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Difficult extubation

Nazan Ülgen-Tekerek, Başak Akyıldız, Alper Özcan, Ayşe Betül Ergül, Cüneyt Turan, Serdal Özcan
Late presentation of congenital diaphragmatic hernia is 5-30% of all congenital diaphragma hernia cases. It can present as Morgagni, Bochdalek and paraesophageal hernia. Misdiagnosis can result in significant morbiditiy. A 17-month-old girl presented with vomiting and abdominal pain. On physical examination, circulatory disturbance, cyanosis, abdominal distantion were present. Her O2 saturation was 60% and she was tachycardic (180 bpm) and tachypneic (58 bpm) with hypotension (60/35 mmhg). Patient's heart and mediastinum were shifted into the right hemithorax on the chest X-ray...
November 2015: Turkish Journal of Pediatrics
Gonzalo Hernández, Concepción Vaquero, Laura Colinas, Rafael Cuena, Paloma González, Alfonso Canabal, Susana Sanchez, Maria Luisa Rodriguez, Ana Villasclaras, Rafael Fernández
Importance: High-flow conditioned oxygen therapy delivered through nasal cannulae and noninvasive mechanical ventilation (NIV) may reduce the need for reintubation. Among the advantages of high-flow oxygen therapy are comfort, availability, lower costs, and additional physiopathological mechanisms. Objective: To test if high-flow conditioned oxygen therapy is noninferior to NIV for preventing postextubation respiratory failure and reintubation in patients at high risk of reintubation...
October 5, 2016: JAMA: the Journal of the American Medical Association
David Ae Imber, Massimiliano Pirrone, Changsheng Zhang, Daniel F Fisher, Robert M Kacmarek, Lorenzo Berra
With a rising incidence of obesity in the United States, anesthesiologists are faced with a larger volume of obese patients coming to the operating room as well as obese patients with ever-larger body mass indices (BMIs). While there are many cardiovascular and endocrine issues that clinicians must take into account when caring for the obese patient, one of the most prominent concerns of the anesthesiologist in the perioperative setting should be the status of the lung. Because the pathophysiology of reduced lung volumes in the obese patient differs from that of the ARDS patient, the best approach to keeping the obese patient's lung open and adequately ventilated during mechanical ventilation is unique...
September 13, 2016: Respiratory Care
Senem Alkan Ozdemir, Esra Arun Ozer, Ozkan Ilhan, Sumer Sutcuoglu
BACKGROUND: Mechanical ventilation is an essential therapy in the treatment of respiratory failure in preterm infants. However, optimal ventilation strategy continues to be difficult to define. OBJECTIVE: To compare the effects of volume guarantee (VG) combined with intermittent mandatory ventilation (SIMV) and VG combined with pressure support ventilation (PSV) on the pulmonary mechanics and short term prognosis in preterm infants with respiratory distress syndrome...
September 13, 2016: Pediatric Pulmonology
Nuray Altay, Hasan H Yüce, Harun Aydoğan, Mustafa E Dörterler
Klippel-Feil syndrome (KFS) has a classical triad that includes short neck, low hair line and restriction in neck motion and is among one of the congenital causes of difficult airway. Herein, we present a 26-day, 3300g newborn with KFS who was planned to be operated for correction of an intestinal obstruction. She had features of severe KFS. Anesthesia was induced by inhalation of sevoflurane 2-3% in percentage 100 oxygen. Sevoflurane inhalation was stopped after 2min. Her Cornmack Lehane score was 2 and oral intubation was performed with 3...
September 2016: Brazilian Journal of Anesthesiology
Deb Sanjay Nag, Devi Prasad Samaddar
We discuss a case of difficult extubation, due to inadequate deflation of the tracheal tube cuff, despite collapse of the pilot balloon, on its aspiration. This was caused by inadvertent kinking of the pilot balloon tubing due to inappropriate tape fixation of the endotracheal tube.
September 2016: Brazilian Journal of Anesthesiology
Scott Masson, Matthew Villerot, Bhavinkumar Dalal
Hydromorphone, unlike other opioids associated with histamine release, has never been reported to cause angioedema. We report a rare case of hydromorphone-induced angioedema in a 34-year-old woman with history of deep venous thrombosis and pulmonary embolism who presented with leg swelling and pain after trauma. Hydromorphone was administered with subsequent rapid development of stridor and edematous changes of the tongue, uvula, and surrounding mucosa. The difficult airway response team was activated, and the airway was secured by emergent awake fiberoptic intubation in the operating room...
August 22, 2016: A & A Case Reports
Susan E Becker
BACKGROUND: Traditional sedation for mechanically ventilated patients causes delirium, which increases the patients' length of stay while hospitalized. When extubation is attempted, these medications must be discontinued because of the side effect of respiratory depression, leaving patients anxious and agitated, delaying extubation and prolonging the need for mechanical ventilation. Dexmedetomidine is a safe alternative sedative that does not cause delirium or respiratory depression. During the weaning process, dexmedetomidine can be continued, allowing the patient to remain calm and successfully extubated...
September 2016: Dimensions of Critical Care Nursing: DCCN
Takashi Hitosugi, Masanori Tsukamoto, Shigeki Fujiwara, Takeshi Yokoyama
We report a child with vocal cord adhesion encountered during induction of anesthesia. A 4-month-old girl was scheduled for bilateral lip plasty. She was intubated for one week due to pneumonia at the age of 3 days. Hoarseness and stridor appeared just after extubation. Although laryngo-fiberoptic examination had been tried several times, otorhinologists could not find any abnormality. We once decided to postpone the operation because of severe stridor. However, laryngofiberoptic examination could not reveal any abnormality, and we rescheduled the operation...
June 2016: Masui. the Japanese Journal of Anesthesiology
Viraj N Namshikar, Nimisha V Dukle, Dattraj S Sukhthanker
Vallecular cyst is uncommon but well-recognized cause of upper airway obstruction in newborn and infants. We hereby present anesthetic management of a case of vallecular cyst in an infant posted for excision and marsupialization. A 4-month-old female infant weighing 3.5 kg presented with inspiratory stridor progressively worsening over 2 months. Anesthesia plan was to carry out inhalational induction maintaining spontaneous respiration and keeping tracheostomy as standby option. In this case, laryngoscopy was challenging due to the size and extent of the cyst thus necessitating gentle laryngoscopy to prevent cyst rupture and pulmonary aspiration...
July 2016: Saudi Journal of Anaesthesia
Sumesh Parat, Maroun Jean Mhanna
BACKGROUND: To investigate strategies used for the management of respiratory distress syndrome (RDS) and bronchopulmonary dysplasia (BPD) in extremely low birth weight (ELBW) infants. METHODS: A survey of neonatal specialists working in US academic institutions with fellowship training programs. RESULTS: Eighty percent (72/89) of the identified academic institutions had at least one physician who responded to the survey. Among respondents, 85% (171/201) agreed or strongly agreed to use continuous positive airway pressure (CPAP) initially for the management of RDS, and the majority agreed or strongly agreed to use a fraction of inspired oxygen (FiO2) ≥0...
August 2016: World Journal of Pediatrics: WJP
Sarah Derieg
Care of pediatric surgical patients is not limited to pediatric facilities, and all perioperative RNs should have a basic understanding of the specialized care that children require. This knowledge set includes an understanding of the basic terminology used to describe this patient population as well as the developmental stages of pediatric patients. Preoperatively, the nurse should conduct a thorough assessment and evaluation and address the anxieties and questions of the patient and his or her parent or guardian...
July 2016: AORN Journal
B Balakrishnan, Z Noor, C L Curran
INTRODUCTION: Venous air embolism (VAE) due to central venous catheter (CVC) placement is a rare but preventable complication which is potentially fatal. We describe a case highlighting unique patient characteristics which increase the risk of developing VAE. CASE DESCRIPTION: A sixty-year-old gentleman was admitted to the hospital with dyspnea and altered mental status. His comorbidities include cancer of the neck and tongue, currently in remission, and schizophrenia...
2016: Respiratory Medicine Case Reports
Thomas Kiss, Thomas Bluth, Marcelo Gama de Abreu
PURPOSE OF REVIEW: The perioperative care of obese patients can often be challenging, as the presence of comorbidities is common in this patient population. In this article, we present recent data on perioperative complications of obese patients and discuss relevant details for daily practice, including drug dosing, airway management, and mechanical ventilation. RECENT FINDINGS: The volatile agent desflurane reduces extubation time, without major effects on postoperative anesthesia care unit discharge time, incidence of postoperative nausea and vomiting, or postoperative pain scores compared with other volatile anesthetics...
August 2016: Current Opinion in Critical Care
Ayman Ads, Frederic Auerbach, Kelly Ryan, Abdel R El-Ganzouri
We report the successful use of the Air-Q laryngeal airway (Air-Q LA) as a ventilatory device and a conduit for tracheal intubation to rescue the airway in a patient with difficult airway and tracheal stenosis. This is the first case report of the device to secure the airway after two episodes of hypoxemia in the operating room and intensive care unit. Consent for submission of this case report was obtained from our institution's human studies institutional review board given that the patient died a few months after his discharge from the hospital before his personal consent could be obtained and before preparation of this report...
August 2016: Journal of Clinical Anesthesia
Yoko Nakano, Hiroaki Suzuki, Takero Arai, Yuichi Hashimoto, Yasuhisa Okuda
A 2-year-and-4-month-old female infant, 12 kg in weight and 90 cm in height fell off from a table, which was about 1 m height with a toothbrush in her mouth without her parents noticing. Urgent CT scan showed that it penetrated the left side of her oropharyngeal wall to the bifurcation of her right carotid artery. According to the initial assessment, carotid artery seemed intact and there seemed to be no sign of CNS involvement. She underwent general anesthesia for further investigation and operation. We could detect vocal code with ease by inserting Glidescope between her tongue and the toothbrush...
April 2016: Masui. the Japanese Journal of Anesthesiology
Dilek Yazicioğlu, Ilkay Baran, Filiz Uzumcugil, Ibrahim Ozturk, Gulten Utebey, M Murat Sayın
OBJECTIVE: To evaluate and compare the face mask (FM) and oral mask (OM) ventilation techniques during anesthesia emergence regarding tidal volume, leak volume, and difficult mask ventilation (DMV) incidence. DESIGN: Prospective, randomized, crossover study. SETTING: Operating room, training and research hospital. SUBJECTS: American Society of Anesthesiologists physical status I and II adult patients scheduled for nasal surgery...
June 2016: Journal of Clinical Anesthesia
Thomas T Joseph, Jonathan S Gal, Samuel DeMaria, Hung-Mo Lin, Adam I Levine, Jaime B Hyman
BACKGROUND: Awake intubation is the standard of care for management of the anticipated difficult airway. The performance of awake intubation may be perceived as complex and time-consuming, potentially leading clinicians to avoid this technique of airway management. This retrospective review of awake intubations at a large academic medical center was performed to determine the average time taken to perform awake intubation, its effects on hemodynamics, and the incidence and characteristics of complications and failure...
July 2016: Anesthesiology
Sina Grape, Patrick Schoettker
Tracheal tube introducers and stylets are highly successful devices for the management of various airway scenarios. Their first-line use is advocated in many difficult airway algorithms. Although they have been used for decades, the shape and design of introducers and stylets as well as their patterns of use are constantly evolving. Our purpose is to provide the clinician with an update on these different devices. We performed a systematic literature search from 2005 until May 2015, without language restrictions...
April 16, 2016: Journal of Clinical Monitoring and Computing
Daniel Felbaum, Hasan R Syed, Joshua E Ryan, Walter C Jean, Amjad Anaizi
Neoplasms of the pineal region comprise less than 2% of all intracranial lesions. A variety of techniques have been adapted to gain access to the pineal region. Classic approaches employ the use of the microscope. More recently, the endoscope has been utilized to improve access to such deep-seated lesions. A 62-year-old female presented with a heterogeneously enhancing lesion in the pineal region with associated hydrocephalus. On exam, the patient exhibited Parinaud's syndrome. The patient initially underwent a single burr hole endoscopic third ventriculostomy and biopsy of the lesion...
2016: Curēus
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