Wang J, Yang S, Chen J, Chen Z
Department of Anesthesiology, Wuhan First Hospital, Wuhan 430022, China.
Department of Respiratory Medicine, Wuhan First Hospital, Wuhan 430022, China.
Nan Fang Yi Ke Da Xue Xue Bao. 2021 Apr 20;41(4):562-566. doi: 10.12122/j.issn.1673-4254.2021.04.12.
To investigate the necessity, safety and feasibility of painless fiberoptic bronchoscopy in patients with coronavirus disease 2019 (COVID-19).
We retrospectively analyzed the clinical characteristics of 33 patients diagnosed with COVID-19 who received painless fiberoptic bronchoscopy in Wuhan First Hospital. The general demographic and clinical data of the patients including age, gender, and ASA classification were collected. The patients received intravenous anesthesia with topical airway anesthesia with lidocaine. The changes in the vital signs of the patients were recorded before, during and after the procedure. The cough intensity of the patients during bronchoscopy were evaluated, and the adverse reactions within 24 h after the procedure were observed. The health status of the medical staff carrying out the procedure was also monitored.
The 33 patients with ASA class Ⅱ to Ⅳ included 19 male and 14 female patients with an average age of 63.58±11.85 years. The lowest SpO of the patients during bronchoscopy was (94.8±4.3)%, which was significantly lower than that before the procedure [(99.1±1.3)%, < 0.05] but was restored to more than 95% after such treatment as holding the jaw to open the airway or face mask positive-pressure ventilation. Bronchoscopy was completed successfully in all the patients, and 28 patients (84.85%) had mild cough during the procedure. None of the patients had obvious complications related to anesthesia. While performing the procedure, all the medical staff used third-level protection and facial protection with powered air-purifying respirators (PAPR), and the patients' face were covered with single-use sterile medical plastic curtains that were originally intended for collecting flushing fluid during arthroscopic procedures. No medical personnel was diagnosed with COVID-19 at the end of the study.
For patients with COVID-19, painless techniques can be valuable during bronchoscopy, and this procedure can be safe and feasible under third-level protection.
探讨2019冠状病毒病（COVID-19）患者行无痛纤维支气管镜检查的必要性、安全性及可行性。
我们回顾性分析了武汉市第一医院33例确诊为COVID-19且接受无痛纤维支气管镜检查患者的临床特征。收集患者的一般人口统计学和临床资料，包括年龄、性别及美国麻醉医师协会（ASA）分级。患者接受静脉麻醉并联合利多卡因气道局部麻醉。记录患者在操作前、操作中和操作后的生命体征变化。评估患者在支气管镜检查期间的咳嗽强度，并观察操作后24小时内的不良反应。同时监测实施操作的医务人员的健康状况。
33例ASAⅡ至Ⅳ级患者中，男性19例，女性14例，平均年龄63.58±11.85岁。患者在支气管镜检查期间的最低血氧饱和度（SpO）为（94.8±4.3）%，显著低于操作前[（99.1±1.3）%，P<0.05]，但经托下颌开放气道或面罩正压通气等处理后恢复至95%以上。所有患者均成功完成支气管镜检查，28例患者（84.85%）在操作过程中出现轻度咳嗽。无患者发生与麻醉相关的明显并发症。操作过程中，所有医务人员均采用三级防护并佩戴动力送风过滤式呼吸器（PAPR）进行面部防护，患者面部覆盖用于关节镜检查时收集冲洗液的一次性无菌医用塑料帘。研究结束时，无医务人员被诊断为COVID-19。
对于COVID-19患者，无痛技术在支气管镜检查期间可能具有重要价值，且该操作在三级防护下可安全可行。
