NAGPUR: The GMCH paediatric department has started conscious-sedation bronchoscopy (CSB) for kids suffering from prolonged, unexplained respiratory illnesses. The procedure is painless. Started in association with the paediatric surgery department, this is one of the first in all state-run medical colleges in Maharashtra to start this technique.
Unlike regular bronchoscopy under general anaesthesia, the scope is inserted in the airway to get real-time assessment, which is usually not possible when the patient is put on artificial support.
“Certain sounds or choking inside the airways remain undetected when general anaesthesia is given,” said Dr Abhishek Madhura, in-charge, paediatric respiratory clinic and associate professor, department of paediatrics at GMCH.
Dr Saira Merchant, head of the department, said, “GMCH being a tertiary care hospital gets very difficult cases. This technique will improve patient care and their outcome.” Dr Rajendra Saoji of paedrictic surgery department is also part of the initiative.
Recently, a couple of complex, rare cases were solved using CSB technique after doctors failed to pinpoint a specific reasons for the respiratory issues in two kids.
A two-year old-girl had been referred to Dr Madhura for recurrent pneumonia and stagnant body weight. The baby had also not been able to achieve any milestone after 6 months of age. “Normally pneumonia happens only once. If it is happening again, we need to investigate whether immune-deficiency or structural defect is causing it. We used CSB and found a laryngeal cleft because of which the acid from stomach was entering the lungs. This is called aspiration pneumonia,” said Dr Madhura.
He added that the saliva must go to the stomach but if there is a cleft, half of the fluid start entering the lungs. “Once the actual problem was known, the required treatment was started on her,” he said.
Another 3-year-old boy was referred to Dr Madhura as a case of difficult to treat asthma. “He had typical wheeze while breathing. His coughing would increase on starting inhalers,” he said.
With no respite even after a year of treatment, he was asked to go for a thorough investigation of the chest. “The CSB revealed teardrop bronchos. This is called bronchomalacia – a congenital disorder causing softening of the airways. Infections, TB or structural defects too can cause bronchomalacia. In this case, it was congenital,” said Dr Madhura.
In such case, if asthma medication is given the problem aggravates. “Asthma medication is given to relax the muscle, which in this case was already weak. The patient has to live with bonchomalacia and manage the condition with inhalers which tighten the airways,” he said.
Similarly, an 8-day-old baby couldn’t breathe from the nose due to blocked nose cavity. “I did CSB to visualise the vocal cords movement. Once it was confirmed that vocal cords are normal. The nose cavity was dilated. Baby was oxygen-dependent for 10 days but after the procedure he is breathing normally and is on mother’s feed,” he said.
Dr Madhura said these are rare cases and are not found in routine OPD. “But require specialist and correct line of investigation,” he said.
To detect anomalies, doctor needs to see airway dynamics or functioning when patient is self-breathing
On artificial support under general anaesthesia, natural breathing process is reversed thereby hiding anomaly
Upper airways, bronchomalacia, airway softening require the patient to be in self-breathing mode
Technique gives doctor a real-time situation inside the airway
Bronchoscopy under general anaesthesia requires technical expertise, blood tests, and radiological investigations and OT

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