GENEL ANESTEZİ ALTINDA FİBEROPTİK BRONKOSKOPİ YAPILAN PEDİATRİK VAKALARIN RETROSPEKTİF ANALİZİ: TEK MERKEZDE BEŞ YILLIK DENEYİM

Year 2023, , 164 - 167, 04.08.2023

Özlem Öz Gergin , Sibel Seçkin Pehlivan , Oğuz Kaan Şimşek , İbrahim Erkan , Karamehmet Yıldız , Mehmet Köse

https://doi.org/10.34108/eujhs.1177820

Abstract

Laringeal maske (LMA)’nin fleksibl fiber optic bronkoskopi (FFB) sırasında kullanımı diğer hava yolu araçlarıyla karşılaştırıldığında daha avantajlıdır. Bu çalışmada, çocuk hastalarda FFB’de hava yolu idamesi için LMA kullanımının uygulama başarı oranları ve karşılaşılan postoperative komplikasyonları hastaların demografik özellikleri, ASA risk grupları, anestezi süresi ve bronkoskopik tanıları ile değerlendirerek literature eşliğinde gözden geçirilmesi planlandı. Ocak 2017 -Ocak 2022 tarihleri arasında FFB yapılan çocuk hastaların dosyaları geriye dönük olarak incelendi. Hastaların demografik verileri, FFB’de hava yolu idamesi için kullanılan hava yolu gereci (LMA, endotrakealtüp, trakealtüp), bronkoskopi endikasyonları, bronkoskopik tanıları, anestezi süresi, işlem sonrası desaturasyon, laringo spazm, bronco spazm ve reentübasyon gereken hasta sayısı kaydedildi. Çalışmaya yaşları 0-17 arasında değişen 162 pediatrik hasta dahil edildi. Median yaş 6.9 (çeyrekler arası aralık 0-17 yaş) ve median ağırlık 24.5 kg (çeyrekler arası aralık 2.5-89) idi. Torasik BT anormallikleri olan ve tanıyı desteklemek için ameliyat gerektiren hasta grubu ensık görülen FOB endikasyonuydu (n=37, %22.8). Toplamda 28 hastada (%17.3) geçici hipoksi, 62 hastada (%38.3) bronco spazm görüldü. Pediatrik hastalarda LMA yoluyla FOB güvenli bir yöntemdir. Uygun ekipman, deneyimli personel, iyi hasta seçimi ve bronkoskopi sonrası hastanın yeterli sure izlemde tutulması komplikasyonların önlenmesinde ve azalmasında en önemli etkenler arasındadır.

Keywords

çocuk, fiberoptik bronkoskopi, laryngeal maske

A RETROSPECTIVE ANALYSIS OF PEDIATRIC CASES UNDERGOING FIBEROPTIC BRONCHOSCOPY UNDER GENERAL ANESTHESIA: A FIVE-YEAR EXPERIENCE AT A SINGLE CENTER

Abstract

The use of the laryngeal mask (LMA) during flexible fiberoptic bronchoscopy (FOB) is more advantageous compared to other airway devices. In this study, the use of LMA for airway maintenance in FOB in pediatric patients was planned to be reviewed in the light of the literature by evaluating the postoperative complications encountered with the demographics of the patients, the duration of anesthesia, and bronchoscopic diagnoses. Between January 2017 and January 2022, the files of pediatric patients who underwent FOB were reviewed retrospectively. The patients' demographics, the airway device used for airway maintenance in FOB (LMA, endotracheal tube, tracheal tube), bronchoscopy indications, bronchoscopic diagnoses, duration of anesthesia, post-procedure hypoxia, laryngospasm, and the number of patients requiring bronchospasm were all recorded. The study included 162 pediatric patients ranging in age from 0 to 17. The median age was 6.9 years old (interquartile range 0-17 years old), and the median weight was 24.5 kg (interquartile range 2.5-89). The patient group having thoracic CT abnormalities and requiring an operation to support the diagnosis was the most prevalent FOB indication (n=37, 22.8%). In all, 28 patients (17.3%) experienced temporary hypoxia, whereas 62 patients (38.3%) experienced bronchospasm. In pediatric patients, FOB via LMA is a safe method. Appropriate equipment, experienced personnel, good patient selection, and adequate follow-up of the patient after bronchoscopy are among the most important factors in the prevention and reduction of complications.

Keywords

child, fiberoptic bronchoscopy, laryngeal mask

References

• Bolliger CT, Mathur PN, Beamis JF, et al. ERS/ATS statement On Interventional Pulmonology. European Respiratory Society/American Thoracic Society. EurRespir J 2002; 19:356-373.
• Wood RE. Bronchoscopy and bronchoalveolar lavage in pediatric patients. In : Wilmott RW, Deterding R, Li A, Ratjen F, Sly P, Zar HJ, Bush A. (eds),Kendig’s Disorders of the Respiratory Tract in Children. Elsevier, Philadelphia 2018; pp 134-146.
• Radhakrishnan D, Yamashita C, Gillio-Meina C, et al. Translational research in pediatrics III: bronchoalveolar lavage. Pediatrics 2014;134:135-154.
• Kennedy VE, Todd JL, Palmer SM. Bronchoalveolar Lavage as a Tool to Predict, Diagnose, and Understand Bronchiolitis Obliterans Syndrome. Am J Transplant 2013; 13:552-561.
• Hamouda S, Oueslati A, Belhadj I, et al. Flexible bronchoscopy contribution in the approach of diagnosis and treatment of children’s respiratory diseases: the experience of a unique pediatric unit in Tunisia. Afr Health Sci2016;16:51-60.
• Rechner JA, Loach VJ, Ali MT, et al. A comparison of the laryngeal mask airway with face mask and oropharyngeal airway for manual ventilation by critical care nurses in children. Anaesthesia 2007;62:790-795.
• Niggemann B, Haack M, Machotta A. How to enter the pediatric airway for bronchoscopy. PediatrInt 2004;46:117-121.
• Stolz D, Pollak V, Chhajed PN, et al. A randomized, placebo-controlled trial of bronchodilators for bronchoscopy in patients with COPD. Chest 2007; 131:765-772.
• Kirvassilis F, Gidaris D, Ventouri M, et al. Flexible fiberoptic bronchoscopy in Greek children. Hippokratia 2011;15:312-315.
• Woodhull S, Goh Eng Neo A, Tang Poh Lin J, et al. Pediatric Flexible Bronchoscopy in Singapore: A 10-year Experience. J BronchologyIntervPulmonol 2010; 17:136-141.
• Kut A, Karakoç F, Karadağ B, Bakaç S, Dağlı E. Çocuklukçağında flexible bronkoskopiuygulaması: 169 olgunundeğerlendirilmesi. T Klin J Pediatr 2001; 10:197-201.
• Kwon HP, Zanders TB, Regn DD, et al. Comparison of virtual bronchoscopy to fiber-optic bronchoscopy for assessment of inhalation injury severity. Burns. 2014; 40:1308-1315.
• Goyal R, Nayar S, Gogia P, et al. Extraction of tracheobronchial foreign bodies in children and adults with rigid and flexible bronchoscopy. J BronchologyIntervPulmonol 2012;19:35-43.
• Adewole OO, Onakpoya UU, Ogunrombi AB, et al. Flexible fiberoptic bronchoscopy in respiratory care: Diagnostic yield, complications, and challenges in a Nigerian Tertiary Center. Niger J ClinPract 2017; 20:77-81.
• De Blic J, Marchac V, Scheinmann P. Complications of flexible bronchoscopy in children: prospective study of 1,328 procedures. EurRespir J 2002; 20:1271-1276.