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Fiberoptic bronchoscopy AND sedation

Pooja Rawat Mathur, Neena Jain, Aji Kumar, Beena Thada, Veena Mathur, Deepak Garg
BACKGROUND: The preferred management strategy for difficult airways is awake fiberoptic bronchoscopy-guided intubation, which requires effective airway anesthesia to ensure patient comfort and acceptance. This randomized single-blind prospective study was conducted to compare lignocaine nebulization and airway nerve block for airway anesthesia prior to awake fiberoptic bronchoscopy-guided intubation. METHODS: Sixty adult patients scheduled for surgical procedures under general anesthesia were randomly allocated to two groups...
April 2018: Korean Journal of Anesthesiology
Junbo Zheng, Yang Gao, Xiaoyu Xu, Kai Kang, Haitao Liu, Hongliang Wang, Kaijiang Yu
Background: This study aims to verify the correlation of bispectral index (BIS) and Richmond agitation sedation scale (RASS) for evaluating these and explore possibility of replacing RASS with BIS. Methods: This retrospective cohort study consisted of 74 patients who were collected from the third Intensive Care Unit (ICU) ward of XXX Hospital between May 2012 and June 2015 in this retrospective study. Sedation levels were evaluated using the 10-grade RASS and were continuously monitored with a BIS monitor during the procedure every 5 minutes...
January 2018: Journal of Thoracic Disease
Oren Fruchter, Yair Manevich, Uri Carmi, Dror Rozengarten, Mordechai R Kramer
BACKGROUND AND OBJECTIVES: Ketamine has been used in pediatric flexible fiberoptic bronchoscopy (FFB). Its efficacy and safety for sedation of adults undergoing FFB has not been thoroughly investigated, and, consequently, it is not used by most interventional bronchoscopists. We aimed to evaluate the safety and efficacy of sedation for FFB under ketamine-propofol-midazolam (KPM) compared with the fentanyl-propofol-midazolam (FPM) regimen. MATERIALS AND METHODS: This was a prospective randomized trial of adult patients (n=80) undergoing FFB, randomized to receive sedation with either KPM (n=39) or FPM (n=41)...
October 2017: Journal of Bronchology & Interventional Pulmonology
Yang Gao, Kai Kang, Haitao Liu, Liu Jia, Rong Tang, Xing Zhang, Hongliang Wang, Kaijiang Yu
This study aimed to investigate the clinical effectiveness of dexmedetomidine and midazolam for sedation of intensive care unit (ICU) patients requiring flexible fiberoptic bronchoscopy (FFB).This retrospective cohort study included 148 patients from the third ICU ward of the Second Affiliated Hospital of Harbin Medical University (Harbin, China) who received simultaneous invasive mechanical ventilation and FFB between March 2012 and December 2014. Patients were divided into dexmedetomidine (n  =  72) and midazolam (n  =  76) groups according to sedative mode...
June 2017: Medicine (Baltimore)
Sherine F Hanna, Marianne Mikat-Stevens, James Loo, Raj Uppal, W Scott Jellish, Matthew Adams
STUDY OBJECTIVE: To compare the use of LMA Fastrach intubating laryngeal mask airway (ILMA) to flexible bronchoscopy (FB) for awake intubation in patients with difficult airways. DESIGN: Randomized prospective study. SETTING: Large academic medical center. PATIENTS: Forty adult patients, American Society of Anesthesiologists I-IV, meeting the criteria for awake intubation based on history and physical examination. INTERVENTIONS: After sedation and airway topicalization, patients were randomized to either FB group, n=19, or ILMA group, n=21...
February 2017: Journal of Clinical Anesthesia
Daniel Alon, Barak Pertzov, Evgeni Gershman, Miryam Frishman, Nader Abdel Rahman, Dror Rosengarten, Mordechai R Kramer
BACKGROUND: The use of laryngeal mask airway (LMA) for fiberoptic bronchoscopy was first described in 1982. The LMA was found to be beneficial in operator view, flexibility, and also in maintaining stable oxygen saturation. Despite its advantages, the use of LMA has not become widespread. OBJECTIVE: The aim of this paper was to evaluate the safety of LMA-assisted bronchoscopy compared to standard nasal bronchoscopy. METHODS: We conducted a prospective randomized trial...
2017: Respiration; International Review of Thoracic Diseases
Saïda Rezaiguia-Delclaux, Florent Laverdure, Talna Kortchinsky, Léa Lemasle, Audrey Imbert, François Stéphan
INTRODUCTION: Sedation optimizes patient comfort and ease of execution during fiber optic bronchoscopy (FOB). Our objective was to describe the safety and efficacy of remifentanil-TCI during FOB in non-intubated, hypoxaemic, thoracic surgery ICU patients. METHODS: Consecutive spontaneously breathing adults requiring FOB after thoracic surgery were included if they had hypoxaemia (PaO2/FiO2<300mmHg or need for non-invasive ventilation [NIV]) and prior FOB failure under topical anaesthesia...
October 2017: Anaesthesia, Critical Care & Pain Medicine
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...
August 13, 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...
March 24, 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
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