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Video rhino-laryngoscope modified into a fibreoptic bronchoscope.

Kothari N, Biyani G, Goyal S, Sharma V - Indian J Anaesth (2015)

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.

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During the next 30–60 min, patient's oxygen (O2) demand increased necessitating increase in fraction of inspired O2 from 30% to 80%, but he remained haemodynamically stable... Auscultation of the chest revealed decreased air entry on the right side... Due to its shorter length, it could not have been possible to reach up to the right bronchus if passed through the full length of ETT, and hence it was cut at 22 cm mark... A suction catheter of 8G was attached along the length of VRL and taped with micropore at four sites as the instrument does not have an in-built suction port [Figure 2]... With gentle to and fro movements of the newly designed assembly and saline wash through the suction catheter, all the debris were cleared and patent opening of the bronchus could be visualised... Patient's O2 requirement gradually decreased over next 4–6 h... In our case, as the FOB was not available and BPL was not feasible, we decided to proceed with VRL... Availability of different airway devices such as FOB, microdebriders and adequate training of BPL are necessary to manage central airway obstruction... In circumstances where FOB and BPL facilities are not available, VRL can be used as alternative device on emergency basis to remove secretions and mucus plugs from the central airway... However, care must be taken to prevent accidental dislodgement of the micropore tapes within the tracheo-bronchial tree.

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Related in: MedlinePlus

Paediatric video rhino-laryngoscope taped with 8G suction catheter whose tip is falling just short of the tip of video rhino-laryngoscope
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Figure 2: Paediatric video rhino-laryngoscope taped with 8G suction catheter whose tip is falling just short of the tip of video rhino-laryngoscope

Mentions: As FOB was not available in the ICU, we decided to proceed with VRL (Karl-Storz 11101 Series, Michigan, USA) which was available in difficult airway cart in operation theatre. It was a paediatric version of VRL, with a working length of 30 cm. Due to its shorter length, it could not have been possible to reach up to the right bronchus if passed through the full length of ETT, and hence it was cut at 22 cm mark. A suction catheter of 8G was attached along the length of VRL and taped with micropore at four sites as the instrument does not have an in-built suction port [Figure 2]. This whole assembly was kept for 20 min in Cidex OPA solution for sterilisation. Care was taken to see that the taped micropore should not get loosened and dislodged within the airway at each point when the scope was withdrawn and number of tapes was counted each time after withdrawal. The arrangement was such that the tip of catheter was just short of the tip of VRL so that it should not hamper the vision but at the same time should be able to bend and follow the path of VRL [Figure 2]. It was passed through the lumen of ETT which revealed normal trachea and left main-stem bronchus. Examination of right bronchus showed large mucus plug completely obstructing the lumen just distal to the carina. With gentle to and fro movements of the newly designed assembly and saline wash through the suction catheter, all the debris were cleared and patent opening of the bronchus could be visualised. Patient's O2 requirement gradually decreased over next 4–6 h. ABG showed improvement in oxygenation, and X-ray chest revealed good aeration of the right lung tissue [Figure 1].


Video rhino-laryngoscope modified into a fibreoptic bronchoscope.

Kothari N, Biyani G, Goyal S, Sharma V - Indian J Anaesth (2015)

Paediatric video rhino-laryngoscope taped with 8G suction catheter whose tip is falling just short of the tip of video rhino-laryngoscope
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4645359&req=5

Figure 2: Paediatric video rhino-laryngoscope taped with 8G suction catheter whose tip is falling just short of the tip of video rhino-laryngoscope
Mentions: As FOB was not available in the ICU, we decided to proceed with VRL (Karl-Storz 11101 Series, Michigan, USA) which was available in difficult airway cart in operation theatre. It was a paediatric version of VRL, with a working length of 30 cm. Due to its shorter length, it could not have been possible to reach up to the right bronchus if passed through the full length of ETT, and hence it was cut at 22 cm mark. A suction catheter of 8G was attached along the length of VRL and taped with micropore at four sites as the instrument does not have an in-built suction port [Figure 2]. This whole assembly was kept for 20 min in Cidex OPA solution for sterilisation. Care was taken to see that the taped micropore should not get loosened and dislodged within the airway at each point when the scope was withdrawn and number of tapes was counted each time after withdrawal. The arrangement was such that the tip of catheter was just short of the tip of VRL so that it should not hamper the vision but at the same time should be able to bend and follow the path of VRL [Figure 2]. It was passed through the lumen of ETT which revealed normal trachea and left main-stem bronchus. Examination of right bronchus showed large mucus plug completely obstructing the lumen just distal to the carina. With gentle to and fro movements of the newly designed assembly and saline wash through the suction catheter, all the debris were cleared and patent opening of the bronchus could be visualised. Patient's O2 requirement gradually decreased over next 4–6 h. ABG showed improvement in oxygenation, and X-ray chest revealed good aeration of the right lung tissue [Figure 1].

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

During the next 30–60 min, patient's oxygen (O2) demand increased necessitating increase in fraction of inspired O2 from 30% to 80%, but he remained haemodynamically stable... Auscultation of the chest revealed decreased air entry on the right side... Due to its shorter length, it could not have been possible to reach up to the right bronchus if passed through the full length of ETT, and hence it was cut at 22 cm mark... A suction catheter of 8G was attached along the length of VRL and taped with micropore at four sites as the instrument does not have an in-built suction port [Figure 2]... With gentle to and fro movements of the newly designed assembly and saline wash through the suction catheter, all the debris were cleared and patent opening of the bronchus could be visualised... Patient's O2 requirement gradually decreased over next 4–6 h... In our case, as the FOB was not available and BPL was not feasible, we decided to proceed with VRL... Availability of different airway devices such as FOB, microdebriders and adequate training of BPL are necessary to manage central airway obstruction... In circumstances where FOB and BPL facilities are not available, VRL can be used as alternative device on emergency basis to remove secretions and mucus plugs from the central airway... However, care must be taken to prevent accidental dislodgement of the micropore tapes within the tracheo-bronchial tree.

No MeSH data available.


Related in: MedlinePlus