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https://www.readbyqxmd.com/read/27907966/getting-rid-of-weakness-in-the-icu-an-updated-approach-to-the-acute-management-of-myasthenia-gravis-and-guillain-barr%C3%A3-syndrome
#1
Alexis A Lizarraga, Karlo J Lizarraga, Michael Benatar
After prompt diagnosis, severe myasthenia gravis and Guillain-Barré syndrome (GBS) usually require management in the intensive care unit. In the myasthenic patient, recognition of precipitating factors is paramount, and frequent monitoring of bulbar, upper airway, and/or respiratory muscle strength is needed to identify impending myasthenic crisis. Noninvasive ventilation can be attempted prior to intubation and mechanical ventilation in the setting of respiratory failure. Cholinesterase inhibitors should be discontinued, but resumed prior to extubation, and steroid dosage could be increased once the airway is secured...
December 2016: Seminars in Neurology
https://www.readbyqxmd.com/read/27899469/emergency-surgical-airways-following-activation-of-a-difficult-airway-management-team-in-hospitalized-critically-ill-patients-a-case-series
#2
REVIEW
Joseph M Darby, Gregory Halenda, Courtney Chou, Joseph J Quinlan, Louis H Alarcon, Richard L Simmons
INTRODUCTION: An emergency surgical airway (ESA) is widely recommended for securing the airway in critically ill patients who cannot be intubated or ventilated. Little is known of the frequency, clinical circumstances, management methods, and outcomes of hospitalized critically ill patients in whom ESA is performed outside the emergency department or operating room environments. METHODS: We retrospectively reviewed all adult patients undergoing ESA in our intensive care units (ICUs) and other hospital units from 2008 to 2012 following activation of our difficult airway management team (DAMT)...
November 28, 2016: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/27884557/laryngeal-trauma-following-an-inhalation-injury-a-review-and-case-report
#3
REVIEW
Gemma Hogg, Jay Goswamy, Sadie Khwaja, Nadeem Khwaja
The primary concern when managing a patient with inhalation injury is security of the airway. Airflow may be impeded by both edema of the upper airway and reduction of oxygen delivery to the lower respiratory tract. Although there has been much discussion regarding management of the latter, the focus of this article is the management of the former. This review aimed to determine the optimum management in burn victims with upper airway inhalation injury as an attempt to prevent laryngeal trauma leading to long-term voice disorders and upper airway dyspnea...
November 21, 2016: Journal of Voice: Official Journal of the Voice Foundation
https://www.readbyqxmd.com/read/27884026/-awake-video-laryngoscopy-an-alternative-to-awake-fiberoptic-intubation
#4
Jana Lohse, Rüdiger Noppens
INTRODUCTION: Awake video laryngoscopy is a novel option in airway management that is drawing more and more attention as an alternative to awake endoscopic guided intubation.Main issues: Intubation under preserved spontaneous breathing is the safest method to secure the expected difficult airway. In direct comparisons to awake flexible endoscopic intubation, awake video laryngoscopy achieves satisfactory intubation times and a high acceptance of patients and anesthesiologists. Specific cases, in particular very limited mouth opening or sub-glottic masses, require awake flexible endoscopic intubation...
November 2016: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
https://www.readbyqxmd.com/read/27882028/patient-specific-depth-of-endotracheal-intubation-from-anthropometry-to-the-touch-and-read-method
#5
Saecheol Oh, Seunguk Bang, Woojin Kwon, Jungwoo Shim
OBJECTIVE: Knowledge of accurate airway length (AL) enables safer placement of the endotracheal tube (ETT) in the trachea. Our objective was to check the safety of a new formula (Touch and Read method) to determine ETT depth. METHODS: AL was measured in 176 patients. Patients were divided into a normal group (AL >25 cm in men, >23 cm in women) and a risk group (AL ≤25 cm in men, ≤23cm in women). A control test (Conventional method) was performed in which the ETT was secured at a depth of 23 cm from the central incisor in men and 21 cm in women...
September 2016: Pakistan Journal of Medical Sciences Quarterly
https://www.readbyqxmd.com/read/27873529/tracheal-allotransplantation-and-regeneration
#6
P Delaere, M Molitor
Non-malignant and malignant obstruction of the tracheal airway causes significant morbidity and mortality. With increased use of artificial airways, benign and iatrogenic complications are increasing. A tracheal stenosis that is less than 5 cm in length can be resected with end-to-end anastomosis. Longer tracheal lesions can be treated in a palliative way by placement of a stent to secure airway lumen patency. The management of tracheal defects is an evolving field. Tracheal transplantation and tracheal regeneration may provide major treatment advances to cases with long-segment tracheal involvement...
2016: Acta Chirurgiae Plasticae
https://www.readbyqxmd.com/read/27871543/soft-palate-trauma-induced-during-glidescope-intubation
#7
Joseph P Allencherril, Linda Joseph
The GlideScope (GVL; Saturn Biomedical Systems, Burnaby, British Columbia, Canada) is a rigid indirect video laryngoscope device that facilitates exposure of the larynx for placement of the endotracheal tube. This blade also reduces the requirement for anterior displacement of the tongue. A unique feature is the acutely angled blade which provides an improved glottic view. Herein, we present 2 instances of soft palate trauma, a rare oropharyngeal complication linked to GlideScope use. In the first case, the GlideScope was used for pedagogical purposes for intubation in a knee surgery...
December 2016: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/27833500/c-mac-%C3%A2-video-laryngoscope-with-d-blade%C3%A2-and-frova-introducer-for-awake-intubation-in-a-patient-with-parapharyngeal-mass
#8
S Vinayagam, S Dhanger, P Tilak, R Gnanasekar
Parapharyngeal tumors are rare head and neck tumors which can present as an intraoral mass and can pose great challenge to anesthesiologists. The primary concern is the difficult airway due to gross anatomical distortion of the upper airway. Securing the airway in an awake state should be the primary goal of anesthesiologists to avoid catastrophic complications. Herewith, we report the successful use of C-MAC(®) video laryngoscope with the acute-angle D-BLADE™ in combination with Frova introducer for awake intubation in a patient with parapharyngeal mass after multiple attempts of failed fiber-optic intubation...
October 2016: Saudi Journal of Anaesthesia
https://www.readbyqxmd.com/read/27833492/submandibular-intubation-in-awake-patient-of-panfacial-trauma
#9
S K Kamra, H K Khandavilli, P Banerjee
Maxillofacial trauma patients present with airway problems. Submandibular intubation is an effective means of intubation to avoid tracheostomy for operative procedures. Airway is secured with oral endotracheal intubation in paralyzed patient and tube is then transplaced in sub mental or submandibular region. However there may be instances when paralyzing such trauma patients is not safe and short term tracheostomy is the only airway channel available for conduction of anesthesia. We report a case of submandibular intubation in awake patient of maxillofacial trauma with anticipated intubation problems...
October 2016: Saudi Journal of Anaesthesia
https://www.readbyqxmd.com/read/27832132/coordinated-respiratory-motor-activity-in-nerves-innervating-the-upper-airway-muscles-in-rats
#10
Satoshi Tachikawa, Kiyomi Nakayama, Shiro Nakamura, Ayako Mochizuki, Takehiko Iijima, Tomio Inoue
Maintaining the patency of the upper airway during breathing is of vital importance. The activity of various muscles is related to the patency of the upper airway. In the present study, we examined the respiratory motor activity in the efferent nerves innervating the upper airway muscles to determine the movements of the upper airway during respiration under normocapnic conditions (pH = 7.4) and in hypercapnic acidosis (pH = 7.2). Experiments were performed on arterially perfused decerebrate rats aged between postnatal days 21-35...
2016: PloS One
https://www.readbyqxmd.com/read/27828805/aspergilloma-of-the-lung-strategy-to-prevent-endobronchial-spillage
#11
Preety Mittal Roy, Sangeeta Khanna, Yatin Mehta, Ali Zamir Khan
Aspergilloma of the lung eroding into the airway may lead to perioperative endobronchial spillage and contamination of the normal lung. Our aim in this group of patients who are undergoing robotic- or video-assisted thoracoscopic lobectomy is to protect the contralateral lung and, if possible, uninvolved lobes of ipsilateral lung. Double-lumen endobronchial tubes do provide lung protection to the contralateral lung intraoperatively, but there is no protection to the ipsilateral lung lobes not involved by the disease process...
September 2016: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
https://www.readbyqxmd.com/read/27808401/continuous-ventilation-during-intubation-through-a-supraglottic-airway-device-guided-by-fiberoptic-bronchoscopy-a-observational-assessment
#12
H E Landsdalen, M Berge, F Kristensen, A B Guttormsen, E Søfteland
INTRODUCTION: supraglottic airway devices remain, despite advances in video laryngoscopy, important tools in the management of unexpected difficult airways. Intubation through a functioning supraglottic airway device with the aid of a fiberoptic bronchoscope is a well-known technique usually performed in apnoea. With a simple modification, the patient can be ventilated during this procedure. METHODS: In this observational study, Tracheal intubation Assisted by Bronchoscopy And Sad during Continuous Oxygenation (TABASCO) was performed as part of department training routine in 26 elective, fasted patients...
January 2017: Acta Anaesthesiologica Scandinavica
https://www.readbyqxmd.com/read/27749292/airway-management-of-a-3-year-old-child-with-a-penetrating-oropharyngeal-foreign-body-risking-vascular-injury
#13
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
https://www.readbyqxmd.com/read/27717508/rare-anatomical-variation-of-the-brachiocephalic-trunk-encountered-in-tracheostomy
#14
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
https://www.readbyqxmd.com/read/27700196/pediatric-blunt-neck-trauma-causing-esophageal-and-complete-tracheal-transection
#15
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
https://www.readbyqxmd.com/read/27692755/apnea-after-low-dose-ketamine-sedation-during-attempted-delayed-sequence-intubation
#16
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
https://www.readbyqxmd.com/read/27692621/use-of-king-vision-videolaryngoscope-in-an-unanticipated-difficult-airway-in-an-adult-patient-with-giant-vallecular-cyst-a-case-report
#17
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
https://www.readbyqxmd.com/read/27687404/fiberoptic-nasopharyngoscopy-for-evaluating-a-potentially-difficult-airway-in-a-patient-with-elevated-intracranial-pressure
#18
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
https://www.readbyqxmd.com/read/27684833/use-of-the-glidescope-video-laryngoscope-for-intubation-during-ex-utero-intrapartum-treatment-in-a-fetus-with-a-giant-cyst-of-the-4th-branchial-cleft-a-case-report
#19
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)
https://www.readbyqxmd.com/read/27678137/-simulation-based-training-and-or-apprenticeship-for-medical-students-a%C3%A2-prospective-randomized-single-blind-study-of-clinical-skills
#20
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
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