Overcoming Airway Hurdles: A Case Report of Anesthetic Challenges in Meningomyelocele Complications.

This case report delves into the anesthesia management in a 23-year-old male with complications of meningomyelocele, a catastrophic congenital neural tube defect. The patient, paraplegic since birth with severe scoliosis, presented with a femoral fracture, prompting the need for careful consideration of anesthesia strategies. The challenges included counseling the family on the risks and benefits of surgery under general anesthesia, selecting an appropriate anesthetic plan for an anticipated difficult airway, and addressing ventilation strategies for restrictive lung disease. To tackle the anticipated difficult airway, an awake pediatric fiberoptic bronchoscopy was performed in the recovery room, facilitating a conscious sedation approach. In the operating room, monitored anesthesia care with dexmedetomidine infusion was employed, complemented by careful positioning and padding in the lateral position. The awake fiberoptic checkscopy proved crucial in avoiding unnecessary general anesthesia. A patient-centered approach contributed to the successful execution of a complex anesthesia plan, ensuring optimal care for this unique patient population.

Induction of lung lesions by bronchial administration using bronchoscope technique in mice.

This study aimed to establish an exposure method that can induce homogeneous lesions with minimal inter-individual variability. The distribution of lesions induced by bleomycin (BLM) administration was also analyzed. C57BL mice were intrabronchially administered 20 µL of BLM (3 mg/mL) using a bronchoscope in the left or right bronchus. The mice were sacrificed 14 days after administration, and their lungs were evaluated histopathologically. BLM-induced inflammatory lesions were widely observed in the lungs. In the left bronchus-treated group, lesions were uniformly observed throughout the lobe, and no individual differences were noted. Meanwhile, in the right bronchus-treated group, individual differences in the distribution of the pulmonary lesions were observed. The distribution of lesions differed among the four lobes of the right lung owing to their anatomical features. Administration into the left bronchus is recommended for highly homogeneous lung exposure and for establishing models that contribute to highly accurate toxicity and efficacy evaluations.

Severe pulmonary edema occurred during endobronchial ultrasound under monitored anesthesia care - A case report.

BACKGROUND: Endobronchial ultrasound (EBUS) is widely used to diagnose lung cancer. Monitored anesthesia care (MAC) can enhance patient comfort and procedural conditions during EBUS. EBUS under MAC is usually safe but can lead to various complications. CASE: A 34-year-old male who had increased sputum for two months showed an enlarged paratracheal lymph node and planned for lymph node biopsy by EBUS. During EBUS under MAC, an unexpected oxygen saturation decline required intervention. After intubation, copious frothy fluid was suctioned from the bronchi, and oxygenation was recovered. A narrowed trachea and the EBUS bronchoscope might have resulted in upper airway obstruction, and suction performed under these conditions might have caused pulmonary edema. The patient received non-invasive ventilation and high-flow nasal cannula and recovered without complications. CONCLUSIONS: When there is an expected risk of upper airway obstruction during EBUS, careful preoperative evaluation and preparation are essential to prevent negative pressure pulmonary edema.

Brochoscopic Airway Clearance Therapy vs. Conventional Sputum Aspiration: The Future of Flexible Brochoscopes in Intensive Care Units?

(1) Background: The aim of our study is to investigate the effectiveness of bronchoscopic airway clearance therapy (B-ACT) on severe pneumonia (SP) patients with invasive mechanical ventilation (IMV) in the intensive care unit (ICU). (2) Methods: Our study retrospectively enrolled 49 patients with sputum aspiration and 99 patients with B-ACT, and the latter were divided into the ≤once every 3 days group (n = 50) and >once every 3 days group (n = 49). (3) Results: We found most laboratory blood results were significantly improved in the B-ACT group as compared with those in sputum aspiration group (p < 0.05). Patients in the B-ACT group and those in ≤once every 3 days group also had significantly better survival to hospital discharge than those in their counterpart groups (Logrank p < 0.001). In patients with cardiopulmonary diseases or positive cultures for bacteria, the B-ACT group and those in the ≤once every 3 days group had significantly better survival outcomes to discharge than those in their counterpart groups (Logrank p < 0.001). B-ACT and the average frequency of ≤once every 3 days had significantly better impact on survival outcomes than their counterpart groups (HR: 0.444, 95% CI: 0.238-0.829, p = 0.011; HR: 0.285, 95% CI: 0163-0.498, p < 0.001). (4) Conclusions: In the future, flexible bronchoscopes may paly an important role in ACT for SP patients with IMV.

Single-use flexible bronchoscopes vs traditional reusable flexible bronchoscopes: a prospective controlled study.

BACKGROUND: Single-use flexible bronchoscopes(SFB) eliminate the risk of bronchoscopy-related infection compared with traditional reusable flexible bronchoscopes(RFB). At present, there is no comparative study between SFB and RFB in the aspects of biopsy and interventional therapy. This study aims to explore whether SFB can perform complex bronchoscopic procedures such as transbronchial biopsies just like RFB. METHODS: We conducted a prospective controlled study. A total of 45 patients who required bronchoscopic biopsy in our hospital from June 2022 to December 2022 were enrolled. The patients were divided into the SFB group and the RFB group, and routine bronchoscopy, bronchoalveolar lavage, and biopsy were performed respectively. Data on the time of routine bronchoscopy, the recovery rate of bronchoalveolar lavage fluid(BALF), biopsy time, and bleeding volume were collected. Then we used the two-sample t-test and the χ2 test to assess the performance differences between SFB and RFB. We also designed a questionnaire to compare the performance between SFB and RFB by different bronchoscope operators. RESULTS: The routine examination time of SFB and RFB was 3.40 ± 0.50 min and 3.55 ± 0.42 min, respectively. There was no significant difference between the two groups (P = 0.308). The recovery rate of BALF was (46.56 ± 8.22) % in the SFB group and (47.00 ± 8.07) in the RFB group, without a significant difference between the two groups(P = 0.863). The biopsy time was similar(4.67 ± 0.51 min VS 4.57 ± 0.45 min) in both groups, with no significant difference(P = 0.512). The positive biopsy rate was 100% in both groups, with no significant difference. Overall, the bronchoscope operators were generally satisfied with SFB. CONCLUSION: SFBs are non-inferior to RFBs in routine bronchoscopy, bronchoalveolar lavage, and biopsy. It is suggested that SFBs have a wider clinical application.

Cross-contamination rate of reusable flexible bronchoscopes: A systematic literature review and meta-analysis.

Background: Bronchoscopy is generally a safe and efficient procedure. However, the risk of cross-contamination with reusable flexible bronchoscopes (RFB) has been detected in several outbreaks worldwide. Aim: To estimate the average cross-contamination rate of patient-ready RFBs based on available published data. Methods: We performed a systematic literature review in PubMed and Embase to investigate the cross-contamination rate of RFB. Included studies identified indicator organisms or colony forming units (CFU) levels, and total number of samples >10. The Contamination threshold was defined according to the European Society of Gastrointestinal Endoscopy and European Society of Gastrointestinal Endoscopy Nurse and Associates (ESGE-ESGENA) guidelines. To calculate the total contamination rate, a random effects model was applied. Heterogeneity was analysed via a Q-test and illustrated in a forest plot. Publication bias was analysed via the Egger's regression test and illustrated in a funnel plot. Results: Eight studies fulfilled our inclusion criteria. The random effects model included 2169 samples and 149 events (positive tests). The total RFB cross-contamination rate was 8.69% ± 1.86 (standard division [SD]) (95% confidence interval [CI]: 5.06-12.33%). The result showed significant heterogeneity of 90% and publication bias. Discussion: Significant heterogeneity and publication bias is likely associated with varying methodology and aversion towards publishing negative findings, respectively. Based on the cross-contamination rate an infection control paradigm shift is needed to ensure patient safety. We recommend to follow the Spaulding classification and classify RFBs as critical items. Accordingly, infection control measures such as obligatory surveillance, and implementing single-use alternatives must be considered where feasible.

Combining three-dimensional fluoroscopy guide system with single-use bronchoscopes for diagnosis of peripheral lesions: First two cases.

Pulmonary Peripheral Lesions (PPLs) diagnosis is usually performed using a guidance system in combination with bronchoscopes and diagnostic tools. We report two cases of PPLs sampling procedures combining the use of the single-use bronchoscope Ambu aScope 5 Broncho and CIOS 3D Spin Mobile (Siemens Healthineers) fluoroscopy system. A 69-year-old-female was found to have a lesion located in right B6 segment and a 73-year-old-male with a mass in the upper right lobe. We used for both cases a single-use bronchoscope to reach the correct area and the fluoroscopy system to guide peripheral transbronchial aspiration needle (TBNA) sampling. After the confirmation of the correct location of the TBNA tool, the sampling was performed. Rapid onsite evaluation (ROSE) confirmed the adequacy of the sample for molecular analysis and the final diagnosis. Thus, the use of ever-new disposable bronchoscopes for sampling peripheral lesions is a viable alternative to reusable bronchoscopes for advanced bronchoscopy procedures.

Comparison of fiberoptic bronchoscopic intubation using silicone and polyvinyl chloride double-lumen tubes.

BACKGROUND: Direct insertion of a double-lumen tube (DLT) using a flexible fiberoptic bronchoscope (FOB) is an option for DLT intubation. The difficult process of fiberoptic intubation is that the different properties of polyvinyl chloride and silicone DLTs may affect railroading differently. Therefore, we aimed to compare intubation using polyvinyl chloride and silicone DLTs over an FOB. METHODS: Patients aged 19-75 years who required one-lung ventilation under general anesthesia were enrolled in this study. After induction of anesthesia, the anesthesiologist intubated the DLT using FOB. The primary outcome was the difficulty of railroading over the flexible FOB scaled into five grades (I, II-1, II-2, III, and IV). Additionally, the intubation time and mucosal damage were recorded. RESULTS: A total of 46 patients participated in this study, 23 each in the silicone and polyvinyl groups. The difficulty of railroading over the FOB was significantly different between the two groups (P < 0.001). In the silicone group, the grades of difficulty in railroading were limited to I and II-1; 20 patients (87%) presented no difficulty in advancing the tube. In contrast, in the polyvinyl group, 13 patients (57%) had scores of II-2 and III. Both the intubation time and mucosal damage were significantly better in the silicone group than in the polyvinyl group. CONCLUSIONS: Intubation using a silicone DLT over an FOB was easier and faster than that with a polyvinyl chloride DLT with lesser trauma around the glottis.

Effect of early interventional therapy with fiberoptic bronchoscope on inflammatory infiltrating tracheobronchial tuberculosis / 中国医师进修杂志

Objective:To investigate the effect of early interventional therapy with fiberoptic bronchoscope in patients with inflammatory infiltrating type (Ⅰ type) tracheobronchial tuberculosis (TBTB).Methods:Using prospective research methods, 306 patients with Ⅰ type TBTB diagnosed by fiberoptic bronchoscopy in the Third People′s Hospital of Kunming City from January 2019 to April 2022 were selected. The patients were divided into observation group and control group according to the random number table method with 153 cases each. The patients in control group were given routine anti-tuberculosis chemotherapy, and the patients in observation group were given routine anti-tuberculosis chemotherapy combined with early interventional therapy with fiberoptic bronchoscope. Sputum smear examination and tuberculosis culture were performed at the end of 1, 3 and 6 months of treatment, and the negative conversion of sputum culture was recorded. Chest X-ray, pulmonary function and fiberoptic bronchoscope were performed at the end of 1, 3 and 6 months of treatment to evaluate the improvement rate of clinical symptoms, effective absorption rate of lesions and effective absorption rate of obstructive pneumonia. The CD 4+, CD 8+, CD 4+/CD 8+, interferon γ (IFN-γ), interleukin-6 (IL-6) and C reactive protein (CRP) before and after treatment were detected. The random walking model of immune inflammation was evaluated. Results:The sputum negative conversion rates at the end of 1, 3 and 6 months of treatment in observation group were significantly higher than those in control group: 64.71%(99/153) vs. 52.29%(80/153), 80.39%(123/153) vs. 62.09%(95/153) and 91.50%(140/153) vs. 73.86%(113/153), and there were statistical differences ( P<0.05 or <0.01). The improvement rate of clinical symptoms at the end of 1 month of treatment in observation group was significantly higher than that in control group: 94.77%(145/153) vs. 66.67%(102/153), and there was statistical difference ( P<0.01); the clinical symptoms disappeared in both groups at the end of 3 and 6 months of treatment. The effective absorption rates of lesions at the end of 1 and 3 months of treatment in observation group were significantly higher than those in control group: 73.20%(112/153) vs. 51.63%(79/153) and 96.73%(148/153) vs. 85.62%(131/153), and there were statistical differences ( P<0.01); all the lesions were absorbed at the end of 6 months of treatment in both groups. The effective absorption rates of obstructive pneumonia at the end of 1 and 3 months of treatment in observation group were significantly higher than those in control group: 78.43% (120/153) vs. 39.87%(61/153) and 89.54%(137/153) vs. 79.08%(121/153), and there were statistical differences ( P<0.01 or <0.05); all obstructive pneumonia were absorbed at the end of 6 months of treatment in both groups. There were no statistical differences in CD 4+, CD 8+, CD 4+/CD 8+, IL-6, IFN-γ and CRP before treatment between the two groups ( P>0.05); the CD 4+, CD 4+/CD 8+ and IFN-γ after treatment in observation group were significantly higher than those in control group: 0.343 ± 0.032 vs. 0.311 ± 0.023, 1.37 ± 0.18 vs. 1.12 ± 0.16 and (38.47 ± 3.50) ng/L vs. (20.52 ± 2.96) ng/L, the CD 8+, IL-6 and CRP were significantly lower than those in control group: 0.251 ± 0.020 vs. 0.268 ± 0.021, (19.40 ± 3.31) ng/L vs. (34.58 ± 5.82) ng/L and (10.41 ± 2.87) mg/L vs. (17.47 ± 3.14) mg/L, and there were statistical differences ( P<0.01). The evaluation results of random walking model showed that CD 4+, CD 8+, CD 4+/CD 8+, IFN-γ, IL-6 and CRP in the observation group were better than those in the control group in the maximum random fluctuation, number of walking steps, positive walking growth rate, random fluctuation power law value, comprehensive improvement rate, recording times of comprehensive evaluation index and expected improvement value. Conclusions:Early interventional therapy with fiberoptic bronchoscope can effectively assist systemic drug therapy in patients with Ⅰ type TBTB, which can accelerate focus absorption, promote sputum negative conversion, enhance cellular immunity and effectively inhibit inflammatory reaction.

Adoption of Improved Reprocessing Decreased Microbiological Non-Compliance for Bronchoscopes.

BACKGROUND: In the past few decades, the inadequate reprocessing of bronchoscopes has been associated with several serious outbreaks caused by multidrug-resistant microorganisms. In this study we evaluated the improvement in the quality of reprocessing in a Bronchoscopy Unit (BU), after the introduction of a new procedure. METHODS: In 2019, observational and clinical audits were conducted in the BU. After the introduction of an improved procedure in 2020, a microbiological surveillance plan was implemented in 2021. RESULTS: In 2019, 13 of 22 bronchoscopes (59%) resulted as non-compliant, 18% as high concern organisms (HCO) and 36.4% as high microbial count (≥100 CFU/all channels) and HCO. The most frequent microorganisms were Staphylococcus aureus (38.5%) and NDM-producing Klebsiella pneumoniae (15.4%). The bronchoscopes were stored inside their transport cases, which in some cases were found to be contaminated by the same strains isolated on the bronchoscopes (Enterobacter gergoviae and Vibrio alginolyticus). In 2021, all 31 bronchoscopes were sampled at least three times and 13/99 (13.1%) resulted as non-compliant, mostly K. pneumoniae (4.04%). Contamination level increases weakly in bronchoscopes in use for more than 14 years (R = 0.32). CONCLUSIONS: The adoption of an improved reprocessing procedure decreased the non-compliance of bronchoscopes, increasing the quality of the process and patient safety.

EUS-B-FNA Enhances the Diagnostic Yield of EBUS Bronchoscope for Intrathoracic Lesions.

INTRODUCTION: Endobronchial ultrasound (EBUS) bronchoscopes have been used mainly through the airway for EBUS-guided transbronchial needle aspiration (EBUS-TBNA); however, they can also be used through the esophagus. The esophageal approach, endoscopic ultrasound with bronchoscope-guided fine needle aspiration (EUS-B-FNA), has gradually become popular, as it can evaluate lesions that cannot be accessed through the airway. PURPOSE: This study aimed to evaluate the value of adding EUS-B-FNA to EBUS-TBNA performed by pulmonologists for intrathoracic lesions in the clinical setting. METHODS: Between March 2009 and March 2020, all patients who underwent EUS-B-FNA and EBUS-TBNA for diagnostic purposes were included and retrospectively analyzed at a single institution. RESULTS: A total of 1794 procedures using an EBUS bronchoscope including, EBUS-TBNA, EUS-B-FNA, and the combination of EBUS-TBNA and EUS-B-FNA for evaluating intrathoracic lesions, were performed. We finally analyzed 276 patients who underwent EUS-B-FNA for diagnostic purposes. EUS-B-FNA provided diagnostic materials from only EBUS-TBNA-inaccessible lesions in 26 patients and in 18 patients whose conditions were inappropriate for bronchoscopy (e.g., respiratory failure, airway stenosis, etc.). EUS-B-FNA provided diagnostic results in four patients with non-diagnostic EBUS-TBNA results. EUS-B-FNA was preferable to EBUS-TBNA in 4.4% (48 of 1091) of patients; therefore, adding EUS-B-FNA to EBUS-TBNA increased the diagnostic yield from 72.6% (1043 of 1437) to 75.9% (1091 of 1437). CONCLUSION: Pulmonologists are able to enhance diagnostic yields by acquiring the EUS-B-FNA technique.

High-flow nasal cannula oxygenation in comparison with apnoeic oxygenation during foreign body removal by rigid bronchoscopy: A randomised controlled trial.

Background and Aims: This trial aimed to assess the safety and efficacy of oxygenation using a high-flow nasal cannula (HFNC) compared with the standard apnoeic oxygenation technique during foreign body (FB) removal by a rigid bronchoscope. Methods: A prospective, blinded, randomised, controlled trial was conducted on subjects planned for FB removal by a rigid bronchoscope. Inclusion criteria were male and female patients aged between 10 and 40 years. The primary outcome was the lowest oxygen saturation level monitored by pulse oximeter during the procedure, and the secondary outcome was the incidence of postoperative atelectasis. Results: Nearly 64 patients were randomised into either HFNC oxygenation (N = 32) or apnoeic oxygenation (N = 32) group. There were no significant differences between the studied groups regarding age, gender, weight, or cardiovascular variables. Intraoperative oxygen saturation was 4% higher in the HFNC group at different times. The end-tidal carbon dioxide measured on induction and after termination by 15 min showed no significant differences between the two groups; however, it was significantly higher in the apnoeic oxygenation group immediately after the procedure, after 5 min, and after 10 min of termination. No adverse effects from the increased end-tidal carbon dioxide were reported. Conclusion: HFNC was superior to apnoeic oxygenation technique in maintaining oxygenation status in patients undergoing rigid bronchoscopy for FB removal.

Application of a video laryngoscope combined with a fiberoptic bronchoscope in emergency endotracheal intubation and its effects on pulmonary infection in patients with craniocerebral trauma / 中国基层医药

Objective:To investigate the application of a video laryngoscope combined with a fiberoptic bronchoscope in emergency endotracheal intubation and its effects on pulmonary infection in patients with craniocerebral trauma.Methods:A total of 105 patients with craniocerebral trauma who received treatment in Yiwu Central Hospital from January 2020 to December 2020 were included in this study. They were randomly allocated to undergo endotracheal intubation with a video laryngoscope (control group, n = 50) or a video laryngoscope combined with a fiberoptic bronchoscope (observation group, n = 55). Glottic exposure, intubation, vital signs, lung infection rate during hospitalization, and incidence of complications were monitored/determined in each group. Results:Glottic exposure in the observation group was superior to that in the control group ( Z = 4.29, P < 0.001). First-pass success rate was significantly higher in the observation group than in the control group [96.36% (53/55) vs. 82.00% (41/50), χ2 = 5.76, P < 0.05]. The number of intubation attempts and the time to successful intubation were (1.07 ± 0.53) times and (85.12 ± 15.36) seconds, respectively in the observation group, which were significantly less or shorter than those in the control group [(1.92 ± 0.74) times, (106.13 ± 16.34) seconds, t = 6.81, 6.79, both P < 0.001). The changes in mean arterial pressure and heart rate during intubation were less in the observation group than in the control group (both P < 0.05). The amplitude of increase in blood oxygen saturation after intubation was greater in the observation group than in the control group ( P < 0.05). Lung infection rate was significantly lower in the observation group than in the control group [10.91% (6/55) vs. 30.00% (15/50), χ2 = 5.96, P < 0.05]. The incidence of complications was significantly lower in the observation group than in the control group [5.45% (3/55) vs. 18.00% (9/50), χ2 = 4.07, P < 0.05]. Conclusion:Application of a video laryngoscope combined with a fiberoptic bronchoscope in emergency endotracheal intubation can increase the first-pass success rate, reduce repeated intubation attempts, shorten time to successful intubation, help to maintain stable vital signs, prevent lung infection and complication. Therefore, the combined method is of clinical application value.

[Analysis of clinical characteristics of 17 patients with inhalation dimethyl sulfate poisoning].

This paper analyzed the clinical data of 17 patients with inhalation dimethyl sulfate poisoning in Changzhou Third People's Hospital, in order to understand the clinical characteristics, treatment and prognosis of patients with inhalation dimethyl sulfate poisoning, and guide clinicians to make effective measures in time. Dimethyl sulfate poisoning progresses rapidly and dangerously. The prognosis is usually better if the patients are separated from the toxic environment as soon as possible, given glucocorticoids in early and short-term, closely observed respiratory tract injury, and treated with endotracheal intubation and invasive mechanical ventilation when necessary.

Bronchoscopy precautions and recommendations in the COVID-19 pandemic.

As the airways of SARS-CoV-2 infected patients contain a high viral load, bronchoscopy is associated with increased risk of patient to health care worker transmission due to aerosolised viral particles and contamination of surfaces during bronchoscopy. Bronchoscopy is not appropriate for diagnosing SARS-CoV-2 infection and, as an aerosol generating procedure involving a significant risk of transmission, has a very limited role in the management of SARS-CoV-2 infected patients including children. During the SARS-CoV-2 pandemic rigid bronchoscopy should be avoided due to the increased risk of droplet spread. Flexible bronchoscopy should be performed first in SARS-CoV-2 positive individuals or in unknown cases, to determine if rigid bronchoscopy is indicated. When available single-use flexible bronchoscopes may be considered for use; devices are available with a range of diameters, and improved image quality and degrees of angulation. When rigid bronchoscopy is necessary, jet ventilation must be avoided and conventional ventilation be used to reduce the risk of aerosolisation. Adequate personal protection equipment is key, as is training of health care workers in correct donning and doffing. Modified full face masks are a practical and safe alternative to filtering facepieces for use in bronchoscopy. When anaesthetic and infection prevention control protocols are strictly adhered to, bronchoscopy can be performed in SARS-CoV-2 positive children.

[Clinical features and interventional bronchoscopic treatment of primary airway tumor in 8 children].

Objective: To summarize the clinical manifestations and to evaluate the feasibility of therapeutic bronchoscopy in pediatric primary airway tumors. Methods: The clinical data of 8 children presented with airway tumors in Beijing Children's Hospital from November 2016 to March 2018 were retrospectively analyzed. Descriptive analysis was used to summarize the outcome and prognosis of these children after interventional bronchoscopy. Results: Among the 8 children, 5 were male and 3 were female, aged from 4 years and 8 months to 9 years and 2 months. The main clinical manifestations were cough and wheezing in 6 cases, hemoptysis in 3 cases and recurrent pulmonary infection in 2 cases, and none of them had lymph node metastasis and extra-pulmonary metastasis. All 8 children underwent bronchoscopic resection of the tumors, and the 4 children with blood-rich tumors had bronchial artery embolization at the blood supply site before the resection. No major bleeding or pneumothorax occurred during or after the operation. Four cases had low grade malignant bronchial mucoepidermoid carcinoma, 2 had inflammatory myofibroblastoma, and the rest two had pleomorphic adenoma and bronchial smooth muscle spindle cell tumor. Postoperative follow-up lasted 2 to 4 years, and 3 had tumor recured. Among the 3 cases, 2 had inflammatory myofibroblastoma who underwent surgical resection of the lesion and combined chemotherapy, respectively; and one had mucoepidermoid carcinoma who was under follow-up after interventional cryotherapy. Conclusions: The clinical manifestations of primary airway tumors in children are atypical. The main clinical manifestations are dry cough, wheezing, recurrent pulmonary infection and hemoptysis. Interventional bronchoscopy is a feasible choice for the treatment of pediatric airway tumors.

Analysis of clinical characteristics of 17 patients with inhalation dimethyl sulfate poisoning / 中华劳动卫生职业病杂志

This paper analyzed the clinical data of 17 patients with inhalation dimethyl sulfate poisoning in Changzhou Third People's Hospital, in order to understand the clinical characteristics, treatment and prognosis of patients with inhalation dimethyl sulfate poisoning, and guide clinicians to make effective measures in time. Dimethyl sulfate poisoning progresses rapidly and dangerously. The prognosis is usually better if the patients are separated from the toxic environment as soon as possible, given glucocorticoids in early and short-term, closely observed respiratory tract injury, and treated with endotracheal intubation and invasive mechanical ventilation when necessary.

Effect of teacher-assisted jaw thrust maneuver on learning effectiveness of Bonfils fiberscope-guided tracheal intubation for beginners / 中华麻醉学杂志

Objective:To evaluate the effect of teacher-assisted jaw thrust maneuver on the learning effectiveness of Bonfils fiberscope-guided tracheal intubation for the beginners.Methods:Forty-eight accompanying physicians who were receiving residents standardized training in the Department of Anesthesiology, Peking Union Medical College from April, 2020 to March 2021 and served as trainees were enrolled in this study.The trainees received Bonfils fiberscope training and were randomly divided into independent group ( n=24) and assisted group ( n=24). After induction of general anesthesia, the trainees independently performed the Bonfils fiberscope-guided endotracheal intubation operation in independent group, and trainees performed the operation with the assistance of the teacher′s jaw thrust maneuver in assisted group.The success of intubation at first attempt, duration of intubation, times of teachers′ guidance and scores for trainees′ learning confidence were recorded. Results:Compared with independent group, the success rate of intubation at first attempt was significantly increased, the duration of intubation was shortened, scores for trainees′ learning confidence was increased ( P<0.05), and no significant change was found in the times of teachers′ guidance in assisted group ( P>0.05). Conclusion:For the beginners learning Bonfils fiberscope-guided tracheal intubation, teacher-assisted jaw thrust maneuver is helpful in raising the learning effectiveness and increasing the beginners′ learning confidence.

Successful wire-guided fiberoptic nasotracheal intubation in a patient with hemifacial microsomia - A case report.

BACKGROUND: Patients with hemifacial microsomia may have a difficult airway due to the accompanying mandibular deformity. Fiberoptic bronchoscope-guided intubation is commonly used method for difficult airway management. However, awake fiberoptic nasotracheal intubation has several disadvantages, including difficulty in advancement of the endotracheal tube (ETT) due to the resistance between the ETT and bronchoscope. Wire-guided fiberoptic nasotracheal intubation may help to overcome the drawbacks of the conventional method. CASE: An 18-year-old man with hemifacial microsomia was scheduled for double-jaw surgery. In preoperative evaluation, he had severe retrognathia and expected difficult airway. We successfully performed wire-guided fiberoptic nasotracheal intubation combined with high-flow nasal cannula and deep sedation without any complications. CONCLUSIONS: A guidewire may be useful, in case of difficultly in advancing the ETT or if a smaller tube is required, while performing intubation with FOB in patients with difficult airways.