Flexible bronchoscopy for foreign body aspiration in children:A single-centre experience

BACKGROUND The technological evolution of bronchoscopy has led to the widespread adoption of flexible techniques and their use for both diagnostic and therapeutic purposes.Currently,there is an active debate regarding the comparative efficacy and safety of rigid vs flexible bronchoscopy in the treatment of foreign body aspiration.AIM To evaluate our experience with tracheobronchial foreign body extraction using flexible bronchoscopy and provide a literature overview.METHODS This was a single-centre retrospective study.Twenty-four patients were enrolled between January 2017 and January 2023.Medical records of patients aged below 18 years who were admitted to authors’affiliated institution with a suspected diagnosis of foreign body aspiration were collected from hospital’s database to Microsoft Excel 2019.Data were analysed using MedCalc Statistical Software.RESULTS Patient ages varied from 9 months to 11 years.The median age was 23.5 months,95%confidence interval(CI)19.49-44.77.We observed age clustering in children with foreign body aspiration at our institution with three age subgroups:(1)0-25 months;(2)40-60 months;and(3)120-140 months.We expectancy of an organic tracheobronchial foreign body was significantly higher in 0-25 months subgroup than that in older ones when subgroups 40-60 and 120-140 months were combined together(odds ratio=10.0,95%CI:1.44-29.26,P=0.0197).Successful foreign body extraction was performed in all cases.Conversion to a rigid bronchoscope was not required in any of the cases.No major complications(massive bleeding,tracheobronchial tree perforation,or asphyxia)were observed.CONCLUSION Flexible bronchoscopy is an effective and safe method for tracheobronchial foreign body extraction in children.

Evaluation of bronchoscopic direct vision glottis anesthesia method in bronchoscopy

BACKGROUND Fibrobronchoscopy is a common adjunct tool that requires anesthesia and is widely used in the diagnosis and treatment of various respiratory diseases.However,current anesthesia methods,such as spray,nebulized inhalation,and cricothyroid membrane puncture,have their own advantages and disadvantages.Recently,studies have shown that bronchoscopic direct-view glottis anesthesia is a simple and inexpensive method that shortens the examination time and provides excellent anesthetic results.AIM To evaluate the effectiveness of bronchoscopic direct vision glottis anesthesia for bronchoscopy.METHODS The study included 100 patients who underwent bronchoscopy during thoracic surgery.A random number table method was used to divide the patients into control and observation groups(50 patients each).The control and observation groups were anesthetized using the nebulized inhalation and bronchoscopic direct vision glottis method,respectively.Hemodynamic indices[systolic blood pressure(SBP),diastolic blood pressure(DBP),heart rate(HR),and oxygen saturation(SpO_(2))before(T1),5 min after anesthesia(T2),and at the end of the operation(T3)]serum stress hormone indices[norepinephrine(NE),epinephrine(E),adrenocorticotropic hormone(ACTH),and cortisol(Cor)before and after treatment]were compared between the 2 groups.Adverse effects were also RESULTS At T2 and T3,SBP,DBP,and HR were lower in the observation group than the control group,whereas SpO_(2) was higher than the control group[(119.05±8.01)mmHg vs(127.05±7.83)mmHg,(119.35±6.66)mmHg vs(128.39±6.56)mmHg,(84.68±6.04)mmHg vs(92.42±5.57)mmHg,(84.53±4.97)mmHg compared to(92.57±6.02)mmHg,(74.25±5.18)beats/min compared to(88.32±5.72)beats/min,(74.38±5.31)beats/min compared to(88.42±5.69)beats/min,(97.36±2.21)%vs(94.35±2.16)%,(97.42±2.36)%vs(94.38±2.69%],with statistically significant differences(all P<0.05).After treatment,NE,E,ACTH,and Cor were significantly higher in both groups than before treatment,but were lower in the observation group than in the control group[(68.25±8.87)ng/mL vs(93.35±14.00)ng/mL,(53.59±5.89)ng/mL vs(82.32±10.70)ng/mL,(14.32±1.58)pg/mL vs(20.35±3.05)pg/mL,(227.35±25.01)nmol/L vs(322.28±45.12)nmol/L],with statistically significant differences(all P<0.05).The incidence of adverse reactions was higher in the control group than in the observation group[12.00%(12/50)vs 6.00%(3/50)](P<0.05).CONCLUSION The use of bronchoscopic direct vision glottis anesthesia method for bronchoscopy patients is beneficial for stabilizing hemodynamic indices during bronchoscopy and reducing the level of patient stress,with good safety and practicality.

Diagnosis based on electromagnetic navigational bronchoscopyguided biopsied peripheral lung lesions in a 10-year-old girl:A case report

BACKGROUND Electromagnetic navigational bronchoscopy(ENB)is an emerging diagnostic tool that enables practitioners to biopsy peripheral lung tissues that were previously only accessible under computed tomography(CT)guidance.However,few studies have investigated ENB use in children.Here,we report a case of a 10-yearold girl with peripheral lung lesions who complained of a 7-d persistent fever.She was diagnosed with Streptococcus parasanguinis infection based on findings obtained using ENB-guided transbronchial lung biopsy(TBLB).CASE SUMMARY A 10-year-old girl presented with constitutional symptoms of cough and fever of 7 days’duration.Chest CT scans detected peripheral lung lesions and no endobronchial lesions.TBLB performed under the guidance of an ENB Lungpro navigation system was safe,well-tolerated,and effective for biopsying peripheral lung lesions.Examination of biopsied samples indicated the patient had a pulmonary Streptococcus parasanguinis infection,which was treated with antibiotics instead of more invasive treatment interventions.The patient’s symptoms resolved after she received a 3-wk course of oral linezolid.Comparisons of pretreatment and post-treatment CT scans revealed absorption of some lung lesions within 7 mo of hospital discharge.CONCLUSION ENB-guided TBLB biopsying of peripheral lung lesions in this child is a safe,well-tolerated,and effective alternative to conventional interventions.

Conf irmation of endotracheal tube placement using disposable f iberoptic bronchoscopy in the emergent setting

BACKGROUND:Patients intubated in the prehospital setting require quick and definitive confirmation of endotracheal (ET) tube placement upon arrival to the emergency department (ED).Direct and adjunct strategies exist,but each has limitations and there is no definitive gold standard.The utility of bronchoscopy in ED intubation has been studied,but scant literature exists on its use for ET tube confirmation.This study aims to assess effectiveness,ease and speed with which ET tube placement can be confirmed with disposable fiberoptic bronchoscopy.METHODS:Emergency medicine residents recruited from a 3-year urban residency program received 5 minutes of active learning on a simulation mannequin using a disposable,flexible Ambu aScope interfaced with a monitor.With residents blinded,the researcher randomly placed the ET tube in the trachea,esophagus or right mainstem.Residents identified ET tube position by threading the bronchoscope through the tube and viewing distal anatomy.Each resident underwent 4 trials.Accuracy,speed and perceptions of difficulty were measured.RESULTS:Residents accurately identified the location of the ET tube in 88 out of 92 trials (95.7%).The median time-to-guess was 7.0 seconds,IQR (5.0-10.0).Average perceived difficulty was 1.6 on a scale from 1-5 (1 being very easy and 5 being very difficult).No tubes were damaged or dislodged.CONCLUSION:While simulation cannot completely replicate the live experience,fiberoptic bronchoscopy appears to be a quick and accurate method for ET tube confirmation.Further studies directly comparing this novel approach to established practices on actual patients are warranted.

Utility of flexible fiberoptic bronchoscopy for critically ill pediatric patients:A systematic review

AIM: To investigate the diagnostic yield, therapeutic efficacy, and rate of adverse events related to flexible fiberoptic bronchoscopy(FFB) in critically ill children. METHODS: We searched Pub Med, SCOPUS, OVID, and EMBASE databases through July 2014 for English language publications studying FFB performed in the intensive care unit in children < 18 years old. We identified 666 studies, of which 89 full-text studies were screened for further review. Two reviewers independently determined that 27 of these studies met inclusion criteria and extracted data. We examined the diagnostic yield of FFB among upper and lower airway evaluations, as well as the utility of bronchoalveolar lavage(BAL). RESULTS: We found that FFB led to a change in medical management in 28.9%(range 21.9%-69.2%) of critically ill children. The diagnostic yield of FFB was 82%(range 45.2%-100%). Infectious organisms were identified in 25.7%(17.6%-75%) of BALs performed, resulting in a change of antimicrobial management in 19.1%(range: 12.2%-75%). FFB successfully reexpanded atelectasis or removed mucus plugs in 60.3%(range: 23.8%-100%) of patients with atelectasis. Adverse events were reported in 12.9%(range: 0.5%-71.4%) of patients. The most common adverse effects of FFB were transient hypotension, hypoxia and/or bradycardia that resolved with minimal intervention, such as oxygen supplementation or removal of the bronchoscope. Serious adverse events were uncommon; 2.1% of adverse events required intervention such as bag-mask ventilation or intubation and atropine for hypoxia and bradycardia, normal saline boluses for hypotension, or lavage and suctioning for hemorrhage. CONCLUSION: FFB is safe and effective for diagnostic and therapeutic use in critically ill pediatric patients.

Intensivist-based deep sedation using propofol for pediatric outpatient flexible bronchoscopy

AIM To evaluate the safety and efficacy of sedating pediatric patients for outpatient flexible bronchoscopy.METHODS A retrospective chart review was conducted for all children, age 17 years or under who underwent flexible bronchoscopy under deep sedation in an outpatient hospital-based setting. Two sedation regimens were used; propofol only or ketamine prior to propofol. Patients were divided into three age groups; infants(less than 12 mo), toddlers(1-3 years) and children(4-17 years). Demographics, indication for bronchoscopy, sedative dosing, sedation and recovery time and adverse events were reviewed.RESULTS Of the total 458 bronchoscopies performed, propofol only regimen was used in 337(74%) while propofol and ketamine was used in 121(26%). About 99% of the procedures were successfully completed. Children in the propofol + ketamine group tend to be youngerand have lower weight compared to the propofol only group. Adverse events including transient hypoxemia and hypotension occurred in 8% and 24% respectively. Median procedure time was 10 min while the median discharge time was 35 min. There were no differences in the indication of the procedure, propofol dose, procedure or recovery time in either sedative regimen. When compared to other age groups, infants had a higher incidence of hypoxemia.CONCLUSION Children can be effectively sedated for outpatient flexible bronchoscopy with high rate of success. This procedure should be performed under vigilance of highly trained providers.

Early Detection of Lung Cancer Using CT Scan and Bronchoscopy in a High Risk Population

Background: Computed tomography (CT) and bronchoscopy have been shown to improve the detection rates of peripheral and central lung cancers (LC), respectively. However, the performance of the combination of CT and bronchoscopy in detecting LC, in high-risk patients, is not clear. Patients & Methods: This prospective study included 205 high-risk patients with a history of at least 2 of the following risk factors: (1) heavy smoking;(2) aero-digestive cancer;(3) pulmonary asbestosis or;(4) chronic obstructive pulmonary disease. Patients were offered chest X-ray, sputum cytology, conventional white-light followed by autofluorescence beonchoscopy (WL/AFB) and low-dose spiral CT both at baseline and follow-up visits. Results: Seven patients (3.4%) were diagnosed with LC or carcinoma in-situ (CIS) at baseline: CT evaluation detected 5 LC/CIS, while WL/AFB evaluation also identified 5 LC/CIS, 2 of which were not detected on CT. Six (85%) of these baseline lesions were early stage (0/IA). The relative-sensitivity of CT with WL/ AFB was 40% better than CT alone. On four year follow-up, 20 patients (9.8%) were diagnosed with an LC/CIS. CT with WL/AFB detected 19 cases (95%), whereas CT alone detected 15 cases (75%). Conclusion: Bimodality surveillance with spiral CT and WL/AFB can improve the detection of early stage LCs among high-risk

Role of bronchoscopy in critically ill patients managed in intermediate care units - indications and complications: A narrative review

Flexible bronchoscopy(FB)has become a standard of care for the triad of inspection,sampling,and treatment in critical care patients.It is an invaluable tool for diagnostic and therapeutic purposes in critically ill patients in intensive care unit(ICU).Less is known about its role outside the ICU,particularly in the intermediate care unit(IMCU),a specialized environment,where an intermediate grade of intensive care and monitoring between standard care unit and ICU is provided.In the IMCU,the leading indications for a diagnostic work-up are:To visualize airway system/obstructions,perform investigations to detect respiratory infections,and identify potential sources of hemoptysis.The main procedures for therapeutic purposes are secretion aspiration,mucus plug removal to solve atelectasis(total or lobar),and blood aspiration during hemoptysis.The decision to perform FB might depend on the balance between potential benefits and risks due to frailty of critically ill patients.Serious adverse events related to FB are relatively uncommon,but they may be due to lack of expertise or appropriate precautions.Finally,nowadays,during dramatic recent coronavirus disease 2019(COVID-19)pandemic,the exact role of FB in COVID-19 patients admitted to IMCU has yet to be clearly defined.Hence,we provide a concise review on the role of FB in an IMCU setting,focusing on its indications,technical aspects and complications.

Subcutaneous Dissociative Conscious Sedation (sDCS) an Alternative Method of Anesthesia for Fiberoptic Bronchoscopy

Objective: Current randomized clinical trial was conducted to compare the efficacy and side effects of dissociative conscious sedation and conscious sedation in patients under bronchoscopy. Methods: In this randomized clinical trial, 110 patients scheduled for Fiberoptic Bronchoscopy in a training hospital in 2012 were enrolled and randomly assigned to receive either SC ketamine plus IV fentanyl (dissociative conscious sedation) or placebo plus IV fentanyl (conscious sedation) and the efficacy and side effects were assessed and compared. Results: There was significant difference between systolic and diastolic blood pressure and heart rate in two groups and more stability was shown in dissociative conscious sedation group (P < 0.05). Also the incidence of cough, the need to extra dose of fentanyl and recall showed less frequency in dissociative conscious sedation group (P < 0.05). Conclusions: Totally, according to the obtained results, it may be concluded that Subcutaneous Dissociative Conscious Sedation (sDCS) in comparison to Conscious Sedation is significantly more efficient accompanied by less side effects in fiberoptic bronchoscopy and using this method is recommended. Implication of the Manuscript: The study was designed in order to evaluate the efficacy of subcutaneous Dissociative Conscious Sedation (sDCS) Method in fiberoptic bronchoscopy.

Flexible Bronchoscopy as a Diagnostic and Therapeutic Method in Patients with Tracheobronchial Foreign Body

Objective: To analyze bronchoscopy as a diagnostic and therapeutic method in patients with tracheobronchial foreign body. Methods: We analyzed reports of flexible bronchoscopy with diagnose of tracheobronchial foreign body performed from 2003 to 2013 in S&#227o Salvador Hospital, in Goiania, capital of Goiás. The analysis was based on: sex and age of the patients, airways and foreign body characteristics, foreign body localization, success rate and rate of bleeding. We calculated the frequencies after analyzing the data. Results: We analyzed 26 reports of the studied period and found that 57.7% of the patients were male with median age of 58.83 years old (+—13.79). The airways characteristics were normal in most of the cases. Sputum wasn’t found in 57.69% of the cases. Foreign bodies were located in right bronchus in 88.46% of the cases, and the extraction of them was successful in 80.76% of the cases. The absence of bleeding was reported in 96.15% of the cases. Conclusions: Flexible bronchoscopy is a notably successful method in management of tracheobronchial foreign bodies. Airways characteristics aren’t good indicatives of FB’s presence, once they are normal in most of the times.

Bronchoscopy Simulation in Anesthesia Resident Education

Simulation in residency training is becoming more popular but there is limited evidence showing that it can improve a resident’s fund of knowledge, particularly in anesthesiology. We looked at whether a bronchoscopy simulation could improve performance on a thoracic anesthesia knowledge test administered both before and after using the simulator. Fourteen first-year anesthesiology residents completed the study with an average improvement on the test of 28% (p 0.05). We conclude that bronchoscopy simulation is an effective method of educating anesthesiology residents.

Effect of sufentanil combined with propofol and scoline on stress response and immune response in fiberoptic bronchoscopy

Objective: To explore the effect of sufentanil combined with propofol and scoline on stress response and immune response in fiberoptic bronchoscopy. Methods: A total of 138 patients with fiberoptic bronchoscopy in the hospital between March 2015 and April 2017 were collected and divided into routine group and scoline group by random number table, 69 cases in each group. Routine group received sufentanil combined with propofol anesthesia, and scoline group received sufentanil, propofol combined with scoline anesthesia. The differences in the levels of stress hormones in serum and immune indexes in alveolar lavage fluid were compared between the two groups before and after examination. Results: Before examination, the differences in the levels of Th1/Th2 cytokines in serum as well as Th1/Th2 cytokines and Th17/Treg cytokines in alveolar lavage fluid were not statistically significant between the two groups;immediately after examination, serum stress hormones Cor, E and NE levels of scoline group were lower than those of routine group;Th1 cytokines IL-2 and IFN-γ levels in alveolar lavage fluid were higher than those of routine group while Th2 cytokines IL-10 and IL-13 levels were lower than those of routine group;Th17 cytokine IL-17 level in alveolar lavage fluid was lower than that of routine group while Treg cytokine IL-23 level was higher than that of routine group. Conclusion: Small-dose scoline for fiberoptic bronchoscopy anesthesia can effectively relieve the systemic stress state and avoid the acute injury of immune response function.

How to manage isolated tension non-surgical pneumoperitonium during bronchoscopy?A case report

BACKGROUND Tension pneumoperitonium is a rare complication during bronchoscopy that can cause acute respiratory and hemodynamic failure,with fatal consequences.Isolated pneumoperitonium during bronchoscopy usually results from ruptures of the abdominal viscera that need surgical repair.Non-surgical pneumoperitoneum(NSP)refers to some pneumoperitoneum that could be relieved without surgery and only by conservative therapy.However,the clinical experience of managing tension pneumoperitonium during bronchoscopy is limited and controversial.CASE SUMMARY A 51-year-old female was admitted to our hospital for cough with bloody sputum of seven days.On the 8th day of her admission,a bronchoscopy was arranged for bronchial-alveolar lavage to detect possible pathogens in the lower respiratory tract,as oxygen was delivered via a 12 F nasopharyngeal cannula,approximately 5-6 cm from the tip of the catheter,with a flow rate of 5-10 L/min.After four minutes of bronchoscopy,the patient suddenly vomited 20 mL of water,followed by severe abdominal pain,while physical examination revealed obvious abdominal distension,as well as hardness and tenderness of the whole abdomen,which was considered pneumoperitonium,and the bronchoscopy was terminated immediately.A computer tomography scan indicated isolated tension pneumoperitonium,and abdominal decompression was performed with a drainage tube,after which her symptoms were relieved.A multidisciplinary expert consultation discussed her situation and a laparotomy was suggested,but finally refused by her family.She had no signs of peritonitis and was finally discharged 5 d after bronchoscopy with a good recovery.CONCLUSION The possibility of tension pneumoperitonium during bronchoscopy should be guarded against,and given its serious clinical consequences,cardiopulmonary instability should be treated immediately.Varied strategies could be adopted according to whether it is complicated with pneumothorax or pneumomediastinum,and the presence of peritonitis.When considering NSP,conservative therapy maybe a reasonable option with good recovery.An algorithm for the management of pneumoperitonium during bronchoscopy is proposed,based on the features of the case series reviewed and our case reported.

Study on timing of preoperative fasting and water deprivation in patients receiving fiberoptic bronchoscopy

Purpose:To compare the effects of different preoperative fasting intervals and water deprivation in patients receiving fiberoptic bronchoscopy(FB).Methods:In total,390 patients receiving FB were divided into two groups.The 200 patients in the experimental group had 100 mL semi-liquid food two hours before FB,and 190 patients in the control group had 250 g ordinary food four hours before FB.The incidence of nausea,vomiting,aspiration,dizziness,and palpitations and vital signs,oxygen saturation,and anxiety level before and after FB were recorded.Results:There was no significant difference in the incidence of nausea,vomiting,aspiration,or palpitations;and respiration rate,heart rate,and oxygen saturation were not different between the two groups(p>0.05).There were,however,significant differences in the incidence of dizziness,comfort level,anxiety,and blood pressure(p<0.05).Conclusion:Intake of 100 mL semi-liquid food two hours prior to FB is safe and feasible.

Bronchoscopy for diagnosis of COVID-19 with respiratory failure:A case report

BACKGROUND Although the imaging features of coronavirus disease 2019(COVID-19)are starting to be well determined,what actually occurs within the bronchi is poorly known.Here,we report the processes and findings of bronchoscopy in a patient with COVID-19 accompanied by respiratory failure.CASE SUMMARY A 65-year-old male patient was admitted to the Hainan General Hospital on February 3,2020 for fever and shortness of breath for 13 d that worsened for the last 2 d.The severe acute respiratory syndrome coronavirus 2 nucleic acid test was positive.Routine blood examination on February 28 showed a white blood cell count of 11.02×109/L,86.9%of neutrophils,6.4%of lymphocytes,absolute lymphocyte count of 0.71×109/L,procalcitonin of 2.260 ng/mL,and C-reactive protein of 142.61 mg/L.Oxygen saturation was 46%at baseline and turned to 94%after ventilation.The patient underwent video bronchoscopy.The tracheal cartilage ring was clear,and no deformity was found in the lumen.The trachea and bilateral bronchi were patent,while the mucosa was with slight hyperemia;no neoplasm or ulcer was found.Moderate amounts of white gelatinous secretions were found in the dorsal segment of the left inferior lobe,and the bronchial lumen was patent after sputum aspiration.The right inferior lobe was found with hyperemia and mucosal erosion,with white gelatinous secretion attachment.The patient’s condition did not improve after the application of therapeutic bronchoscopy.CONCLUSION For patients with COVID-19 and respiratory failure,bronchoscopy can be performed under mechanical ventilation to clarify the airway conditions.Protection should be worn during the process.Considering the risk of infection,it is not necessary to perform bronchoscopy in the mild to moderate COVID-19 patients.

Atrial fibrillation and concomitant left subclavian, axillary and brachial artery embolism after fiberoptic bronchoscopy: A case report

BACKGROUND Fiberoptic bronchoscopy has been widely used in the diagnosis and treatment of respiratory diseases.Numerous major and minor complications have been reported following this procedure.The incidence of major postoperative complications is approximately 0.5%and includes respiratory depression,pneumothorax,pulmonary edema,pneumonia,airway obstruction and cardiorespiratory arrest.Minor complications include vasovagal reactions,cardiac arrhythmias,hemorrhage,pneumothorax,aphonia,nausea,vomiting and fever.However,to our knowledge,a case of atrial fibrillation(AF)concomitant with fatal arterial embolism in the upper extremities following diagnostic bronchoscopy has never been reported.CASE SUMMARY A 70-year-old female patient presented with a history of rheumatic heart disease beginning at 10 years of age and an approximately 10-year history of hypertension.The patient was transferred from the cardiology department to the respiratory department due to recurrent coughing,pneumonia,and fever.She underwent fiberoptic bronchoscopy in the respiratory department.Approximately 2 h after completion of bronchoscopy,she complained of left arm numbness and weakness.Physical examination detected cyanosis of the left upper extremity,grade III weakened limb muscle strength,and undetectable left brachial artery pulsation.Auscultation indicated AF.B-mode ultrasound examination of the blood vessels showed hyperechoic material in the left subclavian,axillary and brachial arteries,and parallel veins.As our hospital has no vascular surgery capability,the patient was transferred to a specialized hospital for emergency thrombectomy that day.A tracking investigation found that the patient’s conditions improved after successful thrombectomy.CONCLUSION Thromboembolism following bronchoscopy is rare,and only a few cases of cerebral air embolism after bronchoscopy have been reported.

Comparison of CT and Fiberoptic Bronchoscopy in the Evaluation of Bronchial Disease

CT was compared to FB in 51 cases to study the value of CT for visualizing bronchial disease. CT finding was positive in 46 of 51, and suggested CT was closely correlated with FB. 3 of 5 with false negative were endobronchial lesions, 2 were submacosal diseases. By camparison, it was found conventional tomography was a useful method in diagnosing the bronchial disease.

Training benefits of virtual bronchoscopy prior to Endobronchial Ultrasound Guide sheath

Research questions. How does a virtual bronchoscopy navigation system (VBNS) improve prediction of candidate bronchus across a range of doctors investigating a range of lesions with Endobronchial ultrasound (EBUS) guide sheath? To what extent do benefits of virtual bronchoscopic pre-procedure navigation apply to experienced versus inexperienced bron- choscopists? Methods: Using archived EBUS Guide sheath cases, a comparison was made between identified candidate 4th order bronchus by Computerised tomography (CT) evaluation versus that identified after virtual path creation. Results: From 7 archived cases, 14 doctors identified the correct bronchus in 94 of 98 assessments (95%). Percentage of cases where there was an improvement in localisation by 2 or more 4th order bronchi was 39.8% overall (28.6% – 51.0%), 26.6 for experienced and 53.1 for inexperienced bronchoscopists (p < 0.02). The absolute mean number of 4th order bronchi different between CT and VBNS was 2.0 ± 2.6 overall, 1.2 (range 0-6) for experienced, and 2.8 (range 0-11) for inexperienced bronchoscopists. Virtual Path software calculation time was 8.1 ± 2.7 minutes, compared to 3.6 ± 2.1 minutes by CT. Conclusion: VBNS allowed rapid accurate assessment with minimal software training. Greatest benefits in reduction of procedure time were obtained in inexperienced bronchoscopists, and VBNS could allow more rapid skill development in EBUS GS in these doctors.

A Patient with Trisomy 15 and Subglottic Tracheal Granuloma: Anesthetic Management for Emergency Rigid Bronchoscopy

Trisomy 15 is a rare genetic disorder presenting unique anesthetic challenges. This is a case of a patient with Trisomy 15 and unrepaired ventriculo-septal defect presented for emergent removal of a subglottic tracheal granuloma. Developed anesthetic plan allowed the patient to breathe spontaneously with a combination of inhalational and intravenous anesthetics. Our technique offered optimal operating conditions and adequate depth of anesthesia. The important points of the case include an understanding of the physical characteristics of a patient with Trisomy 15 and unrepaired ventriculo-septal defect and an anesthetic plan for emergent removal of an obstructing subglottic granuloma via rigid bronchoscopy.

Extraction of Aspirated Headscarf Pins with Fiberoptic Bronchoscopy

Background: Foreign body aspiration is a common yet preventable health problem. Headscarf pin aspiration is a unique example of aspirated foreign bodies in young Muslim women usually removed using the rigid bronchoscope. However, the flexible bronchoscope is increasingly used for this purpose. This prospective study was conducted in Sulaimaniyah Teaching Hospital, Sulaimaniyah, Iraq and aimed to evaluate the usefulness of fiberoptic bronchoscope for removal of aspirated headscarf pins in view of the relevant literature. Methodology: Fifty female patients with headscarf pin aspiration were managed by fiberoptic bronchoscopy over an 8-year period (January 2008 to December 2015). The procedure was performed under local anesthesia and conscious sedation through the mouth. Results: The age ranged from 10 to 45 years with a mean of 27.5. All patients had cough, five had unilateral wheeze (10%) while haemoptysis occurred twice (4%). Fiberoptic bronchoscopy succeeded in 45 cases (90%). Rigid bronchoscopy under general anesthesia was necessary in (n = 4, 8%) while one patient (2%) required thoracotomy. ?Conclusion: Fiberoptic bronchoscopy is safe and effective in removal of aspirated headscarf pins and should be tried first.