• Users Online: 299
  • Home
  • Print this page
  • Email this page
Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 
  Navigate here 
  Search
 
  
 Resource links
 »  Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 »  Article in PDF (662 KB)
 »  Citation Manager
 »  Access Statistics
 »  Reader Comments
 »  Email Alert *
 »  Add to My List *
* Registration required (free)  

 
  In this article
References
Article Figures

 Article Access Statistics
    Viewed159    
    Printed18    
    Emailed0    
    PDF Downloaded41    
    Comments [Add]    

Recommend this journal

 


 
  Table of Contents 
LETTERS TO EDITOR
Year : 2019  |  Volume : 20  |  Issue : 1  |  Page : 57-58
 

Oxygen therapy through bronchoscope using syringe technique: Prevent oxygen desaturation


1 Department of Trauma and Emergency, All India Institute of Medical Sciences, Patna, Bihar, India
2 Department of Anaesthesia, All India Institute of Medical Sciences, Patna, Bihar, India

Date of Web Publication6-May-2019

Correspondence Address:
Dr. Neeraj Kumar
Department of Trauma and Emergency, All India Institute of Medical Sciences, Patna - 801 507, Bihar
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/TheIAForum.TheIAForum_67_18

Rights and Permissions



How to cite this article:
Kumar A, Kumar N, Kumar A, Sinha C, Kumari P. Oxygen therapy through bronchoscope using syringe technique: Prevent oxygen desaturation. Indian Anaesth Forum 2019;20:57-8

How to cite this URL:
Kumar A, Kumar N, Kumar A, Sinha C, Kumari P. Oxygen therapy through bronchoscope using syringe technique: Prevent oxygen desaturation. Indian Anaesth Forum [serial online] 2019 [cited 2019 Aug 26];20:57-8. Available from: http://www.theiaforum.org/text.asp?2019/20/1/57/257688




Sir,

Fiberoptic bronchoscopy (FOB) is used for therapeutic and diagnostic purpose, during difficult intubation, suction of secretions or blood from the airways, during the placement of a percutaneous tracheostomy, double-lumen tube, bronchial blockers, and endobronchial valves. Oxygen desaturation during FOB is a common complication, which could be life-threatening in patients with chronic obstructive airway disease, coronary artery disease, and hypoxemia. Causes of oxygen desaturation during FOB are the use of sedatives, the bronchoscope obstructing the airway, elimination of air and oxygen from the lungs during suctioning, bronchospasm and laryngospasm, etc. Oxygen can be supplemented during FOB procedure through: (1) Nasal cannula, (2) Nasal prongs - continuous positive airway pressure, (3) Nasopharyngeal catheter, (4) Transnasal humidified rapid insufflation ventilatory exchange, (5) Intratracheal catheter, and (6) Oxygen through suction port: use of a three-way stopcock.[1],[2]

We made an assembly by connecting the working channel to 3 ml syringe with its barrel removed, which was easily connected with oxygen tubing as shown in [Figure 1]. The other end of oxygen tubing was connected with oxygen flowmeter. An informed and written consent was obtained from the patient for the procedure. During bronchoscopy, we gave continuous oxygen flow of 2 L/min through the working channel without interruption of the bronchoscopic procedure. In our patient, SPO2 was maintained >95% on 2 L/min of oxygen flow and the whole procedure was uneventful.
Figure 1: Fiberoptic bronchoscopy-syringe-oxygen tubing assembly

Click here to view


Ventilation during FOB is a major concern for anesthesiologist. The working channel (insufflation channel) can be used for local anesthetic insufflation during intubation, for introducing biopsy forceps, injecting fluid for bronchioalveolar lavage and to provide oxygen through bronchoscope. Harken et al.[3] observed improvement in oxygenation on continuous insufflation of oxygen through a fenestrated endotracheal balloon by connecting oxygen tubing with pilot balloon. However, this technique was not useful for nonintubated patients.

Bronchoscopy oxygenation system, a device used for introduction of oxygen and instrumentation (biopsy and other forceps) simultaneously through a bronchoscope through the working channel is not easily available. Kumar et al.[2] successfully used a three-way stopcock assembly by connecting it to the suction port. However, Liao et al.[4] connected three-way stopcock assembly to luer-lock attachment of insufflation channel, and local anesthetic was administered through the stopcock parallel to the oxygen stream.[4] In our assembly, we use 3 ml syringe to connect oxygen tubing with the insufflation channel.

High flow nasal cannula is a simple, effective, noninvasive, well-tolerated and safe technique to ensure oxygenation during bronchoscopy with bronchioalveolar lavage.[5]

Chapman[6] reported gastric rupture and pneumoperitoneum when oxygen insufflation via a fiberoptic bronchoscope after using intermittent oxygen 5 L/min through the working channel. An inflation pressure of 15–25 cm H2O or oxygen flow at 5 L/min is needed to open the lower esophageal sphincter and to force oxygen into the stomach[7] resulting in gastric distension. Gastric perforation is a known complication generally reported when oxygen flow >4 L/min through bronchoscope but we have not encountered any such gastric insufflation in our case as we maintained the oxygen flow at 2 L/min only.

Advantages of oxygen therapy through bronchoscope using the syringe technique are:

  • This assembly is simple, easy to connect with working channel that provides continuous oxygen therapy throughout the FOB procedure and prevents rapid desaturation, especially in a patient having preexisting lung diseases
  • Oxygen insufflation through the working channel blows secretions away from the tip of the bronchoscope, and hence it helps in defogging of the lens by keeping its tip dry. This not only improves the visualization of glottis but also prevents defogging by condensation on the distal lens surface.


Drawbacks of oxygen therapy through bronchoscope using the assembly we used are:

The working channel was not free for biopsy forceps and collection of fluid for bronchoalveolar lavage because it required oxygen interruption; and it may cause the mucosa dryness, air trapping, tracheobronchial mucosal damage and pneumothorax on prolonged use.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Soong WJ, Lee YS, Tsao PC, Yang CF, Jeng MJ. Comparison of oxygenation among different supplemental oxygen methods during flexible bronchoscopy in infants. J Chin Med Assoc 2011;74:556-60.  Back to cited text no. 1
    
2.
Kumar A, Kumar N, Sinha C. Oxygen through suction port: Use of a three way stopcock during fiberoptic bronchoscopy. Anaesth Crit Care Pain Med 2018. pii: S2352-5568(18)30008-0.  Back to cited text no. 2
    
3.
Harken AH, Schonmetzler HK, Rosenkaimer SW, Barsamian EM. Improved oxygenation during bronchoscopy. Ann Thorac Surg 1972;14:683-5.  Back to cited text no. 3
    
4.
Liao X, Xue FS, Zhang YM. Tracheal intubation using the Bonfils intubation fibrescope in patients with a difficult airway. Can J Anaesth 2008;55:655-6.  Back to cited text no. 4
    
5.
La Combe B, Messika J, Fartoukh M, Ricard JD. Increased use of high-flow nasal oxygen during bronchoscopy. Eur Respir J 2016;48:590-2.  Back to cited text no. 5
    
6.
Chapman N. Gastric rupture and pneumoperitoneum caused by oxygen insufflation via a fiberoptic bronchoscope. Anesth Analg 2008;106:1592.  Back to cited text no. 6
    
7.
Lawes EG, Campbell I, Mercer D. Inflation pressure, gastric insufflation and rapid sequence induction. Br J Anaesth 1987;59:315-8.  Back to cited text no. 7
    


    Figures

  [Figure 1]



 

Top
Print this article  Email this article