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Difficult airways

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https://www.readbyqxmd.com/read/28720732/pseudomonas-aeruginosa-alters-staphylococcus-aureus-sensitivity-to-vancomycin-in-a-biofilm-model-of-cystic-fibrosis-infection
#1
Giulia Orazi, George A O'Toole
The airways of cystic fibrosis (CF) patients have thick mucus, which fosters chronic, polymicrobial infections. Pseudomonas aeruginosa and Staphylococcus aureus are two of the most prevalent respiratory pathogens in CF patients. In this study, we tested whether P. aeruginosa influences the susceptibility of S. aureus to frontline antibiotics used to treat CF lung infections. Using our in vitro coculture model, we observed that addition of P. aeruginosa supernatants to S. aureus biofilms grown either on epithelial cells or on plastic significantly decreased the susceptibility of S...
July 18, 2017: MBio
https://www.readbyqxmd.com/read/28719483/difficult-intubation-and-ventilation-in-an-infant-with-retropharyngeal-abscess-with-mediastinal-extension
#2
Michael A Bruno, Tomas Drabek, Mioara D Manole
A previously healthy 7-month-old male infant presented for evaluation of fever, deceased oral intake, and intermittent noisy breathing. Physical examination revealed neck tenderness. Soft tissue neck radiographs and computed tomography (CT) scan supported a diagnosis of retropharyngeal swelling with extension to the superior mediastinum. Surgical exploration was planned, and endotracheal intubation was performed in the operating room. Significant cardiorespiratory derangements developed immediately after the tracheal tube was inserted, including hypotension, hypoxia, and bradycardia with signs of cardiac ischemia...
July 17, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28715092/the-origins-of-oral-medicine-in-the-hippocratic-collected-works
#3
REVIEW
Helen Askitopoulou, Vasileia Nyktari, Alexandra Papaioannou, Georgios Stefanakis, Elina Konsolaki
The collected works of Hippocrates describe for the first time in a systematic way a large number of oral diseases, such as ulcers, inflammations, abscesses and tumours from the epiglottis, mouth, tongue, palate, uvula and the sublingual area. Several of these case reports are remarkable for the accurate observation of clinical symptoms and signs, the aetiology, the pathogenesis and their therapeutic approach in relation to prognosis. The Hippocratic authors report cases of 'aphthae' as part of a polysystemic disease, described many centuries later by Behçet and Adamantiades, while they associate features of splenomegaly from endemic malaria with gingivitis ('ulitis')...
July 17, 2017: Journal of Oral Pathology & Medicine
https://www.readbyqxmd.com/read/28709415/assessing-anesthesiology-residents-out-of-the-operating-room-ooor-emergent-airway-management
#4
Lauryn R Rochlen, Michelle Housey, Ian Gannon, Shannon Mitchell, Deborah M Rooney, Alan R Tait, Milo Engoren
BACKGROUND: At many academic institutions, anesthesiology residents are responsible for managing emergent intubations outside of the operating room (OOOR), with complications estimated to be as high as 39%. In order to create an OOOR training curriculum, we evaluated residents' familiarity with the content and correct adherence to the American Society of Anesthesiologists' Difficult Airway Algorithm (ASA DAA). METHODS: Residents completed a pre-simulation multiple-choice survey measuring their understanding and use of the DAA...
July 15, 2017: BMC Anesthesiology
https://www.readbyqxmd.com/read/28705307/a-new-method-for-enhanced-expectoration-of-sputum-by-vibratory-stimulation-of-the-cervical-trachea
#5
Mitsuhiro Kamimura, Nobuhisa Kameyama, Chie Homma, Tatsuya Ibe, Shinjiro Takeoka, Atsuto Mouri, Yoichiro Hamamoto
BACKGROUND: Expectoration of sputum can be difficult for patients with respiratory conditions such as chronic obstructive pulmonary disease, chronic bronchitis, or bronchiectasis because of the effects of decreased pulmonary function, respiratory muscle fatigue, altered sputum properties, and impaired ciliary function. We developed a new method for the vibratory stimulation of the cervical trachea and this study aimed to compare it with the Acapella (a current oscillation device) method...
July 2017: Respiratory Investigation
https://www.readbyqxmd.com/read/28701849/blunt-trauma-neck-with-complete-tracheal-transection-a-diagnostic-and-therapeutic-challenge-to-the-trauma-team
#6
K N J Prakash Raju, D Anandhi, R Surendar, Ashwith Shetty, Vinay R Pandit
Survival following trachea-esophageal transection is uncommon. Establishing a secure airway has the highest priority in trauma management. Airway management is a unique and a defining element to the specialty of emergency medicine. There is no doubt regarding the significance of establishing a patent airway in the critically ill patient in the emergency department. Cannot intubate and cannot ventilate situation is a nightmare to all emergency physicians. The most important take-home message from this case report is that every Emergency physician should have the ability to predict "difficult airway" and recognize "failed airway" very early and be skilled in performing rescue techniques when routine oral-tracheal intubation fails...
June 2017: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/28698964/iatrogenic-bilateral-hypoglossal-palsy-following-spinal-surgery
#7
Shrijit Panikkar, Govind Tol, Irfan Siddique
INTRODUCTION: Bilateral hypoglossal palsy is a rare complication during airway management in surgery. CASE PRESENTATION: Isolated bilateral hypoglossal palsy was noted post-operatively in a patient who underwent multiple spinal surgeries associated with prone anaesthesia. DISCUSSION: Risk factors include difficult, multiple intubations, prolonged surgical time, throat pack, and hyperextension of the neck during intubation. CONCLUSION: We aim to create awareness about this complication which has a significant morbidity and negative effect on patient outcomes...
July 11, 2017: European Spine Journal
https://www.readbyqxmd.com/read/28692347/prevalence-of-difficult-intubation-and-failed-intubation-in-a-diverse-obstetric-community-based-population
#8
Richard Pollard, Matthew Wagner, Katherine Grichnik, Brittany C Clyne, Ashraf S Habib
Objective To describe the incidence of difficult and failed intubations in obstetric patients during a 6-year period monitored by a quality assurance program together with American Society of Anesthesiologists Physical Status (ASA PS) scores, and obesity (Body mass index > 30 kg/m(2)). Methods Following Institutional Review Board approval, data about obstetric patients who experienced unanticipated difficult or failed intubations from 2010-2015 were obtained from the quality assurance database of a large, community-based anesthesiology group practice...
July 10, 2017: Current Medical Research and Opinion
https://www.readbyqxmd.com/read/28690293/tracheal-compression-caused-by-a-mediastinal-hematoma-after-interrupted-aortic-arch-surgery
#9
Qingwang Hua, Zhiyong Lin, Xingti Hu, Qifeng Zhao
Congenital abnormalities of the aortic arch include interrupted aortic arch (IAA), coarctation of the aorta (CoA), and double aortic arch (DAA). Aortic arch repair is difficult and postoperative complications are common. However, postoperative tracheobronchial stenosis with respiratory insufficiency is an uncommon complication and is usually caused by increased aortic anastomotic tension. We report here a case of tracheal compression by a mediastinal hematoma following IAA surgery. The patient underwent a repeat operation to remove the hematoma and was successfully weaned off the ventilator...
July 10, 2017: International Heart Journal
https://www.readbyqxmd.com/read/28689020/ferulic-acid-supresses-th2-immune-response-and-prevents-remodeling-in-ovalbumin-induced-pulmonary-allergy-associated-with-inhibition-of-epithelial-derived-cytokines
#10
Alessa Sin Singer Brugiolo, Ana Cláudia Carvalho Gouveia, Caio César de Souza Alves, Flávia Márcia de Castro E Silva, Érick Esteves de Oliveira, Ana Paula Ferreira
Asthma is characterized by intermittent airway obstruction and chronic inflammation, orchestrated primarily by Th2 cytokines. There is a strong rationale for developing new asthma therapies, since current treatment protocols present side effects and may not be effective in cases of difficult-to-control asthma. The purpose of this study was to evaluate the effect of ferulic acid, a phenolic acid commonly present in plants, in the ovalbumin-induced pulmonary allergy murine model. METHODS: BALB/c mice were sensitized and challenged with ovalbumin, and treatments were provided by gavage...
July 5, 2017: Pulmonary Pharmacology & Therapeutics
https://www.readbyqxmd.com/read/28688869/ankylosis-of-temporomandibular-joints-after-mandibular-distraction-osteogenesis-in-patients-with-nager-syndrome-report-of-two-cases-and-literature-review
#11
REVIEW
Cheng Chun Wu, Daisuke Sakahara, Keisuke Imai
Nager syndrome, also known as Nager acrofacial dysostosis, was first described by Nager and de Reynier in 1948. The patients commonly present with micrognathia, and a preventive tracheostomy is necessary when there are symptoms of upper airway obstruction. Mandibular distraction osteogenesis is considered as an effective procedure, which not only improves micrognathia but also minimizes the chances of tracheostomy. However, mandibular distraction osteogenesis has some complications such as relapse, teeth injury, infection, and injury of the temporomandibular joints (TMJs)...
February 7, 2017: Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS
https://www.readbyqxmd.com/read/28682951/preoperatively-screened-obstructive-sleep-apnea-is-associated-with-worse-postoperative-outcomes-than-previously-diagnosed-obstructive-sleep-apnea
#12
Ana Fernandez-Bustamante, Karsten Bartels, Claudia Clavijo, Benjamin K Scott, Rachel Kacmar, Kenneth Bullard, Angela F D Moss, William Henderson, Elizabeth Juarez-Colunga, Leslie Jameson
BACKGROUND: Obstructive sleep apnea (OSA) affects up to 26% of US adults, is often undiagnosed, and increases perioperative morbidity. We hypothesized that patients screened on the day of surgery as moderate/high risk for OSA (S-OSA) present similar perioperative respiratory complications, hospital use, and mortality than patients with previously diagnosed OSA (D-OSA). Second, we hypothesized that both OSA groups have more respiratory complications than No-OSA patients. METHODS: The electronic medical database from 1 academic and 2 community hospitals was retrospectively queried to identify adults undergoing nonemergent inpatient surgery (January 1, 2012, to December 31, 2014)...
July 4, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28673655/peak-inspiratory-flow-as-predictor-for-tracheotomy
#13
M Lesnik, J J Sanchez-Guerrero, O De Crouy Chanel, C Hervé, J Guerlain, S Périé
OBJECTIVES: Quantitative evaluation of upper airway obstruction cannot be commonly performed under acute dyspnea, especially in head and neck cancer (HNC); the decision whether or not to perform airway control surgery may be difficult to reach. Peak inspiratory flow (PIF) has been previously demonstrated to be a useful tool to decide on decannulation after HNC surgery. The aim of the present study was to assess the role of PIF as a standardized non-invasive tool in quantifying severe inspiratory dyspnea requiring emergency tracheostomy...
June 30, 2017: European Annals of Otorhinolaryngology, Head and Neck Diseases
https://www.readbyqxmd.com/read/28669461/simulators-for-laryngeal-and-airway-surgery
#14
REVIEW
James A Burns, Lacey K Adkins, Seth Dailey, Adam M Klein
There is growing support from the Accreditation Council for Graduate Medical Education and the Joint Commission of Accreditation of Health Care Organizations for a competency-based evaluation of medical and surgical performance. This is part of the quality movement in health care whereby the Centers for Medicare and Medicaid Services and third-party insurance companies have begun to link reimbursement incentives to positive surgical outcomes. Laryngeal and airway surgery require precise technique and significant mastered skill that can be difficult to obtain during otolaryngology residency training...
June 29, 2017: Otolaryngologic Clinics of North America
https://www.readbyqxmd.com/read/28665848/change-in-posterior-pharyngeal-space-after-counterclockwise-rotational-orthognathic-surgery-for-class-ii-dentofacial-deformity-diagnosed-with-obstructive-sleep-apnea-based-on-cephalometric-analysis
#15
Woo Shik Jeong, Young Chul Kim, Yoo Sam Chung, Chang Yeol Lee, Jong Woo Choi
Although maxillomandibular advancement (MMA) is an orthognathic surgical procedure used to manage obstructive sleep apnea (OSA) in individuals who are noncompliant with continuous positive airway pressure therapy, simple MMA encounters problems in terms of aesthetic outcomes in Asian populations with preexisting dentoalveolar protrusion. Our current prospective investigation describes changes in posterior pharyngeal space and aesthetic outcomes after counterclockwise rotational orthognathic surgery, which is known to be quite difficult in terms of the maintenance of the skeletal stability in skeletal class II patients with OSA...
June 29, 2017: Journal of Craniofacial Surgery
https://www.readbyqxmd.com/read/28659436/broad-spectrum-antiviral-gs-5734-inhibits-both-epidemic-and-zoonotic-coronaviruses
#16
Timothy P Sheahan, Amy C Sims, Rachel L Graham, Vineet D Menachery, Lisa E Gralinski, James B Case, Sarah R Leist, Krzysztof Pyrc, Joy Y Feng, Iva Trantcheva, Roy Bannister, Yeojin Park, Darius Babusis, Michael O Clarke, Richard L Mackman, Jamie E Spahn, Christopher A Palmiotti, Dustin Siegel, Adrian S Ray, Tomas Cihlar, Robert Jordan, Mark R Denison, Ralph S Baric
Emerging viral infections are difficult to control because heterogeneous members periodically cycle in and out of humans and zoonotic hosts, complicating the development of specific antiviral therapies and vaccines. Coronaviruses (CoVs) have a proclivity to spread rapidly into new host species causing severe disease. Severe acute respiratory syndrome CoV (SARS-CoV) and Middle East respiratory syndrome CoV (MERS-CoV) successively emerged, causing severe epidemic respiratory disease in immunologically naïve human populations throughout the globe...
June 28, 2017: Science Translational Medicine
https://www.readbyqxmd.com/read/28658881/cross-sectional-observational-study-performed-to-see-for-relation-of-mallampati-score-and-extended-mallampati-score-with-body-mass-index
#17
Sasha Maria Menon, Shailaja Sampangiramaiah, Megha Mathew
INTRODUCTION: There is increasing incidence of obesity worldwide. Since obese patients have an increased fatty tissue distributed in a truncal fashion, they may have an important and negative impact on the airway patency and respiratory function. Various scoring systems have been used to predict difficult airway, the most commonly used universal bedside tool is the Modified Mallampati Scoring (MMS). It was shown that the Extended Mallampati Score (EMS) predicted difficult laryngoscopy better than the MMS in the obese populations...
May 2017: Journal of Clinical and Diagnostic Research: JCDR
https://www.readbyqxmd.com/read/28658552/mechanisms-and-treatments-for-severe-steroid-resistant-allergic-airway-disease-and-asthma
#18
REVIEW
Philip M Hansbro, Richard Y Kim, Malcolm R Starkey, Chantal Donovan, Kamal Dua, Jemma R Mayall, Gang Liu, Nicole G Hansbro, Jodie L Simpson, Lisa G Wood, Jeremy A Hirota, Darryl A Knight, Paul S Foster, Jay C Horvat
Severe, steroid-resistant asthma is clinically and economically important since affected individuals do not respond to mainstay corticosteroid treatments for asthma. Patients with this disease experience more frequent exacerbations of asthma, are more likely to be hospitalized, and have a poorer quality of life. Effective therapies are urgently required, however, their development has been hampered by a lack of understanding of the pathological processes that underpin disease. A major obstacle to understanding the processes that drive severe, steroid-resistant asthma is that the several endotypes of the disease have been described that are characterized by different inflammatory and immunological phenotypes...
July 2017: Immunological Reviews
https://www.readbyqxmd.com/read/28658109/exchange-of-supraglottic-airways-for-endotracheal-tube-using-the-eschmann-introducer-during-simulated-child-resuscitation-a-randomized-study-comparing-4-devices
#19
RANDOMIZED CONTROLLED TRIAL
Lukasz Szarpak, Zenon Truszewski, Joseph Vitale, Logan Glosser, Kurt Ruetzler, Antonio Rodríguez-Núñez
BACKGROUND: The aim of this study was to examine the application of the Eschmann tracheal tube introducer (ETTI) with 4 types of supraglottic airway devices (SADs) using a child-manikin. METHODS: A total of 79 paramedics were asked to exchange the 4 SADs for an endotracheal tube with the ETTI in 3 different scenarios using a randomized crossover study format: normal airway without chest compression; normal airway with uninterrupted chest compression; and difficult airway with uninterrupted chest compression...
June 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28655959/management-of-predicted-difficult-airway-with-conventional-techniques-in-an-infant-with-rhabdomyosarcoma-of-the-upper-lip
#20
Kavya R Upadhya, Chandrika Y Ramavakoda, Madhavi Ravindra, Anuradha Ganigara
In paediatric patients, airway management can be challenging due to unique anatomical and physiological variations. Hence, a thorough history, examination and pre-operative planning are essential in securing difficult airway in paediatrics. We report a case of a 7-month-old infant with rhabdomyosarcoma of the upper lip with anticipated difficult airway. The airway was managed with three different conventional techniques (modified nasal trumpet, supraglottic airway and direct laryngoscopy) for three different procedures in the same infant...
June 2017: Indian Journal of Anaesthesia
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