Congenital Bronchobiliary Fistula: A Case Report and Literature Review

Congenital bronchobiliary fistula (CBBF) is a rare disease. Children with CBBF mostly have atypical clinical manifestations that can be easily missed. We report a case of a child with CBBF who was diagnosed with fistulography with the help of an endobronchial blocker and a fiberoptic bronchoscope. The CBBF was successfully removed by thoracoscopic surgery.

Effects of head positions on awake fiberoptic bronchoscope oral intubation: a randomized controlled trial

Background There are many factors affecting the success rate of awake orotracheal intubation via fiberoptic bronchoscope. We performed this study was to investigate the effects of head positions on awake Fiberoptic bronchoscope oral intubation. Methods Seventy-five adult patients, received general anaesthesia were included in this study. After written informed consent, these patients were undergoing awake orotracheal intubation via fiberoptic-bronchoscope and according to the head position, the patients were randomized allocated to neutral position group (NP group), sniffing position group (SP group) or extension position group (EP group). After sedation the patients were intubated by an experienced anesthesiologist. The time to view the vocal cords, the percentage of glottic opening scores (POGO), the time to insert the tracheal tube into trachea and the visual analog scale (VAS) scores for ease experienced of passing the tracheal tube through glottis, the hemodynamic changes and the adverse events after surgery were recorded. Results The time to view the vocal cords was significantly shorter and the POGO scores was significantly higher in the EP group compared with the other two groups (P < 0.05); The SpO2 in the EP group was higher than NP group at before intubation and higher than SP group and NP group at immediate after intubation (P < 0.05); The time to insert the tracheal tube into trachea, the VAS scores for passing the tracheal tube through glottis, the coughing scores had no significant differences among groups (P > 0.05). There were also no significant differences regard to the incidence of postoperative complications, mean arterial pressure and heart rate among the groups (P > 0.05). Conclusions The head at extension position had a best view of glottic opening than neutral position or sniffing position during awake Fiberoptic bronchoscope oral intubation, so extension position was recommended as the starting head position for awake Fiberoptic bronchoscope oral intubation. Trial registration Clinical Trials.gov. no. NCT02792855. Registered at https://register.clinicaltrials.gov on 23 september 2017.

Successful airway management with combined use of a McGRATHTM MAC videolaryngoscope and fiberoptic bronchoscope in a patient with congenital tracheal stenosis diagnosed in adulthood

Background Most patients with congenital tracheal stenosis (CTS) develop respiratory symptoms early in life. CTS remaining undiagnosed until adulthood is rare. Case presentation A 51-year-old female was scheduled for cardiovascular surgery. She had undergone laparoscopic surgery 3 years earlier and was found to have a difficult airway. Postoperatively, she was diagnosed with CTS. For the current cardiovascular surgery, combined use of a McGRATHTM MAC videolaryngoscope and fiberoptic bronchoscope allowed sufficient visualization of the glottis and trachea, resulting in successful intubation. Conclusions CTS patients have a high probability of difficult intubation. Our experience suggests the efficacy of combined use of a videolaryngoscope and fiberoptic bronchoscope for airway management in CTS patients.

Comparison of efficacy and safety of ultrasonography and fiber optic bronchoscope guided percutaneous dilatational tracheostomy: A prospective observational study running title: Efficacy and safety of USG and FOB guided tracheostomy

Introduction: We aimed to compare the procedural time, efficacy, and incidence of complications of ultrasonography and fiberoptic bronchoscope-guided percutaneous dilatational tracheostomy (PDT). Methods: The study population included the patients admitted to the department of anesthesiology and critical care. In this prospective observational study, we randomly divided 60 participants into two groups. In the ultrasound (US)-guided group, ultrasonography was used for PDT. While in the FOB guided group, we used the fiberoptic bronchoscope (FOB). We compared efficacy parameters and complications between the two groups. The mean values were compared between study groups using an independent sample t-test. Categorical outcomes were compared using the chi-square test. P-value < 0.05 was considered statistically significant. Results: Compared with the bronchoscopy group, the US group had a significantly shorter PDT operation time (11.8 ± 2.5 versus 15.43 ± 3.27 mins, P < 0.001). FOB group had fewer puncture attempts than the US group. FOB group had more central punctures than the US group (p < 0.001). Among PDT complications, bleeding happened in two patients (6.67%) in the FOB group and tracheal tube cuff puncture was observed in 8 (26.67%) patients in the US group. Conclusion: The US-guided PDT consumes less time for the procedure compared to bronchoscope-guided PDT. FOB was more effective in terms of parameters like the number of needle puncture attempts, the accuracy of the puncture site, the incidence of the posterior tracheal wall hit compared to US-guided PDT. Complications like bleeding were present in FOB.

The use of the Sanuki airway™ in three patients with suspected difficult airway

The Sanuki airway is a single-use intubation oral airway designed for fiberoptic bronchoscope intubation. Sanuki airway has a bite block function and a wide lumen for the tracheal tube to pass through. Here, three cases are reported in which Sanuki airway was used for oral fiberoptic bronchoscope intubation. Case 1 is a patient who presented with reduced mouth opening and intraoral edema due to facial bone fracture. Case 2 is a patient who suffered from severe neck stiffness and had reduced mouth opening due to systemic psoriatic arthritis. Case 3 is a patient who suffered from multiple facial traumas and was in a full-stomach state. In all patients, advancing the tip of the bronchofiber into the larynx using Sanuki airway was possible under dexmedetomidine sedation, which contributed to the successful tracheal intubation. Using Sanuki airway may be considered an option for oral fiberoptic bronchoscope intubation in patients anticipated with difficult airways.

The Effect of Fiberoptic Bronchoscopy-guided Technique for Placement of a Left-sided Double-lumen Tube on the Intubation Performance Compared with the Conventional Method Using a Macintosh Laryngoscope

Background: The accurate placement of the double-lumen endotracheal tube is imperative for effective one-lung ventilation in thoracic surgery. Malpositioning and repositioning of a misplaced tube may cause excessive trauma. Objective: We hypothesized that the fiberoptic bronchoscope-guided method for double-lumen endotracheal tube placement would reduce the incidence of malpositioning as compared to the conventional method using the Macintosh laryngoscope. Methods: Fifty patients scheduled to undergo elective thoracic surgery were recruited and randomly assigned to the fiberoptic bronchoscope-guided [n=25; Group F] and conventional [n=25; Group C] method groups, according to the method of double-lumen endotracheal tube placement. The primary outcome was the incidence of double-lumen endotracheal tube malpositioning observed under the fiberoptic bronchoscope after initial placement. Secondary outcomes included the times for placement, confirmation, and total procedure of double-lumen endotracheal tube intubation. Results: The incidence of malpositioning after initial double-lumen endotracheal tube placement was significantly lower in Group F than in Group C (20.0% vs 68.0%). In addition, the time for placement was significantly higher in Group F than in Group C, and that for confirmation was significantly lower in Group F than in Group C. Conclusion: The fiberoptic bronchoscope-guided method for double-lumen endotracheal tube placement can reduce the incidence of malpositioning after initial placement and expedite the intubation process with a double-lumen endotracheal tube in thoracic surgery.