Development Of Upper Airway Obstruction Research Articles

The revolution of overground respiratory video-endoscopy in exercising horses

The revolution of overground respiratory video-endoscopy in exercising horses

Retropharyngeal haematoma – an unusual bleeding site in an anticoagulated patient: a case report

IntroductionAnticoagulation is used widely for the primary prevention of embolic events in patients with atrial fibrillation. Bleeding is the most common complication with oral anticoagulation. We describe the case of a patient who developed a massive retropharyngeal haematoma after a fall. Whilst the retropharyngeal space is an uncommon site for bleeding complications, it is clinically important as the development of upper airway obstruction may be life threatening.Case PresentationWe present the case of an 85-year-old Caucasian woman on warfarin, who developed a massive retropharyngeal haematoma after a fall. She initially presented with pulmonary oedema and Type 2 respiratory failure. She was commenced on treatment for this with a good clinical response. She subsequently deteriorated, developing stridor and bruising to the neck. She was urgently intubated and ventilated. Computerized Tomography scan showed a massive retropharyngeal haematoma. The baseline International Normalized Ratio (INR) was 4.9. The patients was managed conservatively and treated with Vitamin K and Prothrombin Complex Concentrates (PCCs). The INR was rapidly corrected to 1.1 and the patient made a full recovery.ConclusionRetropharyngeal haematoma should be considered in anticoagulated patients presenting with abrupt respiratory distress after minor head trauma. It can develop after minor traumatic events, such as falls. It can result in upper airway obstruction, which can be life threatening. Patients should be urgently assessed for intubation and ventilation. Computerized Tomography imaging of the neck and mediastinum is diagnostic. Correction of the International Normalized Ratio with Vitamin K and Prothrombin Complex Concentrates is essential. Management is mainly supportive. However, in very large haematomas surgical drainage may be considered.

Severe Upper Airway Obstruction During Sleep

Few disorders may manifest with predominantly sleep-related obstructive breathing. Obstructive sleep apnea (OSA) is a common disorder, varies in severity and is associated with significant cardiovascular and neurocognitive morbidity. It is estimated that between 8 and 18 million people in the United States have at least mild OSA. Although the exact mechanism of OSA is not well-delineated, multiple factors contribute to the development of upper airway obstruction and include anatomic, mechanical, neurologic, and inflammatory changes in the pharynx. OSA may occur concomitantly with asthma. Approximately 74% of asthmatics experience nocturnal symptoms of airflow obstruction secondary to reactive airways disease. Similar cytokine, chemokine, and histologic changes are seen in both disorders. Sleep deprivation, chronic upper airway edema, and inflammation associated with OSA may further exacerbate nocturnal asthma symptoms. Allergic rhinitis may contribute to both OSA and asthma. Continuous positive airway pressure (CPAP) is the gold standard treatment for OSA. Treatment with CPAP therapy has also been shown to improve both daytime and nighttime peak expiratory flow rates in patients with concomitant OSA and asthma. It is important for allergists to be aware of how OSA may complicate diagnosis and treatment of asthma and allergic rhinitis. A thorough sleep history and high clinical suspicion for OSA is indicated, particularly in asthma patients who are refractory to standard medication treatments.

Postobstructive pulmonary edema following anesthesia

Pulmonary edema developing after the relief of upper airway obstruction has been reported in association with a diversity of etiologic factors, including hanging, strangulation, tumors, foreign bodies, goiter, and laryngospasm. Since 1977, 18 cases of adults with postobstructive pulmonary edema associated with anesthesia have been reported. A case is presented of a healthy 20-year-old male who developed pulmonary edema following two episodes of acute upper airway obstruction associated with general anesthesia. Postanesthetic laryngospasm has been implicated as the most frequent cause of this syndrome in adults. Risk factors for the development of upper airway obstruction have been identified in the majority of these cases. A heightened awareness among anesthesiologists of this poorly recognized and hence often perplexing syndrome may help reduce the occurrence and facilitate the treatment of this potential complication of operioperative airway management.