Case Report
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 26, 2018; 6(16): 1189-1193
Published online Dec 26, 2018. doi: 10.12998/wjcc.v6.i16.1189
Oxygen insufflation via working channel in a fiberscope is a useful method: A case report and review of literature
Dowon Lee, Jiseok Baik, Giyoung Yun, Eunsoo Kim
Dowon Lee, Jiseok Baik, Giyoung Yun, Eunsoo Kim, Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Biomedical Research Institute, Pusan National University Hospital, Busan 49241, South Korea
Author contributions: Lee D, Yun G and Baik J designed of the study; Lee D, Yun G and Baik J took care of the patient; Baik J wrote the paper; Yun G and Kim E revised the article.
Supported by clinical research grant from Pusan National University Hospital 2017.
Informed consent statement: Consent was obtained from relatives of the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read CARE Checklist (2016) and prepared the manuscript accordingly.
Open-Access: This is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author to: Jiseok Baik, MD, PhD, Assistant Professor, Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Biomedical Research Institute, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, Busan 49241, South Korea. jidal@pusan.ac.kr
Telephone: +82-51-2407399 Fax: +82-51-2427466
Received: August 27, 2018
Peer-review started: August 27, 2018
First decision: October 18, 2018
Revised: November 2, 2018
Accepted: November 23, 2018
Article in press: November 24, 2018
Published online: December 26, 2018
Abstract
BACKGROUND

Fiberoptic bronchoscopic intubation is the gold standard for endotracheal intubation in difficult or compromised airway situations. However, oxygen insufflation through the working channel of a fiberscope is a controversial method because of the possibility of gastric distention and rupture during an awake fiberoptic bronchoscopic intubation, despite the advantages of preventing fogging of the fiberoptic bronchoscopic lens, blowing oral secretions away, and oxygenation of patients.

CASE SUMMARY

Here, we describe a case of cervical instability where we rapidly performed fiberoptic bronchoscopic intubation using oxygen insufflation through working channel of the broncoscopy to administer general anesthesia after two previous failures due to low visibility. A 50-year-old man with a non-specific medical history underwent emergency cervical spine surgery for posterior fusion of the C2 and C3 vertebrae. After two unsuccessful attempts at intubation using the fiberoptic broncoscopy, we performed it successfully using the oxygen insufflation via the working channel, instead of using suction to remove the secretion from the lens.

CONCLUSION

Oxygen insufflation via the working channel of the broncoscopy is a useful method for assisting with difficult intubation cases.

Keywords: Fiberscope, Fiberoptic intubation, Oxygen insufflation, Difficulty airway, Cervical instability, Case report

Core tip: Oxygen insufflation via the working channel is a useful method for assisting with prolonged and difficult fiberoptic intubations. However, we must carefully consider whether conditions are right before making a choice. Required conditions can be summarized as follows: (1) muscle relaxant must be administered to avoid “eating” oxygen; (2) a nasogastric tube must be inserted to reduce pressure in the stomach and to avoid accidental esophageal intubation; (3) cricoid pres sure must be applied to prevent the regurgitation of gastric contents; and (4) the oxygen flow must be used minimally to prevent possible barotrauma to the lung and other oral structures during the induction of anesthesia.