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Airway Block for Interventional Rigid Bronchoscopy ….. Pros and Cons

Received: 29 July 2019    Accepted: 3 September 2019    Published: 16 September 2019
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Abstract

Introduction: The patients presented for airway surgery either an elderly patients with coexisting disease or young children for foreign body removal. Multiple challenges for safe anaesthesia in that patient population are available. Block of the superior laryngeal nerves bilaterally, along with translaryngeal injection of local anaesthetic, provides anaesthesia of the airway from the infraglottic area to the epiglottis. Additional topical application of local anesthetic to the oral, along with appropriate sedation, by fentayl and propofol provides satisfactory analgesia for endoscopic procedures The glossopharyngeal nerve (i.e., cranial nerve IX) supplies sensation to the posterior third of the tongue, the pharynx, and the superior surface of the epiglottism. Methods: The level of sedation was recorded using Ramsay sedation score. The time of the block, duration of the procedure were also recorded. Arterial blood gases (ABG) was withdrawn after the beginning of the procedure and by the end of the procedure and recorded, event of desaturation as well, The operator and the patients’ satisfaction were also assessed. After the end of the procedure the patients were admitted to recovery room till gag and cough reflexes regained and by the time the patients were reporting that they became no more feeling numbness, clear fluid were started. Results: The mean Duration of procedure, Time of block and Amount of sedation was 44.7±24.06 min, 15.2±3.05 min, and 18.9±10.2 ml respectively. tracheal biopsy was the most common procedure done (40%). In all the patients the Ventilation were Spontaneous and Stable all through the procedure. Arterial blood gases were normal in all the cases. no statistical significance between the depth of the sedation and patients satisfaction but there was statistical significance between the level of the sedation and the operator satisfaction. The mean recovery time from the end of the procedures till the patients fully awake, and hospital stay was 3.5±2.6 min, and 2.2±0.42 hr respectively. No Postoperative complications were recorded. 90% of the Patients were satisfied, while operator satisfaction was 60%. Conclusion: Airway block with sedation is a safe and reliable practice for high risks patients scheduled for interventional bronchoscopic procedures on a day case basis.

Published in International Journal of Anesthesia and Clinical Medicine (Volume 7, Issue 2)
DOI 10.11648/j.ijacm.20190702.11
Page(s) 31-36
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This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Airway, Local, Block, Complications, Rigid, Bronchoscopy

References
[1] J. English, A. Norris and N. Bedforth. Anaesthesia for airway surgery. Continuing Education in Anaesthesia, The Board of Management and Trustees of the British Journal of Anaesthesia Critical Care & Pain 2006; 6: 1.
[2] V. Pathak, I. Welsby, K. Mahmood, M. Wahidi, N. MacIntyre, and Shofer S. Ventilation and Anesthetic Approaches for Rigid Bronchoscopy Annals ATS 2014; 11: 4.
[3] J. Beamis. Rigid bronchoscopy. In: J. Beamis, P. Mathur, editors. Interventional pulmonology. New York, NY: McGraw-Hill; 1999: 17–28.
[4] J. Henderson. Airway Management in the Adult. in: RD. Miller, LI. Eriksson, LA. Fleisher, JP. Wiener-Kronish, WL. Young. Miller’s anesthesia 7th edition chuchil livingstone el sevier; 2010: 50: 1573-1611.
[5] P. Kundra, S. Kutralam, M. Ravishankar: Local anaesthesia for awake fibreoptic nasotracheal intubation. Acta Anaesthesiol Scand 2000; 44: 511-516.
[6] T. Shawn. Simmons, Schleich: Airway Regional Anesthesia for Awake Fiberoptic Intubation Regional Anesthesia and Pain Medicine 2002; 27.
[7] Saunders. Translaryngeal block. In Brown D. Atlas of Regional Anesthesia 2nd edition: Philadelphia; 1999: 215-216.
[8] Nehthorn RW, Amayem A, Ganta R. Which method for intraoral glossopharyngeal nerve block is better? Letters to the Editor. Anesth Analg. 1995; 81: 1114.
[9] Paul H Alfille, jeremi Mountjoy, Anesthesia for adult bronchoscopy, uptodate 2018.
[10] de Lima A, Kheir F, Majid A, Pawlowski J. Anesthesia for interventional pulmonology procedures: a review of advanced diagnostic and therapeutic bronchoscopy. Can J Anaesth 2018; 65: 822.
[11] AR Selzer, M Murrell, E Shostak. New trends in interventional pulmonology. Curr Opin Anaesthesiol 2017; 30: 17.
[12] F. Maltais, F. Laberge, M. Laviolette. A randomized, double-blind, placebo controlled study of lorazepam as premedication for bronchoscopy. Chest 1996; 109: 1195-1198.
[13] SJ Pearce. Fibreoptic bronchoscopy: is sedation necessary? BMJ 1980; 281: 779-780.
[14] MQF Hatton, MB Allen, AS Vathenen. Does sedation help in fibreoptic bronchoscopy? BMJ 1994; 309: 1206-1207.
[15] GL Samsoon, JR Young. Difficult tracheal intubation: a retrospective study. Anaesthesia 1987; 42: 487-490.
[16] S. Putinati, L. Ballerin, L. Corbetta, L. Trevisani, A. Potena. Patient satisfaction with conscious sedation for bronchoscopy. Chest 1999; 115: 1437-1440.
[17] Ni YL, Lo YL, Lin TY, Fang YF, Kuo HP. Conscious sedation reduces patient discomfort and improves satisfaction in flexible bronchoscopy. Chang Gung Med J 2010; 33: 443452.
[18] HJ Lim, YJ. Cho, JS. Park, H. Yoon, Lee J-H, CT. Lee, et al. Predictors of hypoxemia developed during fiberoptic bronchoscopy under monitored anesthesia care. Chest 2012; 142: 915.
[19] G. Maguire, AR. Rubinfeld. Patients prefer sedation for fibreoptic bronchoscopy. Respirology 1998; 3: 81-85.
[20] HM. Hadzri, SMS. Azarisman, ARM. Fauzi, H. Roslan, AM. Roslina, ATN. Adina, et al. Can a bronchoscopist reliably assess a patient's experience of bronchoscopy? JRSM Short Rep 2010; 1: 35-42.
[21] L. Schlatter, E. Pflimlin, B. Fehrke, A. Meyer, M. Tamm, D. Stolz. Propofol versus propofol plus hydrocodone for flexible bronchoscopy: a randomized study. Eur Respir J 2011; 38: 529-537.
[22] B. Maître, S. Jaber, SM. Maggiore, E. Bergot, JC. Richard, H. Bakthiari, et al. Continuous positive airway pressure during fiberoptic bronchoscopy in hypoxemic patients. A randomized double-blind study using a new device. Am J Respir Crit Care Med 2000; 162: 1063-1067.
[23] I. Matot, MR. Kramer, L. Glantz, B. Drenger, S. Cotev. Myocardial ischemia in sedated patients undergoing fiberoptic bronchoscopy. Chest 1997; 112: 1454-1458.
[24] G. Perrin, H. Colt, C Martin, M Mak, J Dumon, F. Gouin. Safety of interventional rigid bronchoscopy using intravenous anesthesia and spontaneous assisted ventilation: a prospective study. Chest 1992; 102: 1526–1530.
[25] M. Ayers, J. Beamis. Rigid bronchoscopy in the twenty-first century. Clin Chest Med 2001; 22: 355–364.
[26] M. Crawford, J. Pollock, K. Anderson, RJ. Glavin, D. Macintyre, D. Vernon. Comparison of midazolam with propofol for sedation in outpatient bronchoscopy. Br J Anaesth 1993; 70: 419-422.
[27] GC. Sun, MC. Hsu, YY. Chia, PY. Chen, FZ. Shaw. Effects of age and gender on intravenous midazolam premedication: a randomized double-blind study. Br J Anaesth 2008; 101: 632-639.
[28] LT. Heuss, P. Schnieper, J. Drewe, E. Pflimlin, C. Beglinger. Conscious sedation with propofol in elderly patients: a prospective evaluation. Aliment Pharmacol Ther 2003; 17: 1493-1501.
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    Walid Youssef Youssef Kamel, Amr Mohammed Hilal Abdou, Eman Mohammed Kamal Aboseif. (2019). Airway Block for Interventional Rigid Bronchoscopy ….. Pros and Cons. International Journal of Anesthesia and Clinical Medicine, 7(2), 31-36. https://doi.org/10.11648/j.ijacm.20190702.11

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    ACS Style

    Walid Youssef Youssef Kamel; Amr Mohammed Hilal Abdou; Eman Mohammed Kamal Aboseif. Airway Block for Interventional Rigid Bronchoscopy ….. Pros and Cons. Int. J. Anesth. Clin. Med. 2019, 7(2), 31-36. doi: 10.11648/j.ijacm.20190702.11

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    AMA Style

    Walid Youssef Youssef Kamel, Amr Mohammed Hilal Abdou, Eman Mohammed Kamal Aboseif. Airway Block for Interventional Rigid Bronchoscopy ….. Pros and Cons. Int J Anesth Clin Med. 2019;7(2):31-36. doi: 10.11648/j.ijacm.20190702.11

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  • @article{10.11648/j.ijacm.20190702.11,
      author = {Walid Youssef Youssef Kamel and Amr Mohammed Hilal Abdou and Eman Mohammed Kamal Aboseif},
      title = {Airway Block for Interventional Rigid Bronchoscopy ….. Pros and Cons},
      journal = {International Journal of Anesthesia and Clinical Medicine},
      volume = {7},
      number = {2},
      pages = {31-36},
      doi = {10.11648/j.ijacm.20190702.11},
      url = {https://doi.org/10.11648/j.ijacm.20190702.11},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijacm.20190702.11},
      abstract = {Introduction: The patients presented for airway surgery either an elderly patients with coexisting disease or young children for foreign body removal. Multiple challenges for safe anaesthesia in that patient population are available. Block of the superior laryngeal nerves bilaterally, along with translaryngeal injection of local anaesthetic, provides anaesthesia of the airway from the infraglottic area to the epiglottis. Additional topical application of local anesthetic to the oral, along with appropriate sedation, by fentayl and propofol provides satisfactory analgesia for endoscopic procedures The glossopharyngeal nerve (i.e., cranial nerve IX) supplies sensation to the posterior third of the tongue, the pharynx, and the superior surface of the epiglottism. Methods: The level of sedation was recorded using Ramsay sedation score. The time of the block, duration of the procedure were also recorded. Arterial blood gases (ABG) was withdrawn after the beginning of the procedure and by the end of the procedure and recorded, event of desaturation as well, The operator and the patients’ satisfaction were also assessed. After the end of the procedure the patients were admitted to recovery room till gag and cough reflexes regained and by the time the patients were reporting that they became no more feeling numbness, clear fluid were started. Results: The mean Duration of procedure, Time of block and Amount of sedation was 44.7±24.06 min, 15.2±3.05 min, and 18.9±10.2 ml respectively. tracheal biopsy was the most common procedure done (40%). In all the patients the Ventilation were Spontaneous and Stable all through the procedure. Arterial blood gases were normal in all the cases. no statistical significance between the depth of the sedation and patients satisfaction but there was statistical significance between the level of the sedation and the operator satisfaction. The mean recovery time from the end of the procedures till the patients fully awake, and hospital stay was 3.5±2.6 min, and 2.2±0.42 hr respectively. No Postoperative complications were recorded. 90% of the Patients were satisfied, while operator satisfaction was 60%. Conclusion: Airway block with sedation is a safe and reliable practice for high risks patients scheduled for interventional bronchoscopic procedures on a day case basis.},
     year = {2019}
    }
    

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  • TY  - JOUR
    T1  - Airway Block for Interventional Rigid Bronchoscopy ….. Pros and Cons
    AU  - Walid Youssef Youssef Kamel
    AU  - Amr Mohammed Hilal Abdou
    AU  - Eman Mohammed Kamal Aboseif
    Y1  - 2019/09/16
    PY  - 2019
    N1  - https://doi.org/10.11648/j.ijacm.20190702.11
    DO  - 10.11648/j.ijacm.20190702.11
    T2  - International Journal of Anesthesia and Clinical Medicine
    JF  - International Journal of Anesthesia and Clinical Medicine
    JO  - International Journal of Anesthesia and Clinical Medicine
    SP  - 31
    EP  - 36
    PB  - Science Publishing Group
    SN  - 2997-2698
    UR  - https://doi.org/10.11648/j.ijacm.20190702.11
    AB  - Introduction: The patients presented for airway surgery either an elderly patients with coexisting disease or young children for foreign body removal. Multiple challenges for safe anaesthesia in that patient population are available. Block of the superior laryngeal nerves bilaterally, along with translaryngeal injection of local anaesthetic, provides anaesthesia of the airway from the infraglottic area to the epiglottis. Additional topical application of local anesthetic to the oral, along with appropriate sedation, by fentayl and propofol provides satisfactory analgesia for endoscopic procedures The glossopharyngeal nerve (i.e., cranial nerve IX) supplies sensation to the posterior third of the tongue, the pharynx, and the superior surface of the epiglottism. Methods: The level of sedation was recorded using Ramsay sedation score. The time of the block, duration of the procedure were also recorded. Arterial blood gases (ABG) was withdrawn after the beginning of the procedure and by the end of the procedure and recorded, event of desaturation as well, The operator and the patients’ satisfaction were also assessed. After the end of the procedure the patients were admitted to recovery room till gag and cough reflexes regained and by the time the patients were reporting that they became no more feeling numbness, clear fluid were started. Results: The mean Duration of procedure, Time of block and Amount of sedation was 44.7±24.06 min, 15.2±3.05 min, and 18.9±10.2 ml respectively. tracheal biopsy was the most common procedure done (40%). In all the patients the Ventilation were Spontaneous and Stable all through the procedure. Arterial blood gases were normal in all the cases. no statistical significance between the depth of the sedation and patients satisfaction but there was statistical significance between the level of the sedation and the operator satisfaction. The mean recovery time from the end of the procedures till the patients fully awake, and hospital stay was 3.5±2.6 min, and 2.2±0.42 hr respectively. No Postoperative complications were recorded. 90% of the Patients were satisfied, while operator satisfaction was 60%. Conclusion: Airway block with sedation is a safe and reliable practice for high risks patients scheduled for interventional bronchoscopic procedures on a day case basis.
    VL  - 7
    IS  - 2
    ER  - 

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Author Information
  • Department of Anesthesia, ICU and Pain Management, Faculty of Medicine, Ain Shams University, Cairo, Egypt

  • Department of Anesthesia, ICU and Pain Management, Faculty of Medicine, Ain Shams University, Cairo, Egypt

  • Department of Anesthesia, ICU and Pain Management, Faculty of Medicine, Ain Shams University, Cairo, Egypt

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