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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
#1
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/27884665/airway-management-for-cesarean-delivery-performed-under-general-anesthesia
#2
S Rajagopalan, M Suresh, S L Clark, B Serratos, S Chandrasekhar
BACKGROUND: With the increasing popularity of neuraxial anesthesia, there has been a decline in the use of general anesthesia for cesarean delivery. We sought to examine the incidence, outcome and characteristics associated with a failed airway in patients undergoing cesarean delivery under general anesthesia. METHODS: A retrospective review of airway management in women undergoing cesarean delivery under general anesthesia over an eight-year period from 2006-2013 at an academic medical center was conducted...
October 27, 2016: International Journal of Obstetric Anesthesia
https://www.readbyqxmd.com/read/27871589/trainee-experience-and-success-of-urgent-airway-management
#3
Thomas E Schulte, Kyle J Ringenberg, Steven J Lisco, Harlan Sayles, Sasha K Shillcutt
BACKGROUND: There are limited data regarding emergent, non-operating room, intubations performed by all levels of anesthesia residents. This study was a large retrospective review of all non-operating room emergent intubations performed at a single tertiary medical center. The study evaluated the rate of difficult intubations by level of resident training, compared success rates for direct versus video laryngoscopy and evaluated the rate and success of rescue video laryngoscopy following failed direct laryngoscopy...
December 2016: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/27871535/lingual-tonsil-hypertrophy-rescuing-the-airway-with-videolaryngoscopy
#4
Fouad Ghazi Souki, Shweta Rahul Yemul-Golhar, Yosaf Zeyed, Ernesto A Pretto
Lingual tonsils are lymphatic tissues located at the base of the tongue that may hypertrophy causing difficulty and sometimes inability to ventilate or intubate during anesthesia. Routine airway assessment fails to diagnose lingual tonsil hypertrophy. There is limited experience with use of videolaryngoscopy in cases of lingual tonsil hypertrophy. We present a case of difficult airway due to unanticipated lingual tonsil hypertrophy successfully managed by atypical video laryngoscope positioning.
December 2016: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/27871527/two-lost-airways-and-one-unexpected-problem-undiagnosed-tracheal-stenosis-in-a-morbidly-obese-patient
#5
Miguel A Cobas, Nicole D Martin, Heather B Barkin
Anesthetic care of the morbidly obese is complex due to anatomic and physiologic alterations. Airway management in particular can be challenging. High body mass index is predictive of difficult ventilation and possibly difficult intubation. Other airway anomalies, such as tracheal stenosis, add to the complexity of airway management. Tracheal stenosis, a form of central airway obstruction, may be challenging to diagnose, especially in the obese. Comorbidities can mask the diagnosis and routine imaging may fail to identify the pathology...
December 2016: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/27870588/assessment-of-paramedic-performance-on-difficult-airway-simulation
#6
Ashish R Panchal, Geoffrey Finnegan, David P Way, Thomas Terndrup
OBJECTIVE: Airway management is a common, important intervention for critically ill patients in the United States. A key element of prehospital airway management is endotracheal intubation (ETI). Prehospital ETI success rates have been shown to be as low as 77% compared to in-hospital rates of 95%. Given these rates, the use of backup airway devices is a necessary precaution for patient safety. The extent to which paramedics integrate backup airway use into their airway algorithm is unknown...
November 21, 2016: Prehospital Emergency Care
https://www.readbyqxmd.com/read/27867577/when-continuous-positive-airway-pressure-cpap-fails
#7
REVIEW
Jagdeep S Virk, Bhik Kotecha
Obstructive sleep apnoea (OSA) is increasingly prevalent, particularly in the context of the obesity epidemic, and is associated with a significant social, health and economic impact. The gold standard of treatment for moderate to severe OSA is continuous positive airway pressure (CPAP). However compliance rates can be low. Methodology to improve patient tolerance to CPAP alongside with alternative, non-surgical and surgical, management strategies are discussed. All patients that fail CPAP therapy would benefit from formal upper airway evaluation by the otolaryngologist to identify any obvious causes and consider site-specific surgical therapies...
October 2016: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/27836871/patient-safety-events-in-out-of-hospital-paediatric-airway-management-a-medical-record-review-by-the-csi-ems
#8
Matthew Hansen, Garth Meckler, William Lambert, Caitlin Dickinson, Kathryn Dickinson, Joshua Van Otterloo, Jeanne-Marie Guise
OBJECTIVE: To describe the frequency and characterise the nature of patient safety events in paediatric out-of-hospital airway management. METHODS: We conducted a retrospective cross-sectional medical record review of all 'lights and sirens' emergency medicine services transports from 2008 to 2011 in patients <18 years of age in the Portland Oregon metropolitan area. A chart review tool (see online supplementary appendix) was adapted from landmark patient safety studies and revised after pilot testing...
November 11, 2016: BMJ Open
https://www.readbyqxmd.com/read/27830584/inhaled-corticosteroids-with-combination-inhaled-long-acting-beta2-agonists-and-long-acting-muscarinic-antagonists-for-chronic-obstructive-pulmonary-disease
#9
REVIEW
Daniel J Tan, Clinton J White, Julia Ae Walters, E Haydn Walters
BACKGROUND: Management of chronic obstructive pulmonary disease (COPD) commonly involves long-acting bronchodilators including beta-agonists (LABA) and muscarinic antagonists (LAMA). In individuals with persistent symptoms or frequent exacerbations, inhaled corticosteroids (ICS) are also used. LABA and LAMA bronchodilators are now available in single combination inhalers. However, the benefits and risks of adding ICS to combination LABA/LAMA inhalers remains unclear. OBJECTIVES: To assess the effect of adding an inhaled corticosteroid (ICS) to combination long-acting beta₂-agonist (LABA)/long-acting muscarinic antagonist (LAMA) inhalers for the treatment of stable COPD...
November 10, 2016: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/27829720/an-encounter-with-enalapril-induced-resistant-life-threatening-angioedema-at-rural-health-center-in-botswana
#10
Nikhil Anish, Abiy Mulugeta Gabremedhin
Angioedema, a rare, potentially fatal and usually self-limiting adverse effect of therapy with enalapril, is always a challenging encounter for an intensive care specialist in a rural setup. Here, we present a 74-year-old female, who presented to the Emergency Department of Sekgoma Memorial Hospital, Serowe village, Botswana, with progressive swelling of her face, tongue and breathing difficulty just 2 days after starting tablet enalapril. She failed to respond to usual treatment with adrenaline, steroids, and H1-antihistaminic agent, but she responded well with intravenous fresh-frozen plasma infusion...
October 2016: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/27810015/pediatric-obstructive-sleep-apnea
#11
REVIEW
Zarmina Ehsan, Stacey L Ishman
Screening for obstructive sleep apnea (OSA) with in-laboratory polysomnography is recommended for children with sleep disordered breathing. Adenotonsillectomy is the first-line therapy for pediatric OSA, although intranasal steroids and montelukast can be considered for those with mild OSA and continuous positive airway pressure for those with moderate to severe OSA awaiting surgery, poor surgical candidates or persistent OSA. Bony or soft tissue upper airway surgery is reasonable for children failing medical management or those with persistent OSA following adenotonsillectomy...
December 2016: Otolaryngologic Clinics of North America
https://www.readbyqxmd.com/read/27783043/progressive-vascular-functional-and-structural-damage-in-a-bronchopulmonary-dysplasia-model-in-preterm-rabbits-exposed-to-hyperoxia
#12
Julio Jiménez, Jute Richter, Taro Nagatomo, Thomas Salaets, Rozenn Quarck, Allard Wagennar, Hongmei Wang, Jeroen Vanoirbeek, Jan Deprest, Jaan Toelen
Bronchopulmonary dysplasia (BPD) is caused by preterm neonatal lung injury and results in oxygen dependency and pulmonary hypertension. Current clinical management fails to reduce the incidence of BPD, which calls for novel therapies. Fetal rabbits have a lung development that mimics humans and can be used as a translational model to test novel treatment options. In preterm rabbits, exposure to hyperoxia leads to parenchymal changes, yet vascular damage has not been studied in this model. In this study we document the early functional and structural changes of the lung vasculature in preterm rabbits that are induced by hyperoxia after birth...
October 24, 2016: International Journal of Molecular Sciences
https://www.readbyqxmd.com/read/27768157/initial-experience-with-low-dose-methotrexate-as-an-adjuvant-treatment-for-rapidly-recurrent-nonvasculitic-laryngotracheal-stenosis
#13
David E Rosow, Jamal Ahmed
Importance: Adult laryngotracheal stenosis (LTS) is typically managed surgically, but some patients fail treatment because of rapid restenosis or granulation tissue formation. The need for frequent surgery or tracheostomy reduces the quality of life in these patients and poses a significant challenge for the treating physician. New adjuvant treatments are required to reduce the surgical burden of this condition. Objective: To examine whether patients with rapidly recurrent nonvasculitic LTS who fail surgical management of their stenosis (ie, requiring dilation more frequently than every 6 months) experience longer intervals between surgical procedures when receiving adjuvant treatment with low-dose methotrexate...
October 20, 2016: JAMA Otolaryngology—Head & Neck Surgery
https://www.readbyqxmd.com/read/27763576/prevention-of-respiratory-insufficiency-after-surgical-management-prism-trial-report-of-the-protocol-for-a-pragmatic-randomised-controlled-trial-of-continuous-positive-airway-pressure-cpap-to-prevent-respiratory-complications-and-improve-survival-following
#14
Rupert M Pearse, Tom E Abbott, Richard Haslop, Tahania Ahmad, Brennan C Kahan, Claudia Filipini, Andrew Rhodes, Marco Ranieri
BACKGROUND: Over 300 million patients undergo surgery worldwide each year. Postoperative morbidity - particularly respiratory complications - are most frequent and severe among high-risk patients undergoing major abdominal surgery. However, standard treatments, like physiotherapy or supplemental oxygen, often fail to prevent these. Preliminary research suggests that prophylactic continuous positive airways pressure (CPAP) can reduce the risk of postoperative respiratory complications...
October 20, 2016: Minerva Anestesiologica
https://www.readbyqxmd.com/read/27742107/transoral-robotic-partial-glossectomy-and-supraglottoplasty-for-obstructive-sleep-apnea
#15
Mark A D'Agostino
The standard treatment for patients with obstructive sleep apnea syndrome is positive airway pressure (PAP) therapy. However when PAP therapy fails, surgery maybe an option to alleviate the obstruction. The base of tongue plays an important role in this obstruction, and addressing the tongue base surgically can be a challenge for the head and neck surgeon. Transoral robotic surgery (TORS) using the da Vinci Surgical System provides a safe and effective way to approach and manage the base of tongue and supraglottis...
October 11, 2016: Otolaryngologic Clinics of North America
https://www.readbyqxmd.com/read/27687379/comparison-of-the-clinical-performances-of-air-qsp-and-i-gel-for-airway-management-under-general-anesthesia-with-a-muscle-relaxant
#16
Asako Watanabe, Mitsutaka Edanaga, Hiromichi Ichinose, Michiaki Yamakage
STUDY OBJECTIVES: Recently, i-Gel intubating laryngeal airway (ILA) has been frequently used because of the ease for airway insertion by residents and young anesthesiologists. However, it sometimes fails to fit or ventilate sufficiently in Japanese patients. Use of Air-Qsp, which is a new non-inflatable cuffed ILA, in a clinical setting has become possible. The purpose of this study was to compare the clinical performance of Air-Qsp with that of i-Gel for airway management in Japanese adult patients...
November 2016: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/27669029/anesthetic-management-for-pediatric-awake-tracheostomy
#17
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.
December 1, 2016: A & A Case Reports
https://www.readbyqxmd.com/read/27642595/insertion-success-of-the-laryngeal-tube-in-emergency-airway-management
#18
REVIEW
Michael Bernhard, André Gries, Alexandra Ramshorn-Zimmer, Volker Wenzel, Bjoern Hossfeld
Background. Emergency airway management (AM) is a priority when resuscitating critically ill or severely injured patients. The goal of this study was to determine the success rates of LT insertion during AM. Methods. Studies that included LT first-pass insertion (FPI) and overall-pass insertion (OPI) success by emergency medical services and in-hospital providers performing AM for emergency situations as well as for scheduled surgery published until July 2014 were searched systematically in Medline. Results...
2016: BioMed Research International
https://www.readbyqxmd.com/read/27616617/categorization-and-repair-of-recurrent-and-acquired-tracheoesophageal-fistulae-occurring-after-esophageal-atresia-repair
#19
C Jason Smithers, Thomas E Hamilton, Michael A Manfredi, Lawrence Rhein, Peter Ngo, Dorothy Gallagher, John E Foker, Russell W Jennings
PURPOSE: Recurrent trachea-esophageal fistula (recTEF) is a frequent (5%-10%) complication of congenital TEF (conTEF) and esophageal atresia (EA) repair. In addition, postoperative acquired TEF (acqTEF) can occur in addition to or even in the absence of prior conTEF in the setting of esophageal anastomotic complications. Reliable repair often proves difficult by endoluminal or standard surgical techniques. We present the results of an approach that reliably identifies the TEF and facilitates airway closure as well as repair of associated tracheal and esophageal problems...
August 31, 2016: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/27594841/efficacy-of-a-mandibular-advancement-appliance-on-sleep-disordered-breathing-in-children-a-study-protocol-of-a-crossover-randomized-controlled-trial
#20
Ghassan Idris, Barbara Galland, Christopher J Robertson, Mauro Farella
BACKGROUND: Sleep-Disordered Breathing (SDB) varies from habitual snoring to partial or complete obstruction of the upper airway and can be found in up to 10% of children. SDB can significantly affect children's wellbeing, as it can cause growth disorders, educational and behavioral problems, and even life-threatening conditions, such as cardiorespiratory failure. Adenotonsillectomy represents the primary treatment for pediatric SDB where adeno-tonsillar hypertrophy is indicated. For those with craniofacial anomalies, or for whom adenotonsillectomy or other treatment modalities have failed, or surgery is contra-indicated, mandibular advancement splints (MAS) may represent a viable treatment option...
2016: Frontiers in Physiology
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