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...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.展开更多
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 endob...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.展开更多
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...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.展开更多
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 bronchosco...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.展开更多
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 ...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.展开更多
Background: Foreign body (FB) aspiration is a common emergency in our practice. The routine method of removal is via rigid bronchoscopy (RB) under general anesthesia. This is the preferred procedure particularly in ch...Background: Foreign body (FB) aspiration is a common emergency in our practice. The routine method of removal is via rigid bronchoscopy (RB) under general anesthesia. This is the preferred procedure particularly in children who form the major affected population. Fiberoptic bronchoscopy (FOB) has also been used for FB removal in many countries, though in Iraq, the standard mean remains rigid bronchoscopy. Objective: Herein, we present 5 cases of FB inhalation in adults in whom FOB was used for removal. The aim is to test its feasibility with literature review. Setting: the department of thoracic surgery/Sulaimania Teaching Hospital/Sulaimania/Iraq. Study Design: a prospective study of 5 patients. Patients and methods: 5 patients (3 females and 2 males) with different bronchial or laryngeal FBs in whom FOB was used as a method for removal are presented. The age ranged from 16 to 71 years. The clinical and radiographic features are recorded. In all these patients, initial FOB examination under local anesthesia transorally or via tracheotomy stoma was done. When removed by this method failed, RB under GA was used and when this failed, thoracotomy was the last resort. Results and Conclusions: FBs encountered in this paper consisted of pins (n = 2), sewing needle (n = 1), speech valve (n = 1) and a medical leach (n = 1). Three FBs (medical leach, speech valve and one pin) were successfully removed by FOB. A pin in RMB was visualized but failed to be removed by FOB and therefore, RB was required for its retrieval, while a needle in left lower lobe was invisible by both FOB and RB and thus surgery was necessary to remove it. We conclude that in adolescent or adult patients with bronchial FBs, FOB should be tried first for removal. If this fails then RB can be used. To increase its success, FOB should be combined with certain accessories like special FB forceps and fluoroscopy.展开更多
文摘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.
文摘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.
文摘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.
文摘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.
文摘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.
文摘Background: Foreign body (FB) aspiration is a common emergency in our practice. The routine method of removal is via rigid bronchoscopy (RB) under general anesthesia. This is the preferred procedure particularly in children who form the major affected population. Fiberoptic bronchoscopy (FOB) has also been used for FB removal in many countries, though in Iraq, the standard mean remains rigid bronchoscopy. Objective: Herein, we present 5 cases of FB inhalation in adults in whom FOB was used for removal. The aim is to test its feasibility with literature review. Setting: the department of thoracic surgery/Sulaimania Teaching Hospital/Sulaimania/Iraq. Study Design: a prospective study of 5 patients. Patients and methods: 5 patients (3 females and 2 males) with different bronchial or laryngeal FBs in whom FOB was used as a method for removal are presented. The age ranged from 16 to 71 years. The clinical and radiographic features are recorded. In all these patients, initial FOB examination under local anesthesia transorally or via tracheotomy stoma was done. When removed by this method failed, RB under GA was used and when this failed, thoracotomy was the last resort. Results and Conclusions: FBs encountered in this paper consisted of pins (n = 2), sewing needle (n = 1), speech valve (n = 1) and a medical leach (n = 1). Three FBs (medical leach, speech valve and one pin) were successfully removed by FOB. A pin in RMB was visualized but failed to be removed by FOB and therefore, RB was required for its retrieval, while a needle in left lower lobe was invisible by both FOB and RB and thus surgery was necessary to remove it. We conclude that in adolescent or adult patients with bronchial FBs, FOB should be tried first for removal. If this fails then RB can be used. To increase its success, FOB should be combined with certain accessories like special FB forceps and fluoroscopy.
