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Fabien Maldonado - One of the best experts on this subject based on the ideXlab platform.

  • utilizing an endobronchial blocker and a Flexible Bronchoscope for transbronchial cryobiopsies in diffuse parenchymal lung disease
    Respiration, 2014
    Co-Authors: Laurie A Hohberger, Eric S Edell, Zachary S. Depew, Fabien Maldonado
    Abstract:

    lung being biopsied has been described [1, 5, 6] . However, a rigid tracheoscope is generally needed because the luminal diameter of regular-size endotracheal tubes is typically insufficient to accommodate both a Bronchoscope and a blocker simultaneously [1] . Additionally, a technique using a supraglottic airway with general anesthesia has also been described to accommodate the need for both an endobronchial blocker and a Flexible Bronchoscope in the central airways [5] . Here, we describe a new technique that does not require rigid bronchoscopy or general anesthesia. An 8.0 Smiths ® cuffed wire spiral endotracheal tube is loaded over the Flexible Bronchoscope. Without the use of the multiport airway adapter, the guide loop of a lubricated and deflated Arndt endobronchial blocker is secured around the distal tip of the Bronchoscope ( fig. 1 a, b). The patient is then fiberoptically intubated using the Flexible Bronchoscope, with the endobronchial blocker riding alongside the Bronchoscope and the endotracheal tube through the oropharynx, larynx, and central airways ( fig. 1 c). Once the endobronchial blocker has been directed into the main stem bronchus on the side to be biopsied, the guide loop is loosened, releasing it from the Bronchoscope, where it remains in position ( fig. 1 d). The Bronchoscope is withdrawn to the mid-trachea and the patient is fiberoptically intubated with the endotraConventional bronchoscopic lung biopsies play a minimal role in the diagnosis of diffuse parenchymal lung diseases due to the small sample size and crush artifact of the biopsied specimen [1] . Recently, transbronchial cryobiopsies have shown promise in their diagnosis [2–4] . However, given the limited experience with cryobiopsies for this purpose to date, pneumothorax and bleeding risk will remain a concern until more safety data become available. To manage the potentially increased bleeding risk, the preemptive placement of a deflated endobronchial blocker in the airway of the Published online: November 14, 2014

  • Silicone stents, the rigid Bronchoscope, and the standard of care in central airway stenosis
    Current Respiratory Care Reports, 2012
    Co-Authors: Hervé Dutau, Fabien Maldonado, Sophie Laroumagne, Philippe Astoul
    Abstract:

    Central airway stenoses often represent a therapeutic challenge and require a multidisciplinary approach involving interventional pulmonologists and thoracic surgeons. While surgery is often the preferred definitive modality, advances in bronchoscopic techniques have led to substantial improvements in patient symptoms and long-term quality of life using minimally invasive techniques generally safe when performed by experienced proceduralists. Endobronchial laser therapy, cryotherapy, conventional electrocautery, or argon plasma coagulation and photodynamic therapy have been used successfully. A variety of stents, silicone or self-expandable (covered or non-covered metallic stents), have been used though little significant progress has been achieved since the description of the dedicated airway silicone stents first described by Jean-Francois Dumon in the 1980s. Rigid bronchoscopy remains the method of choice for the treatment of both benign and malignant central airway obstruction, but significant technological advances allow for effective treatments using the Flexible Bronchoscope. Metallic non-covered stents are generally not recommended, except in selected patients with poor short-term prognosis.

Hisamichi Aizawa - One of the best experts on this subject based on the ideXlab platform.

  • Clinical Study Medical Thoracoscopy Performed Using a Flexible Bronchoscope Inserted through a Chest Tube under Local Anesthesia
    2013
    Co-Authors: Toshinobu Yokoyama, Reiko Toda, Ryusuke Tomioka, Hisamichi Aizawa
    Abstract:

    Background and Objectives. Many cases of pleural effusion can remain undiagnosed following thoracentesis. We evaluated our own technique for performing thoracoscopy under local anesthesia using a 32 Fr chest tube and a Flexible fiberoptic Bronchoscope without a rigid thoracoscope for the diagnosis, inspection, and management of patients with pleurisy. Methods. Seven patients with pleural effusion who underwent thoracoscopy under local anesthesia using a 32 Fr chest tube and a Flexible fiberoptic Bronchoscope were retrospectively studied. Results. Thoracoscopy was safely performed in the diagnosis and management of pleural effusion in all cases. The visualization of the pleura, diaphragm, and lung using this instrumentation was excellent in comparison to that normally obtained during surgical thoracoscopy. A forceps biopsy of the pleura or diaphragm could therefore be easily and effectively performed. Conclusion. This technique is considered to have clinical utility as a diagnostic tool for pleurisy; furthermore, this method is safe, effective and inexpensive, not only for surgeons but also for physicians. Copyright © 2009 Toshinobu Yokoyama et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 1

  • Medical thoracoscopy performed using a Flexible Bronchoscope inserted through a chest tube under local Anesthesia
    Diagnostic and Therapeutic Endoscopy, 2009
    Co-Authors: Toshinobu Yokoyama, Reiko Toda, Ryusuke Tomioka, Hisamichi Aizawa
    Abstract:

    Background and Objectives. Many cases of pleural effusion can remain undiagnosed following thoracentesis. We evaluated our own technique for performing thoracoscopy under local anesthesia using a 32 Fr chest tube and a Flexible fiberoptic Bronchoscope without a rigid thoracoscope for the diagnosis, inspection, and management of patients with pleurisy. Methods. Seven patients with pleural effusion who underwent thoracoscopy under local anesthesia using a 32 Fr chest tube and a Flexible fiberoptic Bronchoscope were retrospectively studied. Results. Thoracoscopy was safely performed in the diagnosis and management of pleural effusion in all cases. The visualization of the pleura, diaphragm, and lung using this instrumentation was excellent in comparison to that normally obtained during surgical thoracoscopy. A forceps biopsy of the pleura or diaphragm could therefore be easily and effectively performed. Conclusion. This technique is considered to have clinical utility as a diagnostic tool for pleurisy; furthermore, this method is safe, effective and inexpensive, not only for surgeons but also for physicians.

A Hamzaoui - One of the best experts on this subject based on the ideXlab platform.

  • airway foreign body removal by Flexible Bronchoscope in children experience of a tunisian pediatric respiratory diseases department
    European Respiratory Journal, 2014
    Co-Authors: A Berraies, B Hamdi, H Snen, I Sahnoun, Jamel Ammar, T Mestiri, A Hamzaoui
    Abstract:

    Objectives: To evaluate the experience with the Flexible bronchoscopic management of airway foreign bodies (FB) in children (age ≤ 16 years). Design: All pediatric bronchoscopies performed in the Pavillon B of Abderrahman Mami Hospital of Ariana from 2002 through 2014 with confirmed FB were reviewed. FB removed by Flexible Bronchoscope, techniques used and complications were analyzed. Results: Of the 76 children with FB, the Flexible Bronchoscope allowed FB extraction in 15 children. It was used as first line to extract the FB in 6 patients, in 6 patients in whom the rigid bronchoscopic procedure was unsuccessful and in 3 patients in whom the rigid bronchoscopy failed to visualize the FB. In two children, extraction failed and removal was made by bronchotomy in one case and by rigid bronchoscopy in the other one. FB were non-organic in 8 cases, among them 3 head scarf pins. Flexible bronchoscopy was performed through an endotracheal tube in 14 children under general anesthesia. In the other child, the procedure was accomplished under local anesthesia. The extraction instruments employed included baskets forceps and biopsy forceps. No major complications occurred, only one children developed laryngeal edema that resolved with medical therapy. Conclusions: Flexible bronchoscopic extraction of pediatric FB can be performed safely with minimal risks and complications. In our experience, it was successful in 88% of cases. Nevertheless, we caution that it must be performed by an experienced bronchoscopist in the operating room and in the presence of a trained anesthetist.

Mary Beth Scholand - One of the best experts on this subject based on the ideXlab platform.

  • transbronchial biopsy interpretation in the patient with diffuse parenchymal lung disease
    Archives of Pathology & Laboratory Medicine, 2007
    Co-Authors: Kevin O. Leslie, James F. Gruden, James M. Parish, Mary Beth Scholand
    Abstract:

    Abstract Context.—The most common lung tissue samples seen by pathologists worldwide are obtained with the Flexible Bronchoscope. Specimens taken for examination of diffuse or multifocal parenchymal lung abnormalities pose special challenges for the general surgical pathologist, and these challenges are often compounded by high clinical expectations for accurate and specific diagnosis. Objective.—To present and discuss the most common histopathologic patterns and diagnostic entities seen in transbronchial biopsy specimens in the setting of diffuse or multifocal lung disease. Specifically, acute lung injury, eosinophilic pneumonia, diffuse alveolar hemorrhage, chronic cellular infiltrates, organizing pneumonia, alveolar proteinosis, sarcoidosis, Wegener granulomatosis, intravenous drug abuse-related microangiopathy, Langerhans cell histiocytosis, and lymphangioleiomyomatosis are presented. Clinical and radiologic context is provided for the more specific diagnostic entities. Data Sources.—The published lit...

Andranik Ovassapian - One of the best experts on this subject based on the ideXlab platform.

  • sedation and fiberoptic intubation of a neonate with a cystic hygroma
    Acta Anaesthesiologica Scandinavica, 2005
    Co-Authors: Y Bryan, Walter J Chwals, Andranik Ovassapian
    Abstract:

    The Flexible Bronchoscope (FB) has been used to secure the difficult airway in pediatric patients (1). Difficult intubations in patients with cystic hygromas have been performed in awake patients or after the induction of general anesthesia (2). A recent case report acknowledges the challenges of performing intubations in pediatric patients under sedation because of their inability to fully cooperate (3). The following case demonstrates the two step-two fiberoptic bronchoscopic tracheal intubation performed using sedation and topical anesthesia in a neonate with a difficult airway.

  • THE Flexible Bronchoscope: A Tool for Anesthesiologists
    Clinics in chest medicine, 2001
    Co-Authors: Andranik Ovassapian
    Abstract:

    Soon after the introduction of the Flexible Bronchoscope into clinical medicine, anesthesiologists recognized its value in airway management. 4,14,37,38,49,71 Because of its continuous refinement, the introduction of new techniques in fiberoptic airway management, and the relative ease of exploring an airway with it, the scope of the anesthesiologist's role in airway management has been expanded. 2,16,29,32,59,72 The enormous popularity of the Flexible Bronchoscope in anesthesia practice has led to the publication of books and monograms devoted to its role in that setting. 43,44,53,57 The Flexible Bronchoscope is used for airway management more than any other intubation technique or device, even though it was not developed for this purpose nor used for the first fiberoptic tracheal intubation. A Flexible fiberoptic choledochoscope was used to perform the first fiberoptic nasotracheal intubation in a patient with a difficult airway complicated by Still's disease. 38 Today, the Flexible Bronchoscope is used for many perioperative applications including tracheal intubation, endobronchial placement of double-lumen tubes and blockers, and evaluation of the airway: ADiagnostic 1Evaluation of a compromised airway aTumors bInfections cEpiglottitis dTracheal stenosis eLaryngeal polyps fSmoke inhalation 2Differential diagnosis of stridor 3Identification of the source of hemoptysis 4Identification of malpositioned tracheal and endobronchial tubes BTherapeutic 1Treatment of acute atelectasis 2Correcting malpositioned endotracheal tube 3Correcting malpositioned endobronchial tubes and blockers 4Tracheobronchial toilet CProblem solving 1Management of failed intubation 2Management of difficult intubation 3Management of failed positioning of endobronchial tubes and blockers 4Identification of the causes of acute hypoxemia DOther 1Fiberoptic changing of the endotracheal tube 2Checking nasogastric tube position 3Checking jet stylet position 4Evaluation for optimal time of extubation aMajor head and neck surgeries bEdema of the upper airway cEpiglottitis