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Anaesthesia for lung bronchoscopy

Julian Arevalo-Ludeña, Jose Juan Arcas-Bellas, Rafael Alvarez-Rementería, Javier Flandes, Laura Morís, Luis E Muñoz Alameda
STUDY OBJECTIVE: To compare the use of the I-gel airway with orotracheal intubation (OTI) for bronchoscopic lung volume reduction (BLVR) coil treatment in patients with severe chronic obstructive pulmonary disease (COPD) with heterogeneous emphysema, since it has been proved that supraglottic airways have lower incidence of postoperative respiratory complaints compared to OTI. DESIGN: A comparative, prospective observational study was designed to assess the use of the I-gel airway compared with the OTI...
June 2016: Journal of Clinical Anesthesia
V A Titov, V D Parshin, M A Rusakov, A V Alekseev, V A Kozhevnikov
The article deals with a case of successful anaesthesia management during the surgery due to tracheoesophageal fistula and double level cicatricial tracheal stenosis. Such surgeries are accompanied with technical and organizational difficulties both for an anaesthesiologists and endoscopist. The article discusses tactics of anaesthesia management during transesophageal balloon dilatation of tracheal stenosis, transesophageal tracheal intubation and respiratory techniques during the separation of tracheoesophageal fistula and tracheal resection...
July 2014: Anesteziologiia i Reanimatologiia
Sara Diab, John F Fraser
Bronchoscopy is an important diagnostic and therapeutic intervention for a variety of patients displaying pulmonary pathology. The heterogeneity of the patients undergoing bronchoscopy affords a challenge for providing minimal and safe respiratory support during anesthesia. Currently, options are intubation and general anesthesia versus frequently inadequate sedation or local anaesthesia with low flow oxygen through nasal prongs or mouthpiece. The advent of high flow nasal cannula allows the clinician to have a "middle man" that allows high flow oxygen delivery as well as a degree of respiratory support, which in some cases has been noted to be between 3 and 4 cm of continuous positive airway pressure-like effect...
2014: Case Reports in Critical Care
N Álvarez-Díaz, I Amador-García, M Fuentes-Hernández, R Dorta-Guerra
OBJECTIVE: To compare the ability of lung ultrasound and a clinical method in the confirmation of a selective bronchial intubation by left double-lumen tube in elective thoracic surgery. MATERIAL AND METHODS: A prospective and blind, observational study was conducted in the setting of a university hospital operating room assigned for thoracic surgery. A single group of 105 consecutive patients from a total of 130, were included. After blind intubation, the position of the tube was confirmed by clinical and ultrasound assessment...
June 2015: Revista Española de Anestesiología y Reanimación
Francesco Petrella, Alessandro Borri, Monica Casiraghi, Sergio Cavaliere, Stefano Donghi, Domenico Galetta, Roberto Gasparri, Juliana Guarize, Alessandro Pardolesi, Piergiorgio Solli, Adele Tessitore, Marco Venturino, Giulia Veronesi, Lorenzo Spaggiari
Palliative airway treatments are essential to improve quality and length of life in lung cancer patients with central airway obstruction. Rigid bronchoscopy has proved to be an excellent tool to provide airway access and control in this cohort of patients. The main indication for rigid bronchoscopy in adult bronchology remains central airway obstruction due to neoplastic or non-neoplastic disease. We routinely use negative pressure ventilation (NPV) under general anaesthesia to prevent intraoperative apnoea and respiratory acidosis...
2014: Multimedia Manual of Cardiothoracic Surgery: MMCTS
Ruixiang Zhang, Shilei Liu, Haibo Sun, Xianben Liu, Zongfei Wang, Jianjun Qin, Xionghuai Hua, Yin Li
Double-lumen endotracheal tube (DLET) anaesthesia is the commonly used method in minimally invasive oesophagectomy (MIE). However, DLET intubation does have its disadvantages. Firstly, the placement of the DLET needs a skilled anaesthetist with familiarity of the technique and subsequent ability to perform a fibre-optic bronchoscopy for confirmation. Secondly, DLET intubation and one-lung ventilation are associated with numerous complications, including hoarseness, tracheobronchial injury and vocal injury. In this report, a retrospective analysis was performed on 42 consecutive patients who underwent MIE using single-lumen endotracheal tube (SLET) anaesthesia with CO2 artificial pneumothorax compared with 81 patients who underwent the same procedure with DLET intubation...
August 2014: Interactive Cardiovascular and Thoracic Surgery
R S Lee, J F Dooley
Intrathoracic dislocation of the scapula is extremely rare. We present the case of a 64 year old man who underwent a lung transplant for emphysema via a standard posterior thoracotomy approach. Four weeks later, following a bronchoscopy, he experienced severe pain and restriction of movement in his shoulder. CT scans revealed intrathoracic dislocation of the inferior angle of the scapula. Two manipulations under anaesthesia were unsuccessful and formal exploration required with closure of the intercostal defect...
November 2012: Acta Chirurgica Belgica
Engin Aynaci, Celalettin Ibrahim Kocatürk, Pinar Yildiz, Mehmet Ali Bedirhan
We present a case that used argon plasma coagulation (APC) for the healing of bronchopleural fistulas (BPF), which most probably developed secondary to tracheobronchial anastomotic failure (TBAF). We aimed to show this procedure as an alternative treatment for the small fistulas that could develop after pneumonectomy. In a 56-year old male patient, right upper lobe squamous cell carcinoma was detected in 2009. Sleeve pneumonectomy was done because of the carina and major fissure invasion. There was no morbidity in the early post-operative period...
June 2012: Interactive Cardiovascular and Thoracic Surgery
A Subedi, M Tripathi, L Pathak, B Bhattarai, A Ghimire, R Koirala
Penetrating injury in the back with knife (Khukri) demands induction of anaesthesia and intubation in lateral position. In thoracic injury a double lumen tube placement is required to facilitate one lung ventilation during thoracotomy. In emerging situation, we could successfully execute induction of patient in right lateral position using right sided DLT for left thoracotomy. Its correct placement was confirmed by fiberoptic bronchoscopy. In conclusion right-DLT intubation can be performed without difficulty by conventional direct laryngoscopy using Macintosh blade in lateral position...
October 2010: JNMA; Journal of the Nepal Medical Association
A Hitter, E Hullo, C Durand, C-A Righini
INTRODUCTION: Foreign body aspiration is a serious condition during childhood that requires prompt management to avoid complications and irreversible lung injury. Rigid bronchoscopy under general anaesthesia is the procedure of choice for removal of aspirated foreign bodies, but it can be associated with serious complications. The positive diagnosis can sometimes be challenging except in the case of radiopaque or obstructive foreign bodies, due to the low sensitivity and specificity of clinical history and physical examination...
November 2011: European Annals of Otorhinolaryngology, Head and Neck Diseases
Ajmal Khan, Ritesh Agarwal, Ashutosh N Aggarwal, Nalini Gupta, Amanjit Bal, Navneet Singh, Dheeraj Gupta
BACKGROUND: Transbronchial needle aspiration (TBNA) is an established procedure for sampling the mediastinal lymph nodes. Data reported from India are limited on this routine procedure. We describe our experience of the efficacy, diagnostic accuracy and safety of TBNA. METHODS: We retrospectively reviewed all TBNAs done at our centre between 2006 and 2009. Under local anaesthesia, accessible lymph node stations were sampled thrice without fluoroscopy and without an on-site cytopathologist...
May 2011: National Medical Journal of India
N Ambrosino, F Guarracino
The use of noninvasive ventilation (NIV) in acute hypercapnic respiratory failure, cardiogenic pulmonary oedema, acute lung injury/acute respiratory distress syndrome (ARDS), community-acquired pneumonia and weaning/post-extubation failure is considered common in clinical practice. Herein, we review the use of NIV in unusual conditions. Evidence supports the use of NIV during fibreoptic bronchoscopy, especially with high risks of endotracheal intubation (ETI), such as in immunocompromised patients. During transoesophageal echocardiography as well as in interventional cardiology and pulmonology, NIV can reduce the need for deep sedation or general anaesthesia and prevent respiratory depression induced by deep sedation...
August 2011: European Respiratory Journal: Official Journal of the European Society for Clinical Respiratory Physiology
Y Douadi, H Bentayeb, S Malinowski, E Hoguet, E Lecuyer, M Boutemy, S Lachkar, C Fournier, C Dayen
INTRODUCTION: Endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) has recently been shown to be an accurate modality in the diagnosis and staging of mediastinal lymph node metastases. This procedure takes significantly longer than a conventional bronchoscopy and may therefore cause more discomfort. Since its introduction into respiratory practice in France, several airway management strategies have been used. PATIENTS AND METHODS: Both anaesthesia care and procedural sedation services share the goals of providing the patient with comfort during a potentially distressing procedure while also ensuring that the operating physician has an acceptable working environment...
2010: Revue des Maladies Respiratoires
A R L Medford, J A Bennett, C M Free, S Agrawal
Staging for non-small cell lung cancer (NSCLC) requires accurate assessment of the mediastinal lymph nodes which determines treatment and outcome. As radiological staging is limited by its specificity and sensitivity, it is necessary to sample the mediastinal nodes. Traditionally, mediastinoscopy has been used for evaluation of the mediastinum especially when radical treatment is contemplated, although conventional transbronchial needle aspiration (TBNA) has also been used in other situations for staging and diagnostic purposes...
February 2010: Postgraduate Medical Journal
H Ranu, B P Madden
Endobronchial interventions including the deployment of endobronchial stents have a clear role in the management of central airway problems. The use of endobronchial stents has rapidly increased since the first airway stent was developed in the 1960s and with the subsequent manufacture of improved silicone and metallic stents. They provide effective relief for symptoms of intrinsic and extrinsic airway obstruction secondary to a wide range of pathologies including lung cancer, lymphoma, thyroid carcinoma and benign disease such as tracheal strictures and tracheobronchomalacia...
December 2009: Postgraduate Medical Journal
Artur Szlubowski, Marcin Zieliński, Jerzy Soja, Jouke T Annema, Witold Sośnicki, Magdalena Jakubiak, Juliusz Pankowski, Adam Cmiel
OBJECTIVES: This prospective study aimed to assess the diagnostic yield of the combined approach - endobronchial (EBUS) and endoscopic (EUS) ultrasound-guided needle aspiration (combined ultrasound-needle aspiration (CUS-NA)) in the radiologically normal mediastinum in non-small-cell lung cancer (NSCLC) staging. METHODS: CUS-NA was performed simultaneously under local anaesthesia and sedation in consecutive NSCLC patients with mediastinal nodes that were not enlarged on CT (stage IA-IIB)...
May 2010: European Journal of Cardio-thoracic Surgery
Peter Vilmann, Jouke Annema, Paul Clementsen
The diagnostic approach to diseases of the mediastinum is divided into two phases: (1) imaging techniques and (2) procedures for obtaining tissue samples for cytologic and histologic examination. The latter has for many years represented a considerable challenge to the clinician. Often invasive procedures in general anaesthesia as mediastinoscopy or thoracoscopy have been necessary. However, the sampling of tissue from the mediastinum has been revolutionized by EBUS and EUS, since they give access to the middle and the posterior compartment via the trachea and the oesophagus, respectively...
2009: Best Practice & Research. Clinical Gastroenterology
Laurent Bertoletti, Aurélie Robert, Michèle Cottier, Marie Laure Chambonniere, Jean-Michel Vergnon
BACKGROUND: Recent studies have described the promising method of electromagnetic navigated bronchoscopy (ENB) for diagnosis of peripheral solitary nodules. However, they require general anaesthesia or intravenous sedation. We wanted to know if ENB could be applied more easily in outpatients. OBJECTIVES: We prospectively evaluated the accuracy and the feasibility of ENB under local anaesthesia and nitrous oxide/oxygen inhalation as unique sedation in outpatients...
2009: Respiration; International Review of Thoracic Diseases
L Thiberville, M Salaün, S Lachkar, S Dominique, S Moreno-Swirc, C Vever-Bizet, G Bourg-Heckly
The aim of the present study was to assess fibred confocal fluorescence microscopy (FCFM) as a tool for imaging the alveolar respiratory system in vivo during bronchoscopy. A 488-nm excitation wavelength FCFM device was used in 41 healthy subjects including 17 active smokers. After topical anaesthesia, the 1.4-mm miniprobe was introduced into the bronchoscope working channel and advanced distally to the alveoli. Morphometric and cellular analyses were performed on selected frames harbouring a minimal compression effect...
May 2009: European Respiratory Journal: Official Journal of the European Society for Clinical Respiratory Physiology
D Steinmann, C A Stahl, J Minner, S Schumann, T Loop, A Kirschbaum, H J Priebe, J Guttmann
BACKGROUND: Double-lumen tubes (DLTs) are frequently used to establish one-lung ventilation (OLV). Their correct placement is crucial. We hypothesized that electrical impedance tomography (EIT) reliably displays distribution of ventilation between left and right lung and may thus be used to verify correct DLT placement online. METHODS: Regional ventilation was studied by EIT in 40 patients requiring insertion of left-sided DLTs for OLV during thoracic surgery. EIT was recorded during two-lung ventilation before induction of anaesthesia and after DLT placement, and during OLV in the supine and subsequently in the lateral position...
September 2008: British Journal of Anaesthesia
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