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Fiberoptic bronchoscopy AND sedation

Takahiro Haga, Mizuki Fukuoka, Mizuo Morita, Kohei Cho, Koichiro Tatsumi
BACKGROUND: Moderate sedation has been commonly used for fiberoptic bronchoscopy (FB). However, patients may find FB under moderate sedation to be unpleasant. We therefore examined whether deep sedation was a useful premedication for FB. METHODS: We designed a prospective, randomized study using a patient questionnaire to address the perceptions of the procedures and complications of patients who underwent FB with deep sedation (deep sedation group) with midazolam in comparison with those who underwent FB with moderate sedation (moderate sedation group) with the same drug...
April 2016: Journal of Bronchology & Interventional Pulmonology
David L Stahl, Kathleen M Richard, Thomas J Papadimos
Flexible and rigid bronchoscopes are used in diagnosis, therapeutics, and palliation. While their use is widespread, effective, and generally safe; there are numerous potential complications that can occur. Mechanical complications of bronchoscopy are primarily related to airway manipulations or bleeding. Systemic complications arise from the procedure itself, medication administration (primarily sedation), or patient comorbidities. Attributable mortality rates remain low at < 0.1% for fiberoptic and rigid bronchoscopy...
July 2015: International Journal of Critical Illness and Injury Science
Umesh Goneppanavar, Rahul Magazine, Bhavya Periyadka Janardhana, Shreepathi Krishna Achar
Dexmedetomidine, an α2 agonist, has demonstrated its effectiveness as a sedative during awake intubation, but its utility in fiberoptic bronchoscopy (FOB) is not clear. We evaluated the effects of midazolam and dexmedetomidine on patient's response to FOB. The patients received either midazolam, 0.02 mg/kg (group M, n=27), or dexmedetomidine, 1 µg/kg (group D, n=27). A composite score of five different parameters and a numerical rating scale (NRS) for pain intensity and distress were used to assess patient response during FOB...
2015: Pulmonary Medicine
Maria Vargas, Yuda Sutherasan, Massimo Antonelli, Iole Brunetti, Antonio Corcione, John G Laffey, Christian Putensen, Giuseppe Servillo, Paolo Pelosi
INTRODUCTION: Percutaneous dilatational tracheostomy (PDT) is one of the most frequent procedures performed in the intensive care unit (ICU). PDT may add potential benefit to clinical management of critically ill patients. Despite this, no clinical guidelines are available. We sought to characterize current practice in this international survey. METHODS: An international survey, endorsed and peer reviewed by European Society of Intensive Care Medicine (ESICM), was carried out from May to October 2013...
2015: Critical Care: the Official Journal of the Critical Care Forum
Sudeshna Mondal, Sarmila Ghosh, Susmita Bhattacharya, Brojen Choudhury, Suchismita Mallick, Anu Prasad
BACKGROUND AND AIMS: Various drugs are used for providing favorable intubation conditions during awake fiberoptic intubation (AFOI). However, most of them cause respiratory depression and airway obstruction leading to hypoxemia. The aim of this study was to compare intubation conditions, and incidence of desaturation between dexmedetomidine and fentanyl group during AFOI. MATERIAL AND METHODS: This randomized double-blind prospective study was conducted on a total of 60 patients scheduled for elective laparotomies who were randomly allocated into two groups: Group A received dexmedetomidine 1 mcg/kg and Group B received fentanyl 2 mcg/kg over 10 min...
April 2015: Journal of Anaesthesiology, Clinical Pharmacology
Özlem Kar Kurt, Fahrettin Talay, Aysel Karğı, Zehra Yaşar, Tuncer Tuğ
Fiberoptic bronchoscopy (FOB) is a procedure which has an important role in the diagnosis and treatment of lung diseases and is widely used in clinical practice. It is an invasive procedure and can cause cough, shortness of breath, nose and throat irritation. Stress during bronchoscopy can cause release of catecholamines, which may lead to tachycardia, vasoconstriction and possible myocardial ischemia in patients with impaired cardiopulmonary function. Current guidelines for bronchoscopy recommend offering sedation to patients, with the aim of improving patient comfort and reducing complications...
2015: Tüberküloz Ve Toraks
Tomoko Mine, Minori Wada, Ai Hashimoto, Kotaro Minami, Tetsuro Nikai, Noritaka Imamachi, Yoji Saito
A male patient in his thirties was scheduled to undergo adenotonsillectomy due to dyspnea from bilateral tonsillar hypertrophy. He was morbidly obese (body mass index 56 kg x m(-2)) with severe obstructive sleep apnea syndrome (OSAS), and thus was evaluated with extreme risk for difficult ventilation and intubation. We planned awake intubation via video-assisted laryngoscopy and fiberoptic bronchoscopy under dexmedetomidine sedation, and the intubation was successfully performed. After adenotonsillectomy, upper airway obstruction due to hemorrhage and oropharyngeal swelling can be life-threatening requiring emergent airway management...
November 2014: Masui. the Japanese Journal of Anesthesiology
Levent Dalar, Cengiz Ozdemir, Sinem Sökücü, Levent Karasulu, Sedat Altın
Massive hemoptysis can be a life threatening condition and needs urgent treatment in lung cancer. In the fiberoptic bronchoscopy of a fifty-two-year-old who was admitted with hemoptysis, left upper lobe upper division orifice was seen totally obstructed with a submucosal infiltration. One hour after the mucosal biopsies, massive hemoptysis occurred. Urgent rigid bronchoscopy was performed. The left main bronchus was occluded by sterile gauze. After cleaning of the coagulum patient was intubated and charged to intensive care unit...
2014: Case Reports in Pulmonology
Ashraf Abualhasan Abdellatif, Monaz Abdulrahman Ali
BACKGROUND: Awake fiberoptic intubation is the gold standard for management of predicted difficult intubation. The purpose of this study was to test whether Glide Scope video laryngoscopy (GVL) will provide significant advantages over fiberoptic bronchoscopy (FOB) for awake intubation in morbidly obese patients with predicted difficult intubation. We therefore tested the hypothesis that intubation using GVL is faster than intubation with FOB. METHODS: 64 morbidly obese patients with predicted difficult intubation undergoing laparoscopic bariatric surgery were enrolled in this study...
February 2014: Middle East Journal of Anesthesiology
Tülay Dal, Hilal Sazak, Mehtap Tunç, Saziye Sahin, Aydın Yılmaz
OBJECTIVE: We aimed to compare the effectiveness and safety of ketamine-midazolam and ketamine-propofol combinations for procedural sedation in endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA). METHODS: Sixty patients who were undergoing EBUS-TBNA were included in this study. Patients were randomly divided into two groups. Group 1 was given 0.25 mg/kg intravenous (iv) ketamine, 2 min later than 0.05 mg/kg iv midazolam. Group 2 received 0...
June 2014: Journal of Thoracic Disease
Andrea M Collins, Jamie Rylance, Daniel G Wootton, Angela D Wright, Adam K A Wright, Duncan G Fullerton, Stephen B Gordon
We describe a research technique for fiberoptic bronchoscopy with bronchoalveolar lavage (BAL) using manual hand held suction in order to remove nonadherent cells and lung lining fluid from the mucosal surface. In research environments, BAL allows sampling of innate (lung macrophage), cellular (B- and T- cells), and humoral (immunoglobulin) responses within the lung. BAL is internationally accepted for research purposes and since 1999 the technique has been performed in > 1,000 subjects in the UK and Malawi by our group...
2014: Journal of Visualized Experiments: JoVE
Don Hayes, Aymen Naguib, Stephen Kirkby, Mark Galantowicz, Patrick I McConnell, Peter B Baker, Benjamin T Kopp, Eric A Lloyd, Todd L Astor
BACKGROUND: Limited data exist on methods to evaluate allograft function in infant recipients of lung and heart-lung transplants. At our institution, we developed a procedural protocol in coordination with pediatric anesthesia where infants were sedated to perform infant pulmonary function testing, computed tomography imaging of the chest, and flexible fiberoptic bronchoscopy with transbronchial biopsies. METHODS: A retrospective review was performed of children aged younger than 1 year who underwent lung or heart-lung transplantation at our institution to assess the effect of this procedural protocol in the evaluation of infant lung allografts...
May 2014: Journal of Heart and Lung Transplantation
S Hamad, M Al-Alawi, N Devaney, A Subramaniam, S Lane
INTRODUCTION: Optimisation of patient comfort during flexible bronchoscopy is achieved with the use of intravenous sedation and vocal anaesthesia. METHODS: The effect of transcricoid lignocaine injection was investigated with regards to ease of procedure and frequency of cough. A single-blinded study was carried out and two visual analogue scales were used as markers of efficacy. Treatment groups were matched for age, gender and total dose of lignocaine administered...
June 2015: Irish Journal of Medical Science
Oren Fruchter, Michal Tirosh, Uri Carmi, Dror Rosengarten, Mordechai R Kramer
BACKGROUND: The clinical benefits associated with the use of the bispectral index (BIS) to monitor the depth of sedation during flexible fiberoptic bronchoscopy (FFB) are questionable. OBJECTIVES: To evaluate the added value in terms of procedural safety and patients' awareness of monitoring sedation depth using the BIS compared to conventional clinical judgment alone in patients undergoing FFB under propofol sedation. METHODS: The cohort included 81 patients undergoing diagnostic or therapeutic bronchoscopy under propofol sedation that were prospectively randomized to guide the depth of sedation by BIS monitoring (BIS group; n = 40) or conventional monitoring (control group; n = 41)...
2014: Respiration; International Review of Thoracic Diseases
Ezgi Ozyilmaz, Aylin Ozsancak Ugurlu, Stefano Nava
BACKGROUND: Identifying the predictors of noninvasive ventilation (NIV) failure has attracted significant interest because of the strong link between failure and poor outcomes. However, very little attention has been paid to the timing of the failure. This narrative review focuses on the causes of NIV failure and risk factors and potential remedies for NIV failure, based on the timing factor. RESULTS: The possible causes of immediate failure (within minutes to <1 h) are a weak cough reflex, excessive secretions, hypercapnic encephalopathy, intolerance, agitation, and patient-ventilator asynchrony...
February 13, 2014: BMC Pulmonary Medicine
Sai-Ying Wang, Yang Mei, Hui Sheng, Yang Li, Rui Han, Cheng-Xuan Quan, Zhong-Hua Hu, Wen Ouyang, Zhao-Qian Liu, Kai-Ming Duan
OBJECTIVE: To explore the feasibility and dosage of tramadol combined with fentanyl in awake endotracheal intubation. METHODS: Using Dixon's up-and-down sequential design, the study enrolled patients from each of the 20-49, 50-60 and 70-and-above age groups scheduled for elective surgery under general anesthesia. The feasibility and dosage of tramadol combined with fentanyl in awake endotracheal intubation, guided by fiberoptic bronchoscopy, were verified. RESULTS: After intravenous injection with fentanyl 2...
June 2013: Journal of Thoracic Disease
Hyo-Jeong Lim, Young-Jae Cho, Jong Sun Park, Hoil Yoon, Jae-Ho Lee, Choon-Taek Lee, Sei Won Lee
SESSION TYPE: Bronchoscopy and Interventional Procedures PostersPRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PMPURPOSE: Sedation is currently suggested in all patients during the bronchoscopy to facilitate the diagnostic procedures and to improve patients' comfort unless contraindications exist. However, sometimes unexpected hypoxemia develops during the bronchoscopy using sedatives. We conducted this prospective study to determine the incidence and predictors of hypoxemia during the fiberoptic bronchoscopy under monitored anesthesia care...
October 1, 2012: Chest
Takeaki Shinjo, Satoki Inoue, Junji Egawa, Masahiko Kawaguchi, Hitoshi Furuya
We report two cases in which development of laryngospasm and release of the spasm immediately after applying pressure in the "laryngospasm notch" was confirmed by ultrasonographic and fiberoptic examinations. A bronchoscopy was planned under propofol sedation using a laryngeal mask airway for a 61-year-old man after subtotal esophagotomy. When a bronchoscope was advanced into the trachea, the vocal cords suddenly closed. Immediately after pressure with the fingertips was applied to the "laryngospasm notch," the vocal cords opened, which was observed through the bronchoscope in real time...
October 2013: Journal of Anesthesia
L Cabrini, L Nobile, E Cama, G Borghi, M Pieri, S Bocchino, A Zangrillo
BACKGROUND: Upper endoscopies (UE) are widely performed. Non-invasive ventilation (NIV) during UE has been used to avoid respiratory complications, mainly in high-risk or sedated patients. We performed a systematic review on this topic. METHODS: BioMedCentral, PubMed, Embase and the Cochrane Central Register of Clinical Trials were searched (updated September 1, 2012). Further searches involved conference proceedings. RESULTS: We included in this systematic review 27 papers out of 405 publications retrieved...
June 2013: Minerva Anestesiologica
Pascal Beuret, Bénédicte Philippon, Xavier Fabre, Mahmoud Kaaki
UNLABELLED: HASH(0x531f4e0) BACKGROUND: This clinical study evaluated the effect of a suctioning maneuver on aspiration past the cuff during mechanical ventilation. METHODS: Patients intubated for less than 48 hours with a PVC-cuffed tracheal tube, under mechanical ventilation with a PEEP ≥5 cm H2O and under continuous sedation, were included in the study. At baseline the cuff pressure was set at 30 cm H2O. Then 0.5ml of blue dye diluted with 3 ml of saline was instilled into the subglottic space just above the cuff...
2012: Annals of Intensive Care
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