Rigid bronchoscopy under intravenous general anaesthesia with oxygen Venturi ventilation.

Abstract

In a study of 100 patients undergoing rigid bronchoscopy under intravenous general anaesthesia with oxygen Venturi ventilation no major complications were observed. Minor complications included one adverse reaction to alphaxalone-alphadolone acetate (Althesin), one prolonged episode of laryngeal spasm after removal of the bronchoscope, and subsequent muscle pain attributed to suxamethonium in 36 patients. The last complication occurred significantly less frequently (p < 0-025) in those patients who were pretreated with a small dose of a nondepolarising neuromuscular blocking agent.

Rigid bronchoscopy induces bacterial translocation: an experimental study in rats

“…This may induce translocation of bacteria or endotoxins to systemic circulation and organs [23]. Rigid bronchoscopic procedures have been shown to induce alterations in arterial blood gases including acidosis, hypoxaemia, and hypercarbia [24,25]. Likewise, the current study found a decrease in pH and Pa,O 2 and an increase in Pa,CO 2 values following bronchoscopy in rats.…”

From the Authors

“…There may some reports indicating that rigid bronchoscopy does not impair ventilation and oxygenation [2]. However, what about clinical studies that do show that rigid bronchoscopy induces alterations in arterial blood gases, including hypoxaemia, respiratory acidosis and hypercarbia [3][4][5]? GODDEN et al [3] measured serial arterial blood gases in 10 patients during rigid bronchoscopy and showed carbon dioxide retention in nine patients even though ventilation was adequate in all.…”

“…However, what about clinical studies that do show that rigid bronchoscopy induces alterations in arterial blood gases, including hypoxaemia, respiratory acidosis and hypercarbia [3][4][5]? GODDEN et al [3] measured serial arterial blood gases in 10 patients during rigid bronchoscopy and showed carbon dioxide retention in nine patients even though ventilation was adequate in all. MATHISEN and GRILLO [4] observed 19 complications of 56 patients after rigid bronchoscope, in whom two of those complications were hypoxia and/or hypercarbia.…”

“…We have also found that oxidative stress is involved in the pathophysiology of post-traumatic inflammation [2][3][4]. In order to integrate the different alterations that are produced after injury by mechanical energy, we consider that a response based on the successive functional predominance of the nervous, immune and endocrine systems would be produced.…”

“…Furthermore, it has been suggested that the term rigid bronchoscopy should be replaced with "open ventilating bronchoscopy", because the property of splinting open the airway and providing a side-arm for delivery of oxygen or anesthetic gases is an inherent feature of all present rigid bronchoscopes. In contrast, the flexible bronchofibrescope inevitably fills a portion of the airway and diminishes ventilation [3]. These findings suggest that rigid bronchoscopy is a safe procedure regarding hypoxaemia.…”