A Knauth1, M Weiss, M Dave, A Frotzler, T Haas. 1. Abteilung Anästhesie, Universitäts-Kinderkliniken Zürich, Steinwiesstr. 75, 8032 Zürich, Schweiz. axel.knauth@kispi.uzh.ch
Abstract
BACKGROUND: The use of a flexible or rigid fiberoptic bronchoscope belongs to the standard repertoire in anesthesiology. Besides a lack of training these procedures may be considerably compromised by endoscopic lens fogging. Several antifogging approaches are commercially available but to date no controlled studies regarding the efficacy of these devices in bronchoscopes exists. The aim of the present study was to compare the efficacy of different commercially available anti-fogging techniques for rigid and flexible bronchoscopes. MATERIALS AND METHODS: The study was performed at the department of anesthesia in a university children's hospital. An artificial airway model was created to simulate in vivo conditions with respect to airflow, temperature and atmospheric moisture. A test picture was inserted into the artificial airway for assuring a standardized view through the bronchoscopes. Antifogging efficacy of two liquid antifog solutions (Ultrastop and Anti-Fog), two antifog wipes (Lina Clear and Reso Clear) and an induction endoscope preheater system (used after one and two induction preheating phases) was assessed by video taping of the bronchoscope view of the test picture. In addition the administration of continuous oxygen airflow of 2 l min⁻¹ through the suction channel of the flexible bronchoscope was tested as an alternative method to prevent lens fogging. All final pictures were rated by 10 staff anesthesiologists who were blinded to the antifog devices used. To assess the clinical relevance of the results, ratings were classified into a 5 grade rating scale (ranging from no visualization of any structure to excellent endoscopic view allowing safe endotracheal intubation). In addition, the failure rate of each anti-fog technique was calculated. RESULTS: A total of 300 endoscopic test pictures were taken and assessed. Using the flexible bronchoscope, the use of anti-fog solution (failure rate 3 %) and Lina Clear wipes (failure rate 4%) showed the best results. In the rigid bronchoscope group Ultrastop solution (failure rate 5 %) and Lina Clear wipes (failure rate 3.5 %) showed superior results. The two-time use of the endoscope preheater system was effective using flexible (failure rate 6 %) and rigid bronchoscopes (failure rate 10 %). The application of a continuous oxygen flow of 2 l/min failed to provide a clear endoscopic view (failure rate 93.5 %). CONCLUSIONS: All commercially available antifog liquids and wipes showed slightly different reduction of lens fogging. However, other factors such as frequency of usage, the type of endoscope, hygiene properties as well as cost-effectiveness might have a substantial impact on the comparison of all tested anti-fog devices. The use of an endoscope preheater system might be a conceivable alternative method to reduce lens fogging despite the higher initial cost. However, the multiple use of the preheater system cannot be recommended at present as additional handling procedures to ensure an appropriate but safe temperature of the endoscopic tip should be provided by the manufacturer. Application of a continuous oxygen flow was shown not to be effective in preventing lens fogging using a flexible fiberoptic bronchoscope.
BACKGROUND: The use of a flexible or rigid fiberoptic bronchoscope belongs to the standard repertoire in anesthesiology. Besides a lack of training these procedures may be considerably compromised by endoscopic lens fogging. Several antifogging approaches are commercially available but to date no controlled studies regarding the efficacy of these devices in bronchoscopes exists. The aim of the present study was to compare the efficacy of different commercially available anti-fogging techniques for rigid and flexible bronchoscopes. MATERIALS AND METHODS: The study was performed at the department of anesthesia in a university children's hospital. An artificial airway model was created to simulate in vivo conditions with respect to airflow, temperature and atmospheric moisture. A test picture was inserted into the artificial airway for assuring a standardized view through the bronchoscopes. Antifogging efficacy of two liquid antifog solutions (Ultrastop and Anti-Fog), two antifog wipes (Lina Clear and Reso Clear) and an induction endoscope preheater system (used after one and two induction preheating phases) was assessed by video taping of the bronchoscope view of the test picture. In addition the administration of continuous oxygen airflow of 2 l min⁻¹ through the suction channel of the flexible bronchoscope was tested as an alternative method to prevent lens fogging. All final pictures were rated by 10 staff anesthesiologists who were blinded to the antifog devices used. To assess the clinical relevance of the results, ratings were classified into a 5 grade rating scale (ranging from no visualization of any structure to excellent endoscopic view allowing safe endotracheal intubation). In addition, the failure rate of each anti-fog technique was calculated. RESULTS: A total of 300 endoscopic test pictures were taken and assessed. Using the flexible bronchoscope, the use of anti-fog solution (failure rate 3 %) and Lina Clear wipes (failure rate 4%) showed the best results. In the rigid bronchoscope group Ultrastop solution (failure rate 5 %) and Lina Clear wipes (failure rate 3.5 %) showed superior results. The two-time use of the endoscope preheater system was effective using flexible (failure rate 6 %) and rigid bronchoscopes (failure rate 10 %). The application of a continuous oxygen flow of 2 l/min failed to provide a clear endoscopic view (failure rate 93.5 %). CONCLUSIONS: All commercially available antifog liquids and wipes showed slightly different reduction of lens fogging. However, other factors such as frequency of usage, the type of endoscope, hygiene properties as well as cost-effectiveness might have a substantial impact on the comparison of all tested anti-fog devices. The use of an endoscope preheater system might be a conceivable alternative method to reduce lens fogging despite the higher initial cost. However, the multiple use of the preheater system cannot be recommended at present as additional handling procedures to ensure an appropriate but safe temperature of the endoscopic tip should be provided by the manufacturer. Application of a continuous oxygen flow was shown not to be effective in preventing lens fogging using a flexible fiberoptic bronchoscope.