Respiratory complications of propofol,sevoflurane,and dexmedetomidine anesthesia for fiberoptic bronchoscopy in children aged 1 month to 3 years:a randomized trial

Objective To evaluate the effect of propofol,sevoflurane,and dexmedetomidine on respiratory complications inchildren undergoing fiberoptic bronchoscopy(FOB).Methods This double-blind randomized clinical trial was conductedamong 120 children aged 1 month to 3 years undergoing FOB.The patients were randomized into 3 groups(n=40)foranesthesia induction with sevoflurane inhalation,1 mg/kg propofol,or 1μg/kg dexmedetomidine before bronchoscopy,andthe changes in hemodynamic parameters,sedation level,and respiratory complications during and after the procedure wereassessed.Results The patients'heart rate during bronchoscopy was significantly lower and the mean arterial blood pressuresignificantly higher in dexmedetomidine group than in sevoflurane and propofol groups(P<0.05).Cough duringbronchoscopy did not occur in any of the cases in propofol group,while the highest frequency of cough was recorded indexmedetomidine group.The incidence of laryngospasm in the propofol group(12.5%)was significantly lower than those insevoflurane and dexmedetomidine groups(30%and 32.5%,respectively)(P<0.05).Conclusion Sevoflurane and propofol aresafe and suitable for anesthesia induction in children below 3 years of age undergoing diagnostic FOB and can achieve bettersedative effect and lower the incidences of cough and respiratory complications as compared with dexmedetomidine.

Ultrasound-guided sphenopalatine ganglion block for effective analgesia during awake fiberoptic nasotracheal intubation: A case report

BACKGROUND Awake fiberoptic nasotracheal intubation(AFNI)is the preferred airway ma-nagement strategy for patients with difficult airways.However,this procedure can cause significant physical and psychological distress.This case report explores the application of a sphenopalatine ganglion(SPG)block as an alternative anal-gesic modality to mitigate the discomfort associated with AFNI.CASE SUMMARY A 63-year-old female with a history of right maxillary osteosarcoma underwent craniotomy for a suspected malignant brain lesion.The patient’s medical history included prior surgery,chemotherapy,and radiation therapy,resulting in signi-ficant jaw impairment and limited neck mobility.Considering the anticipated air-way challenges,AFNI was planned.A SPG block was performed under real-time ultrasound guidance,providing effective analgesia during nasotracheal intuba-tion.CONCLUSION The SPG block represents a promising analgesic approach in AFNI,offering po-tential benefits in alleviating pain involving the nasal and nasopharyngeal regions as well as improving patient cooperation.

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.

Awake fiberoptic intubation and use of bronchial blockers in ankylosing spondylitis patients

BACKGROUND Patients with ankylosing spondylitis(AS)combined with severe cervical fusion deformity have difficult airways.Awake fiberoptic intubation is the standard treatment for such patients.Alleviating anxiety and discomfort during intubation while maintaining airway patency and adequate ventilation is a major challenge for anesthesiologists.Bronchial blockers(BBs)have significant advantages over double-lumen tubes in these patients requiring one-lung ventilation.AIM To evaluate effective drugs and their optimal dosage for awake fiberoptic nasotracheal intubation in patients with AS and to assess the pulmonary isolation effect of one-lung ventilation with a BB.METHODS We studied 12 AS patients(11 men and one woman)with lung or esophageal cancer who underwent thoracotomy with a BB.Preoperative airway evaluation found that all patients had a difficult airway.All patients received an intramuscular injection of penehyclidine hydrochloride(0.01 mg/kg)before anesthesia.In the operating room,dexmedetomidine(0.5μg/kg)was infused intravenously for 10 min,with 2%lidocaine for airway surface anesthesia,and a 3%ephedrine cotton swab was used to contract the nasal mucosa vessels.Before tracheal intubation,fentanyl(1μg/kg)and midazolam(0.02 mg/kg)were administered intravenously.Awake fiberoptic nasotracheal intubation was performed in the semi-reclining position.Intravenous anesthesia was administered immediately after successful intubation,and a BB was inserted laterally.The pre-intubation preparation time,intubation time,facial grimace score,airway responsiveness score during the fiberoptic introduction,time of end tracheal catheter entry into the nostril,and lung collapse and surgical field score were measured.Systolic blood pressure(SBP),diastolic blood pressure(DBP),and heart rate(HR)were recorded while entering the operation room(T1),before intubation(T2),immediately after intubation(T3),2 min after intubation(T4),and 10 min after intubation(T5).After surgery,all patients were followed for adverse reactions such as epistaxis,sore throat,hoarseness,and dysphagia.RESULTS All patients had a history of AS(20.4±9.6 years).They had a Willson's score of 5 or above,grade III or IV Mallampati tests,an inter-incisor distance of 2.9±0.3 cm,and a thyromental(T-M)distance of 4.8±0.7 cm.The average pre-intubation preparation time was 20.4±3.4 min,intubation time was 2.6±0.4 min,facial grimace score was 1.7±0.7,airway responsiveness score was 1.1±0.7,and pulmonary collapse and surgical exposure score was 1.2±0.4.The SBP,DBP,and HR at T5 were significantly lower than those at T1-T4(P<0.05).While the values at T1 were not significantly different from those at T2-T4(P>0.05),they were significantly different from those at T5(P<0.05).Seven patients had minor epistaxis during endotracheal intubation,two were followed 24 h after surgery with a mild sore throat,and two had hoarseness without dysphagia.CONCLUSION Patients with AS combined with severe cervical and thoracic kyphosis should be intubated using fiberoptic bronchoscopy under conscious sedation and topical anesthesia.Proper doses of penehyclidine hydrochloride,dexmedetomidine,fentanyl,and midazolam,combined with 2%lidocaine,administered prior to intubation,can provide satisfactory conditions for tracheal intubation while maintaining the comfort and safety of patients.BBs are safe and effective for onelung ventilation in such patients during thoracotomy.

Value of Fiberoptic Ductoscopy in Diagnosing and Treating Multiporous Nipple Discharge

OBJECTIVE To explore the value of fiberoptic ductoscopy in diagnosing and treating bilateral and polyporous nipple discharge (ND).METHODS Fiberoptic ductoscopy was conducted in 29 patients with bilateral and polyporous ND.After the ductoscopy,the patients with intraductal papilloma (IDP) underwent a surgical procedure,and the others,identified with galactostasis,mammary duct ectasia (MDE) and obstructive galactophoritis (OG),received a ductoscopy-guided interventional therapy. RESULTS Among 29 cases,and with 79 galactophores examined,IDP was found in 11 cases (37.9% of the total cases),or 13.9% of the galactopores examined.IDP was found in 9 of 11 cases with a bloody nipple discharge,while IDP was seen in 2 of the 18 cases with a non-bloody nipple discharge.The excision accuracy achieved 100% in the cases,and postoperative pathological diagnosis accordance rate reached 88.9%. CONCLUSION Fiberoptic ductoscopy has many features such as ability to see the lesion,and accurate preoperative localization,thus eliminating excessive excision of tissue during surgery.For most patients with ND,especially those suffering galactostasis,OG or MDE,washout under fiberoptic ductoscopy and interventional therapy may achieve a thorough cure of the disease.

Application of fiberoptic bronchscopy in patients with acute exacerbations of chronic obstructive pulmonary disease during sequential weaning of invasive-noninvasive mechanical ventilation

BACKGROUND:Early withdrawal of invasive mechanical ventilation(IMV) followed by noninvasive MV(NIMV) is a new strategy for changing modes of treatment in patients with acute exacerbations of chronic obstructive pulmonary disease(AECOPD) with acute respiratory failure(ARF).Using pulmonary infection control window(PIC window) as the switch point for transferring from invasive to noninvasive MV,the time for early extubation can be more accurately judged,and therapy efficacy can be improved.This study aimed to prospectively investigate the clinical effectiveness of fiberoptic bronchscopy(FOB) in patients with AECOPD during sequential weaning of invasive-noninvasive MV.METHODS:Since July 2006 to January 2011,106 AECOPD patients with ARF were treated with comprehensive medication and IMV after hospitalization.Patients were randomly divided into two groups according to whether fiberoptic bronchoscope is used(group A,n=54) or not(group B,n=52) during sequential weaning from invasive to noninvasive MV.In group A,for sputum suction and bronchoalveolar lavage(BAL),a fiberoptic bronchoscope was put into the airway from the outside of an endotracheal tube,which was accompanied with uninterrupted use of a ventilator.After achieving PIC window,patients of both groups changed to NIMV mode,and weaned from ventilation.The following listed indices were used to compare between the groups after treatment:1) the occurrence time of PIC,the duration of MV,the length of ICU stay,the success rate of weaning from MV for the first time,the rate of reventilatJon and the occurrence rate of ventilator-associated pneumonia(VAP);2) the convenience and safety of FOB manipulation.The results were compared using Student's f test and the Chi-square test.RESULTS:The occurrence time of PIC was(5.01 ±1.49) d,(5.87±1.87) d in groups A and B,respectively(P<0.05);the duration of MV was(6.98±1.84) d,(8.69±2.41) d in groups A and B,respectively(P<0.01);the length of ICU stay was(9.25±1.84) d,(11.10±2.63) d in groups A and B,respectively(P<0.01);the success rate of weaning for the first time was 96.30%,76.92%in groups A and B,respectively(P<0.01);the rate of reventilation was 5.56%,19.23%in groups A and B,respectively(P<0.05);and the occurrence rate of VAP was 3.70%,23.07%in groups A and B,respectively(P<0.01).Moreover,it was easy and safe to manipulate FOB,and no side effect was observed.CONCLUSIONS:The application of FOB in patients with AECOPD during sequential weaning of invasive-noninvasive MV is effective in ICU.It can decrease the duration of MV and the length of ICU stay,increase the success rate from weaning MV for the first time,reduce the rate of reventilation and the occurrence rate of VAP.In addition,such a method is convenient and safe in patients of this kind.

Effects of mucosolvan combined with fiberoptic bronchoscopy on respiratory function, inflammatory response and stress state in patients with severe pneumonia

Objective: To investigate the effect of mucosolvan combined with fiberoptic bronchoscopy on respiratory function, inflammatory response and stress state in patients with severe pneumonia. Methods: From January 2017 to June 2018, 82 patients with severe pneumonia were randomly divided into observation group and control group (all 41 cases). Patients in the control group received conventional anti-infective treatment, and the observation group was treated with fiberoptic bronchoscopy combined with mucosolvan on the basis of the control group. Respiratory function, inflammatory response and stress status were compared between the two groups. Results: Before treatment, there was no significant difference in Cdyn, WOB and PaO2/FiO2 between the two groups. After treatment, Cdyn and PaO2/FiO2 in the observation group were (36.28±4.28) mL/cmH2O and (376.23±24.21) mmHg respectively, while those in the control group were (26.89±3.76) mL/cmH2O and (322.12±23.16) mmHg, respectively. The levels of Cdyn and PaO2/FiO2 in the observation group were higher than those in the control group. After treatment, the WOB in the observation group was (7.81±0.72) J/L, and the WOB in the control group was (8.33±1.23) J/L. WOB of both groups was lower than that before treatment, and in observation group WOB was lower than that of control group, the difference was statistically significant. In CRP, PCT and sTREM-1 levels, there was no significant difference between the two groups before treatment. After treatment, CRP, PCT and sTREM-1 in the observation group were (39.10±6.03) mg/L, (14.57±2.05) ng/L, (15.02±3.02) ng/L respectively, while those in the control group were (59.72±8.81) mg/L, (20.03±3.09) ng/L, (34.21±5.28) ng/L, respectively. CRP, PCT, sTREM-1 in both groups were lower than those before treatment, and CRP, PCT, sTREM-1 in observation group were lower than those in control group. Before treatment, there was no significant difference with Cor, Ang-I and Ang-II in two groups. After treatment, the levels of Cor, Ang-I and Ang-II in the observation group were (114.76±15.85) ng/mL, (6.72±0.64) ng/mL, (27.28±3.43) ng/mL respectively, while those in the control group were (193.15±22.64) ng/mL, (12.10±1.68) ng/mL, (43.02±5.57) ng/mL, respectively. In the observation group, the levels of Cor, Ang-I and Ang-II were lower than those in the control group. Conclusion: Mucosolvan combined with fiberoptic bronchoscopy can effectively improve the respiratory function of patients with severe pneumonia, and reduce inflammation and stress state of the body.

The value of cytologic brushing with the aid of fiberoptic colonoscopy in the diagnosis of carcinoma of colon

Preoperative cytologic brushing and biopsy under direct Vision withfiberoptic colonoscopy(FC)and postoperative histopathologic examination wereperformed in 147 patients who were suspected of suffering from carcinoma of co-lon.In FC cytologic brushing,128 cases were positive for malignancy(87.1percent),18 false-negative(12.2 percent)and only one false-positive(0.7 percent).In the 146 FC biopsy specimens,124 were positive for malignancy(84 4 percent)and 22 false-negative and no false-positive.Combination of FC cytologic brushingwith FC biopsy could raise the diagnostic rate of colonic carcinoma to 95.2% anddecrease false-negative and false-positive because the two methods may replenisheach other in sampling and observation.Cytologic brushing is most valuable tothe early diagnosis of colonic carcinoma.When colonic stricture and obstructionprevent the colonoscope from reaching the lesion and FC biopsy cannot bedone,FC cytologic brushing is an effective method for diagnosis.The positiverate and false-negative rate of the cytologic brushing did not correlate to grosstyping,histopathologic typing and Dukes staging(P】0.05).The factorsinfluencing the correct diagnosis of colonic carcinoma by FC cytologic brushingare discussed in this paper.

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.

A Comparative Study between Dexmedetomidine versus Fentanyl on Intubating Conditions and Side Effects during Awake Fiberoptic Nasal Intubation under Topical Anesthesia in Patients Underwent Elective Surgical Operation

Awake fiber optic intubation is the gold standard technique for management of anticipated difficult airway. In spite of availability of several sedatives, at higher doses these drugs cause respiratory depression and sensorium. This study was conducted to evaluate and compare the efficacy of Dexmedetomidine or Fentanyl for sedation during AFOI. Sixty patients, aged 20 - 40 years undergoing AFOI were made into two groups, group D Dexmedetomidine 1 mcg/kg, and group F Fentanyl 2 μg/kg, both drugs was diluted with 50 ml saline to be infused over 10 minutes). Demographic data, patient cough score, sedation score and post-intubation score were compared between two groups. Cough score ≤ 2 was 25 patients in group D compared with 2 patients in group F, post intubation score 1 in group D was 24 vs. 2 in group F, mean Ramsy sedation score in group D was 3 vs. 2.1 in group F, SpO2 ≥ 95% in group D was 28 vs. 5 patients in group F, insignificant rise in MAP from 93 to 96 mmhg in group D (P = 0.347), but there was significant rise from 92.3 to 118.18 (P ≤ 0.0001) in group F, there was significant decrease in HR from 77.4 to 71 (P = 0.005) vs. significant rise from 77 to 114 (P ≤ 0.0001) in group F. Thus, we can conclude that Dexmedetomidine provides better intubating condition, sedation, less respiratory depression and hemodynamic stability than fentanyl for AFOI, without adversely affecting airway.

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.

Conscious Sedation and Awake Fiberoptic Intubation in a Patient with Difficult Mask Ventilation—A Case Report

Since maxillofacial malignancy is a common cause of facial defects and disfigurement of the face that may make fitting of a mask difficult and cause air leakage from the side, thus making mask ventilation difficult. In addition, distorted anatomy of the airway and base of the skull in such patients may cause difficult intubation (DI). We experienced a case with a huge facial defect due to maxillary carcinoma, in which difficult mask ventilation (DMV) and DI were predicted. After evaluation by three-dimensional airway computed tomography, the airway was secured with conscious sedation using dexmedetomidine, and awake fiberoptic intubation was safely performed. Three-dimensional airway computed tomography seems to be a good tool for successful intubation when DMV and DI are predicted.

Fiberoptic Intubation through Adapter Removable Supraglottic Airways;Comparison of the Air-Q ILA^TM, LMA Classic Excel^TM, and LMA Unique^TM

Study Objective: We studied the overall efficacy of fiberoptic aided intubation using three different supraglottic airways (SGA) as intubation conduits with a standard endotracheal tube (ETT) to determine which, if any, is superior as an intubation conduit. Design: After induction of general anesthesia, subjects were randomized to one of three groups: Air-Q ILATM, LMA Classic ExcelTM, and LMA UniqueTM. Subjects were intubated with a fiberoptic aided technique with continuous ventilation with FiO2 = 1.0 through one of these SGAs. The primary endpoint was the overall efficacy of the intubation procedure. In addition, the following data were collected: demographic data, intubation times, grade of view of the larynx, and a visual analog scale (VAS) score of difficulty as determined by the primary anesthesiologist performing the procedure. Data were analyzed using a Kruskal-Wallis one-way analysis of variance and Post hoc analysis was done using Dunn’s Multiple Comparison Test. Results: 126 total subjects were studied. Intubation success rates were 100%, 87.8%, and 95% with the Air-Q ILATM, LMA Classic ExcelTM, and LMA UniqueTM respectively. There was no significant difference among the three different SGAs when comparing the times to place the SGA (T1), the true intubating time (T2), the time to remove the SGA (T3), or the total time (T4). Data were also stratified by the grade of view of the larynx;all grade I views, grade II views, and grade III views were grouped together regardless of the type of the SGA used. The grade I view of the larynx group had significantly faster true intubation times (T2 = 75.1 sec, p = 0.01) and significantly lower VAS scores (VAS = 1.9, P = TM provides the best view of the larynx and is the easiest one to use as an intubation conduit.

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.

The use of fiberoptic bronchoscope to remove aspirated tracheobronchial foreign bodies: Our experience

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.

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.

床旁纤维支气管镜肺泡灌洗注入抗生素在老年重症肺炎患者中的应用价值

目的探索纤维支气管镜肺泡灌洗注入抗生素在老年重症肺炎患者中的应用价值。方法回顾性分析2021年8月至2022年12月我院收治的126例老年重症肺炎患者的临床资料,根据治疗方式分为试验组(n=57)和对照组(n=69)。两组患者均接受纤维支气管镜肺泡灌洗,试验组患者于灌洗结束后,将敏感抗生素注入病变位置。比较两组患者患者治疗前后白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)、降钙素原(PCT)、氧分压(PaO_(2))、二氧化碳分压(PaCO_(2))、机械通气时间、ICU住院时间、临床疗效。结果试验组总有效率显著高于对照组(P<0.05)。治疗后,试验组的IL-6、TNF-α、CRP、PCT水平显著低于对照组,PaCO_(2)水平显著低于对照组(P<0.05),机械通气时间与ICU住院时间明显短于对照组,差异均有统计学意义(P<0.05)。结论肺泡灌洗后注入抗生素可降低老年重症肺炎患者血清炎症因子水平、优化血气指标、缩短机械通气时间、ICU住院时间、提高整体疗效。

视可尼喉镜在引导经鼻气管插管中的临床应用

目的探讨视可尼喉镜(Shikani optical stylet,SOS)在引导经鼻气管插管中的应用效果。方法回顾性分析我院2017年1月~2022年12月60例经鼻气管插管全身麻醉择期手术的临床资料,按照经鼻气管插管的引导方式分为3组,每组20例:视频喉镜引导气管插管(V组),纤维支气管镜引导气管插管(F组)和SOS引导气管插管(S组)。比较3组患者气管插管过程中喉部显露分级、鼻出血情况、气管插管成功率、完成时间和术后气管插管并发症的发生情况。结果F、S组患者喉显露分级均为Ⅰ级,V组患者喉显露分级Ⅰ级7例、Ⅱ级10例、Ⅲ级3例,F、S组患者喉显露效果明显优于V组(Z=-4.274,P=0.000;Z=-4.274,P=0.000)。F、S组患者无鼻出血分别为15、14例,轻度分别为5、6例,均无患者发生重度鼻出血,V组患者无鼻出血7例,轻度10例,重度3例,F、S组患者鼻出血的程度明显轻于V组(Z=-2.678,P=0.007;Z=-2.402,P=0.016)。S组患者气管插管完成中位时间37.5(34.3,41.5)s,显著短于V组45.0(39.8,72.5)s和F组89.0(76.0,102.5)s(Z=15.703,P=0.013;Z=32.050,P=0.000),V组明显短于F组(Z=-16.347,P=0.009)。V组2例插管失败,F和S组患者均顺利完成气管插管,3组插管成功率差异无统计学意义(P>0.05)。3组患者术后鼻咽部疼痛、鼻塞发生率差异无统计学意义(P>0.05)。结论SOS引导经鼻气管插管可以提供良好的喉显露,气管插管成功率满意且不增加不良反应发生率,可视为一种安全而有效的经鼻气管插管方式。

丙泊酚与苯磺酸瑞马唑仑在择期行无痛纤维支气管镜活检术患者血流动力学及苏醒质量的比较

目的探讨丙泊酚与苯磺酸瑞马唑仑应用于无痛纤维支气管镜活检术的临床价值。方法选取2020年1月—2022年12月什邡市人民医院拟接受无痛纤维支气管镜活检治疗的60例患者,采用随机数字表法分为丙泊酚组(P组)和苯磺酸瑞马唑仑组(R组),每组30例。对比两组患者血流动力学指标变化趋势、麻醉效果指标、苏醒期质量指标、血糖和乳酸水平变化以及麻醉不良反应的差异。结果R组苏醒时间短于P组(P<0.05)。两组患者麻醉起效时间、苏醒后达离室标准时间比较,差异均无统计学意义(P>0.05)。两组患者麻醉前、内镜检查开始时、开始后3 min、苏醒时的心率(HR)、血氧饱和度(SpO_(2))、平均动脉压(MAP)比较,结果:(1)不同时间点的HR、SpO_(2)、MAP比较,差异均有统计学意义(P<0.05);(2)两组患者MAP比较,差异有统计学意义(P<0.05),两组患者HR、SpO_(2)比较,差异均无统计学意义(P>0.05);(3)两组患者MAP变化趋势比较,差异有统计学意义(P<0.05),两组患者HR、SpO_(2)变化趋势比较,差异均无统计学意义(P>0.05)。两组患者麻醉效果分级比较,差异无统计学意义(P>0.05)。两组患者不同时间点Ramsay评分比较,结果:(1)不同时间点间Ramsay评分比较,差异有统计学意义(P<0.05);(2)两组患者Ramsay评分比较,差异无统计学意义(P>0.05);(3)两组患者Ramsay评分变化趋势比较,差异无统计学意义(P>0.05)。两组患者术前、术后即刻、术后4 h血糖、乳酸比较,结果:(1)不同时间点血糖、乳酸比较,差异均有统计学意义(P<0.05);(2)两组患者血糖、乳酸比较,差异均无统计学意义(P>0.05);(3)两组患者血糖、乳酸变化趋势比较,差异均无统计学意义(P>0.05)。R组不良反应发生率低于P组(P<0.05)。结论苯磺酸瑞马唑仑应用于无痛纤维支气管镜活检术较丙泊酚能更有利于血流动力学的稳定,可缩短苏醒时间,减少麻醉不良反应。

Neural Network Signal Processing Approach for Damage Assessment in Fiberoptic Smart Material Systems and Structures

An approach by using neural network signal processing in associate with embedded fiberoptic sensing array for the newly developed “smart material systems and structures” is discussed in this paper.The principle,structure of this approach and suitable neural network algorithms are described.The results of simulation experiments are also given.