association of fever with fiberoptic bronchoscopy and bronchoalveolar washing in non critically ill immunocompetent children

In children, flexible bronchoscopy [FB] and bronchoalveolar lavage [BAL] have been applied increasingly to evaluate various lung diseases. In Egypt, although fever has been reported following FB and BAL, its concomitant occurrence with abnormal bronchoalveolar lavage fluid [BALF] was not analyzed. Moreover, whether its development could be influenced by the clinical characters of children before the procedure. The purpose of this study is to find out the frequency of high fever [>/= 39°C] post BAL and to determine the clinical characters of children who developed high fever including BAL fluid chanicters and management of post-BAL fever. This prospective study records on 123 children [76 boys and 47 girls] with mean age 36.5 months [range from 7 months to 157 months] subjected to FR at the unit of pediatric bronchoscopy, Al-Hussein Hospital, Al-Azhar University during 28 months period from March 2001 to July 2003. It was found that seven children [5.6%] developed high fever [>/= 39°C] [fever group]. The seven patients in the fever group had a median age of 27 [range 9-57] months and a reported median temperature [T] of 39.2°C [39-40.8] occurring 6.3 [range 3-18] hours after BAL. To determine if there were differences in clinical or BAL fluid [BALF] characteristics, we compared each child in the fever group with two children in non fever group based on primary indications and age. There were no differences in the demographic or clinical characteristics between the two groups. Lymphocyte number in BALF were significantly reduced in the fever group [P<0.001]. An abnormal BALF cell differential [defined as one or more of the following]: neutrophits>10%, Lymphocytes>30%, oreosinophils>1%] was in significantly more common in the fever group [P>0.05]. In Conclusion high fever is an infrequent adverse event following BAL in non-critically ill"immunocompetent children with underlying pulmonary diseases. Pit-BAL clinical characters are not associated with high Fever. Also, the finding of abnormal BALE cell differential is not associated with development of high fever Post-BAL

Usefulness of bronchoscopy in children

Seventy-three fiberoptic bronchoscopes, using flexible bronchoscope under general anesthesia, were carried out. Bronchoscopic diagnosis was established in 63 cases, while in the remaining 10 cases, the airways appeared normal. Its efficacy, as a diagnostic tool, was 100% in cases presented with stridor and in cases of suspected foreign body aspiration. As a therapeutic tool, the rigid bronchoscope [Doesel- Huzly] was used to remove foreign bodies from the airways of children successfully, but the flexible type failed to inflate the collapsed lung segments not due to foreign body inhalation. Minimal and trivial complications had occurred during and after bronchoscopy. The high diagnostic and therapeutic benefits, with low rate of complications, strongly support the use of bronchoscopes in children and infants who have a variety of pulmonary problems

Laryngeal mask airway as an alternative to face mask during paediatric fiberoptic bronchoscopy

The aim of this study was to evaluate the usefulness of the laryngeal mask airway [LMA] as an alternative to face mask [FM] during fiberoptic bronchoscopy in pediatric patients. Fifty pediatric patients scheduled for fiberoptic bronchoscopy [FOB] were divided into two groups: Group 1 using LMA and group 2 using face mask for the insertion of fiberoptic bronchoscope through the bronchoscope T-tube adaptor. All patients were pre-medicated and received general anesthesia. It was found that heart rate [HR] was increased and oxygen saturation was decreased during FOB insertion. The insertion time, number of trials and the need for muscle relaxants were higher in face mask group than in LMA group. The incidence of complications as hypoxia, laryngospasm, bronchospasm, coughing was insignificantly higher in FM group