Apnoeic oxygenation using transnasal humidified rapid-insufflation ventilatory exchange during rigid bronchoscopy: a report of four cases

Abstract

General anaesthesia with a muscle relaxant is usually performed for rigid bronchoscopy (RB), but ventilation is challenging due to large amounts of leakage. Optiflow™ supplies 100% humidified, warmed oxygen at a rate of up to 70 l/min and this high flow rate may overcome the leakage problem. This case report describes four patients that were scheduled for RB. The lung lesions were all located below the carina, so a bronchial tube was inserted under general anaesthesia. Once a large amount of leakage was confirmed by manual ventilation, Optiflow™ was connected to the bronchial tube (flow rate, 70 l/min). All of the ports of the bronchoscopy were left open to prevent the risk of outlet obstruction. Oxygenation was well maintained with stable vital signs throughout the procedures, which took up to 34 min without airway intervention. There were no occurrences of cardiac arrhythmia or changes in the electrocardiograms. Respiratory acidosis recovered after emergence, which was confirmed by arterial blood gas analysis in all cases. Apnoeic oxygenation using Optiflow™ was applied successfully during RB. Applying Optiflow™ could make cases of difficult ventilation during RB much easier for the anaesthetist. Larger studies need to demonstrate the efficacy and safety of this technique.

Supraglottic jet oxygenation and ventilation via nasopharyngeal airway for a patient with iatrogenic tracheoesophageal fistula: A case report

“…During RB examination and stent retraction, desaturation occurred due to insufficient ventilation through the side port. High-flow oxygen ventilation could have been less compromised if no fistula in the trachea or oropharynx had been packed with gauze ( 6 ); or if the oxygen flow rate could be even higher (70 L/min) via a special ventilator like Optiflow ® ( 7 ), we might not have to do mask ventilation repeatedly. However, the dilemma lies in further injury due to the fistula with a less open airway system.…”