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Airway securement

Jenny Feldman Eskildsen, Brian D Thorp, Hemanth A Baboolal
Management of anesthesia for a child with an upper airway foreign body is fraught with particular challenges. We present the case of a 3-year-old girl who presented to the emergency department with a 12-cm sewing needle protruding from her mouth and unknown vascular involvement. We were faced with establishing a secure airway despite exclusion of mask ventilation or use of a laryngeal mask airway. Moreover, peripheral intravenous access was lost before adequate sedation. Ultimately, we were able to safely induce anesthesia and achieve endotracheal intubation...
October 5, 2016: A & A Case Reports
Heike Huempfner-Hierl, Thomas Hierl, Dirk Halama
Tracheostomy is a common procedure in head and neck surgery and emergency medicine to secure a patent airway. Surgeons should always be aware of anatomical variants of the branches of the aortic arch, which could lead to life-threatening complications. Open tracheostomy is the safest emergency procedure.
October 4, 2016: British Journal of Oral & Maxillofacial Surgery
Benjamin Nicholson, Harinder Dhindsa, Louis Seay
BACKGROUND: Blunt injuries to the cervical trachea remain rare but present unique and challenging clinical scenarios for prehospital providers. These injuries depend on prehospital providers either definitively securing the injured airway or bridging the patient to a treatment facility that can mobilize the necessary resources. CASE SUMMARY: The case presented here involves a clothesline injury to a pediatric patient that resulted in complete tracheal transection and partial esophageal transection...
October 4, 2016: Prehospital Emergency Care
Brian E Driver, Robert F Reardon
Some patients are agitated and unable to tolerate conventional preoxygenation methods, including face mask oxygen or noninvasive positive-pressure ventilation. Sedation with ketamine for preoxygenation, also known as delayed sequence intubation, is a technique that can be used to achieve preoxygenation in this patient population. No complications of delayed sequence intubation have previously been reported. A 60-year-old woman presented with acute hypoxic respiratory failure. Despite application of high-flow oxygen (60 L/min) with a nonrebreather face mask, her oxygen saturation remained at 93%...
September 27, 2016: Annals of Emergency Medicine
L España Fuente, P de la Rica Fernández, J L González González
Laryngeal cysts are largely asymptomatic and typically described in the context of incidental discovery on routine laryngoscopy. These cysts, in adults are even rarer and can have catastrophic consequences in an anaesthetized patient if airway management is inappropriate. We describe a case of difficult endotracheal intubation and the treatment of an adult patient with an asymptomatic, giant vallecular cyst that was discovered during rapid-sequence induction of general anesthesia in urgent surgery. In conclusion, vallecular cysts can cause extreme problems in securing the airway...
September 27, 2016: Revista Española de Anestesiología y Reanimación
Lakshmi N Kurnutala, Gurneet Sandhu, Sergio D Bergese
A 62-year-old man with a left temporal lobe tumor was scheduled for a semiurgent craniotomy for tumor excision. Previously, the patient had a laryngeal carcinoma that was resected and treated with chemotherapy and radiotherapy and a history of laryngeal biopsy with awake fiberoptic intubation. Because a difficult airway was anticipated, awake fiberoptic nasopharyngoscopy of the airway was performed under topical anesthesia in the operating room. This revealed a narrow glottic opening with no supraglottic pathology or friable tissue...
November 2016: Journal of Clinical Anesthesia
Sung Hye Byun, So Young Lee, Seong Yeon Hong, Taeha Ryu, Baek Jin Kim, Jin Yong Jung
INTRODUCTION: In fetuses who are predicted to be at risk of catastrophic airway obstruction at delivery, the ex utero intrapartum treatment (EXIT) procedure is useful for securing the fetal airway while maintaining fetal oxygenation via placental circulation. Factors, including poor posture of the fetus and physician, narrow visual field, and issues of contamination in the aseptic surgical field, make fetal intubation during the EXIT procedure difficult. Herein, we report our experience of the usefulness of the GlideScope video laryngoscope (GVL) for intubation during the EXIT procedure...
September 2016: Medicine (Baltimore)
T Ott, I Schmidtmann, T Limbach, P F Gottschling, H Buggenhagen, S Kurz, G Pestel
BACKGROUND: Simulation-based training (SBT) has developed into an established method of medical training. Studies focusing on the education of medical students have used simulation as an evaluation tool for defined skills. A small number of studies provide evidence that SBT improves medical students' skills in the clinical setting. Moreover, they were strictly limited to a few areas, such as the diagnosis of heart murmurs or the correct application of cricoid pressure. Other studies could not prove adequate transferability from the skills gained in SBT to the patient site...
September 27, 2016: Der Anaesthesist
Ian Yuan, Benjamin B Bruins, Eleanor P Kiell, Luv R Javia, Jorge A Galvez
Awake tracheostomy is indicated for acute upper airway obstruction, when other methods of securing the airway, such as intubation and cricothyrotomy, have failed or are inappropriate. This option is rarely considered in pediatrics because of the concerns of patient cooperation and safety and has not been described in the literature. We describe the anesthetic management of an awake tracheostomy performed on a 7-year-old girl, with a large supraglottic mass obstructing the laryngeal introitus.
September 23, 2016: A & A Case Reports
Moussa Riachy, Samer Najem, Mirella Iskandar, Jad Choucair, Ihab Ibrahim, Georges Juvelikian
PURPOSE: Obstructive sleep apnea (OSA) is associated with a range of neurocognitive and cardiovascular complications, leading to a compromised quality of life. Continuous positive airway pressure (CPAP) is the gold standard therapeutic intervention for this disorder, yet patient compliance remains essential to its success. This study aimed at identifying the determinants of short-term and long-term CPAP adherence in a group of Lebanese patients. METHODS: This cross-sectional study, conducted at the Sleep Center of Hôtel-Dieu de France hospital in Lebanon, included patients diagnosed with OSA and treated with CPAP for at least one night between June 2008 and January 2015...
September 16, 2016: Sleep & Breathing, Schlaf & Atmung
Ali Jalali, Mohamed Rehman, Arul Lingappan, C Nataraj
This paper is concerned with the mathematical modeling and detection of endotracheal (ET) intubation in children under general anesthesia during surgery. In major pediatric surgeries, the airway is often secured with an endotracheal tube (ETT) followed by initiation of mechanical ventilation. Clinicians utilize auscultation of breath sounds and capnography to verify correct ETT placement. However, anesthesia providers often delay timely charting of ET intubation. This latency in event documentation results in decreased efficacy of clinical decision support systems...
November 2016: Journal of Dynamic Systems, Measurement, and Control
M B Avnstorp, P V F Jensen, T Dzongodza, N Matinhira, C Chidziva, J Melchiors, C Von Buchwald
BACKGROUND: In developing countries with limited access to ENT services, performing emergency cricothyroidotomy in patients with upper airway obstruction may be a life-saving last resort. An established Danish-Zimbabwean collaboration of otorhinolaryngologists enrolled Zimbabwean doctors into a video-guided simulation training programme on emergency cricothyroidotomy. This paper presents the positive effect of this training, illustrated by two case reports. CASE REPORTS: A 56-year-old female presented with upper airway obstruction due to a rapidly progressing infectious swelling of the head and neck progressing to cardiac arrest...
September 9, 2016: Journal of Laryngology and Otology
Praveer K Banerjee, Abhineet Jain, Bikram Behera
BACKGROUND AND AIMS: Airway management in anaesthesia for maxillofacial surgical procedures is tricky at times when the nasal/oral routes are contraindicated or are impossible. Tracheostomy as an alternative inherits its own complications. We present a case series of the submandibular route for tracheal intubation as an alternative. METHODS: The procedure was performed in ten selected adult patients with maxillofacial/mandibular fractures associated with a fracture of skull base or nasal bone...
August 2016: Indian Journal of Anaesthesia
Azho Kezo, Rajendra D Patel, Shraddha Mathkar, Sonal Butada
BACKGROUND: We report the management of two patents from the Indian subcontinent with extrahepatic portal vein obstruction presenting with anticipated difficult airway. A Macintosh blade was used to secure the airway after using various instruments designed for difficult airway. To the best of our knowledge, no case has previously been reported in which a Macintosh blade was used successfully in patients with extrahepatic portal vein obstruction with a difficult airway. CASE PRESENTATION: Two women (case 1 and case 2) of South Asian ethnicity with extrahepatic portal vein obstruction presented for an elective splenorenal shunt...
2016: Journal of Medical Case Reports
Stacey Watt, Jonathan Kalpan, Venkatesware Kolli
INTRODUCTION: The use of videolaryngoscopy continues to play a larger role in the approach to patients with airway pathology. Looking specifically at patients with potential difficulty in ventilation and intubation due to thyroid goiter, video laryngoscopy may provide a faster and easier technique to secure the airway compared to direct laryngoscopy. PRESENTATION OF CASE: In the case we will present to you, a 60-year-old female with a large goiter presented to a community hospital emergency room where she was found to be in respiratory distress with increased work of breathing...
2016: International Journal of Surgery Case Reports
S N Rogers, L Russell, D Lowe
A temporary tracheostomy is commonly done in patients who have reconstruction after the ablation of advanced oral cancer to provide easy access to a secure airway in case a haematoma forms or the patient needs a return to theatre. Although relatively simple to do, we know little about the patients' experience, and to find out, we designed a three-stage study. First, we conducted semi-structured interviews to identify items related to the functional, emotional, and social impacts of the tracheostomy, on the ward and on removal (n=15 patients)...
September 2, 2016: British Journal of Oral & Maxillofacial Surgery
Kati Knudsen, Ulrica Nilsson, Marieann Högman, Ulrika Pöder
BACKGROUND: Awake fiberoptic intubation is an alternative procedure for securing the airway and is a recommended option when a difficult airway is expected. The aim of the present study was to describe patient experiences with this procedure. METHODS: A qualitative, descriptive design was used and patients were recruited from three county hospitals and one university hospital in Sweden. Data was collected by semi-structured interviews with 13 patients who underwent awake fiberoptic intubation...
2016: BMC Anesthesiology
Ramiro Mireles, Ravinder Devgun, Blake Tucker, Timothy Votta, Prabhdeep Chahal, Robert Ramsdell, Christopher Heard
The laryngeal mask airway (LMA) has been used successfully for an ever-increasing number of applications. Utilization in oral maxillofacial surgery has been hampered by surgical difficulties working around the device. In this case series, a novel device, the LMA-PROP, was used to determine whether it was possible to alleviate device-positioning concerns with third molar extraction cases. LMA-PROP was used with both anesthesia and surgical satisfaction in this small pilot study. LMA-PROP appears to be a helpful new tool allowing the surgeon to maintain current surgical techniques for third molar extraction while securing LMA adequately for anesthesia maintenance...
August 29, 2016: Anesthesia and Analgesia
Tetsuya Yumoto, Tatsushi Matsumura, Kohei Tsukahara, Keiji Sato, Toyomu Ugawa, Yoshihito Ujike
INTRODUCTION: Cricothyroidotomy is an emergency procedure that can be used to secure the airway in situations in which intubation and ventilation are not possible. PRESENTATION OF CASE: We describe a case of 79-year-old male presenting with facial trauma combined with massive upper airway bleeding and swelling in which cricothyroidotomy was required to open the airway in an elderly male patient taking antiplatelet agents who suffered a simple ground-level fall. DISCUSSION: Although emergency airway management is often required in patients with Le Fort fractures, mandibular condyle fractures exhibit a significant relationship with ground-level falls, which are not usually associated with emergency airway management...
2016: International Journal of Surgery Case Reports
R Kamal Kanthan
AIM: (1) To assess the feasibility, safety, and effectiveness of superficial cervical plexus (SCP) block in oral and maxillofacial surgical (OMFS) practice as an alternative to general anesthesia in selective cases. (2) To assess any associated complication specifically related to the procedure. SUBJECTS AND METHODS: The total number of patients was 10, out of which 6 were male and 4 were female patients. Six patients had incision and drainage of perimandibular space infections, two patients had Level Ib cervical lymph node biopsies, one patient had enucleation of cyst in the body of mandible, one patient had open reduction and internal fixation isolated angle fracture...
January 2016: Annals of Maxillofacial Surgery
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