Zhang Huimin,Kang Chengbin,Chen Xia,et al.Current research status of pediatric painless flexible bronchoscopic airway management[J].Journal of Clinical Pediatric Surgery,2026,(01):96-100.[doi:10.3760/cma.j.cn101785-202405044]
Current research status of pediatric painless flexible bronchoscopic airway management
- Abstract:
- Currently flexible bronchoscopy (FOB) is widely applied in the diagnosis and treatment of pediatric respiratory diseases.Due to its invasive nature,it often causes nervousness,panic and resistance to children.Also it causes inconvenience to bronchoscopic physicians.As a result,the outcomes of examination and treatment are greatly compromised.With the latest development of painless technology,traditional local anesthesia can no longer meet the demand for patient comfort at this stage.And pediatric painless FOB shall overcome this defect.Through summarizing airway anatomical characteristics of FOB children and current status and future research directions of airway management techniques,this review tried to seek an economical,safe,simple and feasible mode of airway management to boost the success rate of examination and lower the incidence of complications.
References:
[1] Goudra BG,Singh PM,Borle A,et al.Anesthesia for advanced bronchoscopic procedures:state-of-the-art review[J].Lung,2015,193(4):453-465.DOI:10.1007/s00408-015-9733-7.
[2] Santillanes G,Gausche-Hill M.Pediatric airway management[J].Emerg Med Clin North Am,2008,26(4):961-975.DOI:10.1016/j.emc.2008.08.004.
[3] Sunder RA,Haile DT,Farrell PT,et al.Pediatric airway management:current practices and future directions[J].Paediatr Anaesth,2012,22(10):1008-1015.DOI:10.1111/pan.12013.
[4] Brambrink AM,Braun U.Airway management in infants and children[J].Best Pract Res Clin Anaesthesiol,2005,19(4):675-697.DOI:10.1016/j.bpa.2005.07.002.
[5] Wani TM,Bissonnette B,Engelhardt T,et al.The pediatric airway:Historical concepts,new findings,and what matters[J].Int J Pediatr Otorhinolaryngol,2019,121:29-33.DOI:10.1016/j.ijporl.2019.02.041.
[6] McNiece WL,Dierdorf SF.The pediatric airway[J].Semin Pediatr Surg,2004,13(3):152-165.DOI:10.1053/j.sempedsurg.2004.04.008.
[7] Eckel HE,Koebke J,Sittel C,et al.Morphology of the human larynx during the first five years of life studied on whole organ serial sections[J].Ann Otol Rhinol Laryngol,1999,108(3):232-238.DOI:10.1177/000348949910800303.
[8] Hsu G,von Ungern-Sternberg BS,Engelhardt T.Pediatric airway management[J].Curr Opin Anaesthesiol,2021,34(3):276-283.DOI:10.1097/ACO.0000000000000993.
[9] de Lima A,Kheir F,Majid A,et al.Anesthesia for interventional pulmonology procedures:a review of advanced diagnostic and therapeutic bronchoscopy[J].Can J Anaesth,2018,65(7):822-836.DOI:10.1007/s12630-018-1121-3.
[10] Rochwerg B,Granton D,Wang DX,et al.High flow nasal cannula compared with conventional oxygen therapy for acute hypoxemic respiratory failure:a systematic review and meta-analysis[J].Intensive Care Med,2019,45(5):563-572.DOI:10.1007/s00134-019-05590-5.
[11] Wong DT,Yee AJ,Leong SM,et al.The effectiveness of apneic oxygenation during tracheal intubation in various clinical settings:a narrative review[J].Can J Anaesth,2017,64(4):416-427.DOI:10.1007/s12630-016-0802-z.
[12] Sharluyan A,Osona B,Frontera G,et al.High flow nasal cannula versus standard low flow nasal oxygen during flexible bronchoscopy in children:a randomized controlled trial[J].Pediatr Pulmonol,2021,56(12):4001-4010.DOI:10.1002/ppul.25655.
[13] Gautam G,Kumar P,Goyal JP.High-flow nasal cannula during flexible bronchoscopy:Is it effective in children?[J].Pediatr Pulmonol,2022,57(2):588-589.DOI:10.1002/ppul.25767.
[14] Riccio CA,Sarmiento S,Minhajuddin A,et al.High-flow versus standard nasal cannula in morbidly obese patients during colonoscopy:a prospective,randomized clinical trial[J].J Clin Anesth,2019,54:19-24.DOI:10.1016/j.jclinane.2018.10.026.
[15] 袁红,钟海,刘天品,等.双通道面罩用于无痛纤维支气管镜检查术患者气道管理的效果[J].中华麻醉学杂志,2017,37(8):1019-1020.DOI:10.3760/cma.j.issn.0254-1416.2017.08.031. Yuan H,Zhong H,Liu TP,et al.Efficacy of double channel mask for airway management in patients undergoing painless fiberopticbronchoscopy[J].Chin J Anesthesiol,2017,37(8):1019-1020.DOI:10.3760/cma.j.issn.0254-1416.2017.08.031.
[16] 刘光顺,王忠慧,周敏,等.KHC型面罩吸氧在无痛纤维支气管镜检查术中的应用[J].山东医药,2022,62(36):71-75.DOI:10.3969/j.issn.1002-266X.2022.36.016. Liu GS,Wang ZH,Zhou M,et al.Application of KHC mask oxygen therapy in painless fiberoptic bronchoscopy examination[J].Shandong Med J,2022,62(36):71-75.DOI:10.3969/j.issn.1002-266X.2022.36.016.
[17] 梁宇峰,王超,黄献锋,等.内镜面罩与喉罩无创辅助通气在无痛支气管镜诊疗中的应用效果比较[J].中华临床医师杂志(电子版),2022,16(7):652-656.DOI:10.3877/cma.j.issn.1674-0785.2022.07.010. Liang YF,Wang C,Huang XF,et al.Comparison of noninvasive ventilation with endoscopic mask and laryngeal mask in disease diagnosis and treatment by indolent fiberoptic bronchoscopy[J].Chin J Clin (Electronic Edition),2022,16(7):652-656.DOI:10.3877/cma.j.issn.1674-0785.2022.07.010.
[18] Law R,Cardenas A.General endotracheal anesthesia for ERCP:Don’t sleep on it![J].Gastrointest Endosc,2019,89(4):863-864.DOI:10.1016/j.gie.2018.10.044.
[19] Qin Y,Li LZ,Zhang XQ,et al.Supraglottic jet oxygenation and ventilation enhances oxygenation during upper gastrointestinal endoscopy in patients sedated with propofol:a randomized multicentre clinical trial[J].Br J Anaesth,2017,119(1):158-166.DOI:10.1093/bja/aex091.
[20] Zha BJ,Wu ZY,Xie P,et al.Supraglottic jet oxygenation and ventilation reduces desaturation during bronchoscopy under moderate to deep sedation with propofol and remifentanil:a randomised controlled clinical trial[J].Eur J Anaesthesiol,2021,38(3):294-301.DOI:10.1097/EJA.0000000000001401.
[21] 邵刘佳子,万磊,刘缚鲲,等.魏氏鼻咽通气道与鼻导管吸氧对丙泊酚镇静无痛胃镜检查患者血流动力学的影响[J].中华实用诊断与治疗杂志,2021,35(6):610-613.DOI:10.13507/j.issn.1674-3474.2021.06.017. Shao LJZ,Wan L,Liu FK,et al.Influence of Wei nasal jet tube versus nasal cannula oxygen supplementation on hemodynamics during painless gastroscopy with propofol sedation[J].J Chin Pract Diagn Ther,2021,35(6):610-613.DOI:10.13507/j.issn.1674-3474.2021.06.017.
[22] Wei J,Zhang XW,Min KT,et al.Supraglottic jet oxygenation and ventilation to minimize hypoxia in patients receiving flexible bronchoscopy under deep sedation:a 3-arm randomized controlled trial[J].Anesth Analg,2024,138(2):456-464.DOI:10.1213/ANE.0000000000006678.
[23] In CB,Cho SA,Lee SJ,et al.Comparison of the clinical performance of airway management with the i-gel? and laryngeal mask airway SupremeTM in geriatric patients:a prospective and randomized study[J].Korean J Anesthesiol,2019,72(1):39-46.DOI:10.4097/kja.d.18.00121.
[24] 张杨,陈霞,马浩南.Ambu AuraGain喉罩用于无痛纤维支气管镜检查术患者气道管理的效果[J].中华麻醉学杂志,2020,40(10):1228-1231.DOI:10.3760/cma.j.cn131073.20200201.01019. Zhang Y,Chen X,Ma HN.Efficacy of laryngeal mask airway Ambu AuraGain for airway management in patients during painless fiberoptic bronchoscopy[J].Chin J Anesthesiol,2020,40(10):1228-1231.DOI:10.3760/cma.j.cn131073.20200201.01019.
[25] Consales G,Michelagnoli G,Zamidei L,et al.Safety and efficacy of laryngeal mask airways during tracheostomy[J].Anaesthesia,2015,70(2):236-237.DOI:10.1111/anae.12981.
[26] 张杰.支气管镜操作麻醉方式及无痛支气管镜的相关问题[J].中华结核和呼吸杂志,2015,38(3):162-163.DOI:10.3760/cma.j.issn.1001-0939.2015.03.002. Zhang J.Anesthesia modes of bronchoscopy and related problems of painless bronchoscopy[J].Chin J Tuberc Respir Dis,2015,38(3):162-163.DOI:10.3760/cma.j.issn.1001-0939.2015.03.002.
[27] McLaughlin CW,Skabelund AJ,Easterling ER,et al.The safety and utility of fiberoptic bronchoscopy in the very elderly[J].J Bronchology Interv Pulmonol,2018,25(4):300-304.DOI:10.1097/LBR.0000000000000511.
[28] Haga T,Cho K,Nakagawa A,et al.Complications of fiberoptic bronchoscopy in very elderly adults[J].J Am Geriatr Soc,2016,64(3):676-677.DOI:10.1111/jgs.13999.
[29] 黄娅琴,雷卫平,程远,等.经气管导管声门上通气方式在无痛纤维支气管镜诊疗中的可行性评估[J].中华医学杂志,2018,98(46):3767-3772.DOI:10.3760/cma.j.issn.0376-2491.2018.46.009. Huang YQ,Lei WP,Cheng Y,et al.Feasibility of supraglottic tracheal tube ventilation during painless fiberbronchoscopy[J].Natl Med J China,2018,98(46):3767-3772.DOI:10.3760/cma.j.issn.0376-2491.2018.46.009.
[30] Ratjen F,Nicolai T.Paediatric bronchoscopy[J].Paediatr Respir Rev,2004,5(S1):S21-S22.DOI:10.1016/s1526-0542(04)90004-8.
[31] Siciliani A,Rendina EA,Ibrahim M.State of the art in tracheal surgery:a brief literature review[J].Multidiscip Respir Med,2018,13:34.DOI:10.1186/s40248-018-0147-2.
[32] 禹二友,向珍,吴磊,等.全身麻醉喉罩通气在小儿声门下狭窄纤维支气管镜介入手术中的应用研究[J].临床小儿外科杂志,2021,20(11):1038-1041,1047.DOI:10.12260/lcxewkzz.2021.11.009. Yu EY,Xiang Z,Wu L,et al.Application of laryngeal mask controlled ventilation under general anesthesia in interventional surgery via fiberoptic bronchoscope for pediatric subglottic stenosis[J].J Clin Ped Sur,2021,20(11):1038-1041,1047.DOI:10.12260/lcxewkzz.2021.11.009.
[33] Vorasubin N,Vira D,Jamal N,et al.Airway management and endoscopic treatment of subglottic and tracheal stenosis:the laryngeal mask airway technique[J].Ann Otol Rhinol Laryngol,2014,123(4):293-298.DOI:10.1177/0003489414525340.
[34] Zhong Y,Jiang M,Wang YS,et al.Evaluating efficacy and safety of sub-anesthetic dose esketamine as an adjuvant to propofol/remifentanil analgosedation and spontaneous respiration for children flexible fibreoptic bronchoscopy:a prospective,double-blinded,randomized,and placebo-controlled clinical trial[J].Front Pharmacol,2023,14:1184663.DOI:10.3389/fphar.2023.1184663.
[35] de Blic J,Marchac V,Scheinmann P.Complications of flexible bronchoscopy in children:prospective study of 1,328 procedures[J].Eur Respir J,2002,20(5):1271-1276.DOI:10.1183/09031936.02.02072001.
[36] 杜真.小儿围术期舒适化技术的研究进展[J].临床小儿外科杂志,2018,17(2):150-154.DOI:10.3969/j.issn.1671-6353.2018.02.015. Du Z.Research advances of applying perioperative comfort-enhancing technology in children[J].DOI:10.3969/j.issn.1671-6353.2018.02.015.
[37] Apostolos F,Nikolaos Z,Charalampos M,et al.Dexmedetomidine-ketamine combination versus fentanyl-midazolam for patient sedation during flexible bronchoscopy:a prospective,single-blind,randomized controlled trial[J].BMC Pulm Med,2024,24(1):301.DOI:10.1186/s12890-024-02988-w.
[38] Pieri M,D’Andria Ursoleo J,Di Prima AL,et al.Remimazolam for anesthesia and sedation in pediatric patients:a scoping review[J].J Anesth,2024,38(5):692-710.DOI:10.1007/s00540-024-03358-w.
Memo
收稿日期:2024-5-21。
基金项目:2023 年度国家临床重点专科重大科研专项资助(Z2023078);郴州市第一人民医院院内技术项目(2021B042)
通讯作者:刘孟江,Email:737318082@qq.com