Awake intubation with videolaryngoscopy and fiberoptic bronchoscope

Difficult intubation in ENT patient: Simultaneous videolaryngoscopy with flexible bronchoscopy. A combined approach. Case report

INTRODUCTION

Difficult intubation is the situation when a skilled anesthetist has difficulties to manage airway using face mask, laryngoscopy, supraglottic device, tracheal intubation, surgery. Videolaryngoscope and flexible fibroscope (FFS) represent valid alternatives for difficult airway management, with some limitations. However, literature lacks of studies about the efficacy of the combined use of videolaryngoscope and FFS.

CASE REPORT

We report a case of a man, with glottic lesion, who needs surgery under general anesthesia. Anesthesiologic pre-operative evaluation revealed that he's a difficult intubation case. So, in a supine position, intubation was performed on first attempt by videolaryngoscope combined with FFS. On post-op, no signs of injuries due to intubation have been found.

DISCUSSION

In 2022, the American Society of Anesthesiologists defined the guidelines to manage difficult intubation: based on patient' anatomical and clinical feature and anesthetist' skills, several intubation procedures could be used. Each procedure has pros and cons.

CONCLUSION

It's the first case of anticipated difficult intubation in adult man that was intubated under general anesthesia by using videolaryngoscope combined with FFS. We demonstrated that this procedure is safe and useful in case of difficult airway and recommended in case of laryngeal lesions that hinder the visualization of glottic plane.

The Effectiveness of Supportive Psychotherapy on the Anxiety and Depression Experienced by Patients Receiving Fiberoptic Bronchoscope

Objectives

As the largest cohort of healthcare workers and nurses can practice as psychotherapists to integrate the psychotherapeutic interventions as part of routine care. The present study aims to evaluate the effectiveness of supportive psychotherapy (SPT) on patients who had been scheduled to undergo a fiberoptic bronchoscopy (FOB) procedure.

Methods

This study retrospectively analyzed 92 patients who underwent FOB, which was divided into the SPT group and usual-care group based on whether patients were given SPT interventions or not. The Patient Health Questionnaire-9 (PHQ-9) and Hospital Anxiety and Depression Scale (HADS) were used to determine the severity of depression and anxiety, as well as the 36-Item Short-Form Health Survey questionnaire (SF-36) to evaluate the health-related quality of life (HRQoL). Moreover, the patients' satisfaction was assessed based on the Likert 5-Point Scale.

Results

The baseline status of anxiety, depression, and HRQoL in patients was similar in the SPT group and the usual-care group with no significant difference. Both PHQ-9 score and HADS-D score in the SPT group after intervention were lower than that in the usual-care group, accompanied by the deceased HADS-A subscale. Moreover, the improved HRQoL was found in the patients undergoing FOB after SPT interventions as compared to those receiving conventional nursing care using the SF-36 score. Additionally, the patient satisfaction in the SPT group was higher than in the usual-care group.

Conclusions

The study demonstrated that anxiety and depression, as negative emotions, can be reduced by supportive psychotherapy in patients receiving FOB with improved mental health and satisfaction with nursing care.