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PubMed1977

The value of topical lignocaine for bronchoscopy under general anaesthesia.

Patients for bronchoscopy were randomly allocated to two groups, one receiving 4 ml 4% lignocaine spray and a control group which was not sprayed. There were no significant differences in the incidence of cough and spasm on recovery between the groups. The findings of a double-blind study comparing patients sprayed with 0-9% saline or lignocaine showed a significantly higher incidence of spasm in the saline group.

Administration, Topical↗
PubMed1978

Blood levels of nitrous oxide during bronchoscopy.

Arterial blood levels of nitrous oxide have been measured during bronchoscopy using two types of ventilating bronchoscope. It seems unlikely that the blood levels of nitrous oxide achieved using these devices would contribute to a reduction in the incidence of awareness during this procedure.

Adult↗
PubMed1979

Methohexitone and etomidate for bronchoscopy.

General anaesthesia for bronchoscopy has been provided with either methohexitone or etomidate, with and without fentanyl. Recovery was faster following methohexitone and there was no statistically significant difference in the incidence of complications. Inclusion of fentanyl in the technique did not confer any benefits with either drug.

Anesthesia, General↗
PubMed1986

The haemodynamic effects of bronchoscopy. Effect of pretreatment with fentanyl and alfentanil.

The cardiovascular responses to bronchoscopy under general anaesthesia were investigated in 36 premedicated patients. Twelve patients acting as controls received a standard intravenous anaesthetic of intermittent thiopentone and suxamethonium. A further 24 patients were given either fentanyl 6 micrograms/kg or alfentanil 18 micrograms/kg intravenously, one minute prior to induction. There were significant rises in systolic arterial blood pressure (p less than 0.05) and in rate pressure product (p less than 0.05) in the patients in the control group, but these changes were not seen in those patients receiving either fentanyl or alfentanil. However, dysrhythmias and ST segment changes indicative of myocardial ischaemia were present in some patients in all three groups.

Alfentanil↗
PubMed1987

Carbon dioxide laser bronchoscopy. A review of problems and complications.

The records of 20 patients who underwent carbon dioxide laser bronchoscopy were analysed retrospectively. Many of the cases presented with evidence of severe obstruction of the trachea or major bronchi and were regarded as highly at risk from anaesthesia. The majority of problems in the 35 laser sessions related to the use of a rigid bronchoscope for delivering the laser and to the ventilatory difficulties associated with the airway pathology. Invasive arterial monitoring for blood gas analysis and blood pressure measurement proved essential to detect and correct changes of a potentially serious nature. This experience is compared and contrasted with that of others.

Adult↗
PubMed1988

Nalbuphine combined with midazolam for outpatient sedation. An assessment in fibreoptic bronchoscopy patients.

Forty patients who required day case fibreoptic bronchoscopy were sedated with either nalbuphine 0.2 mg/kg and midazolam 0.05 mg/kg (n = 20), or midazolam 0.05 mg/kg alone (n = 20). Extra midazolam was administered when required. The degree of respiratory depression measured by arterialised venous carbon dioxide levels was recorded together with heart rate, arterial blood pressure, respiratory rate and sedation score, before administration of the drugs and at regular intervals thereafter. Patients who received nalbuphine had slightly higher carbon dioxide levels but respiratory rate and cardiovascular changes were similar in both groups. The addition of nalbuphine to midazolam improves the quality of sedation but prolongs the recovery time and increases the incidence of side effects.

Ambulatory Care↗
PubMed1989

Alfentanil used to supplement propofol infusions for oesophagoscopy and bronchoscopy.

This randomised double-blinded study compared the cardiovascular stability and rate of recovery when propofol infusions with or without alfentanil were used to provide anaesthesia for rigid oesophagoscopy and (or) bronchoscopy. Forty-six patients were allocated randomly to receive either alfentanil 10 micrograms/kg or saline just before a rapid sequence induction with propofol. Suxamethonium 1 mg/kg was given and infusions of suxamethonium 10 mg/minute and propofol (10 mg/kg/hour for 10 minutes, 8 mg/kg/hour for 10 minutes and then 6 mg/kg/hour thereafter) were started. There were 23 patients in each group with no significant demographic differences between the groups. A significantly mean lower induction dose of propofol was needed in the alfentanil group (1.7 mg/kg compared to 2.2 mg/kg). Cardiovascular measurements were made on the ward pre-operatively, just before induction, just after induction, just after intubation, and at 3-minute intervals thereafter. Arterial pressure was significantly lower during the procedure in the patients who received alfentanil and there was a significant incidence of hypotension. There was no significant difference between the groups in respect of heart rate, with a significant increase in both groups just after intubation compared to the baseline values. Recovery from anaesthesia was assessed using the critical flicker fusion threshold. No differences were found between the groups and patients in both groups had returned to baseline values by 60 minutes. No patient had any recall of intra-operative events, and there were no other adverse effects of any significance.

Adjuvants, Anesthesia↗
PubMed1984

Absorption of lignocaine and bupivacaine from the respiratory tract during fibreoptic bronchoscopy.

Absorption of lignocaine and bupivacaine from the upper and lower respiratory tract was studied in patients undergoing fibreoptic bronchoscopy. No significant differences were found between the drugs and between the routes of administration in terms of the time taken to achieve maximum plasma concentrations. The relative availability of lignocaine was greater following administration via the upper respiratory tract, but bupivacaine availability did not differ. The apparent clearance of lignocaine was not affected by the route of administration but bupivacaine clearance was higher following administration via the lower respiratory tract. Bupivacaine, previously unreported as a topical agent in man, produced adequate anaesthesia at one-eighth of the dose of lignocaine. Plasma bupivacaine concentrations had a very wide safety margin.

Absorption↗
PubMed1988

Fiberoptic bronchoscopy and bronchial mucosal biopsies in asthmatics undergoing long-term high-dose budesonide aerosol treatment.

Mucosal biopsies from the pharynx, right main stem bronchus and right lower lobe were obtained during flexible fiberoptic bronchoscopy and were examined with light microscopy (LM) and electron microscopy (EM) in 10 asthmatics after 11 months' (range 7-15 months) treatment with high doses of inhaled budesonide via the Nebuhaler, i.e. 1600 micrograms daily. Results were compared with biopsies from 10 controls suspected of having focal, malignant lung diseases. Visual inspection of the tracheobronchial tree showed no signs of atrophy, ulcerations or thrush patches, and LM and EM showed no specific signs of mucosa and connective tissue atrophy; however, epithelial desquamation was seen in the asthmatics. No complications were observed.

Adolescent↗
PubMed1991

Comparison of intravenous and topical lidocaine as a suppressant of coughing after bronchoscopy during general anesthesia.

Twenty-four consecutive patients scheduled for fiberbronchoscopy were randomized to receive double-blind either intravenous (1.5 mg/kg) or laryngotracheal (3 mg/kg) lidocaine to evaluate the influence on post-bronchoscopic laryngospasm, pain in the throat and coughing. Plasma lidocaine concentrations were analyzed 5, 15, 30 and 60 min after administration. None of the patients demonstrated laryngospasm or pain in the throat during the first hour after bronchoscopy. Patients receiving topical lidocaine coughed significantly more than patients receiving intravenous lidocaine, with a median number of coughs of 20 compared to 4, during the first hour (P less than 0.01). The plasma lidocaine concentrations were significantly higher after intravenous than after topical administration (P less than 0.001). After intravenous administration the plasma lidocaine concentrations exceeded the accepted level for potential toxicity in five out of 11 patients, but none of the patients developed toxic symptoms and no side-effects were observed.

Administration, Topical↗
PubMed1998

Negative pressure ventilation vs. spontaneous assisted ventilation during rigid bronchoscopy. A controlled randomised trial.

BACKGROUND: Ventilation during interventional rigid bronchoscopy (IRB) under general anaesthesia (jet ventilation, positive pressure ventilation and spontaneous assisted ventilation) may offer some difficulties. This study compares the effectiveness during IRB of intermittent negative pressure ventilation (INPV) and spontaneous assisted ventilation (SAV). METHODS: Thirty-eight patients submitted to IRB were randomised into two groups: SAV or INPV. All patients received a total intravenous anaesthesia; INPV patients were paralysed. Pre- and intra-operative arterial blood gases and O2 flow through a rigid bronchoscope were assessed. The endoscopist applying a subjective score evaluated the operating conditions. RESULTS: Patients of the INPV group, as compared to the SAV group, required a lower dosage of fentanyl (2.6 +/- 1.8 micrograms.kg-1.h-1 vs. 6.6 +/- 4.8 micrograms.kg-1.h-1), a lower O2 supply (3.3 +/- 2.8 l/min vs. 11.6 +/- 3.4 l/min), a shorter recovery time (5.4 +/- 2.9 min vs. 9.8 +/- 7.1 min) and no manually assisted ventilation (0 +/- 0 vs. 1 +/- 1.1 n degree/procedure). Intraoperative PaCO2 was higher in the SAV (8.1 +/- 1.3 kPa) than in the INPV group (5.0 +/- 1.6 kPa) and intraoperative pH differed in the two groups (7.26 +/- 0.05, SAV vs. 7.47 +/- 0.08, INPV). Operating conditions, as assessed by a subjective score, were considered better with INPV than with SAV (4.9 vs. 4.3). CONCLUSIONS: As compared to SAV, INPV in paralysed patients during IRB reduces administration of opioids, shortens recovery time, prevents respiratory acidosis, excludes the need for manually assisted ventilation, reduces O2 need and affords optimal surgical conditions. INPV appears a safe, non-invasive and effective ventilatory management during IRB.

Adult↗
PubMed2005

Bronchoscopy in the diagnosis and surveillance of respiratory infections in lung and heart-lung transplant recipients.

Fiberoptic bronchoscopy (FOB) with bronchoalveolar lavage (BAL) and transbronchial biopsies (TBB) is a widely used method to detect respiratory infections and to differentiate them from other postoperative complications in lung transplant (LTX) recipients, but the usefulness of surveillance FOBs is not yet established. The aim of this study was to evaluate the usefulness of FOB in the diagnosis and surveillance of infections in LTX recipients. We reviewed all the consecutive 609 FOBs performed on 40 lung or heart-LTX recipients between February 1994 and November 2002. The overall diagnostic yield was 115/190 (61%) and 43/282 (15%) for clinically indicated and surveillance FOBs respectively (P < 0.001). Infection was established by bronchoscopic samples in 96/190 (50.5.%) of the clinically indicated FOBs and 34/282 (12.1%) of the surveillance FOBs (P < 0.001). The diagnostic yield of the clinically indicated FOBs was highest (72%) from 1 to 6 months post-transplant (P = 0.04). Pneumocystis carinii was detected in 23 (4.9%) of the bronchoscopic specimens and 15 (65%) of the P. carinii infections were detected during adequate chemoprophylaxis. To conclude, in LTX recipients clinically indicated FOB has a good diagnostic yield in detecting infections and other postoperative complications, whereas the information received from surveillance FOB has remained less significant. With current prophylaxis and screening strategies FOB is still required to detect P. carinii infections.

Adolescent↗
PubMed1995

The role of bronchoscopy in the diagnosis and treatment of pulmonary disease in HIV-infected patients.

BACKGROUND: Pulmonary disease is the most common reason for presentation and the major cause of death in HIV-infected patients. There has been an evolution in the optimal approach to the investigation of a pulmonary infiltrate in HIV-infected patients since the introduction of induced sputum for the diagnosis of Pneumocystis carinii pneumonia (PCP). AIMS: To evaluate the usefulness of flexible fibreoptic bronchoscopy (FFB), bronchoalveolar lavage (BAL), transbronchial biopsy (TBB) and bronchial brushings (BB) in the diagnosis of pulmonary disease in HIV-infected patients and to examine the effect of FFB on changes in therapy and survival. METHODS: The histories of all HIV-infected patients referred to Fairfield Hospital for FFB between January 1990 and June 1993 were examined retrospectively. RESULTS: Forty-two FFB were performed on 41 patients (40 male and one female). Definitive diagnoses made at FFB included Kaposi's sarcoma (KS) (n = 9), invasive aspergillosis (n = 5), PCP (n = 4), Mycobacterium avium complex (MAC) pneumonia (n = 2), cytomegalovirus (CMV) pneumonia (n = 1), Cryptococcus neoformans pneumonia (n = 1), microsporidium (n = 1) and Pseudomonas aeruginosa pneumonia (n = 1). TBB and BB did not provide a diagnosis for diseases not seen macroscopically at FFB or diagnosed by BAL. FFB findings altered diagnosis in 21/42 (50%) presentations and changed therapy in 26/42 (62%) cases. CONCLUSIONS: FFB together with BAL altered the working diagnosis and changed therapy in a significant number of patients. TBB and BB should not be routinely performed in all patients as these procedures are of limited value in this setting.

AIDS-Related Opportunistic Infections↗
PubMed2004

Endoscopic intratracheal carbon dioxide measurements during pediatric flexible bronchoscopy.

BACKGROUND: CO2 monitoring is recommended for thoracic telescopic procedures and for spontaneous breathing general anesthesia in children. During flexible bronchoscopy (FB) in children, the various currently available methods of CO2 measurements are limited. The CO2 falls and increases have been reported in FB but it is unknown whether airway lesions predispose to CO2 change. The aim of this study was to describe and validate endoscopic intratracheal CO2 measurements in children undergoing FB under spontaneously breathing GA. METHODS: Endtidal CO2 (P(E)CO2) measurements at the start (Start-CO2) and end (End-CO2) of FB on 100 consecutive children were performed using a newly designed endoscopic intratracheal method. To validate the method blood gas sampling was simultaneously performed in 28 children and results analyzed using the Bland and Altman method, intraclass correlation and 95% range for repeatability. RESULTS: End-CO2 and CO2-change (End-CO2 minus Start-CO2) were significantly different in children with airway lesions (CO2 change: no lesion = 3 mmHg, extrathoracic airway lesion = 4.5, intrathoracic airway lesion = 8, P = 0.038). There was no significant difference in Start-CO2 values among the groups. CO2-change in those aged < or =12 months was similar to those >12 months. Intratracheal CO2 measurements were comparable with arterial blood values in the Bland and Altman plots. The intraclass correlation was 0.69 and 95% range for repeatability was 3.7-4.17 mmHg. CONCLUSIONS: Midtracheal P(E)CO2 provides a useful estimate of P(a)CO2 for monitoring the respiratory status of children undergoing FB. The presence of airway lesions rather than age is associated with significant increased PCO2 rise.

Adolescent↗
PubMed1997

Prevalence of Helicobacter pylori in respiratory physicians performing bronchoscopy: a comparison with gastroenterologists using the carbon 13 urea breath test.

BACKGROUND: The mode of transmission of Helicobacter pylori is unclear, but it has been shown that gastroenterologists are at a greater risk of acquiring the infection when performing endoscopy. The current study was designed to assess the risk H. pylori infection in respiratory physicians performing bronchoscopy compared to an at-risk group of gastroenterologists. We were interested in identifying whether the oral cavity is important in the transmission of H. pylori. MATERIALS AND METHODS: Respiratory physicians and gastroenterologists in southern England and Wales were invited to participate in the study. Medical, personal, and professional details were recorded, and H. pylori status was established using a carbon 13 urea breath test. RESULTS: The study included 30 gastroenterologists and 30 respiratory physicians. The groups were similar for age (mean age, 46.2 years [SD 8.7] and 43.9 years [SD 8.5], respectively), number of years in practice (mean, 16.1 [6.8] and 13.2 [5.5], respectively), amount of Third-World travel, and glove and drug use (antacids, H2 antagonists, proton pump inhibitors, promotility agents, and bismuth). The prevalence of upper gastrointestinal symptoms (indigestion, heartburn, abdominal pain) and history of previous peptic ulcer or hiatus hernia were similar for both groups. Fifteen of thirty gastroenterologists and three of thirty respiratory physicians had positive breath tests (chi square, p < .001, 1 df). There was no relation between age and H. pylori status. Within the group of gastroenterologists, performance of endoscopy without gloves for longer than 7 years was associated with an increased prevalence of infection (> 7 years, 11 of 15 breath-test-positive; < 7 years, 4 of 15 breath-test-positive [chi square, p = .01, 1 df]). CONCLUSIONS: Gastroenterologists in this study appeared to be at risk of infection, whereas respiratory physicians are not. Gastroenterologists who wear gloves during endoscopy appear to be at lower risk of H. pylori infection.

Adult↗
PubMed1993

Flexible bronchoscopy as a diagnostic tool in the evaluation of pulmonary tuberculosis in an elderly population.

OBJECTIVE: This study intends to determine what role fiberoptic bronchoscopy (FOB) plays in the diagnosis of tuberculosis (TB), particularly in a geriatric population. DESIGN: Cases of tuberculosis reported to the Tennessee Department of Health during the years 1989 and 1990 were divided into two age groups: Group A (< 65 years) and Group B (> or = 65 years). Natural sputum smears and cultures positive for M. tuberculosis (M. TB) in each group were compared with FOB specimens, acid-fast bacilli (AFB) smears and cultures. Data were analyzed by chi-square tests of independence for each year, then compared to determine statistical significance. SETTING AND PATIENTS: Of the 601 TB cases reported to the State of Tennessee in 1989, 285 patients were in Group A and 316 in Group B. For 1990, 525 cases were reported, 269 in Group A and 256 in Group B. All cases met CDC-approved criteria for diagnosis of tuberculosis. MEASUREMENTS: The number of positive AFB smears and M. TB cultures were compared in each group. In cases with sputum negative but FOB specimens positive for TB, identification was made by FOB only. MAIN RESULTS: In Group A, 26 (9.1%) were diagnosed by FOB; only eight of these had positive sputum cultures. In Group B, 77 (24.4%) were diagnosed by FOB. Of these, 23 had positive sputum cultures; the remaining 54 patients (17.1%) had diagnoses based on FOB alone. In 1990, 269 cases of TB were reported in Group A. Of these, 38 (14.1%) were diagnosed by FOB. There were 256 TB cases reported among Group B, 83 (32.4%) of which were diagnosed by FOB. Of these 83 cases, 60 (23.4%) were diagnosed by FOB only. While no statistically significant difference was seen between the 1989 and 1990 rates of TB diagnosis by FOB for those in Group A (age < 65), the difference in rates for those in Group B (age > or = 65) was statistically significant (P < 0.05). CONCLUSIONS: A steady increase in the use of FOB as a diagnostic tool was noted, suggesting that a significant number (19.9%) of geriatric TB cases might have been missed without the aid of FOB. While the exact reason for its increased utilization is not known, this study indicates that FOB has become a more important source of diagnosis in pulmonary TB, particularly among the elderly.

Age Factors↗