Palliative treatment of malignant airway obstruction by Nd-YAG laser

Mehta, Atul C.; Golish, Joseph A.; Ahmad, Muzaffar; Zurick, Andrew O.; Padua, Nilda Shanon; O'Donnell, James

doi:10.3949/ccjm.52.4.513

Cited by 27 publications

(9 citation statements)

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“…The introduction of laser technology has added an important tool in endoscopic surgery of the trachea and bronchi [128]. Of the available laser systems, carbon dioxide, argon, and neodymium-yttrium aluminum garnet have been most widely used in the treatment of airway obstruction from occluding tumors [129,130]. This can be achieved by aiming precise laser energy at the target tissue through an endoscopic system, producing thermally induced dehydration, coagulation, carbonization, or vaporization.…”

Section: To Perform Difficult Intubations and To Guide Proper Placemementioning

confidence: 99%

“…When necessary, the coagulated tumor mass can be excised by forceps or removed by powerful suction [129]. Although the rigid bronchoscope has been the endoscopic system of [131], recent articles have demonstrated the value of the flexible FOB in this clinical setting [129,132,133]. ].…”

Section: To Perform Difficult Intubations and To Guide Proper Placemementioning

confidence: 99%

“…Complications associated with the use of laser therapy range from hypotension and hemorrhage to cardiopulmonary arrest [129,[134][135][136]. Despite these risks, laser therapy can improve the quality of life in otherwise hopeless clinical situations where the alternative is death by prolonged asphyxiation.…”

Section: To Perform Difficult Intubations and To Guide Proper Placemementioning

confidence: 99%

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Flexible Fiberoptic Bronchoscopy in the Intensive Care Unit

Brandstetter

1989

J Intensive Care Med

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For the past 20 years, flexible fiberoptic bronchoscopy (FOB) has been shown to be an important procedure in the diagnosis and management of patients in intensive care units (ICU). In adults, FOB is used therapeutically to remove retained secretions and to correct atelectasis not improved by conservative means. In the pediatric population, however, FOB is mainly used to diagnose tracheal disease in critically ill children. The principal risks of FOB are hypoxemia and dysrhythmias; hemor rhage and pneumothorax may occur as a result of biopsy procedures. In competent hands, these adverse compli cations of FOB are minimal. Although rigid bronchos copy remains pivotal in most pediatric bronchoscopic procedures, massive hemoptysis, foreign body removal, and laser therapy for occluding tumors of the upper airway, flexible FOB has an increasingly important role in the diagnosis and management of these disorders.

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Section: To Perform Difficult Intubations and To Guide Proper Placemementioning

confidence: 99%

Section: To Perform Difficult Intubations and To Guide Proper Placemementioning

confidence: 99%

Section: To Perform Difficult Intubations and To Guide Proper Placemementioning

confidence: 99%

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Flexible Fiberoptic Bronchoscopy in the Intensive Care Unit

Brandstetter

1989

J Intensive Care Med

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“…Laser therapy improves airway patency in 79–92% of patients, 58–60 while its coagulative property palliates those with haemorrhagic endobronchial tumours. Laser is very effective in relieving symptoms of cough, dyspnoea and haemoptysis as well as in achieving endoscopic, 61 radiographic, 61,62 spirometric 63 and quality‐of‐life improvements 64 .…”

Section: Relief Of Malignant Airway Obstructionmentioning

confidence: 99%

Management of complications from diagnostic and interventional bronchoscopy

2009

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From the humble beginnings as a mere curiosity, the art of bronchoscopy has progressed at a rapid pace.The millennium ushers in new technologies and refinements in established techniques to facilitate early detection of cancer, precise targeting of pulmonary nodules and infiltrates, near-total staging of the mediastinum with combined endoscopic modalities and more effective palliation of inoperable tumours. Bronchoscopists are faced with an increasing myriad of tools and equipment, each promising to carry out better than the previous. It is opportune to review the complications of established bronchoscopic techiques and how to manage them as well as new complications associated with novel technologies. In this article, we provide a concise overview of diagnostic and therapeutic bronchoscopic modalities, discussion of associated complications and their management strategies.

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“…An awake patient also restrains the therapist from attempting to accomplish too much in a single procedurc. General anesthesia adds another set of possible complications to patients who already are critically ill. Mehta et al [6] reported two cases of pulmonary edema, and some of their patients were under general anesthesia for up to 5 hr. If we use general anesthesia or assisted ventilation, we do not use more than 30% oxygen during the laser procedurc.…”

Section: Discussionmentioning

confidence: 99%

Management of endobronchial tumors: A comparative study

McCaughan

Hawley

Walker

1989

Seminars in Surgical Oncology

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Between September 1982 and July 1987 we treated 102 patients with endobronchial or endotracheal disease with one or a combination of the following modalities: CO2 laser, Nd:YAG laser, and photodynamic therapy (PDT). Many patients had multiple treatments and treatment sites. In all, 259 Nd:YAG treatments were performed on 154 sites in 80 patients, 118 PDT treatments were performed on 87 sites in 45 patients, and nine CO2 treatments were performed on nine sites in nine patients. Of the 71 patients who died, 19 lived longer than 6 months, and seven lived longer than 1 year. A total of 11 patients have survived for more than 1 year, including four who are still alive 18, 22, 33, and 54 months after treatment. Five patients achieved a status of "no evidence of disease," and at autopsy, two others had no evidence of disease to the treated site. All seven of these patients were treated with PDT only. There were no intraoperative deaths or cases of intraoperative bleeding or smoke with PDT. Eight patients died from pulmonary hemorrhage 2 to 9 weeks after treatment. Four had been treated with Nd:YAG therapy alone and four with PDT alone. Evaluation of the survival rate in this study must consider that this therapy involves severely ill patients with a high potential for intraoperative or perioperative fatality. Some patients who were near death before treatment have enjoyed quality survival for over 1 year.

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Palliative treatment of malignant airway obstruction by Nd-YAG laser

Cited by 27 publications

References 0 publications

Flexible Fiberoptic Bronchoscopy in the Intensive Care Unit

Flexible Fiberoptic Bronchoscopy in the Intensive Care Unit

Management of complications from diagnostic and interventional bronchoscopy

Management of endobronchial tumors: A comparative study

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