Children's bronchoscope - the wonderful journey of "Mirror"

Author: Zhao Zhihua Children's Hospital Affiliated to Chongqing Medical University

Illustration: Yang Mao Children's Hospital Affiliated to Chongqing Medical University

Reviewer: Niu Chao, Associate Researcher, Children's Hospital Affiliated to Chongqing Medical University

Hello everyone, I am a good helper in the diagnosis and treatment of children's respiratory diseases - bronchoscopy. You can call me "Jingjing". With the improvement of diagnosis and treatment technology of children's respiratory diseases, my application is becoming more and more extensive. Although I have been accepted by most parents, they are afraid of me because they lack understanding of me. Who am I? Why do children want to get to know me? How do I work? Will I cause harm to children? Today I will introduce myself to you in detail.

Figure 1 Copyright image, no permission to reprint

1. What am I? What is my role?

The trachea is an important respiratory passage for the human body. When children have respiratory diseases, in order to more accurately examine and treat the symptoms or diseases of the airway and the organs below, I, bronchoscopy, must be used. In order to adapt to the development of various symptoms or diseases, I am also constantly learning and improving. I am a "variable man" who can transform according to the different treatment needs of children!

2. Which children want to get to know me?

Children with the following symptoms or diseases may meet me.

(1) Unexplained hoarseness and cough.

(2) Recurrent or persistent wheezing.

(3) Recurrent respiratory tract infections.

(4) Suspected foreign body inhalation.

(5) Other diseases as required.

Children with the following symptoms or diseases should consider carefully when getting acquainted with me.

(1) Severe cardiopulmonary diseases.

(2) High fever: The child’s body temperature can be lowered to below 38.5°C before surgery to prevent febrile convulsions.

(3) Active severe hemoptysis.

(4) Severe malnutrition.

Figure 2 Copyright image, no permission to reprint

3. How do I work?

In fact, I am a flexible, thin mirror with a lens and a light source. My working principle is similar to the gastroscope that everyone is familiar with, but my body is thinner than the gastroscope. The thinnest diameter of the insertion part of my mirror body is 2.2 mm. It is a fiber bronchoscope without a working channel. The insertion part of the commonly used bronchoscope with a working channel has a diameter of 2.8 to 4.9 mm, and the working channel diameters are 1.2 mm and 2.0 mm, respectively. I will slim down or gain weight according to the age group and physical development of the children: generally, diameters ≤3.0 mm are suitable for all age groups, and diameters 4.0 to 4.9 mm are suitable for children over 1 year old. This ensures that the mirror body can smoothly pass through the nasal cavity and glottis into the lower respiratory tract to complete various examinations and treatments.

After the child has completed the preoperative preparation, the anesthesiologist will use anesthesia technology to make the child fall asleep instantly. At this time, the nurse will give the child oxygen, cover the eyes with gauze to prevent oral and nasal secretions from flowing into the eyes, and apply lubricant to the child's nose; the doctor gently inserts me into the child's nasal cavity to diagnose and treat lung, tracheal and bronchial lesions. The doctor can visually see the lesions of the child's trachea and bronchus through the display screen, and perform corresponding examinations and treatments based on the lesions. When the child wakes up, the examination is complete. The doctor will observe the condition throughout the process to ensure the safety of the child. In this way, it is not as scary as you imagined.

4. Will I cause harm to the children?

First of all, my work needs to be evaluated by doctors and anesthesiologists in many aspects; the whole process is performed under general anesthesia. The current anesthesia method can shorten the examination time, anesthesia time and awakening time, which is beneficial to protect the cardiopulmonary function of children and has good safety. It is also rare for children to have adverse reactions after contact with me.

5. What do the children need to do before and after I work?

Preoperative preparation:

(1) Before the operation, the doctor will explain to the parents the purpose, specific methods and precautions of bronchoscopy for their children.

(2) Assess the child's condition, vital signs, blood routine, blood biochemistry, blood type, coagulation function, related infectious disease examinations, electrocardiogram, chest CT or X-ray, etc.

(3) Older children are prohibited from drinking water 2 hours before surgery and eating fat solid foods 8 hours before surgery; infants who need to be breastfed are prohibited from eating for 4 hours; and milk, formula milk, and starch solid foods are prohibited for 6 hours.

Figure 3 Copyright image, no permission to reprint

Postoperative precautions:

(1) After the operation, the medical staff will send the child to the recovery room for oxygen inhalation and ECG monitoring, and will promptly communicate the child's condition to the parents; observe for 10 to 15 minutes, and send the child back to the ward after the child wakes up, and continue to monitor vital signs and observe changes in the condition.

(2) After the operation, the child should try not to cough too hard and observe whether he or she has drug allergy, breathing difficulties, suffocation, laryngeal spasm or bronchial spasm, fever, chest pain, chest tightness, hemoptysis, etc.

(3) Children need to fast for 2 to 3 hours after surgery. They should try drinking a small amount of warm water first. They can eat warm liquid food or soft food only after they stop choking. They can eat normally on the second day.

Compared with chest X-rays, CT and other imaging examinations, doctors can transmit images to the screen through the lens at the front of my device, directly observe the manifestations of upper respiratory tract (nasal cavity, pharynx, glottis) and lower respiratory tract (trachea, bronchus) lesions in children, perform various necessary biopsies (clamping, brushing, lavage, puncture, etc.) and pathogen culture, and complete the diagnosis of lesions. With my help, not only can sputum and foreign bodies that cannot be discharged by themselves in the trachea be sucked out, airway stents be inserted, airway stenosis be expanded, local injections be performed, tumors be removed and chemotherapy be performed, but also lesions that are invisible under chest CT can be found and treated early.

Okay, that’s the end of my self-introduction. I hope that through my introduction more parents and children will get to know me better and no longer be “afraid” of me!

References

[1] Pediatric respiratory endoscopy diagnosis and treatment technology expert group of the National Health Commission Talent Exchange Service Center. Chinese Pediatric Flexible Bronchoscopy Guidelines (2018 Edition)[J]. Chinese Journal of Practical Pediatrics, 2018, 33(13):983-989.

[2] Yuan Lina, Zhang Yuge. Application effect of nursing process management in fiberoptic bronchoscopy and its impact on the success rate of examination[J]. Clinical Medical Research and Practice, 2022, 7(32): 163-165.

[3] Wang Chunhong, Xie Junjie. Effects of midazolam combined with dexmedetomidine on anesthetic effect and myocardial and pulmonary function in children undergoing bronchoscopy[J]. Northern Pharmacy, 2021, 18(11): 50-52.