Maintain Airway Patency Research Articles

Failure of Double-Lumen Tube Positioning in a Patient With Lingual Tonsil Hypertrophy

A 59-year-old man (weight, 93 kg; height, 172 cm) was scheduled for left video-assisted thoracoscopy. The preoperative airway assessment revealed a Mallampati grade 2, an interdental distance of 5 cm, a wide mouth and limited cervical spine movement. After preoxygenation, general anesthesia was induced with intravenous fentanyl (2 g/kg), propofol (2 mg/ kg), and succinylcholine (0.8 mg/kg). The direct laryngoscopy with a Macintosh 3 blade revealed a Cormack/Lehane (C/L) grade 4 view; no glottic structures were visible at all. A second attempt was performed using the GlideScope videolaryngoscope, and the best view of the larynx achieved was C/L grade 3; direct vision of the tongue revealed a lingual tonsil hypertrophy. Ventilation and oxygenation with a bag and mask continued to be effective, and anesthesia was continued with a mixture of sevoflurane 2% and oxygen 100%. The previous sniffing position was changed, the patient was placed in simple head extension, and a further attempt with the GlideScope was tried (C/L grade 3). A blind technique of tracheal intubation failed, and the right tonsil began bleeding, probably because of direct contact with the blade and the endotracheal tube. A size 5 supraglottic airway i-gel device (Intersurgical Ltd, Berkshire, UK) was inserted without further drugs, and spontaneous ventilation was achieved. Afterwards, fiberoptic endotracheal intubation through the supraglottic device was attempted unsuccessfully. The anesthesia was stopped, and consciousness returned. The fiberoptic view showed an anterior and small glottis perpendicular to the axis of the trachea with a small space between the glottis and arytenoids. The airway was secured by awake nasal fiberoptic intubation under topical anesthesia, and surgery took place as scheduled without any problem for the patient; one-lung ventilation was achieved using a Cohen endobronchial blocker, and tonsillar bleeding stopped before the end of surgery. The supraglottic airway i-gel device permitted us to achieve spontaneous ventilation by maintaining airway patency and preventing collapse of laryngeal structures; this device was also

Atemwegsmanagement beim sedierten Patienten

The decrease in airway muscular tone seen during natural sleep and sedation, as well as in the supine position, can lead to anatomic changes in the structures that surround the airway. Some patients need sedation for diagnostic or interventional procedures. In these patients, knowledge about morphological and mechanical aspects of the soft-tissue structures is essential for a complete understanding of the changes that occur in upper airway caliper. Maintaining the patency of the upper airway during spontaneous breathing in sedated or anesthetized patients may become a major challenge for anesthetists, especially in patients with preexisting sleep disordered breathing or airway obstruction. In addition to different techniques of body positioning, simple airway maneuvers, such as chin lifting can maintain airway patency or open an obstructed upper airway. These maneuvers need an age-related evaluation and application.

A Case of Laryngeal Neurofibroma with Sleep Obstructive Apnea

' disease), which is characterized by cafe-au-lait spots and cutaneous neurofibromas. Neurofibromas in the laryngeal area are extremely rare. Most patients with a laryngeal neurofibroma present with dyspnea, dysphagia, stridor, or hoarseness, depending on the location and size of the tumor. We present a case of a laryngeal neurofibroma in a boy with neurofibromatosis type 1. A 30-month-old boy with neurofibromatosis presented to our hospital with respiratory difficulty and obstructive sleep apnea. Magnetic resonance imaging demonstrated a round mass over the left carotid space, and its location made surgical resection impossible. Hence, tracheostomy was performed to maintain airway patency. The patient s symptoms improved after tracheostomy. Long ' -term follow-up is es- sential owing to the possibility of recurrence. The patient has thus far shown no obstructive airway symptoms for one year after closure of the tracheostomy. (Pediatr Allergy Respir Dis(Korea) 2011;21:131-136)

Airway management in trauma

Trauma has assumed epidemic proportion. 10% of global road accident deaths occur in India. Hypoxia and airway mismanagement are known to contribute up to 34% of pre-hospital deaths in these patients. A high degree of suspicion for actual or impending airway obstruction should be assumed in all trauma patients. Objective signs of airway compromise include agitation, obtundation, cyanosis, abnormal breath sound and deviated trachea. If time permits, one should carry out a brief airway assessment prior to undertaking definitive airway management in these patients. Simple techniques for establishing and maintaining airway patency include jaw thrust maneuver and/or use of oro- and nas-opharyngeal airways. All attempts must be made to perform definitive airway management whenever airway is compromised that is not amenable to simple strategies. The selection of airway device and route- oral or -nasal, for tracheal intubation should be based on nature of patient injury, experience and skill level.

Explore the artificial airway's nursing management of neurosurgical patient

Objective To evaluate neurosurgical patients with artificial airway care methods.Methods A retrospective analysis of our hospital from January 2008-December 2009 126 patients admitted to neurosurgical clinical information, review the method of artificial airway care. Results 126 patients in this group improved 123 cases cured, 3 died, the mortality rate was 2.4%. 78 cases in which tracheotomy,intubation in 37 cases, 11 cases of nasal intubation. This group of patients with artificial airway time 2 ～ 23 d, an average of 9.4 d.Conclusion The artificial airway care and management of neurosurgical patients to maintain airway patency crucial role in the airway. Key words: Artificial airway; Care; Neurosurgery; Critical

Intralesional corticosteroid injection and dilatation provides effective management of subglottic stenosis in Wegener's granulomatosis

To describe our experience with the use of intralesional corticosteroid injection and dilatation (ILCD) in the management of subglottic stenosis (SGS). Retrospective chart review. A retrospective chart review was performed of all patients with SGS requiring ILCD, from 2003 to 2008, at the Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Hospital, Toronto, Canada. Twelve patients with SGS underwent 36 ILCD operations with a mean of three procedures per patient. We identified eight patients with Wegener's granulomatosis (WG) and four patients without WG. The eight WG patients received an average of 3.37 procedures, whereas non-WG patients required an average of 2.25 procedures. This maintained airway patency and symptom control for an average of 11.9 and 8.1 months, respectively. Only one complication was identified, and no long-term sequelae were found. No patients required new tracheotomies and one patient with a previous tracheotomy was successfully decannulated. Our data supports the use of ILCD as a safe and effective treatment of SGS in both WG and non-WG patients.

Right Thoracotomy for Carinal Resection With Left Thoracoscopic Pneumonectomy as a New Approach for Left Sleeve Pneumonectomy: A Case Report

A 43-year-old woman, with a history of asthma that had been treated for the previous 3 years, was diagnosed with an endobronchial tumor, based on chest computed tomography. A biopsy proved the tumor to be adenoid cystic carcinoma. For carinal involvement and submucosal extension in the left main bronchus, rigid bronchoscopy was done to maintain airway patency, and then a left sleeve pneumonectomy was done via a right thoracotomy and left video-assisted thoracoscopic surgery. The distance between the tumor-free left main bronchus and the carina was large; therefore, preservation of the left lung would have compromised the healing of the carinal tracheobronchoplasty and led to life-threatening complications. This case revealed that endobronchial lesions should be highly suspected after treatment for asthma fails. It also highlighted that, because the carina naturally deviates to the right, combined right thoracotomy and left video-assisted thoracoscopic surgery for left sleeve pneumonectomy provides an anatomical advantage for carinal tracheobronchoplasty. Furthermore, the combination reduces the postoperative physiological burden that could be caused by bilateral thoracotomy.

Part 13: pediatric basic life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.

Part 13: pediatric basic life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.

European Resuscitation Council Guidelines for Resuscitation 2010 Section 2. Adult basic life support and use of automated external defibrillators

Basic life support (BLS) refers to maintaining airway patency and supporting breathing and the circulation, without the use of equipment other than a protective device.1 This section contains the guidelines for adult BLS and for the use of an automated external defibrillator (AED). It also includes recognition of sudden cardiac arrest, the recovery position and management of choking (foreign-body airway obstruction). Guidelines for the use of manual defibrillators and starting in-hospital resuscitation are found in Sections 3 and 4.

Laryngeal framework reconstruction using titanium mesh in glottic cancer after frontolateral vertical partial laryngectomy

To investigate the feasibility and efficacy of laryngeal framework reconstruction using titanium mesh in patients with glottic cancer after frontolateral vertical partial laryngectomy. Prospective study. Defect of laryngeal framework, caused by frontolateral vertical partial laryngectomy in nine patients with T2 or T3 squamous cell carcinoma of glottic, were reconstructed with titanium mesh from 2007 to 2009. Computed tomography (CT) and fiberscopic examinations were performed at two weeks and three months postoperatively. No aspiration and laryngeal stenosis was observed in the nine patients. CT scanning showed that titanium mesh was fastened well without displacement and deformity and that there was no laryngeal stenosis. Fiberscopic inspection showed that the larynx lumen was maintained well without stricture, shrinkage, and necrosis. No titanium mesh was exposed to the larynx lumen. Titanium mesh was a good alternative for reconstruction of the laryngeal framework. It provided adequate structural support to maintain airway patency.

Innovations to Achieve Excellence in COPD Diagnosis and Treatment in Primary Care

Recognition of chronic obstructive pulmonary disease (COPD) is often missed or delayed in primary care. Once recognized, COPD is often undertreated or episodically treated, focusing on acute exacerbations without establishing maintenance treatment to control ongoing disease. Diagnostic and therapeutic pessimism result in missed opportunities to reduce exacerbations, maintain physical functioning, and reduce emergent health care requirements. Proactive diagnosis and evidence-based management can alleviate the impact of COPD on patients' lives. Smoking cessation has been proven to slow the rate of lung function decline. Maintenance pharmacotherapy and immunizations reduce exacerbations. Pulmonary rehabilitation improves respiratory symptoms and physical functioning and reduces rehospitalizations after exacerbations. Self-management education improves health-related quality of life and reduces inpatient and emergency care usage. Maintenance treatment with long-acting inhaled bronchodilators is appropriate beginning in moderate COPD to maintain airway patency and reduce exacerbations. Tiotropium is US Food and Drug Administration (FDA) approved to treat bronchospasm and reduce exacerbations in patients with COPD; salmeterol/fluticasone is FDA approved to treat airflow obstruction in COPD and reduce exacerbations in patients with a history of exacerbations. Other maintenance long-acting bronchodilators—salmeterol, formoterol, and budesonide/formoterol—are FDA approved to treat airway obstruction in COPD but lack an approved indication against exacerbations. FDA warnings on the use of long-acting beta-adrenergic agents (LABAs) in asthma specifically exempt COPD and do not apply to LABA/inhaled corticosteroid combinations used in COPD. The actual effectiveness achieved in practice with any COPD therapies depends on patients' inhaler technique, adherence, and persistence. Medication usage rates and inhaler proficiency may be improved by concordance, in which the health care provider and patient collaborate to make treatment plans sustainable in the patient's daily life. Practice redesign for whole-patient primary care provides additional tools for comprehensive COPD management. Innovations such as group visits and the patient-centered medical home provide newer ways to interact with COPD patients and their families. Patient-focused and evidence-based options enable primary care practices to manage COPD longitudinally and improve patient outcomes through the course of the disease.

Syndromic craniosynostosis: complicated airway obstruction calls for progressive strategies in surgical management

Evaluation of: Bannink N, Nout E, Wolvius EB, Hoeve HL, Joosten KF, Mathijssen IM. Obstructive sleep apnea in children with syndromic craniosynostosis: long-term respiratory outcome of midface advancement. Int. J. Oral Maxillofac. Surg. 39(2), 115–121 (2010).Children with syndromic craniosynostosis are at high risk for upper airway obstruction due to midface hypoplasia. Le Fort III osteotomy with midface advancement can expand the naso- and palatopharynx and potentially relieve obstruction. Short-term success has been demonstrated with these surgical techniques; however, little is known regarding the long-term effect of midface advancement on maintaining airway patency. The purpose of this study was to evaluate the long-term effect of midface advancement for treatment of severe obstructive sleep apnea in patients with syndromic craniosynostosis. Results showed that midface advancement had short-term (4 months) success in six of 11 patients with resolution of the need for positive airway pressure, tracheostomy or oxygen (54%); however, long-term success was maintained in only four of these six patients. All failures had concomitant hypopharyngeal obstruction, which cannot be corrected by midface advancement. Endoscopy and 3D CT scan may be useful for predicting which patients will require additional surgical procedures, such as mandibular or genio-hyoid advancement.

Incident sleep disordered breathing in old age.

Little is known about progression of and risk factors for sleep disordered breathing (SDB) in old age. We prospectively examined elderly volunteers to understand how changes in body weight are related to SDB for a period of 20-30 years. Participants were 30 surviving members of a community-based cohort (mean entry age = 57.8) studied over a median follow-up of 23.4 years. SDB was quantified as the apnea-hypopnea index (AHI) via in-lab polysomnography from 215 nights, representing 733.3 person-years of follow-up. Weights were recorded in kilograms. We used linear regression to derive individual trajectories of AHI and weight regressed on time. Individuals had relatively low AHI (X = 2.3 [SD = 3.5]) and body mass index (kg/m(2); X = 24.6 [SD = 4.6]) at entry. Rates of change in AHI were characterized by positive slopes and linear increases by least squares regression. Mean rate of change was +0.43 events per hour per year, a 3.3% yearly increase relative to the maximum AHI observed for each case. Within individuals, curve fitting indicated statistically significant AHI increases associated not only with increases, but also decreases, in weight. Rates of increase in AHI were larger than for aging reported for other organ systems (eg, autonomic, musculoskeletal, and respiratory), possibly reflecting complex mechanistic determination of SDB in old age. Association between decreased weight and increased SDB with advancing years represents an important "proof of concept," perhaps compatible with failure to maintain airway patency during sleep as a component of generalized muscle weakness in old age.

Schemat postępowania i wstępne wyniki leczenia brodawczaków krtani dotkankowym preparatem cidofovir

Recurrent respiratory papillomatosis (RRP) is a rare disease in children and adults. It is characterized by proliferation of benign squamous cell papillomas within the respiratory-digestive tract, predominantly the larynx. Standard treatment consists of surgical excision of papillomata to maintain airway patency and voice quality. For last several years cidofovir is the most contemporary adjuvant anti-viral treatment for recurrent respiratory papillomatosis and its topical use is widely described. Intralesional cidofovir therapy was given to 20 patients treated for laryngeal papillomas in the Department of Otolaryngology in Poznan between I-XII.2009. The character of the lesion differed: from one anatomical site and moderate growth to four or five localizations with heavy extension. The number of cidofovir injections per patient varied from one to six times and the volume of solution ranges from 1-12 ml. The cidofovir injections were combined with laser or mechanical excision of the lesions. In disperse papillomata the injections administered in particular anatomical sites in 4-6 weeks period. In massive lesions injections were repeated in the same anatomical site. Complete remission was observed in 3 out of 20 patients. 12 patients show remission in a place of cidofovir injection. In 4 patients during the 4 week observation new foci of papillomatosis occurred. In two patients hepatic toxic side effect were observed. Intralesional cidofovir injection has been shown to be an effective an safe therapy for laryngeal papilloma and should be considered in those patients who experienced disease relapse.

Cervical Support Collar: A Substitute to the Jaw Thrust/Chin Lift Methods of Airway Management During Oral Maxillofacial Surgeries

Outpatient single-surgeon-provided intravenous sedation is a safe, cost-effective means of providing anesthesia for numerous oral and maxillofacial surgical procedures. 1 The sedation allows for increased comfort for the patient and can make difficult procedures less stimulating and more routine for patient and surgeon. When sedation is used, it is extremely important that proper airway management techniques are used. 2 Two very basic techniques to maintain airway patency in the sedated patient are the jaw thrust and chin lift methods. The jaw thrust method consists of grasping the angles of the mandible and advancing them forward to increase the opening of the pharynx. The chin lift method consists of advancing the mandible forward by grasping just under the mental protuberance and opening up the pharynx that way. 3 The job of manually maintaining airway patency is routinely designated to the Oral and Maxillo-facial Surgery Anesthesia Assistants Program trained surgical assistant who stands at the head of the patient. To more safely administer anesthesia and avoid fatigue by the assistant for longer procedures, we have developed the following method to assist with airway management.

Bilateral Tension Pneumothorax and Tension Pneumoperitoneum Secondary to Tracheal Tear in a Patient With Relapsing Polychondritis

Relapsing polychondritis (RP) is a rare disease that is characterized by recurrent inflammation and destruction of cartilage and connective tissues. RP can have significant airway pathology that may require procedures to maintain airway patency and thus may have serious implications for anesthesiologists. Anesthesiologists must be prepared to deal with the possible complications that may occur during airway manipulation in patients with RP. Here, we present a case of life-threatening bilateral tension pneumothorax and tension pneumoperitoneum that developed after a tracheal tear during Montgomery T-tube insertion in a patient with tracheal stenosis due to RP. Correct diagnosis was delayed due to a misdiagnosis of airway obstruction. As a result, we emphasize that bilateral tension pneumothorax should be considered during refractory cardiac arrest in patients with increased airway pressure. A high index of suspicion and adequate management are mandatory for patients to survive these life-threatening complications.

Opioid‐induced suppression of genioglossal muscle activity: is it clinically important?

Opioid‐induced suppression of genioglossal muscle activity: is it clinically important?

Two-piece cryopreserved tracheal allotransplantation: an experimental study

For successful reconstruction with tracheal allotransplants following long tracheal resections, problems related to the preservation and vascularisation of the tracheal graft have to be solved. In this study, instead of using a long-segment single-piece graft, we used a graft that has been split into two. The aim was to use this graft after cryopreservation in order to ease neo-vascularisation and to maintain tracheal integrity by transplanting it to two separate regions of the dog cervical trachea. This experimental study was conducted in animal laboratories of the medical school on 11 half-blood dogs. The trachea obtained from the first dog was 8 cm in length; it was split into two pieces of 4 cm each and stored in the preservation solution at -80 degrees C for 4 weeks. Following this, the dog was sacrificed. Two 2 cm portions of cervical trachea were excised from the second dog. These parts were then reconstructed with two tracheal grafts of the same length as the cryopreserved ones. Ten dogs that were grouped into five groups of two dogs each underwent the same procedure. The subjects had a bronchoscopic evaluation on the third postoperative week. Anastomosis regions of the test tracheas were resected to be examined histopathologically. Seven subjects were found to have third-degree obstructions during bronchoscopy; two had close to fourth-degree obstructions. In the histopathological examination, contrary to the findings of the bronchoscopies, 75% of the anastomoses had intact epithelium. The cartilage was seen to have well-preserved structural characteristics in all the anastomoses. Twelve anastomoses had moderate, seven mild and one had severe inflammation. All anastomoses had either good or very good level of vascularisation. The integrity of the tracheal epithelium can be maintained with cryopreservation and split anastomosis technique. The cartilage preserves its structural characteristics despite losing its viability, thereby offering an advantage to maintain airway patency.

Tratamento cirúrgico das estenoses traqueais congênitas

To analyze the outcomes of patients undergoing repair of congenital tracheal stenosis. This was a retrospective review of congenital tracheal stenosis patients treated between 2001 and 2007 at the University of São Paulo School of Medicine Hospital das Clínicas in São Paulo, Brazil. Six boys and one girl (age at diagnosis ranging from 28 days to 3 years) were included. Five of the patients also had cardiac or major vessel malformations. The stenosis length was short in three patients, medium in one and long in three. The techniques used were pericardial patch tracheoplasty in three patients, resection and anastomosis in two, slide tracheoplasty in one and vascular ring correction in one. One patient died during surgery due to hypoxia and hemodynamic instability, and one died from septic shock on postoperative day 11. Other complications included pneumonia, arrhythmia, stenosis at the anastomosis level, residual stenosis, granuloma formation and malacia. The mean follow-up period was 31 months; four patients were cured, and one required the use of a T tube to maintain airway patency. Congenital tracheal stenosis is a curable disease. However, its repair is complex and is associated with high rates of morbidity and mortality.

Airway wall geometry in asthma and nonasthmatic eosinophilic bronchitis

Variable airflow obstruction and airway hyperresponsiveness (AHR) are features of asthma, which are absent in nonasthmatic eosinophilic bronchitis (EB). Airway remodelling is characteristic of both conditions suggesting that remodelling and airway dysfunction are disassociated, but whether the airway geometry differs between asthma and nonasthmatic EB is uncertain. We assessed airway geometry by computed tomography (CT) imaging in asthma vs EB. A total of 12 subjects with mild-moderate asthma, 14 subjects with refractory asthma, 10 subjects with EB and 11 healthy volunteers were recruited. Subjects had a narrow collimation (0.75 mm) CT scan from the aortic arch to the carina to capture the right upper lobe apical segmental bronchus (RB1). In subjects with asthma and EB, CT scans were performed before and after a 2-week course of oral prednisolone (0.5 mg/kg). Mild-moderate and refractory asthma were associated with RB1 wall thickening in contrast to subjects with nonasthmatic EB who had maintained RB1 patency without wall thickening [mean (SD) % wall area and luminal area mild-t0-moderate asthma 67.7 (7.3)% and 6.6 (2.8) mm(2)/m(2), refractory asthma 67.3 (5.6)% and 6.7 (3.4) mm(2)/m(2), healthy control group 59.7 (6.3)% and 8.7 (3.8) mm(2)/m(2), EB 61.4 (7.8)% and 11.1 (4.6) mm(2)/m(2) respectively; P < 0.05]. Airway wall thickening of non-RB1 airways generation three to six was a feature of asthma only. There was no change in airway geometry of RB1 after prednisolone. Proximal airway wall thickening was associated with AHR in asthma (r = -0.56; P = 0.02). Maintained airway patency in EB may protect against the development of AHR, whereas airway wall thickening may promote AHR in asthma.