Table of Contents  
CASE REPORT
Year : 2016  |  Volume : 9  |  Issue : 3  |  Page : 463-464

Innovative use of damaged fiberoptic bronchoscope


Department of Anaesthesiology and Critical Care, Kauvery Hospitals, Trichy, Tamil Nadu, India

Date of Submission30-Jun-2015
Date of Acceptance06-Apr-2016
Date of Web Publication31-Aug-2016

Correspondence Address:
Khaja Mohideen Sherfudeen
Department of Anaesthesiology and Critical Care, Kauvery Hospitals, No-1, K.C. Road, Tennur, Trichy - 620 017, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1687-7934.189094

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  Abstract 

Flexible fiberoptic bronchoscope is a delicate instrument that can get damaged due to improper handling. Once damaged, this costly instrument becomes useless. We reported a case in which we used a damaged flexible fiberoptic bronchoscope in overcoming a difficulty in advancing the endotracheal tube after visualization of the vocal cord with TruviewPCD in a patient with cervical spine injury.

Keywords: damaged flexible fiberoptic bronchoscope, optic bundle, TruviewPCD


How to cite this article:
Kaliannan SK, Sherfudeen KM, Dammalapati PK. Innovative use of damaged fiberoptic bronchoscope. Ain-Shams J Anaesthesiol 2016;9:463-4

How to cite this URL:
Kaliannan SK, Sherfudeen KM, Dammalapati PK. Innovative use of damaged fiberoptic bronchoscope. Ain-Shams J Anaesthesiol [serial online] 2016 [cited 2021 Apr 14];9:463-4. Available from: http://www.asja.eg.net/text.asp?2016/9/3/463/189094


  Introduction Top


Flexible fiberoptic bronchoscope (FFB) is a delicate, sophisticated instrument used in intubating difficult airways. Improper handling of FFB during intubation, improper cleaning methods and maintenance, failure to place bite-blocks resulting in patient biting the FFB, certain procedures such as transbronchial needle aspiration, laser photoresection, etc. can damage FFB [1]. These result in the costly instrument becoming useless. We report a case in which we used a damaged FFB in overcoming a difficulty in advancing the endotracheal tube (ETT) after visualization of the vocal cord with TruviewPCD in a patient with cervical spine injury.


  Case report Top


A 35-year-old male patient with cervical spine injury (C5–C6 fracture with minimal cord compression) was posted for anterior cervical fixation. Neurological examination of the patient revealed quadriparesis and absent sensation below the chest. He had no other medical illness. There were no indicators of difficult airway (Mallampati grade 2) except for cervical spine injury. Written consent was obtained from the patient after explaining the possibility of difficulty in intubation. Our plan was to intubate with TruviewPCD laryngoscope along with manual in axial stabilization (MIAS). Oral airways, laryngeal mask airway (classic and proseal), I-gel, and bougie were available with us. After induction with fentanyl, propofol, and vecuronium, laryngoscopy was attempted with TruviewPCD along with MIAS. SpO2, ECG, end-tidal CO2 concentration, and blood pressure were monitored. The preformed stylet (Optishape) in TruviewPCD was used for intubation. ETT was entered from the side of mouth as advised by the manufacturer. Even though the vocal cords were visualized in the TruviewPCD monitor (Cormack–Lehane grade 2), we were not able to intubate initially. Further attempts made after applying optimal external laryngeal maneuver also resulted in failed intubation. Gum elastic bougie was also tried for intubation but in vain. We faced difficulty in advancing the tip of tracheal tube toward the view of digital camera. These maneuvers were tried for nearly 90 s and the patient started desaturating. Once again, mask ventilation was carried out with 100% oxygen, and propofol was administered in boluses. A damaged FFB (broken optic bundle but intact metal wires guiding the tip movement) was available with us. Flexometallic ETT 8.5 size was railed over the FFB. One anesthesiologist performed laryngoscopy with TruviewPCD maintaining MIAS. With the help of an indirect view of the vocal cords on the monitor of TruviewPCD, another anesthesiologist was able to intubate by adjusting the tip of FFB with the control lever. There was no difficulty in advancing the FFB with the TruviewPCD in position. Surgery was uneventful.


  Discussion Top


The fiberoptic bronchoscope is composed of thousands of densely packed flexible glass fibers. A set of high precision objective and ocular lenses are placed at the distal and proximal ends of the fiber bundle, respectively. The distal bending portion of the FFB is connected by metal wire to the control lever located at the proximal end. The objective lens and the delicate quartz filaments of the FFB are particularly susceptible to trauma during routine use [1]. Once the optic bundle is damaged, the glottis cannot be visualized and intubation becomes difficult. We had one such FFB where the optic bundle was damaged but the metal wire was intact.

Newer devices such as Glidescope, Airwayscope, Truview EVO2, and TruviewPCD laryngoscope are used successfully in cervical spine fracture patients maintaining MIAS. These devices have reduced the intubation difficulty score, improved the Cormack–Lehane grade, and reduced the number of optimization maneuvers compared with the Macintosh laryngoscope. However, the duration of tracheal attempts was longer when compared with Macintosh [2],[3].

TruviewPCD laryngoscope is a device with a unique blade that provides an optical view ‘around the corner,’ allowing a view of the glottis through the prismatic lens without having to align oral, pharyngeal, and tracheal axes [3]. TruviewPCD comes with its camera attachment on the top of the blade to magnify the view of vocal cords through the eyepiece. The glottic view was angulated, which necessitates the use of preformed angulated stylet, during tracheal intubation, which comes with TruviewPCD laryngoscope. It was difficult to advance the tracheal tube toward the view with this stylet. This could be one of the reasons for increased duration of tracheal intubation [4].

We also faced similar difficulty but we were not able to intubate even after multiple attempts. The glottis view in our patient was normal. However, the intraoral space was less, which limited ETT manipulation toward the glottic view. Thus, with the help of the damaged FFB, we successfully intubated the patient maintaining the MIAS [Figure 1].
Figure 1 TruviewPCD.

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  Conclusion Top


This case is presented to share innovative use of damaged FFB in case of difficulty in advancing the ETT. We used damaged FFB (with intact metal wire guiding the tip movement) as a stylet with the laryngoscopic view of the TruviewPCD (indirect image of the glottis) in advancing the ETT. Therefore, in such case we should be aware of this technique that is simple yet helpful and may prove to be a good aid.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Mehta AC, Curtis PS, Scalzitti ML, Meeker DP. The high price of bronchoscopy. Maintenance and repair of the flexible fiberoptic bronchoscope. Chest 1990; 98:448– 454.  Back to cited text no. 1
[PUBMED]    
2.
Malik MA, Maharaj CH, Harte BH, Laffey JG. Comparison of Macintosh, Truview EVO2, Glidescope, and Airwayscope laryngoscope use in patients with cervical spine immobilization. Br J Anaesth 2008; 101:723– 730.  Back to cited text no. 2
    
3.
Bag SK, Kumar VR, Krishnaveni N, Ravishankar M, Velraj J, Aruloli M. A comparative study between Truview(PCD) laryngoscope and Macintosh laryngoscope in viewing glottic opening and ease of intubation: a crossover study. Anesth Essays Res 2014; 8:372– 376.  Back to cited text no. 3
  Medknow Journal  
4.
Riveros R, Sung W, Sessler DI, Sanchez IP, Mendoza ML, Mascha EJ, Niezgoda J. Comparison of the Truview PCD™ and the GlideScope(®) video laryngoscopes with direct laryngoscopy inpediatric patients: a randomized trial. Can J Anaesth 2013; 60:450– 457.  Back to cited text no. 4
    


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  In this article
   Abstract
  Introduction
  Case report
  Discussion
  Conclusion
   References
   Article Figures

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