Background-In recent years, flexible fiberoptic bronchoscopy (FFB) has been applied for diagnostic and therapeutic purposes. Premedication along with the passage of FFB into the airway, even in the presence of supplemental oxygen, may cause hypoventilation leading to hypoxia and desaturation. Arterial oxygen saturation is usually monitored with pulse oximetry (Spo2) during FFB; END-tidal Pco2 (ET-Pco2) monitoring is not routinely used. Methods-Two-hundred patients, ages 53±19 years (mean±SD), underwent FFB and received supplemental oxygen during various stages of FFB: 1-before and during instillation of lidocaine on the vocal cords, 2-during passage of instrument into the trachea, RMB, IMB, 3-during bronchoalveolar lavage, bronchial biopsy, transbronchial biopsy (TBB), and 4-at the final stages of FFB. ET-Pco2 changes were studied with a capnograph and Spo2 using a pulse oximeter simultaneously and the results were recorded. Results-Mean ET-Pco2 significantly decreased from 28.7±4.5 mmHg before FFB to 28±5.7 mmHg, 27.9±5.5 mmHg, 27.5±5.6 mmHg, 27.1±4.5 mmHg, 27.9±5.3 mmHg during bronchoscopy of the right main bronchus (RMB), left main bronchus (LMB), bronchial washing, bronchial biopsy and transbronchial biopsy (TBB), and at the termination of FFB, respectively (p<0.05). In 118 patients (59%), the decrease of ET-Pco2 was equal to or greater than 4 mmHg; in 105 patients (52.5%) the amount of decrease in Spo2 was  5% and in 32 patients (16%), Spo2 decreased  10%. No correlation was found between decreasing ETPco2 and Spo2 during the procedure. Conclusion- ET-Pco2 and Spo2 decreased during bronchoscopy. We also speculate that this reflects airway obstruction by the instrument. Further studies and more experimental analysis in this field is recommENDed

Cost-effectiveness analysis (CEA), as a system of allocative efficiency for global health programs, is an influential criterion for resource allocation in the context of diplomacy and inherent foreign policy decisions therein. This is because such programs have diplomatic benefits and costs that can be uploaded from the recipient and affect the broader foreign policy interests of the donor and the diplomacy landscape between both parties. These diplomatic implications are vital to the long-term success of both the immediate program and any subsequent programs; hence it is important to articulate them alongside program performance, in terms of how well their interrelated interventions were perceived by the communities served. Consequently, the exclusive focus of cost-effectiveness on medical outcomes ignores (1) the potential non-health benefits of less cost-effective interventions and (2) the potential of these collateral gains to form compelling cases across the interdisciplinary spectrum to increase the overall resource envelope for global health. The assessment utilizes the Kevany Riposte’s "K-Scores" methodology, which has been previously applied as a replicable evaluation tool1 and assesses the trade-offs of highly cost-effective but potentially "undiplomatic" global health interventions. Ultimately, we apply this approach to selected HIV/AIDS interventions to determine their wider benefits and demonstrate the value alternative evaluation and decision-making methodologies. Interventions with high "K-Scores" should be seriously considered for resource allocation indepENDent of their cost-effectiveness. "Oregon Plan" thresholds2 are neither appropriate nor enforceable in this regard while "K-Score" results provide contextual information to policy-makers who may have, to date, considered only cost-effectiveness data. While CEA is a valuable tool for resource allocation, its use as a utilitarian focus should be approached with caution. Policy-makers and global health program managers should take into account a wide range of outcomes before agreeing upon selection and implementation.