Objective:To analyze the application value of remazolam compound alfentanil anesthesia regimen in fiberoptic bronchoscopy in elderly debilitated patients.Methods:Seventy-two cases of elderly debilitated patients who u...Objective:To analyze the application value of remazolam compound alfentanil anesthesia regimen in fiberoptic bronchoscopy in elderly debilitated patients.Methods:Seventy-two cases of elderly debilitated patients who underwent fiberoptic bronchoscopy in the Department of Respiratory Medicine of a hospital from August 2023 to July 2024 were selected,and were divided into the control group and the observation group using the mean score method,with 36 cases in each group.In both groups,7–10μg/kg alfentanil was injected intravenously after oxygen denitrification,and 1 min later propofol 1.5 mg/kg was given intravenously in the control group and remazolam 0.3 mg/kg was given intravenously in the observation group.Subsequently,mivacurium chloride 0.1mg/kg IV was given to both groups.Propofol 5mg/(kg-h)was given in the control group and remazolam 0.5mg/(kg-h)was given intravenously pumped in the observation group during anesthesia maintenance.Changes in vital signs such as HR,MAP and SpO_(2) and the occurrence of adverse reactions were recorded in the two groups before anesthesia administration(T_(1)),at the moment of placing fiberoptic bronchoscope(T_(2)),at the moment of placing the tracheal tube(T_(3)),and at 1 min after placing the tracheal tube(T4).Results:Compared with T1,patients in the observation group had lower MAP at T_(2),T_(3),T_(4) and lower SpO_(2) at T_(3),T_(4)(P<0.05);in the control group,HR slowed down at T_(2),T_(3),T_(4) and MAP and SpO_(2) decreased at T_(2),T_(3),T_(4)(P<0.05).SpO_(2) at T_(3) and T_(4) was lower in both groups compared with that at T2(P<0.05).SpO_(2) at T_(4) was lower in the control group compared with that at T_(3)(P<0.05).Compared with the control group,patients in the observation group suffered from increased HR and elevated MAP at T_(2),T_(3),and T_(4),and increased SpO_(2) at T_(3) and T4(P<0.05).The incidence of intraoperative hypotension and bradycardia in the observation group was lower than that in the control group,and the difference was statistically significant(P<0.05).The incidence of intraoperative choking and coughing,postoperative hypoxemia,nausea and vomiting,and dizziness were found in the patients of both groups,drowsiness and other adverse reactions incidence rate comparison,the difference are not statistically significant(P>0.05).Conclusion:Remazolam and alfentanil are used in fiberoptic bronchoscopy for elderly debilitated patients with remarkable effect,which can effectively improve the vital signs of patients,reduce the risk of intraoperative hypotension,bradycardia,and other adverse reactions,and have high anesthetic effectiveness and safety.展开更多
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 cond...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.展开更多
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 ...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.展开更多
BACKGROUND Foreign body ingestion is a common emergency in clinical practice.While the majority of cases are resolved following successful removal,rare and unexpected complications can arise,such as the spontaneous di...BACKGROUND Foreign body ingestion is a common emergency in clinical practice.While the majority of cases are resolved following successful removal,rare and unexpected complications can arise,such as the spontaneous displacement of a foreign body during the procedure.This report describes a unique case where a foreign body initially lodged in the esophagus was dropped during the procedure,leading to aspiration and migration to the airway.CASE SUMMARY A 69-year-old Chinese woman presented with a 6-hour history of throat pain and tightness after consuming rabbit meat.She had no fever or bloody stools but had a history of hypertension.Initial imaging,including a neck computed tomography scan,indicated a foreign body in the upper esophagus.Esophageal endoscopy was performed,during which the patient’s vital signs remained stable.The procedure showed a 14-cm mucosal erosion with food debris and a visible foreign body located in the gastric fundus.The foreign body was removed with forceps but unexpectedly dropped into the hypopharynx.Subsequent upper gastrointestinal endoscopy did not identify the foreign body.On awakening from anesthesia,the patient exhibited hypoxia and coarse breath sounds,but without coughing.A chest X-ray indicated that the foreign body had migrated into the airway.An emergency fiberoptic bronchoscopy was performed,successfully retrieving the foreign body.The patient recovered without complications.CONCLUSION Endoscopic removal of an esophageal foreign body can cause silent aspiration in elderly patients with absent cough reflexes,necessitating bedside imaging and prompt intervention.展开更多
BACKGROUND Foreign body aspiration mainly occurs in children,which can cause a severe concurrent syndrome and even death without timely treatment.As a rare foreign body,aspiration of lime is seldom reported,and most c...BACKGROUND Foreign body aspiration mainly occurs in children,which can cause a severe concurrent syndrome and even death without timely treatment.As a rare foreign body,aspiration of lime is seldom reported,and most cases involve a small amount of hydrated lime.Although the symptoms are usually severe,the prognosis is good after suitable treatment.Experience of treatment for lime aspiration is lacking,and this report provides novel evidence for treatment of mass burnt lime aspiration using bronchoscopy.CASE SUMMARY We report an adult with a large amount of burnt lime aspiration.Because of delay in clearance of the inhaled lime in the trachea and bronchus at the local hospital,he suffered several severe complications,including complete occlusion of the right primary bronchus,aeropleura,aerodermectasia,pneumomediastinum,secondary infection and hypoxemia at 4 d after injury.After transferring to our department,bronchoscopy was immediately carried out to clear the lime in the major airway,using foreign body forceps,biopsy forceps,puncture needle,and hairbrush.The patient’s condition recovered rapidly and at 3-months’follow-up,he demonstrated good recovery of the bronchus and lung parenchyma.CONCLUSION After mass lime aspiration,flexible fiberoptic bronchoscopy is suggested as early as possible,using clamping,flushing or cryotherapy.展开更多
BACKGROUNDRelapsing polychondritis (RP) is a rare, long-term, and potentially life-threateningdisease characterised by recurrent paroxysmal inflammation that can involve anddestroy the cartilage of the external ear, n...BACKGROUNDRelapsing polychondritis (RP) is a rare, long-term, and potentially life-threateningdisease characterised by recurrent paroxysmal inflammation that can involve anddestroy the cartilage of the external ear, nose, larynx, and trachea.CASE SUMMARYWe here report a case of RP involving solely the tracheobronchial cartilage ring(and not the auricular. nasal or articular cartilage) complicated by Sjögren's syndrome in a 47-year-old female whose delayed diagnosis caused a sharpdecline in pulmonary function. After corticosteroid treatment, her pulmonaryfunction improved.CONCLUSIONIn such cases, our experience suggested that 18F-fluorodeoxyglucose positronemission tomography/computed tomography (18F-FDG PET/CT) and fiberopticbronchoscopy should be used to diagnose airway chondritis as relapsing polychondritisin the early phase of disease.展开更多
Tracheobronchopathia osteochondroplastica （TO） is a rare and benign disorder of unknown cause affecting the large airways. It is characterized by the presence of multiple osseous and cartilaginous nodules in the sub...Tracheobronchopathia osteochondroplastica （TO） is a rare and benign disorder of unknown cause affecting the large airways. It is characterized by the presence of multiple osseous and cartilaginous nodules in the submucosa of the trachea and main bronchi that is characterized by the progression of submucosal bone and/or cartilage including nodules through the lumen of trachea and bronchus, We present four cases that were diagnosed TO while investigating for the causes of hemoptysis and chronic cough. We plan to emphasize TO in differential diaqnosis in proper patients.展开更多
文摘Objective:To analyze the application value of remazolam compound alfentanil anesthesia regimen in fiberoptic bronchoscopy in elderly debilitated patients.Methods:Seventy-two cases of elderly debilitated patients who underwent fiberoptic bronchoscopy in the Department of Respiratory Medicine of a hospital from August 2023 to July 2024 were selected,and were divided into the control group and the observation group using the mean score method,with 36 cases in each group.In both groups,7–10μg/kg alfentanil was injected intravenously after oxygen denitrification,and 1 min later propofol 1.5 mg/kg was given intravenously in the control group and remazolam 0.3 mg/kg was given intravenously in the observation group.Subsequently,mivacurium chloride 0.1mg/kg IV was given to both groups.Propofol 5mg/(kg-h)was given in the control group and remazolam 0.5mg/(kg-h)was given intravenously pumped in the observation group during anesthesia maintenance.Changes in vital signs such as HR,MAP and SpO_(2) and the occurrence of adverse reactions were recorded in the two groups before anesthesia administration(T_(1)),at the moment of placing fiberoptic bronchoscope(T_(2)),at the moment of placing the tracheal tube(T_(3)),and at 1 min after placing the tracheal tube(T4).Results:Compared with T1,patients in the observation group had lower MAP at T_(2),T_(3),T_(4) and lower SpO_(2) at T_(3),T_(4)(P<0.05);in the control group,HR slowed down at T_(2),T_(3),T_(4) and MAP and SpO_(2) decreased at T_(2),T_(3),T_(4)(P<0.05).SpO_(2) at T_(3) and T_(4) was lower in both groups compared with that at T2(P<0.05).SpO_(2) at T_(4) was lower in the control group compared with that at T_(3)(P<0.05).Compared with the control group,patients in the observation group suffered from increased HR and elevated MAP at T_(2),T_(3),and T_(4),and increased SpO_(2) at T_(3) and T4(P<0.05).The incidence of intraoperative hypotension and bradycardia in the observation group was lower than that in the control group,and the difference was statistically significant(P<0.05).The incidence of intraoperative choking and coughing,postoperative hypoxemia,nausea and vomiting,and dizziness were found in the patients of both groups,drowsiness and other adverse reactions incidence rate comparison,the difference are not statistically significant(P>0.05).Conclusion:Remazolam and alfentanil are used in fiberoptic bronchoscopy for elderly debilitated patients with remarkable effect,which can effectively improve the vital signs of patients,reduce the risk of intraoperative hypotension,bradycardia,and other adverse reactions,and have high anesthetic effectiveness and safety.
文摘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.
文摘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.
文摘BACKGROUND Foreign body ingestion is a common emergency in clinical practice.While the majority of cases are resolved following successful removal,rare and unexpected complications can arise,such as the spontaneous displacement of a foreign body during the procedure.This report describes a unique case where a foreign body initially lodged in the esophagus was dropped during the procedure,leading to aspiration and migration to the airway.CASE SUMMARY A 69-year-old Chinese woman presented with a 6-hour history of throat pain and tightness after consuming rabbit meat.She had no fever or bloody stools but had a history of hypertension.Initial imaging,including a neck computed tomography scan,indicated a foreign body in the upper esophagus.Esophageal endoscopy was performed,during which the patient’s vital signs remained stable.The procedure showed a 14-cm mucosal erosion with food debris and a visible foreign body located in the gastric fundus.The foreign body was removed with forceps but unexpectedly dropped into the hypopharynx.Subsequent upper gastrointestinal endoscopy did not identify the foreign body.On awakening from anesthesia,the patient exhibited hypoxia and coarse breath sounds,but without coughing.A chest X-ray indicated that the foreign body had migrated into the airway.An emergency fiberoptic bronchoscopy was performed,successfully retrieving the foreign body.The patient recovered without complications.CONCLUSION Endoscopic removal of an esophageal foreign body can cause silent aspiration in elderly patients with absent cough reflexes,necessitating bedside imaging and prompt intervention.
文摘BACKGROUND Foreign body aspiration mainly occurs in children,which can cause a severe concurrent syndrome and even death without timely treatment.As a rare foreign body,aspiration of lime is seldom reported,and most cases involve a small amount of hydrated lime.Although the symptoms are usually severe,the prognosis is good after suitable treatment.Experience of treatment for lime aspiration is lacking,and this report provides novel evidence for treatment of mass burnt lime aspiration using bronchoscopy.CASE SUMMARY We report an adult with a large amount of burnt lime aspiration.Because of delay in clearance of the inhaled lime in the trachea and bronchus at the local hospital,he suffered several severe complications,including complete occlusion of the right primary bronchus,aeropleura,aerodermectasia,pneumomediastinum,secondary infection and hypoxemia at 4 d after injury.After transferring to our department,bronchoscopy was immediately carried out to clear the lime in the major airway,using foreign body forceps,biopsy forceps,puncture needle,and hairbrush.The patient’s condition recovered rapidly and at 3-months’follow-up,he demonstrated good recovery of the bronchus and lung parenchyma.CONCLUSION After mass lime aspiration,flexible fiberoptic bronchoscopy is suggested as early as possible,using clamping,flushing or cryotherapy.
文摘BACKGROUNDRelapsing polychondritis (RP) is a rare, long-term, and potentially life-threateningdisease characterised by recurrent paroxysmal inflammation that can involve anddestroy the cartilage of the external ear, nose, larynx, and trachea.CASE SUMMARYWe here report a case of RP involving solely the tracheobronchial cartilage ring(and not the auricular. nasal or articular cartilage) complicated by Sjögren's syndrome in a 47-year-old female whose delayed diagnosis caused a sharpdecline in pulmonary function. After corticosteroid treatment, her pulmonaryfunction improved.CONCLUSIONIn such cases, our experience suggested that 18F-fluorodeoxyglucose positronemission tomography/computed tomography (18F-FDG PET/CT) and fiberopticbronchoscopy should be used to diagnose airway chondritis as relapsing polychondritisin the early phase of disease.
文摘Tracheobronchopathia osteochondroplastica （TO） is a rare and benign disorder of unknown cause affecting the large airways. It is characterized by the presence of multiple osseous and cartilaginous nodules in the submucosa of the trachea and main bronchi that is characterized by the progression of submucosal bone and/or cartilage including nodules through the lumen of trachea and bronchus, We present four cases that were diagnosed TO while investigating for the causes of hemoptysis and chronic cough. We plan to emphasize TO in differential diaqnosis in proper patients.
