Application and implementation of narrow band imaging in fiberscope / 医疗卫生装备

Objective To explore the application and implementation of narrow band imaging (NBI) in fiberscope.Methods NBI color filter in the light source gifted the host machine with NBI function,and the application of DBI technique in fiberscope was implemented with a compatible HD camera.Results NBI technique involved in fiberscope decreased the costs in hospital and departments,relieved patient pain and increased the diagnosis rate.Conclusion NBI technique can be applied to electron mirror and fiberscope,and gains advantages in the future.

3D-Printed Nose-to-Larynx Airway Model, Preliminary Study / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Flexible fiberscopy is essential in the examination of the nose to larynx airway. However, the instrument is sensitive to manipulation and can sometimes be damaged when excessive external force is applied. In addition, patients can be injured during fiberscopic examination. In this regard, a airway model mimicking the human airway passage was developed for the education of fiberscopy to minimize the danger to both patient and fiberscope. MATERIALS AND METHOD: Neck CT data was used to 3D-print the airway model. Using the 3D doctor software, the outlines of the air-filled cavities were extracted. The outline data was modified to make the inside of the outline empty and the outside filled with 3D ink resin. The airway data was used to 3D-print the replica in three pieces, which were then assembled into one. Flexible laryngoscopic examination of nose to larynx was performed using the nose-to-larynx airway model, and for a male patient enrolled in the study. Virtual endoscopy was performed using the same CT data. The examination data were then compared frame by frame with regards to the shapes and positions of nasal inlet, inferior turbinate, torus tubarius, hypopharynx, epiglottis and vocal cord. RESULTS: The airway model was very similar in shape and position of the anatomic landmarks compared with real human airway examined by the fiberscope. CONCLUSION: The results of 3D-printed airway model showed similar shapes as the real human airway, and real time endoscopy could be done using the model. This technique can be extended to make models of tubed organs such as the intestine or the bronchial tree.

Learning fiberoptic intubation for awake nasotracheal intubation

BACKGROUND: Fiberoptic nasotracheal intubation (FNI) is performed if it is difficult to open the mouth or if intubation using laryngoscope is expected to be difficult. However, training is necessary because intubation performed by inexperienced operators leads to complications. METHODS: Every resident performed intubation in 40 patients. Success of FNI was evaluated as the time of FNI. First intubation time was restricted to 2 min 30 s. If the second attempt was unsuccessful, it was considered a failed case, and a specialist performed nasotracheal intubation. If the general method of intubation was expected to be difficult, awake intubation was performed. The degree of nasal bleeding during intubation was also evaluated. RESULTS: The mean age of the operators (11 men, 7 women) was 27.8 years. FNI was performed in a total of 716 patients. The success rate was 88.3% for the first attempt and 94.6% for the second attempt. The failure rate of intubation in anesthetized patients was 4.9%, and 13.6% in awake patients. When intubation was performed in anesthetized patients, the failure rate from the first to fifth trial was 9.6%, which decreased to 0.7% when the number of trials increased to > 30 times. In terms of awake intubation, there was no failed attempt when the resident had performed the FNI > 30 times. The number of FNIs performed and nasal bleeding were important factors influencing the failure rate. CONCLUSION: The success rate of FNI increased as the number of FNI performed by residents increased despite the nasal bleeding.

Analgo-sedación con remifentanil para la intubación vigil con el laringoscopio retromolar de Bonfils / Analgo-sedation using Remifentanil for the awake insertion of the Bonfils retromolar Intubation Fiberscope

Introducción: se considera la intubación del paciente despierto como el método fundamental para asegurar el acceso a la vía respiratoria difícil sospechada. Para afrontar esta situación se han desarrollado nuevos dispositivos como el fibroscopio retromolar de Bonfils. Los analgésicos de acción corta y fácilmente evaluables, como el remifentanil, son elecciones excelentes para alcanzar este objetivo. Resulta importante su dosificación ya que no está desprovisto de efectos adversos. Objetivos: determinar la concentración plasmática de remifentanil que garantice un efecto analgo-sedativo óptimo para la intubación vigil con el laringoscopio retromolar de Bonfils. Métodos: Se realizó un estudio descriptivo, en la Clínica Central «Cira García¼. La muestra quedó constituida por 12 pacientes programados para cirugía espinal cervical que requirieron intubación orotraqueal debido a su incapacidad de extender el cuello. Resultados: El tiempo medio para lograr el adecuado estado de conciencia con el método anestésico empleado fue 14 ± 5,8 min. La saturación de oxígeno descendió hasta una media de 94,2 ± 5,8 %. Los valores de tensión arterial media (TAM), frecuencia cardiaca (FC) y frecuencia espiratoria (FR) fueron 100,7 ± 17 mmHg, 77,6 ± 9,8. min-1 y 13,9 ±39 min-1 respectivamente. Presentaron recuerdos durante el procedimiento 4 pacientes, que refirieron estar satisfechos con el proceder. La concentración plasmática (Cp) de remifentanil calculada, necesaria para tener condiciones de intubación apropiadas fue de 0,0027 ± 0,005 µg/mL. Conclusiones: El empleo de remifentanil en dosis adecuadamente calculadas para alcanzar el efecto analgo-sedativo, para abordar la vía respiratoria difícil con el fibroscopio retromolar de Bonfils, en pacientes despiertos, fue una estrategia apropiada.

Background: The awake tracheal intubation of patients is considered as the essential method to guarantee the access to the suspected difficult airway. In order to face this problem, new disposals as the Bonfils retromolar Intubation Fiberscope have been developed. Short action and easily evaluated analgesics such as Remifentanil constitute an excellent election to achieve this goal; nevertheless, its dosage is very important as it is not free of adverse effects. Objectives: To determine the concentration of Remifentanil in plasma that guarantees an optimal analgo-sedation for the awake tracheal intubation of patients with the Bonfils retromolar Intubation Fiberscope. Methods: A descriptive study was carried out at "Cira García" Central Clinic. The sample was composed by 12 patients that were scheduled for cervical spine surgery that required orotracheal intubation because of their inability to stretch the neck. Results: The average time to achieve an adequate state of consciousness with the applied anaesthetic method was 14 ± 5,8 min. Oxygen saturation decreased to an average of 94,2 ± 5,8 %. The values of mean arterial blood pressure (MAP), cardiac frequency (CF) and expiratory rate (ER) were 100,7 ± 17 mmHg, 77,6 ± 9,8. min-1 y 13,9 ±39 min-1 respectively. Four patients had memories during the procedure and reported to be satisfied with it. The calculated plasma concentration (PC) of Remifentanil, also necessary to achieve adequate intubation conditions, was 0,0027 ± 0,005 µg/mL. Conclusions: The use of Remifentanil in properly calculated doses to achieve the analgo-sedation effect to tackle the suspected difficult airway with the Bonfils retromolar Intubation Fiberscope for the wake tracheal intubation of patients was an adequate strategy.

Endotracheal intubation in a patient with an almost complete obstruction of the glottis due to a movable supraglottic tumor: A case report / 대한마취과학회지

Intubation in patients with an obstruction of the glottis due to a large mass may present great challenge to most anesthesiologists. If tracheostomy is not available, flexible fiberscope guided endotracheal intubation is now the part of the standard management in these cases, but difficulty in advancing the tracheal tube over the fiberscope and into the trachea may be encountered. In this case, a 60-year-old male with a huge supraglottic mass was given general anesthesia for laryngomicroscopic surgery and debulking of the mass lesion. We planned an awake flexible fiberoptic intubation but failed to railroad the tube over the fiberscope even after successfully placing the scope inside the trachea. During various attempts to pass the tracheal entrance, the patient coughed and the tube slid into the trachea as mass moved aside and we could successfully secure the airway.

Anesthetic Experience of an Acromegalic Patient with Body Weight of 205 kg: A case report / 대한마취과학회지

Acromegaly is a rare and slowly progressive multisystem disorder caused by excessive secretion of growth hormone. The anesthetic risks of an acromegalic patient include hypertension, cardiac, gastrointestinal, renal problem and difficulties in an airway management by typical facial features, which require careful attention. We report a case of an anesthetic management for total knee replacement in an acromegalic patient with body weight of 205 kg.

Clinical evaluation of bronchial intubation of Bonfils intubation fiberscope in acromegaly patients / 基础医学与临床

Objective To evaluate the clinical intubation of Bonfils intubation fiberscope in difficult airway of acromegaly patients.Methods Fifteen acromegaly patients who have one of the following criteria of preoperative airway assessment,Mallampati score ≥3,thyromental distance (≤6 cm),mouth opening(≤3.5 cm).After routine anesthetic induction the patients were intubated with Bonfils intubation fiberscope.Haemodynamic changes were observed and handling of the Bonfils intubation fiberscope was evaluated in terms of the ease of insertion into oropharynx,visualization of epiglottis,advancement into glottis aperture and slide down the tracheal tube.Intubating time and success rate were also recorded.Postoperatively,sore throat or hoarseness were followed up for all patients.Results After intubation systolic pressure and heart rate increased as compared with pre-intubation((P

A Comparison of the Blind Intubation and the Fiberscope-guided Intubation Techniques via Laryngeal Mask Airway / 대한마취과학회지

BACKGROUND: The laryngeal mask airway (LMA) has an established role in difficult airway management as a ventilatory device and airway intubator. It is ease to view the laryngeal aperature with a fiberscope through a laryngeal mask airway, so it offers a route to obtaining rapid access to the larynx. The objective of this study was to evaluate a narrowing degree of LMA by the epiglottis and to compare the intubation time and success rate of the blind intubation techinique with the fiberscope-guided intubation techinique through the laryngeal mask airway. METHODS: The LMA (#4) was placed into the hypopharynx after induction of anesthesia and muscle paralysis. The fiberscopic findings through the lumen of the LMA were recorded after the LMA placements. The degree of narrowing of the LMA by the epiglottis was estimated as 0%, 1 25%, 26 50%, 51 75%, or 76 100%. The breathing circuit of the anesthesia circle system was then disconnected from the LMA and a well-lubricated, cuffed, 5.5 mm ID endotracheal tube was inserted into the trachea through the lumen of the LMA either by the blind techiniques or fiberscope-guided techniques, and then intubation time and success rate were measured. RESULTS: The most frequent incidence (44/60, 73.3%) of narrowing by epiglottis in both groups was 76 100%. The success rate for fiberscope-guided intubation was 100%, while the success rate for blind intubation was 20%. The average intubation time of fiberscope-guided intubation was 26.0 s, while the average intubation time of blind intubation was 17.7 s. CONCLUSIONS: The fiberscope-guided tracheal intubation technique through the LMA is a more reliable method than the blind intubation technique through the LMA.

A Comparison of the Blind Intubation and the Fiberscope-guided Intubation Techniques via Laryngeal Mask Airway / 대한마취과학회지

BACKGROUND: The laryngeal mask airway (LMA) has an established role in difficult airway management as a ventilatory device and airway intubator. It is ease to view the laryngeal aperature with a fiberscope through a laryngeal mask airway, so it offers a route to obtaining rapid access to the larynx. The objective of this study was to evaluate a narrowing degree of LMA by the epiglottis and to compare the intubation time and success rate of the blind intubation techinique with the fiberscope-guided intubation techinique through the laryngeal mask airway. METHODS: The LMA (#4) was placed into the hypopharynx after induction of anesthesia and muscle paralysis. The fiberscopic findings through the lumen of the LMA were recorded after the LMA placements. The degree of narrowing of the LMA by the epiglottis was estimated as 0%, 1 25%, 26 50%, 51 75%, or 76 100%. The breathing circuit of the anesthesia circle system was then disconnected from the LMA and a well-lubricated, cuffed, 5.5 mm ID endotracheal tube was inserted into the trachea through the lumen of the LMA either by the blind techiniques or fiberscope-guided techniques, and then intubation time and success rate were measured. RESULTS: The most frequent incidence (44/60, 73.3%) of narrowing by epiglottis in both groups was 76 100%. The success rate for fiberscope-guided intubation was 100%, while the success rate for blind intubation was 20%. The average intubation time of fiberscope-guided intubation was 26.0 s, while the average intubation time of blind intubation was 17.7 s. CONCLUSIONS: The fiberscope-guided tracheal intubation technique through the LMA is a more reliable method than the blind intubation technique through the LMA.