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https://www.readbyqxmd.com/read/28074820/airway-management-of-the-cardiac-surgical-patients-current-perspective
#1
REVIEW
Arindam Choudhury, Nishkarsh Gupta, Rohan Magoon, Poonam Malhotra Kapoor
The difficult airway (DA) is a common problem encountered in patients undergoing cardiac surgery. However, the challenge is not only just establishment of airway but also maintaining a definitive airway for the safe conduct of cardiopulmonary bypass from initiation to weaning after surgical correction or palliation, de-airing of cardiac chambers. This review describes the management of the DA in a cardiac theater environment. The primary aims are recognition of DA both anatomical and physiological, necessary preparations for (and management of) difficult intubation and extubation...
January 2017: Annals of Cardiac Anaesthesia
https://www.readbyqxmd.com/read/28003693/all-india-difficult-airway-association-2016-guidelines-for-the-management-of-anticipated-difficult-extubation
#2
Pankaj Kundra, Rakesh Garg, Apeksh Patwa, Syed Moied Ahmed, Venkateswaran Ramkumar, Amit Shah, Jigeeshu Vasishtha Divatia, Sumalatha Radhakrishna Shetty, Ubaradka S Raveendra, Jeson R Doctor, Dilip K Pawar, Ramesh Singaravelu, Sabyasachi Das, Sheila Nainan Myatra
Extubation has an important role in optimal patient recovery in the perioperative period. The All India Difficult Airway Association (AIDAA) reiterates that extubation is as important as intubation and requires proper planning. AIDAA has formulated an algorithm based on the current evidence, member survey and expert opinion to incorporate all patients of difficult extubation for a successful extubation. The algorithm is not designed for a routine extubation in a normal airway without any associated comorbidity...
December 2016: Indian Journal of Anaesthesia
https://www.readbyqxmd.com/read/27995626/difficult-tracheal-tube-passage-and-subglottic-airway-injury-during-intubation-with-the-glidescope-%C3%A2-videolaryngoscope-a-randomised-controlled-comparison-of-three-tracheal-tubes
#3
K Su, X Gao, F-S Xue, G-N Ding, Y Zhang, M Tian
Difficulty during placement of the tracheal tube is a known problem when intubating with the GlideScope(®) , which may lead to subglottic airway injury. This randomised, controlled clinical trial was designed to compare the resistance to passage of PVC (polyvinyl chloride), reinforced or BlockBuster tracheal tubes during intubation with the GlideScope. Secondary outcomes included the time taken to intubate and assessment of subglottic airway injury. One-hundred and seventy-seven patients were included in the data analysis...
December 20, 2016: Anaesthesia
https://www.readbyqxmd.com/read/27920974/a-case-report-of-malignant-obesity-hypoventilation-syndrome-a-weighty-problem-in-our-icus
#4
Michael Tatusov, Joshua J Joseph, Brian M Cuneo
INTRODUCTION: The obesity epidemic is reflected by increasing numbers of morbidly obese patients being admitted to intensive care units (ICUs). These are complicated patients whose care involves many diagnostic and treatment challenges. We are presenting a fatal case of super obesity, hypoventilation, and multi-organ failure known as malignant obesity hypoventilation syndrome (MOHS). CASE PRESENTATION: 35 year old African American gentleman with a body mass index (BMI) of 115 kg/m(2) presented to the hospital with respiratory distress...
2017: Respiratory Medicine Case Reports
https://www.readbyqxmd.com/read/27918405/certified-registered-nurse-anesthetist-perceptions-of-factors-impacting-patient-safety
#5
Susan P McMullan, Charlotte Thomas-Hawkins, Maria R Shirey
Certified registered nurse anesthetists (CRNAs) provide more than 40 million anesthetics each year in the United States. This article describes a study that investigates relationships among CRNA organizational structures (CRNA practice models, work setting, workload, level of education, work experience), CRNA ratings of patient safety culture, and CRNA adverse anesthesia-related event (ARE) reporting. This is a cross-sectional survey study of 336 CRNAs randomly selected from American Association of Nurse Anesthetists database...
January 2017: Nursing Administration Quarterly
https://www.readbyqxmd.com/read/27909593/our-anaesthetic-experiences-in-patients-undergoing-percutaneous-mitraclip-implantation
#6
Ezgi Erkılıç, Elvin Kesimci, Cihan Döğer, Tülin Gümüş, Süleyman Ellik, Orhan Kanbak
OBJECTIVE: Percutaneous mitraclip implantation system, is a new technique developed for patients with high surgical risks. It is generally performed in a catheterisation laboratory with the guidance of fluoroscopy and transesophageal echocardiography. In this study, we aimed to share our experiences on anaesthetic in patients undergoing mitraclip implantation under general anaesthesia. METHODS: Eighty four patients with severe, symptomatic mitral insufficiency, who had undergone MitraClip implantation under general anaesthesia between July 2012 and March 2015 (54 male, 30 female; mean age: 68...
August 2016: Turkish Journal of Anaesthesiology and Reanimation
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
#7
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/27804108/tracheal-extubation-of-the-adult-intensive-care-patient-with-a-predicted-difficult-airway-a-narrative-review
#8
REVIEW
D J Sturgess, K B Greenland, S Senthuran, F A Ajvadi, A van Zundert, M G Irwin
Management of the difficult airway is an important, but as yet poorly-studied, component of intensive care management. Although there has been a strong emphasis on prediction and intubation of the difficult airway, safe extubation of the patient with a potentially difficult airway has not received the same attention. Extubation is a particularly vulnerable time for the critically ill patient and, because of the risks involved and the consequences of failure, it warrants specific consideration. The Royal College of Anaesthetists 4th National Audit Project highlighted differences in the incidence and consequences of major complications during airway management between the operating room and the critical care environment...
November 2, 2016: Anaesthesia
https://www.readbyqxmd.com/read/27793243/anesthesia-in-pregnant-women-with-hellp-syndrome-case-report
#9
Eduardo Barbin Zuccolotto, Eugenio Pagnussatt Neto, Glínia Cavalcante Nogueira, José Roberto Nociti
BACKGROUND AND OBJECTIVES: HELLP syndrome, characterized by hemolysis, high levels of liver enzyme, and low platelet count, is an advanced clinical stage of pre-eclampsia, progressing to high maternal (24%) and perinatal (up 40%) mortality, despite childbirth care in a timely manner. The goal is to describe the anesthetic management of a case with indication to emergency cesarean. CASE REPORT: Female patient, 36 years old, gestational age of 24 weeks, with hypertensive crisis (BP 180/100mmHg) and severe headache, was admitted to the operating room for a cesarean section after diagnosis of HELLP syndrome...
November 2016: Brazilian Journal of Anesthesiology
https://www.readbyqxmd.com/read/27735810/late-presentation-of-congenital-diaphragmatic-hernia
#10
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
https://www.readbyqxmd.com/read/27706464/effect-of-postextubation-high-flow-nasal-cannula-vs-noninvasive-ventilation-on-reintubation-and-postextubation-respiratory-failure-in-high-risk-patients-a-randomized-clinical-trial
#11
RANDOMIZED CONTROLLED TRIAL
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 18, 2016: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/27624632/respiratory-management-of-perioperative-obese-patients
#12
REVIEW
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...
December 2016: Respiratory Care
https://www.readbyqxmd.com/read/27623133/impact-of-targeted-volume-ventilation-on-pulmonary-dynamics-in-preterm-infants-with-respiratory-distress-syndrome
#13
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
https://www.readbyqxmd.com/read/27591474/airway-management-in-newborn-with-klippel-feil-syndrome
#14
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
https://www.readbyqxmd.com/read/27591469/inappropriate-fixation-of-an-endotracheal-tube-causing-cuff-malfunction-resulting-in-difficult-extubation
#15
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
https://www.readbyqxmd.com/read/27552239/a-rare-case-of-hydromorphone-induced-angioedema-effectively-managed-by-a-difficult-airway-response-team
#16
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...
November 1, 2016: A & A Case Reports
https://www.readbyqxmd.com/read/27487756/a-pilot-study-implementing-a-protocol-using-dexmedetomidine-as-a-safe-alternative-to-traditional-sedation-to-decrease-ventilator-days-for-patients-difficult-to-extubate
#17
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
https://www.readbyqxmd.com/read/27483652/-perioperative-management-of-a-child-with-vocal-adhesion-leading-to-unexpected-difficult-airway
#18
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
https://www.readbyqxmd.com/read/27375399/anesthetic-management-of-vallecular-cyst-excision-in-an-infant-an-airway-challenge
#19
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
https://www.readbyqxmd.com/read/27351566/respiratory-management-of-extremely-low-birth-weight-infants-survey-of-neonatal-specialists
#20
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
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