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      A novel approach for ventilation with Aintree catheter during rigid bronchoscopy: A non-ventilated case report

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          Abstract

          Herein, we present a novel method to overcome difficult ventilation in a patient with a carinal tumor. After induction of anesthesia, we observed difficult ventilation due to obstruction of the right main bronchus as a result of herniation of the tumor mass arising from the left bronchial stump. Traditional lung ventilation techniques were not an option under these conditions. Therefore, the Aintree intubation catheter was used to obtain a patent airway and, with this technique, the patient was successfully and securely ventilated throughout the whole procedure. To the best of our knowledge, this technique is the first to describe successful ventilation during rigid bronchoscopy in a case with a tracheal carinal tumor.

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          Ventilation and anesthetic approaches for rigid bronchoscopy.

          Due to growing interest in management of central airway obstruction, rigid bronchoscopy is undergoing a resurgence in popularity among pulmonologists. Performing rigid bronchoscopy requires use of deep sedation or general anesthesia to achieve adequate patient comfort, whereas maintaining oxygenation and ventilation via an uncuffed and often open rigid bronchoscope requires use of ventilation strategies that may be unfamiliar to most pulmonologists. Available approaches include apneic oxygenation, spontaneous assisted ventilation, controlled ventilation, manual jet, and high-frequency jet ventilation. Anesthetic technique is partially dictated by the selected ventilation strategy but most often relies on a total intravenous anesthetic approach using ultra-short-acting sedatives and hypnotics for a rapid offset of action in this patient population with underlying respiratory compromise. Gas anesthetic may be used with the rigid bronchoscope, minimizing leaks with fenestrated caps placed over the ports, although persistent circuit leaks can make this approach challenging. Jet ventilation, the most commonly used ventilatory approach, may be delivered manually using a Sanders valve or via an automated ventilator at supraphysiologic respiratory rates, allowing for an open rigid bronchoscope to facilitate ease of moving tools in and out of the airway. Despite a patient population that often suffers from significant respiratory compromise, major complications with rigid bronchoscopy are uncommon and are similar among modern ventilation approaches. Choice of ventilation technique should be determined by local expertise and equipment availability. Appropriate patient selection and recognition of limitations associated with a given ventilation strategy are critical to avoid procedural-related complications.
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            Rigid bronchoscopy and silicone stents in the management of central airway obstruction.

            The field of interventional pulmonology has grown significantly over the past several decades now including the diagnosis and therapeutic treatment of complex airway disease. Rigid bronchoscopy is an invaluable tool in the diagnosis and management of several malignant and non-malignant causes of central airway obstruction (CAO) and has become integral after the inception of airway stenting. The management of CAO can be a complicated endeavor with significant risks making the understanding of basic rigid bronchoscopy techniques, ablative technologies, anesthetic care and stenting of utmost importance in the care of these complex patients. This review article will focus on the history of rigid bronchoscopy, the technical aspects of performing a rigid bronchoscopy as well as the use of silicone stents their indications, complications and placement techniques.
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              The 'dedicated airway': a review of the concept and an update of current practice.

              The term 'dedicated airway' was first used in connection with nasal fibreoptic intubations using the cuffed nasopharyngeal airway. Since that time, the concept has developed and the term has been extended to include fibreoptic intubation techniques involving both the laryngeal mask airway and cuffed oropharyngeal airway. 'Dedicated airway' can now be defined as: 'An upper airway device dedicated to the maintenance of airway patency while other major airway interventions are anticipated or are in progress. The device should be compatible with spontaneous and controlled ventilation. 'Dedicated airway techniques allow planned fibreoptic intubations in difficult cases and provide an emergency airway option in an unexpected difficult intubation when the alternative may be to wake the patient. As well as promoting safe conditions for training fibreoptic intubation in general, there is the particular advantage of being able to train using these techniques in patients known to be difficult to intubate. The authors' evolved clinical experiences in promoting the concept and the relevant literature are reviewed.
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                Author and article information

                Journal
                Turk Gogus Kalp Damar Cerrahisi Derg
                Turk Gogus Kalp Damar Cerrahisi Derg
                tjtcs_pmc
                Turkish Journal of Thoracic and Cardiovascular Surgery
                Bayçınar Medical Publishing
                1301-5680
                2149-8156
                January 2021
                13 January 2021
                : 29
                : 1
                : 129-132
                Affiliations
                [1 ] Department of Anesthesiology and Reanimation, Mersin University Faculty of Medicine, Mersin, Turkey
                [2 ] Department of Thoracic Surgery, Mersin University Faculty of Medicine, Mersin, Turkey
                Author notes
                Davud Yapıcı, MD. Mersin Üniversitesi Tıp Fakültesi, Anestezi ve Reanimasyon Anabilim Dalı, 33343 Yenişehir, Mersin, Türkiye. Tel: +90 535 - 724 65 67 davudyapici@ 123456yahoo.com .
                Article
                10.5606/tgkdc.dergisi.2021.19427
                7970086
                4fc69451-d8f4-467d-8ab9-9a84b58249b4
                Copyright © 2021, Turkish Society of Cardiovascular Surgery

                This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

                History
                : 24 February 2020
                : 11 May 2020
                Categories
                How to Do It?

                catheter ventilation,rigid bronchoscopy,tracheal stenosis

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