during FOB are well-recognised, but there are few data about its cardiovascular effects. Forty five patients (median age 65 yrs) undergoing elective FOB were studied prospectively. Patients were connected to a 12-lead computerized electrocardiographic recorder, a finger plethysmographic blood pressure (FPBP) monitor and pulse oximeter. Forty three patients were sedated with fentanyl and droperidol, and all were given 5 mL 2.5% cocaine intratracheally and xylocaine spray to the pharynx. Mean sphygmomanometric cuff blood pressure was raised initially (167/88 mmHg). Mean blood pressure recorded by FPBP rose on intratracheal injection (178/96 mmHg) and remained high throughout the procedure. Mean (SD) initial cardiac frequency was 93 (5.1) beats x min(-1) and rose to 134 (7.5) beats x min(-1) during the procedure. Four of the 45 patients showed unexpected ST segment depression of >1 mm for >1 min, and a further three developed bundle branch block. These seven patients had significantly greater tachycardia (152 vs 131 beats x min(-1)) and higher blood pressure (238/131 vs 207/109 mmHg). They were older (72 vs 61 yrs), had smoked more (63 vs 39 pack-years), but had similar lung function and similar changes in oxygen saturation. Oxygen desaturation occurred in 19 patients and this was associated with poor lung function (69 vs 84% predicted forced expiratory volume in one second), but was independent of the cardiovascular changes. Significant cardiovascular changes occur during fibreoptic bronchoscopy, with evidence of cardiac strain in 21% of patients over the age of 60 yrs.

Adjuvants, Anesthesia↗
PubMed1997

[Bronchoscopy in inhalation burns].

The treatment of burns of various depth and location which are combined with thermoinhalation affections of the respiratory organs is a serious problem during the entire course of burn disease. Despite advances in modern treatment of burns, the death rate of pulmonary complications is still high. Pulmonary disorders encountered in inhalation of chemical toxic products of burning, smoke and its finely divided components increase the fatal outcomes by 30-100% in different periods of the burn disease. Until recently, thermoinhalation affections were not often taken into account in analysis of the causes of death of patients with burns, and the diagnosis was based on scanty historical data and late clinical symptoms. In works published from the beginning of the eighties, bronchoscopy was assigned secondary significance. Evaluation of the character of the lesion, the extent and depth of pathological changes in the tracheobronchial tree in thermoinhalation affections is based in most cases on the post-mortem findings. The purpose of this work was to evaluate clinically and by laboratory studies the role and significance of bronchoscopy in establishing the diagnosis in individuals with burns and thermoinhalation damage during life, in the treatment and prevention of the expected complications in the respiratory organs, and to promote wide use of a bronchoscope in this category of seriously ill patients. On the basis of the study, the authors revealed a close correlation between respiratory insufficiency of various degree and extent and the depth of the affection of the tracheobronchial tree. They also substantiated indications for systemic bronchoscopic treatment of thermoinhalation lesions.

Adolescent↗
PubMed1996

[Methylene blue staining in fiberoptic bronchoscopy in the diagnosis of bronchial tumors].

47 patients were stained by using methylene blue in fiberoptic bronchoscopy. Of these, 35 had central lung cancer, and 12 bronchitis. 40 patients with central lung cancer were detected by general fibreoptic endoscopy. The results demonstrated that normal bronchial mucosa was not stained, 97.14% central malignant bronchial tumors stained, and 8.33% bronchitis stained. X2test showed the marked difference. Positive diagnosis was 97.06% in biopsy specimens stained, it was higher than 77.05% in the general investigated (P < 0.05). Using methylene blue in fiberoptic bronchoscopy would help diagnose central lung cancer, determine tumors limits, permit accurate biopsy. The stain was not related to the pathological classification, differentiation of cancer cells, and classification of clinical pathology (P > 0.05).

Adult↗
PubMed1997

[Analysis of ventilation parameters before and after fiber optic bronchoscopy in patients with atopic bronchial asthma and chronic obstructive pulmonary diseases].

Bronchial asthma and chronic bronchitis in a stable period of the disease could be an indication for diagnostic bronchofiberoscopy. The aim of the authors of this article is to assess whether bronchoscopy may be safely used either as diagnostic or therapeutic procedure. 21 patients (age 33-46), 13 with atopic bronchial asthma and 8 with COPD took part in this study. The measurements were carried out one day before and 3 hours after the bronchoscopy. The following parameters: Forced Vital Capacity (FVC), Forced Expiratory Volume (FEV1), Forced Expiratory Flow (FEF25, FEF50, FEF75) and Resistance of Airways (R aw) were taken into consideration. It was shown that bronchofiberoscopy could be performed safely in these patients and did not lead to woersing ventilation parameters. Bronchospasm was not observed during the study. Moreover the increase in FEF50, FEF75 and R aw were observed. This significant decrease of amount of bronchial discharge could serve as an explanation of this phenomenon.

Adult↗
PubMed1995

[Bronchoscopy and biopsy methods in the diagnosis of bronchial carcinoma].

A review of today possibilities of bronchoscopy in diagnosis of bronche cancer was given in this paper. Endoscopic findings at bronche cancer were classified, and other biopsy methods during bronchoscopy were reviewed. A review of other diagnostic methods of bronche cancer was given: needle blind biopsy of pleura, percutaneous aspirated needle biopsy of lungs. The possibilities of treatment local endoscopic changes were given: cryotherapy and laser-therapy.

Biopsy, Needle↗
PubMed1997

Tracheal ring rupture and herniation during percutaneous dilatational tracheostomy identified by fibreoptic bronchoscopy.

We present a case of rupture and herniation of cartilaginous tracheal rings into the lumen of the trachea that was noticed as an incidental finding during bronchoscopy after percutaneous dilatational tracheostomy. While percutaneous methods of tracheostomy formation gain popularity in intensive care settings, the number of reported problems associated with this technique continue to grow. We propose that fibreoptic bronchoscopy used routinely with percutaneous tracheostomy formation will identify a number of complications involving the tracheal skeleton.

Aged↗
PubMedDate not supplied

Is there a place for rigid bronchoscopy in the management of pediatric lung disease?

A review of 364 rigid bronchoscopies in children is presented of whom 55% were younger than 3 years old. The commonest diagnoses in the under 1 year old group were related to congenital anomalies, in the 1-3 year group to inhaled foreign bodies, and in the over 3 year group to bronchiectasis. It is noted that some 30-40% of the tests could have been undertaken with a flexible bronchoscope, but it is suggested that the advantages of the flexible instrument in children with lung disease, as distinct from upper airway disease, are less than in adult practice. Clear benefits for the management of the patient should be obvious before undertaking bronchoscopy in children, and careful consideration should be given to the type of instrument most likely to provide the results desired.

Adolescent↗
PubMed2005

[Bronchoscopy].

Through the introduction of new techniques, bronchoscopy, a standard tool for years, has made great strides within the last years. With the introduction of endobronchial ultrasound, staging can be improved considerably in patients with lung carcinoma, thereby also leading to a better estimate of the patient's prognosis. By means of navigation techniques it is possible today to biopsy even smaller coin lesions, so that the number of diagnostic operations should decline in the next years. Also in the therapy of lung emphysema, an endoscopic technique is now available as a further treatment option. There is a good chance that broader possibilities and fields of application of bronchoscopy will emerge.

Biopsy↗