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Showing 4 results for Bronchoscopy
Measurement of airway related distances: virtual bronchoscopy in 140 cases
Noyan Ashraf Ma, Samadi Sh, Ghanaati H, Farahani Dawood-Abadi A,
Volume 67, Issue 5 (8-2009)
Abstract

Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: The insertion depth of tracheal tube differs based on sex, age, position of head and neck, type of surgery, and anatomical consideration. The aim of this study was to determine the airway related distances in Iranian patients with a non-invasive, and accurate method, the computerized reconstruction of High Resolution CT (HRCT) Virtual Bronchoscopy.
Methods: A total of 140 Iranian patients who became candidate for sinus and chest tomography, were enrolled in a cross- sectional study in Imam Khomeini Hospital Complex, Tehran, Iran, from 2006 to 2008. After reconstruction of airway related distances, Incisor- Vocal cord (IVD), Vocal cord- Carina (VCD) and Incisor- Carinal (ICD) Distances were determined.
Results: A total of 140 patients were evaluated, while 70(50%) were male. There was no statistically significant difference between age groups, sex and BMI in study patients. The measured IVD were 145.5±9.7 (males), 127.29±6.3 (females) and 136.43±12.29mm (total). For VCD, the distances were 131±13.99 (males), 122.59±11.7 (females), and 127.09±13.65mm (total). The measures for ICD in males, females, and total of patients were 277.17±16.63, 249.88±11.54, and 263.52±19.66mm respectively.
Conclusion: The insertion depth for fixation of endotracheal tube in Iranian adult patients is the same as that of anesthesia textbooks. There were no statistically significant difference between our study data and previously measured distances using invasive and less accurate methods. Virtual bronchoscopy is a noninvasive and accurate method based on reconstruction of computed tomographic images and the reconstructed images of tomography could be useful in measuring and assessment of airway anatomy.


Double-lumen endotracheal tube positioning: Bag compliance Vs. fiberoptic bronchoscopy
Noyan Ashraf Ma, Hoseini Mr, Bannazadeh M,
Volume 70, Issue 8 (11-2012)
Abstract

Background: Lung separation is the basis of thoracic anesthesia, which is performed by different instruments. Checking probable malpositioning of tracheal tube needs fiberoptic bronchoscopy. The aim of this study was to compare respirator suggested compliance with fiberoptic findings in detecting major tracheal tube malpositioning.
Methods: A total of 256 patients undergoing thoracic surgery with double-lumen tracheal tube insertion in Imam Khomeini Hospital, Tehran, Iran, during 2010-11 were divided into three groups (n=86). We used left-sided double-lumen tube (DLT) for left or right-sided surgeries (groups 1 and 2), and right-sided DLT for left-sided surgeries (group 3). The position of the tubes was evaluated and compared using bag compliance versus fiberoptic bronchoscopy.
Results: The mean age of the study population was 44.7±13.4 (16-73) years, while 155 (59.9%) were male. The sensitivity, specificity, positive and negative predictive values, and the accuracy of bag compliance test for left-sided DLT in supine position were 40% (95% CI: 20-60%), 99% (95% CI: 96-99%), 84% (95% CI: 54-94%) 92% (95% CI: 88-95%) and 92% (95% CI: 87-95%), respectively. The above-mentioned variables for lateral decubitus position respectively were 27%, 98%, 76%, 89%, and 88%. Malpositioning was more prevalent in right-sided DLTs (P=0.02).
Conclusion: Based on the results of this study, and the high specificity, positive predictive value, and accuracy of bag compliance test, its use is encouraged as an alternative to fiberoptic bronchoscopy for checking DLT position, specially, in emergent surgeries or when fiberoptic bronchoscopy is unreachable due to lack of expertise or personnel.


Comparative study of the sedative effect of ketamine-dexmedetomidine (Ketodex)with ketamine-midazolam(Ketomid) in candidates of fibroptic bronchoscopy
Behzad Nazemroaya , Samin Jahanbin,
Volume 80, Issue 8 (11-2022)
Abstract
Background: A variety of sedatives like ketamine, propofol, opioids, and benzodiazepines are used during Fibroptic bronchoscopy. The effectiveness of ketamine-dexmedetomidine and ketamine-midazolam on pain level and sedation after Fibroptic bronchoscopy was examined.
Methods: A double-blind, randomized clinical trial was carried out from October 2020 to April 2021 at educational hospitals affiliated with Isfahan University of Medical Sciences. The participants were 60 candidates for fibroptic bronchoscopy who were allocated randomly into two groups of 30 people. Group one (Ketodex) received 1mg/kg ketamine and 1 µg/kg dexmedetomidine for 10 min followed by an infusion of 0.5 µg/kg of dexmedetomidine and 0.5mg/min ketamine. Group two (Ketomed) received 2.5mg of midazolam and 1mg/kg of ketamine for 10min along with infusion of 1 µg/kg/min midazolam and 0.5mg/min of ketamine. The variables under the study were systolic blood pressure (SBP), mean arterial pressure (MAP), diastolic blood pressure (DBP), percentage of arterial oxygen saturation (SpO2), heart rate (HR), and level of pain. Furthermore, the sedation score of patients were recorded on the basis
of sedation score is a 5-point scale from 1 to 5. The obtained data were analyzed in SPSS (v.26). To compare the data collected at different occasions and different groups, repeated measure tests and independent t-test were used (P<0.05).
Results: Compared to the Ketomed group, the sedation term in patients in the Ketodex group was longer significantly (P<0.001) with a significantly shorter recovery term (P<0.001). In addition, the differences between the groups were insignificant in terms of diastolic blood pressure, systolic blood pressure, mean arterial pressure, heart rate, and percentage of arterial oxygen saturation (P>0.05). The pain levels were notably lower in patients who received Ketomed compared to Ketomed during 20 min (P=0.04) and 30 min (P=0.001) following the procedure.
Conclusion: The use of Ketodex was associated with a longer sedation duration and significantly shorter stay in the recovery room and lower pain intensity compared to Ketomed, therefore it may be more preferable in bronchoscopy.

Point-of-care ultrasound and auscultation versus fiberoptic bronchoscope in determining the position of double-lumen tube
Behzad Nazemroaya, Fatemeh Kazemi Goraji , Azim Honarmand, Mohammad Saleh Jafarpisheh ,
Volume 80, Issue 11 (2-2023)
Abstract
Background: Double lumen tube (DLT) is used in lung surgeries. Classically, the patient should undergo fiberoptic bronchoscopy (FOB) to confirm the location of the DLT and its proper function. However, the sensitivity of ultrasound and clinical methods in diagnosing the correct position of DLT has not yet been definitively determined. This study was designed to assess the accuracy of point-of-care ultrasound and auscultation versus Fiberoptic Bronchoscope in determining the position of the Double-Lumen Tube.
Methods: This cross-sectional study of diagnostic value measurement type was conducted on patients who were candidates for double lumen implantation. After induction of anesthesia, DLT with the appropriate size was implanted, and then the position of DLT was evaluated. In the first step, the lungs were examined by auscultation, then the ultrasound was performed, and two signs of lung pulse sign and lung sliding sign were examined as signs of normal lung and ventilated lung. FOB was performed by an anesthesiologist. At the end, by opening the chest after surgery, the surgeon's opinion about the quality of lung collapse was recorded.
Results: In our study, the correct placement of the tube was correct in 37 cases and wrong in 3 cases, which were checked and corrected by FOB. Vital signs of the patients were stable before and during the operation. There were no problems with anesthesia during the surgery. Diagnostic sensitivity of lung auscultation clinical examination was 64.9% and chest ultrasound was 91.9%. The sensitivity of ultrasound compared to auscultation was not significant (P=0.242), but there was a clinically significant difference in the positive predictive value of the two, so that the positive predictive value of lung auscultation was 88.9% and lung ultrasound was 91.9%. In terms of surgeon satisfaction level, 22 cases (59.5%) had excellent satisfaction and 15 cases (40.5%) had moderate satisfaction. The sensitivity of ultrasound was not significant in comparison with the surgeon's satisfaction.
Conclusion: Ultrasound can be a good substitute for FOB. Although ultrasound cannot have all the functions of FOB, but having advantages such as lower cost, speed of operation, and non-invasiveness, makes it more practical than FOB.

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