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Difficult extubation

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https://www.readbyqxmd.com/read/29905609/double-supercharged-jejunal-interposition-for-late-salvage-of-long-gap-esophageal-atresia
#1
Ingrid M Ganske, Joseph M Firriolo, Laura C Nuzzi, Oren Ganor, Thomas E Hamilton, C Jason Smithers, Russell W Jennings, Joseph Upton, Brian I Labow, Amir H Taghinia
BACKGROUND: A variety of surgical techniques exist to manage long-gap esophageal atresia (LGEA), including gastric pull-up (GPU), colonic interposition (CI), jejunal interposition (JI), and distraction lengthening. Salvage reconstruction for late failure of any conduit type is a complex surgical problem fraught with technical difficulty and significant risk. Jejunal interposition can be used as a salvage procedure in the management of LGEA. However, the opposing requirements of conduit length and adequate perfusion make the procedure technically challenging...
June 13, 2018: Annals of Plastic Surgery
https://www.readbyqxmd.com/read/29802903/difficult-intubation-and-extubation-in-adult-anaesthesia
#2
O Langeron, J-L Bourgain, D Francon, J Amour, C Baillard, G Bouroche, M Chollet Rivier, F Lenfant, B Plaud, P Schoettker, D Fletcher, L Velly, K Nouette-Gaulain
OBJECTIVE: To provide an update to French guidelines about « Difficult intubation and extubation in adult anaesthesia 2006 » DESIGN: A consensus committee of 13 experts was convened. A formal conflict-of-interest (COI) policy was developed at the onset of the process and enforced throughout. The entire guidelines process was conducted independent of any industry funding. The authors were advised to follow the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to guide assessment of quality of evidence...
May 23, 2018: Anaesthesia, Critical Care & Pain Medicine
https://www.readbyqxmd.com/read/29766735/-a-case-of-post-intubation-tracheal-stenosis-mimicking-bronchial-asthma-case-report
#3
Monika Šatánková, Kristián Brat, Zdeněk Merta, Miloš Šteffl
Postintubation tracheal stenosis (PITS) is one of the most frequent causes of lower airways obstruction. Usually, PITS is the consequence of prolonged intubation period, but may occur also after short-term intubation. Diagnosis may be difficult if stridor is not present and the post-extubation period is many years long. Bronchoscopy and CT scanning are the diagnostic gold standard. In some cases, lung function tests may also be helpful. Treatment options include conservative treatment, surgery and endoscopic methods...
2018: Vnitr̆ní Lékar̆ství
https://www.readbyqxmd.com/read/29757757/use-of-an-airway-exchange-catheter-assisted-extubation-with-continuous-end-tidal-carbon-dioxide-monitoring-in-a-pediatric-patient-with-a-known-difficult-airway-a-case-report
#4
Courtney C Yegian, Lana M Volz, Richard E Galgon
Tracheal extubation in children with known difficult airways is associated with an increased risk of adverse events. Currently, there is no reliable measure to predict the need for emergent reintubation due to airway inadequacy. Airway exchange catheter-assisted extubation has been shown to be a useful adjunct in decreasing the risk of adverse events due to failed extubation. We report a case of using an airway exchange catheter-assisted extubation with continuous end-tidal carbon dioxide monitoring for a pediatric patient with a known difficult airway...
May 11, 2018: A&A practice
https://www.readbyqxmd.com/read/29717916/risk-factors-associated-with-the-development-of-acquired-airway-disease-after-congenital-heart-surgery-a-retrospective-cohort-study
#5
Andrew J Matisoff, Pranathi Ari, David Zurakowski, Alexandra G Espinel, Nina Deutsch, Brian K Reilly
OBJECTIVE: In this single-center, retrospective review, we sought to determine the risk factors associated with the development of severe acquired airway disease (AAD; vocal cord paralysis [VCP] or subglottic stenosis [SGS]) in pediatric patients who had undergone surgery for congenital heart disease (CHD) with cardiopulmonary bypass. All patients who required surgical treatment for CHD using cardiopulmonary bypass at our institution between 2010 and 2015 were reviewed. We defined severe AAD as either clinically significant VCP, SGS, or both, requiring consultation with the otolaryngology (ENT) service for evaluation...
April 1, 2018: Seminars in Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29701761/size-of-recurrent-laryngeal-nerve-as-a-new-risk-factor-for-postoperative-vocal-cord-paralysis
#6
Y Saito, H Takeuchi, K Fukuda, K Suda, R Nakamura, N Wada, H Kawakubo, Y Kitagawa
Recurrent laryngeal nerve paralysis (RLNP) is a frequent and serious complication following esophageal cancer surgery. Therefore, this study aims to evaluate the correlation between recurrent laryngeal nerve (RLN) size and RLNP. This was a retrospective study of esophageal cancer patients who underwent thoracoscopic esophagectomy from January 2012 to December 2014. Eighty-four patients were included in the primary analysis. Diameter of the RLN was measured using the digital video recording of surgical procedures by the ratio between scissor and RLN...
April 26, 2018: Diseases of the Esophagus: Official Journal of the International Society for Diseases of the Esophagus
https://www.readbyqxmd.com/read/29696515/use-of-bioglue%C3%A2-to-seal-a-difficult-to-treat-air-leak-in-a-complicated-empyema-patient
#7
Vasileios Kouritas, Emmanouel Kefaloyannis, Peter Tcherveniakov
Surgical sealants have been used in thoracic surgery in an effort to reduce air leak duration, intercostal drain duration, length of stay and complications. They are instilled over a defect usually treated with other means. We herein present the technique of controlling a difficult to treat defect by directly instilling Bioglue™ alone into a crater, caused during empyema Video-assisted thoracic surgery in a 50-year-old patient with a trapped lung. This deep crater had caused a significant air leak rendering intraoperative ventilation challenging...
April 25, 2018: General Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/29614554/-effect-of-foam-sclerotherapy-for-the-treatment-of-oropharyngeal-venous-malformation
#8
C Q Niu, H Jiang, S Y Zhou, G Shen, H B Li, J Zhang
Objective: To evaluate the safety and efficacy of foam sclerotherapy with polidocanol for the treatment of venous malformation in the oropharynx. Methods: The clinical data of 21 children with venous malformation in the oropharynx treated by foam sclerotherapy were retrospectively analyzed. There were 10 males and 11 females, ranging in age from 1 month to 13 years, with a median age of 2.3 years. MRI was performed in all children, and the diagnosis was further confirmed by radiography. After general anesthesia, the oropharynx was exposed by opening device...
March 7, 2018: Zhonghua Er Bi Yan Hou Tou Jing Wai Ke za Zhi, Chinese Journal of Otorhinolaryngology Head and Neck Surgery
https://www.readbyqxmd.com/read/29609909/-why-is-the-morbidly-obese-patient-at-high-risk-of-anesthetic-complications
#9
REVIEW
Audrey De Jong, Daniel Verzilli, Marie Geniez, Gérald Chanques, David Nocca, Samir Jaber
Obesity is often associated with obstructive sleep apnea (OSA), which increases the risk of intraoperative and postoperative complications. The role of preoperative screening of OSA is crucial, with adequate management based on continuous positive pressure before, during and after surgery. The obese patient is at risk of postoperative complications: difficult airway management, acute respiratory failure following extubation due to atelectasis and airway obstruction, added to morphine overdosing. Optimal management of difficult mask ventilation and intubation, protective ventilation, combined to the reduction of sedatives and analgesics and the sitting position as soon as possible with a postoperative monitoring should decrease the occurrence of complications...
May 2018: La Presse Médicale
https://www.readbyqxmd.com/read/29605361/combined-nd-yag-laser-and-bleomycin-sclerotherapy-under-the-same-anesthesia-for-cervicofacial-venous-malformations-a-safe-and-effective-treatment-option
#10
Stacie Gregory, Patricia E Burrows, Herodotos Ellinas, Michael Stadler, Robert H Chun
INTRODUCTION: Extensive cervicofacial venous malformations (VM) pose significant challenges to a patient's quality of life (altered breathing, dysphagia, dysarthria). Treatment options include: 1) Surgical debulking; 2) Sclerotherapy; 3) laser therapy; or 4) Combined modalities. Recent studies have demonstrated the importance of multimodality and multidisciplinary management of these patients. However, no studies have described combined single anesthetic laser and sclerotherapy treatment...
May 2018: International Journal of Pediatric Otorhinolaryngology
https://www.readbyqxmd.com/read/29584447/inspiratory-muscle-rehabilitation-in-critically-ill-adults-a-systematic-review-and-meta-analysis
#11
Stefannie Vorona, Umberto Sabatini, Sulaiman Al-Maqbali, Michele Bertoni, Martin Dres, Bernie Bissett, Frank Van Haren, A Daniel Martin, Cristian Urrea, Debbie Brace, Matteo Parotto, Margaret S Herridge, Neill K J Adhikari, Eddy Fan, Luana T Melo, W Darlene Reid, Laurent J Brochard, Niall D Ferguson, Ewan C Goligher
RATIONALE: Respiratory muscle weakness is common in critically ill patients; the role of targeted inspiratory muscle training (IMT) in intensive care unit rehabilitation strategies remains poorly defined. OBJECTIVES: The primary objective of the present study was to describe the range and tolerability of published methods for IMT. The secondary objectives were to determine whether IMT improves respiratory muscle strength and clinical outcomes in critically ill patients...
June 2018: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/29577233/an-assessment-of-the-tolerability-of-the-cook-staged-extubation-wire-in-patients-with-known-or-suspected-difficult-airways-extubated-in-intensive-care
#12
S McManus, L Jones, C Anstey, S Senthuran
The Cook staged extubation set (Cook Medical) has been developed to facilitate management of the difficult airway. A guidewire inserted before tracheal extubation provides access to the subglottic airway should re-intubation be required. This prospective cohort study examines patients' tolerance of the guidewire and its impact on clinical status around tracheal extubation in the intensive care unit. Vital signs, incidence of symptoms and patient tolerance of the wire were recorded. Twenty-three patients were enrolled and 17 (73%) tolerated the wire for 4 h...
May 2018: Anaesthesia
https://www.readbyqxmd.com/read/29554711/-difficult-airway-management-in-thoracic-anaesthesia
#13
Sarah-Hélène Müller, Jérôme M Defosse, Mark U Gerbershagen, Torsten Loop
Difficult airway management in thoracic anesthesia has rarely been addressed in current guidelines. However, difficult airway management may be a challenge in thoracic anaesthesia: Achieving lung separation and collapse in combination of potentially distorted upper airway anatomy (difficult upper airway), the presence of subglottic pathologies (difficult lower airway) and the need for one-lung ventilation (difficult lung separation). This review will focus on identification of patients at risk, recommendations and algorithms for the airway management in the anticipated and unexpected difficult in-/extubation, and choice of devices for lung separation in this context...
March 2018: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
https://www.readbyqxmd.com/read/29519925/impact-of-sleep-alterations-on-weaning-duration-in-mechanically-ventilated-patients-a-prospective-study
#14
Arnaud W Thille, Faustine Reynaud, Damien Marie, Stéphanie Barrau, Ludivine Rousseau, Christophe Rault, Véronique Diaz, Jean-Claude Meurice, Rémi Coudroy, Jean-Pierre Frat, René Robert, Xavier Drouot
Sleep is markedly altered in intensive care unit (ICU) patients and may alter respiratory performance. Our objective was to assess the impact of sleep alterations on weaning duration.We conducted a prospective physiological study at a French teaching hospital. ICU patients intubated for at least 24 h and difficult to wean were included. Complete polysomnography (PSG) was performed after the first spontaneous breathing trial failure. Presence of atypical sleep, duration of sleep stages, particularly rapid eye movement (REM) sleep, and electroencephalogram (EEG) reactivity at eyes opening were assessed by a neurologist...
April 2018: European Respiratory Journal: Official Journal of the European Society for Clinical Respiratory Physiology
https://www.readbyqxmd.com/read/29491518/fast-tracking-in-adult-living-donor-liver-transplantation-a-case-series-of-15-patients
#15
Pooja Bhangui, Prashant Bhangui, Nikunj Gupta, Annu Sarin Jolly, Seema Bhalotra, Nishant Sharma, A S Soin, Vijay Vohra
Background and Aims: Fast tracking (FT) for more efficacious use of resources may be difficult after living donor liver transplantation (LDLT) due to a partial liver graft, complex vascular anastomoses and longer operating time. Our study was aimed at reporting our experience with FT (on table extubation) in LDLT recipients. A secondary objective of our study was to look at defining a subgroup of patients who could be prospectively planned for FT. Methods: We studied the demographics and outcomes of 15 LDLT recipients extubated immediately in the operating suite based on an uneventful intraoperative course, haemodynamic stability after graft reperfusion and improvement of metabolic parameters post-implantation and vascular anastomoses...
February 2018: Indian Journal of Anaesthesia
https://www.readbyqxmd.com/read/29430408/using-bronchoscopy-to-detect-acquired-tracheoesophageal-fistula-in-mechanically-ventilated-patients
#16
Michael S Green, Johann J Mathew, Lia J Michos, Parmis Green, Mansoor M Aman
Introduction: An acquired Tracheoesophageal fistula (TEF) is commonly caused by a malignancy or trauma, with pulmonary infection or aspiration being the presenting symptom. However, in the critical care setting the presentation can be subtle and may present with difficult ventilation. High endotracheal tube cuff pressures can lead to tracheal erosions and thus increasing the chances for developing a TEF. Prolonged intubation in the presence of other risk factors like poor general state of health, episodic hypotension, nasogastric tubes, and repeated intubations can increase the likelihood of developing an acquired TEF...
August 2017: Anesthesiology and Pain Medicine
https://www.readbyqxmd.com/read/29284880/securing-a-difficult-airway-tracheal-intubation-achieved-after-deliberate-placement-of-an-endotracheal-tube-in-esophagus-a-new-approach
#17
Vanilla Chopra, Nandita Mehta, Mohd Reidwan Dar
Enlarged thyroid gland with retrosternal extension has an increased incidence of difficult intubation, and it poses real airway challenge for the anesthesiologists. Here, we present a case of successful management of a difficult airway in a female patient of enlarged thyroid gland, planned for open reduction and internal fixation of the upper end of humerus. Endotracheal intubation was achieved after deliberate insertion of an endotracheal tube in esophagus. The patient was extubated over a ventilating bougie, with uneventful postoperative course...
October 2017: Anesthesia, Essays and Researches
https://www.readbyqxmd.com/read/29284851/comparison-of-i-gel-versus-endotracheal-tube-in-patients-undergoing-elective-cesarean-section-a-prospective-randomized-control-study
#18
Manohar Panneer, Saravana Babu, Prakash Murugaiyan
Background and Aim: Physiological changes during pregnancy and the sympatho adrenalstimulation during larynoscopy and intubation leads to evaluation of safe devices to secure airway during cesarean section under general anesthesia. I-gel, recently emerging effective supra glottic device found safe during general anesthesia in cesarean section. Aim of the study is to compare the hemodynamic disturbances and airway related complications of I-gel and Endotracheal tube in patients undergoing cesarean section under general anesthesia...
October 2017: Anesthesia, Essays and Researches
https://www.readbyqxmd.com/read/29279645/methadone-gastrobezoar-in-a-psychiatric-patient-presented-in-coma
#19
Alexandra Gavala, Despoina Manou, Vasiliki Psalida, Maria Nystatzaki, Christos Mavrogiannis, George Alevizopoulos, Pavlos Myrianthefs
A 43-year-old psychiatric patient was transferred in coma and hypercapnic respiratory failure at the emergency department. He was intubated for airway protection and transferred to the Intensive Care Unit (ICU). Abdominal X-ray revealed a radiopaque mass; a pharmacobezoar was suspected and confirmed by gastroscopy; one large in the stomach fundus and a smaller one in the pylorus. Gastric lavage through the gastroscope and administration of gastro-kinetic drugs and laxatives were able to dilute the bezoars. Tablets retrieved from the stomach identified as methadone and toxicological tests of the gastric fluid confirmed the presence of methadone as the only organic chemical compound...
November 2017: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/29262440/who-is-safe-to-extubate-in-the-neuroscience-intensive-care-unit
#20
Julian Bösel
Patients admitted to the neuroscience intensive care unit (NICU) may have respiratory compromise from either central or peripheral neurological pathology, and may hence require intubation and mechanical ventilation for very diverse reasons. Liberation from invasive ventilation, that is, extubation, at the earliest possible time is a widely accepted principle in intensive care. For this, classic extubation criteria have been established in the general critical care setting, mainly targeting pulmonary function and cooperativeness of the patient...
December 2017: Seminars in Respiratory and Critical Care Medicine
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