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Upper Airway Obstruction (upper + airway_obstruction)
Kinds of Upper Airway Obstruction Selected AbstractsQualitative and quantitative evaluation of equine respiratory mechanics by impulse oscillometryEQUINE VETERINARY JOURNAL, Issue 1 2006E. VAN ERCK Summary Reasons for performing study: The long- established conventional reference technique (CRT) for measuring respiratory mechanics in horses lacks sensitivity and there is a need for further refinement in new technology, such as the impulse oscillometry system (IOS). Objectives: To evaluate the potential use of the IOS as a clinical respiratory function test and compare it to the current CRT in horses suffering from common upper and lower airway dysfunctions. Methods: Six healthy horses were tested before and after induction of a unilateral nasal obstruction (UNO) or transient left laryngeal hemiplegia (LLH). Six heaves-affected horses were tested in clinical remission and during a heaves crisis, before and after nebulisation of cumulative doses of a bronchodilator therapy (ipratropium bromide; IPB). Results: As opposed to the CRT, the IOS was able to detect partial upper airway obstruction (UAO) caused by UNO or LLH in resting horses, without differentiating both conditions. Upper airway obstruction caused an upward shift of resistance (Rrs) from 5 to 35 Hz without altering reactance (Xrs). As for the CRT, IOS respiratory parameters measured in heaves-affected horses in crisis differed significantly from values measured during remission. The difference in frequency-dependent behaviour of Rrs and Xrs allowed discrimination between upper and lower airway obstructions. Bronchodilator treatment induced significant dose-dependent changes in Xrs at 5 and 10 Hz, from the first dose. Total pulmonary resistance (RL) and Rrs at 5 Hz were affected from the second dose and displayed similar sensitivity. Although post treatment RL values were comparable to remission, Rrs and Xrs remained significantly different, characterising persistent peripheral obstruction. Conclusions: The IOS was more sensitive than the CRT in detecting partial UAO in resting horses and persistent post treatment peripheral dysfunction in heaves-affected horses. The IOS is a sensitive test that provides graded quantitative and qualitative information on disease-induced respiratory dysfunctions as well as on treatment efficiency in horses. Potential relevance: The IOS could represent a practical and sensitive alternative respiratory function test for routine clinical investigations of common airway obstructive diseases and therapy in horses. [source] Awake upper airway obstruction in children with spastic quadriplegic cerebral palsyJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 1-2 2006Dominic J Wilkinson Objective: Some children with severe cerebral palsy develop symptoms of upper airway obstruction (UAO) while awake. The aetiology, natural history and treatment of this complication have not previously been systematically described. This study documents a case series of children with severe cerebral palsy admitted to hospital because of severe awake UAO and reviews the relevant literature. Methods: The case records of children admitted to hospital with UAO while awake over an 8-month period were reviewed. Details of antecedent illness, comorbidities, acute management and follow up were collated. One case is presented in detail. Results: Eight children were admitted with UAO. Seven children required intensive care admission. One child died, and two underwent tracheostomy. Nasendoscopy showed pharyngeal collapse without anatomical obstruction in the majority. One child was discovered to have a brainstem malignancy. Conclusions: Upper airway obstruction is a potentially severe and life-threatening complication of cerebral palsy. In this series, a majority of children had obstruction related to pharyngeal hypotonia and collapse. This can lead to prolonged hospitalization and intensive care admission. It may raise difficult management issues. [source] Upper airway obstruction in childrenPEDIATRIC ANESTHESIA, Issue 2009FRCS (ORL-HNS), IAIN A. BRUCE MD First page of article [source] The prolonged use of the laryngeal mask airway in a neonate with airway obstruction and Treacher Collins syndromePEDIATRIC ANESTHESIA, Issue 6 2003Martin J.L. Bucx MD Summary Upper airway obstruction and difficult tracheal intubation are often encountered in patients with Treacher Collins syndrome (mandibulofacial dysostosis). In this case report, the use of a laryngeal mask airway (LMATM) in a 10-day-old newborn with severe Treacher Collins syndrome and acute airway obstruction is described. It successfully relieved the airway obstruction and was left in situ for an exceptionally long period of 4 days. The difficult decisions with respect to the management of the airway and specifically the role of the laryngeal mask are described. In our opinion, in some newborns with severe mandibulofacial disorders and upper airway obstruction, where conservative airway management procedures have failed, the laryngeal mask can be considered not only to relieve the obstruction but also to buy time until there is full insight into the medical condition and its consequences. [source] Upper airway obstruction in a patient with a tracheostomyANAESTHESIA, Issue 1 2004R. McKendrick No abstract is available for this article. [source] Effects of unilateral laser-assisted ventriculocordectomy in horses with laryngeal hemiplegiaEQUINE VETERINARY JOURNAL, Issue 6 2006P. ROBINSON Summary Reasons for performing study: Recent studies have evaluated surgical techniques aimed at reducing noise and improving airway function in horses with recurrent laryngeal neuropathy (RLN). These techniques require general anaesthesia and are invasive. A minimally invasive transnasal surgical technique for treatment of RLN that may be employed in the standing, sedated horse would be advantageous. Objective: To determine whether unilateral laser-assisted ventriculocordectomy (LVC) improves upper airway function and reduces noise during inhalation in exercising horses with laryngeal hemiplegia (LH). Methods: Six Standardbred horses were used; respiratory sound and inspiratory transupper airway pressure (Pui) measured before and after induction of LH, and 60, 90 and 120 days after LVC. Inspiratory sound level (SL) and the sound intensities of formants 1, 2 and 3 (F1, F2 and F3, respectively), were measured using computer-based sound analysis programmes. In addition, upper airway endoscopy was performed at each time interval, at rest and during treadmill exercise. Results: In LH-affected horses, Pui, SL and the sound intensity of F2 and F3 were increased significantly from baseline values. At 60 days after LVC, Pui and SL had returned to baseline, and F2 and F3 values had improved partially compared to LH values. At 90 and 120 days, however, SL increased again to LH levels. Conclusions: LVC decreases LH-associated airway obstruction by 60 days after surgery, and reduces inspiratory noise but not as effectively as bilateral ventriculocordectomy. Potential relevance: LVC may be recommended as a treatment of LH, where reduction of upper airway obstruction and respiratory noise is desired and the owner wishes to avoid risks associated with a laryngotomy incision or general anaesthesia. [source] Dynamic pharyngeal collapse in racehorsesEQUINE VETERINARY JOURNAL, Issue S36 2006A. G. BOYLE Summary Reason for performing study: Dynamic pharyngeal collapse (PC) is a condition seen in racehorses that can be career-ending. Objectives: To characterise and grade PC and describe the effects of PC on athletic performance. Methods: Medical records were reviewed for 828 horses, of which 49 (6%) records were identified as horses with a primary diagnosis of PC. Tapes of video-endoscopy of the pharynx during exercise were reviewed. Each video recording was assigned a grade (0,4) reflecting the degree of PC and a classification for severity of upper airway obstruction. Earnings per race prior to diagnosis of PC were compared to earnings per race after diagnosis of PC for all horses, as well as performance index (PI). Available exercising arterial blood gases were reviewed for horses with PC. Results: There were 35 (80%) Thoroughbreds (TB), and 9 (20%) Standardbreds (STD). 32 (73%) had a history of making an upper respiratory noise. 4 (9%) grade 1 PC, 8 (18%) grade 2 PC, 26 (59%) grade 3 PC, and 6 (14%) grade 4 PC. Seven (16%) horses were classified as mild PC, 18 (41%) as low-moderate PC, 14 (32%) as high-moderate PC, and 5 (11%) as severe PC. Of 30 horses 11 had abnormally decreased PaO2 and 8 horses had abnormally elevated PaCO2. A significant decrease was found in earnings per race prediagnosis when compared to post diagnosis earnings per race in horses ?4 years of age (P = 0.003). A significant decrease was also observed for earnings per race prediagnosis when compared to post diagnosis earnings per race in horses with grade 3 PC (P = 0.03) No significant differences were observed in PI before or after diagnosis of PC. Conclusions: There was a trend for PC to be observed in more TB than STD, and more males than females compared to the general hospital population. Horses with PC significant had decreases in arterial oxygenation. Racing records after a diagnosis of PC in all horses ?4 years of age suggesting that older horses have a guarded prognosis for continued success. Potential relevance: This study provides a classification system for dynamic pharyngeal collapse and suggests that older racehorses (?4 years of age) diagnosed with PC and all horses with grade 3 PC have a poor prognosis for return to previous level of performance. [source] Qualitative and quantitative evaluation of equine respiratory mechanics by impulse oscillometryEQUINE VETERINARY JOURNAL, Issue 1 2006E. VAN ERCK Summary Reasons for performing study: The long- established conventional reference technique (CRT) for measuring respiratory mechanics in horses lacks sensitivity and there is a need for further refinement in new technology, such as the impulse oscillometry system (IOS). Objectives: To evaluate the potential use of the IOS as a clinical respiratory function test and compare it to the current CRT in horses suffering from common upper and lower airway dysfunctions. Methods: Six healthy horses were tested before and after induction of a unilateral nasal obstruction (UNO) or transient left laryngeal hemiplegia (LLH). Six heaves-affected horses were tested in clinical remission and during a heaves crisis, before and after nebulisation of cumulative doses of a bronchodilator therapy (ipratropium bromide; IPB). Results: As opposed to the CRT, the IOS was able to detect partial upper airway obstruction (UAO) caused by UNO or LLH in resting horses, without differentiating both conditions. Upper airway obstruction caused an upward shift of resistance (Rrs) from 5 to 35 Hz without altering reactance (Xrs). As for the CRT, IOS respiratory parameters measured in heaves-affected horses in crisis differed significantly from values measured during remission. The difference in frequency-dependent behaviour of Rrs and Xrs allowed discrimination between upper and lower airway obstructions. Bronchodilator treatment induced significant dose-dependent changes in Xrs at 5 and 10 Hz, from the first dose. Total pulmonary resistance (RL) and Rrs at 5 Hz were affected from the second dose and displayed similar sensitivity. Although post treatment RL values were comparable to remission, Rrs and Xrs remained significantly different, characterising persistent peripheral obstruction. Conclusions: The IOS was more sensitive than the CRT in detecting partial UAO in resting horses and persistent post treatment peripheral dysfunction in heaves-affected horses. The IOS is a sensitive test that provides graded quantitative and qualitative information on disease-induced respiratory dysfunctions as well as on treatment efficiency in horses. Potential relevance: The IOS could represent a practical and sensitive alternative respiratory function test for routine clinical investigations of common airway obstructive diseases and therapy in horses. [source] Awake upper airway obstruction in children with spastic quadriplegic cerebral palsyJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 1-2 2006Dominic J Wilkinson Objective: Some children with severe cerebral palsy develop symptoms of upper airway obstruction (UAO) while awake. The aetiology, natural history and treatment of this complication have not previously been systematically described. This study documents a case series of children with severe cerebral palsy admitted to hospital because of severe awake UAO and reviews the relevant literature. Methods: The case records of children admitted to hospital with UAO while awake over an 8-month period were reviewed. Details of antecedent illness, comorbidities, acute management and follow up were collated. One case is presented in detail. Results: Eight children were admitted with UAO. Seven children required intensive care admission. One child died, and two underwent tracheostomy. Nasendoscopy showed pharyngeal collapse without anatomical obstruction in the majority. One child was discovered to have a brainstem malignancy. Conclusions: Upper airway obstruction is a potentially severe and life-threatening complication of cerebral palsy. In this series, a majority of children had obstruction related to pharyngeal hypotonia and collapse. This can lead to prolonged hospitalization and intensive care admission. It may raise difficult management issues. [source] Laryngeal foreign bodies in children: First stop before the right main bronchusJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 6 2003PJ Robinson Abstract: Laryngeal foreign bodies may produce either complete or incomplete airways obstruction. In complete airways obstruction the presentation is with calamitous respiratory difficulty. However incomplete laryngeal obstruction may present with less severe symptoms, resulting in possible misdiagnosis and confusion with other causes of upper airway obstruction such as infectious croup. This report describes three cases of incomplete laryngeal obstruction secondary to inhaled foreign bodies. In each case, the diagnosis of an inhaled foreign body was initially missed, resulting in delay in diagnosis and in one case prolonged recovery. The importance of considering laryngeal foreign bodies, both in cases of suspected foreign body inhalation and clinical cases of incomplete laryngeal obstruction are discussed. [source] Tremulous arytenoid movements predict severity of glottic stenosis in multiple system atrophy,MOVEMENT DISORDERS, Issue 10 2010Tetsutaro Ozawa MD Abstract To determine whether tremulous arytenoid movements predict the severity of glottic stenosis in patients with multiple system atrophy (MSA), 28 MSA patients and 14 age-matched controls underwent fiberoptic laryngoscopy with video monitoring during wakefulness and under anesthesia induced by intravenous injection of propofol. Presence or absence of tremulous arytenoid movements was recorded during wakefulness. The ratio of glottic stenosis (%), which represents the extent of airway narrowing under anesthesia, was obtained by measuring the inspiratory glottic angle during wakefulness and under anesthesia. The median ratio of glottic stenosis was significantly higher in patients with MSA (57.5%) than in control subjects (0.5%). Tremulous arytenoid movements were characterized by shaking movements of the arytenoid region including the vocal folds, which are most apparent in the arytenoid cartilage. In this study, tremulous arytenoid movements were observed in 18 (64.2%) of 28 patients with MSA, who displayed a significantly higher median ratio of glottic stenosis (71.2%) than other patients (34.9%). None of the control subjects exhibited tremulous arytenoid movements. A clear correlation existed between the ratio of glottic stenosis and disease duration. Our observations indicate that tremulous arytenoid movements are a marker of the severity of glottic stenosis, which confers an increased risk of upper airway obstruction in patients with MSA. © 2010 Movement Disorder Society [source] Presurgical fentanyl vs caudal block and the incidence of adverse respiratory events in children after orchidopexyPEDIATRIC ANESTHESIA, Issue 12 2009SAMIA N. KHALIL MD Summary Background:, There is controversy about the etiology of early postoperative hypoxemia. Age, weight, intubation, surgical procedure, use of muscle relaxants, and/or administration of opioids may affect the incidence of early postoperative hypoxemia. In this prospective, randomized, and single-blinded study, we evaluated whether the administration of caudal analgesia vs i.v. fentanyl affected the number of children who develop postextubation adverse upper airway respiratory events, (upper airway obstruction, laryngospasm) and/or early postoperative hypoxemia. Methods/materials:, Institutional approval and written parental informed consents were obtained. Thirty-eight healthy outpatient boys, aged 1,6 years, scheduled for elective orchidopexy were randomized to receive pain relief either with a presurgical caudal block or by i.v. fentanyl. The primary outcome of the study was the number of children who developed postextubation adverse upper airway respiratory events and/or early postoperative hypoxemia. Results:, The number of boys who developed postextubation adverse upper airway respiratory events and/or early postoperative hypoxemia in the caudal group was less compared with those in the fentanyl group (P = 0.04). Conclusions:, Compared to fentanyl, placement of a presurgical caudal block in boys scheduled for orchidopexy was associated with a lower incidence of postextubation adverse upper airway respiratory events and/or early postoperative hypoxemia. [source] Raised intracranial pressure in a neonate presenting as stridorPEDIATRIC ANESTHESIA, Issue 8 2006KATE SOLAN FRCA Summary Neonatal stridor is an important sign of upper airway obstruction. This is most commonly secondary to laryngeal pathology and investigated by otolaryngologists. However neurological causes of stridor, secondary to vocal cord paralysis also occur for a variety of reasons (1). In cases of meningomyelocele up to 20% of infants may develop stridor (2). Respiratory distress may be severe and require prompt surgical and medical intervention. We describe a neonate born with a meningomyelocele, who developed stridor secondary to evolving hydrocephalus after surgical repair of the meningomyelocele. This was treated acutely by direct tapping of cerebrospinal fluid from the right coronal horn via the coronal suture with immediate symptomatic improvement prior to a definitive shunt procedure. [source] The prolonged use of the laryngeal mask airway in a neonate with airway obstruction and Treacher Collins syndromePEDIATRIC ANESTHESIA, Issue 6 2003Martin J.L. Bucx MD Summary Upper airway obstruction and difficult tracheal intubation are often encountered in patients with Treacher Collins syndrome (mandibulofacial dysostosis). In this case report, the use of a laryngeal mask airway (LMATM) in a 10-day-old newborn with severe Treacher Collins syndrome and acute airway obstruction is described. It successfully relieved the airway obstruction and was left in situ for an exceptionally long period of 4 days. The difficult decisions with respect to the management of the airway and specifically the role of the laryngeal mask are described. In our opinion, in some newborns with severe mandibulofacial disorders and upper airway obstruction, where conservative airway management procedures have failed, the laryngeal mask can be considered not only to relieve the obstruction but also to buy time until there is full insight into the medical condition and its consequences. [source] Pressure-rate product and phase angle as measures of acute inspiratory upper airway obstruction in rhesus monkeysPEDIATRIC PULMONOLOGY, Issue 7 2010FAAP, Patrick A. Ross MD Abstract Rationale There are limited validated, objective, and minimally invasive techniques for the bedside evaluation of upper airway obstruction (UAO) in sick infants, despite its frequency in pediatric medicine. Prior techniques include pressure-rate product (PRP), a product of esophageal pressure and respiratory rate and phase angles (PAs), a measure of asynchrony between ribcage and abdominal respiratory movements in infants with UAO. The purpose of this study is to validate the PRP and compare it to a previously validated PA in rhesus monkeys. Methods Calibrated resistors were applied to the inspiratory limb of 10 anesthetized, intubated, and spontaneously breathing rhesus monkeys (weight 8.7,±,2.5,kg). Airway pressure, respiratory rate, PAs, heart rate, and oxygen saturation were recorded. Obstruction was applied in random order as 0, 5, 20, 200, 500, and 1,000,cmH2O/L/sec for 2-min periods, the last 15,sec (10,20 breaths) were analyzed for each timeframe. Results PA increased significantly at the 200,cmH2O/L/sec level but it reached a plateau above 500,cmH2O/L/sec. PRP rose progressively and was significantly different at all levels of obstruction. Esophageal pressure change was progressively and statistically significantly different from baseline and each other at 200, 500, and 1,000,cmH2O/L/sec (P,<,0.001). Conclusions In this model of UAO, PRP tracks increasing inspiratory load better than PA. PRP continued to be linear up through the highest inspiratory resistance where the change in PA reached a plateau before the highest load. The assessment of esophageal pressure changes may offer the simplest objective measure of UAO. Pediatr Pulmonol. 2010; 45:639,644. © 2010 Wiley-Liss, Inc. [source] Noninvasive ventilation in the pediatric intensive care unit for children with acute respiratory failure,,PEDIATRIC PULMONOLOGY, Issue 6 2003W. Gerald Teague MD Abstract Noninvasive ventilation, a novel treatment to increase alveolar ventilation, is accomplished with either subatmospheric or positive pressure administered via an external interface. In adults with acute respiratory failure, noninvasive positive pressure ventilation (NPPV) is superior to standard therapy in preventing intubation and reducing mortality. The role of NPPV in pediatric-age patients with acute respiratory distress is not as well established. Early case reports showed that NPPV treatment does acutely improve both the clinical manifestations of respiratory distress and respiratory gas exchange in children with respiratory distress. However, it is not clear whether NPPV in this setting can prevent vs. delay endotracheal intubation. Other uses of NPPV in the pediatric intensive care unit include the treatment of upper airway obstruction, atelectasis, and exacerbations of neuromuscular disorders, and to facilitate weaning from invasive mechanical ventilation. Successful use of NPPV in young infants with respiratory distress is impeded by the lack of suitable size interfaces, and the response characteristics of commercially available bilevel ventilators. Despite these challenges, NPPV is a promising alternate to standard therapies in the treatment of acute respiratory distress in the pediatric-age patient. Pediatr Pulmonol. 2003; 35:418,426. © 2003 Wiley-Liss, Inc. [source] Severe upper airway obstruction in the tropics requiring intensive carePEDIATRICS INTERNATIONAL, Issue 1 2001Pwk Chan Background: The clinical profile of severe upper airway obstruction, a challenging acute pediatric emergency, has not been extensively documented in the developing nations of the tropics. Methods: The diagnostic categories, severity of illness and outcome from 63 episodes of severe upper airway obstruction in 56 children admitted to the Pediatric Intensive Care Unit between January 1994 and December 1999 were reviewed. Outcome variables studied included requirement for ventilation, mortality and complications. Severity of illness was determined with the Pediatric Risk of Mortality (PRISM) II score. Results: Viral croup (29%) was the most common diagnosis, followed by mediastinal malignancy (13%), bacterial tracheitis (11%) and Pierre Robin syndrome (11%). There were no admissions for acute epiglottitis. Thirty episodes (48%) required ventilation for a median duration of 4.0 days. Bacterial tracheitis (100%) and subglottic stenosis (100%) were the most likely diagnoses requiring ventilation. Difficulty in intubation was encountered in 13 episodes (43%) involving, in particular, patients with bacterial tracheitis (83%; P=0.006). Only two patients required a tracheostomy. The overall mortality was 11%. The PRISM score for all categories was generally low (mean 10.3~1.0; median 9.0). Non-survivors had a significantly higher PRISM II score than survivors (27.4~9.7 vs 8.1~4.9, respectively; P=0.002) and were more likely to include children with bacterial tracheitis and mediastinal malignancy. Conclusions: There is marked heterogeneity in the causes of upper airway obstruction in the tropics with viral croup remaining the most common. A significant proportion required ventilation, but outcome is generally favorable, except in those with bacterial tracheitis and mediastinal malignancy. [source] Physical complications for elderly inpatients with senile dementia in the Imaise Branch of Ichinomiya City HospitalPSYCHOGERIATRICS, Issue 4 2009Katsuyuki UKAI Abstract Background:, In the present study, we investigated the physical complications of elderly patients with senile dementia in the Department of Psychogeriatrics, Imaise Branch, Ichinomiya City Hospital. Methods:, Physical complications that occurred in our ward in the 12 months from April 2007 to March 2008 were recorded. Our ward has 50 beds and, over the 12 months, the average occupation rate was approximately 90%. We subdivided physical complications into two categories: (i) serious emergencies occurring in the ward with a possible high risk of mortality within a few days (e.g. pneumonia and upper airway obstruction); and (ii) life-threatening complications arising in the ward that required diagnosis and treatment by specialists from other medical departments (e.g. bone fracture and cancer). Results:, Serious emergencies with a high risk of mortality occurred 56 times. Six patients died. Life-threatening complications requiring diagnosis and treatment by specialists from other departments occurred 44 times. Both categories of physical complications in occurred at a high rate, with various types of diseases recorded. Conclusions:, The present study confirms the high frequency of physical complications that require treatment in facilities for patients with senile dementia. It is necessary to diagnose and treat these various physical complications and to cooperate with specialists from other medical departments. [source] CT analysis after distraction osteogenesis in Pierre Robin SequenceTHE LARYNGOSCOPE, Issue 2 2009Saswata Roy MD Abstract Objectives/Hypothesis: Early mandibular lengthening by distraction osteogenesis provides an alternative to traditional methods of airway management in infants with Pierre Robin sequence (PRS). Little evidence in the medical literature quantitatively demonstrates the changes in skeletal, soft tissue, and hypopharyngeal spaces with mandibular distraction. Study Design: Prospective analysis of a cohort of three patients with PRS. Methods: We reviewed a series of infants with PRS and severe upper airway obstruction who underwent mandibular distraction. The infants underwent mandibular lengthening with the same internal, unidirectional distraction osteogenesis device. Standardized serial computed tomography (CT) scans were obtained according to established protocol. Computed tomography data were extracted and analyzed with medical image analysis software for mandibulo-maxillary arch harmony, symmetry, hypopharyngeal airway volume, geniohyoid distance, distraction osteogenesis bone volume, and mandibular length. Results: Mandibulo-maxillary alveolar ridge distances were corrected to 0.5 mm after distraction. Clinical examination showed good arch harmony without open-bite or cross-bite deformities. Mandibular ramus was lengthened by 19.5%; the body, 43.4%. After distraction, total mandibular length was increased by 26.2%; hypopharyngeal airway volume, 192%; posterior distance from pharyngeal wall to tongue base, 198.9%; and geniohyoid distance, 14.1%. Conclusions: Unidirectional internal microdistractors can achieve good mandibulo-maxillary arch harmony. Hypopharyngeal airway volume increases substantially, with an even greater increase in distance between tongue base and posterior pharyngeal wall. As the distal mandibular segment is distracted, the hyoid moves anteriorly, with minor increase in geniohyoid relationship. Internal mandibular microdistraction devices represent a substantial advance in airway obstruction management in infants with micrognathia. Laryngoscope, 2009 [source] Postobstructive Pulmonary Edema After Laryngospasm in the Otolaryngology PatientTHE LARYNGOSCOPE, Issue 9 2006Vishvesh M. Mehta MD Abstract Context: Post-obstructive pulmonary edema (PPE) is an uncommon complication which develops immediately after the onset of acute airway obstruction such as laryngospasm or epiglottitis (type I) or after the relief of chronic upper airway obstruction such as adenotonsillar hypertrophy (type II). Objective: To describe the development of type I PPE following laryngospasm in pediatric and adult patients undergoing otolaryngologic surgical procedures other than those for treatment of obstructive sleep apnea. Design: Retrospective case series of 13 otolaryngology patients from 1996 to 2003. Setting: Tertiary care teaching hospital and its affiliates. Patients: 13 patients (4 children, 9 adults, 5 males, 8 females) ranging in age from 9 months to 48 years. Results: Operative procedures included adenoidectomy, tonsillectomy, removal of an esophageal foreign body, microlaryngoscopy with papilloma excision, endoscopic sinus surgery, septorhinoplasty, and thyroidectomy. Six patients required reintubation. Treatment included positive pressure ventilation, oxygen therapy, and diuretics. Seven patients were discharged within 24 hours and the others were discharged between 2 and 8 days postoperatively. There were no mortalities. Conclusion: Laryngospasm resulting in PPE may occur in both children and adults after various otolaryngologic procedures. Among the subgroup of children, our study is the first to report its occurrence in healthy children without sleep apnea undergoing elective surgery. [source] Pediatric Laryngotracheal Obstruction: Current Perspectives on StridorTHE LARYNGOSCOPE, Issue 7 2006John Bent MD Abstract Objectives/Hypothesis: To assess how medical advances have impacted the diagnosis, management, and outcomes of pediatric laryngotracheal obstruction, and to describe the advantages of audio-video documentation of stridorous children. Study Design and Methods: Retrospective. Methods and Materials: 268 patients were referred for suspected laryngotracheal obstruction during the 30 months between September 1, 1995 and March 1, 1998: 173 had 206 flexible fiberoptic laryngoscopies, and 160 had 273 direct laryngoscopies. One hundred and forty-one children were identified with laryngotracheal obstruction, yielding 40 different diagnoses that could be classified into 9 major categories. Thirty-six children (25.5%) had multiple sites of upper airway obstruction. Results: 138 children had follow-up >1 month. Twelve children died (8.7%), leaving 126 survivors (mean follow-up = 21.1 months). Outcomes were classified as resolved (44.2%), improved (37.0%), stable (9.4%), failed (0.7%), or death (8.7%). Better outcomes were seen in more readily treated diagnostic categories, such as tracheobronchial foreign body, chronic laryngitis, and suprastomal granulation tissue; laryngeal stenosis, tracheomalacia, and recurrent respiratory papillomatosis, had less favorable outcomes (P <.001). The former group also showed superior outcome compared to laryngomalacia (P <.001) and vocal cord mobility disorders (P = .004). Ninety-four patients (68.1%) had comorbidities complicating their management. Comorbid conditions were universal among deceased patients and least common in the resolved outcomes category (56.7%), supporting the premise that patients with poor outcomes are more likely to have comorbidities than patients with resolution of laryngotracheal symptoms (P = .034). Conclusions: Audio-video recording of pediatric laryngotracheal obstruction offers numerous advantages. Children classified into an array of diagnostic categories usually have favorable outcomes, but opportunities for continued advances exist, particularly regarding management of comorbidity and chronic obstruction. [source] Ear, Nose and Throat Disorders in Children With Down SyndromeTHE LARYNGOSCOPE, Issue 2 2003Ron B. Mitchell MD Abstract Objective To document the reasons for which children with Down syndrome were referred to a pediatric otolaryngology practice, the underlying causes for these referrals, and the complications of routine surgical therapy. Study Design The study is a retrospective review of children referred to the Pediatric Otolaryngology Clinic at the University of New Mexico Health Sciences Center (Albuquerque, NM) during a period of 2.5 years. Methods Data were collected on 55 parameters related to ethnicity, demographics, diagnosis, surgical therapy, complications, and systemic comorbid conditions. Results The ethnicity of the study population was predominantly Hispanic or Latino (62%). The majority of children (76%) were referred for upper airway obstruction. Obstructive sleep apnea and laryngomalacia were the most common disorders in these children. An otological disorder was diagnosed in 70% of the children. Complications occurred after 27% of procedures for insertion of pressure equalization (PE) tubes to treat recurrent otitis media. Systemic comorbid conditions were present in 93% of the children, and the most common was gastroesophageal reflux disease. Conclusions Obstructive sleep apnea and laryngomalacia were the most common reasons for referral of children with Down syndrome. Routine surgical procedures that required general anesthesia caused complications that are not common in other children. Treatment for systemic comorbid conditions should be considered as a component of therapy for otolaryngological disorders in children with Down syndrome. [source] Regular Tracheostomy Tube Changes to Prevent Formation of Granulation TissueTHE LARYNGOSCOPE, Issue 1 2003Kathleen Yaremchuk MD Abstract Objectives/Hypothesis Tracheostomy is a commonly performed operative procedure that has been described since 2000 b.c. The early indications for tracheostomy were for upper airway obstruction, usually occurring in young people as a result of an infectious process. Recently, tracheostomies are more commonly performed in the critically ill patient to assist in long-term ventilatory support. Granulation tissue at the stoma and the trachea has been described as a late complication resulting in bleeding, drainage, and difficulty with maintaining mechanical ventilatory support. Study Design The present report is of an observational study of a newly implemented policy that required regular changing of tracheostomy tubes. Comparable groups of patients were compared before and after this procedural change to document complications. Data collection consisted of chart reviews of all admissions for 1 year before the policy change and the subsequent 2 years. Complication rates were compared using standard statistical techniques. Methods A policy change was instituted that required all tracheostomy tubes to be changed every 2 weeks in conjunction with a detailed evaluation of the tracheostomy stoma. Charts were reviewed the year before the change in policy and in the subsequent 2 years to determine the incidence of granulation tissue requiring operative intervention. Results The number of patients requiring surgical intervention secondary to granulation tissue showed a statistically significant decrease (P = .02). A review of policies and procedures from the six largest hospitals in southeastern Michigan had no recommendations for routine tracheostomy tube changes. Conclusions A policy requiring a routine change of tracheostomy tubes results in fewer complications from granulation tissue. Tracheostomy tube changes to prevent granulation tissue and its complications. [source] Correspondence: Bench study of ventilation in simulated upper airway obstructionANAESTHESIA, Issue 9 2010L. Cohen No abstract is available for this article. [source] Use of the neonatal GlideScope® in the management of acute upper airway obstructionANAESTHESIA, Issue 1 2010S. Griffiths No abstract is available for this article. [source] A bench study of ventilation via two self-assembled jet devices and the Oxygen Flow Modulator in simulated upper airway obstructionANAESTHESIA, Issue 12 2009A. E. W. Hamaekers Summary In managing an obstructed upper airway, an emergency transtracheal ventilation device needs to function as a bidirectional airway, allowing both insufflation of oxygen and egress of gas. The aim of the present study was to determine the capability of two self-assembled, three-way stopcock based jet devices and the Oxygen Flow Modulator to function as a bidirectional airway in conjunction with a small lumen catheter. For each device the effective pressures at the catheter's tip during the expiratory phase and the achievable minute volumes were determined in a laboratory set-up. Using the three-way stopcock based jet devices, changing the connection position of the transtracheal catheter from the in-line port to the side port of the three-way stopcock resulted in a decrease of expiratory pressure at the catheter's tip from a dangerous mean (SD) of 71.1 (0.08) cmH2O to ,14.71 (0.05) cmH2O. Yet this negative expiratory pressure did not facilitate the egress of gas. All devices tested impeded the expiratory outflow and hence decreased the achievable minute volume. This decrease in minute volume was smallest with the Oxygen Flow Modulator. [source] Use of the McGrath video laryngoscope in awake patientsANAESTHESIA, Issue 8 2009B. E. McGuire Summary Reported are three cases of successful tracheal intubation using the McGrath Video Laryngoscope in awake patients. All three patients had predicted difficult direct laryngoscopy and signs of upper airway obstruction. [source] Acute upper airway obstruction due to oesophageal achalasiaANAESTHESIA, Issue 2 2009A. R. Walton No abstract is available for this article. [source] Multiple system atrophy as a cause of upper airway obstructionANAESTHESIA, Issue 11 2007Y. S. Lim Summary A patient presented to the ear, nose and throat department with inspiratory stridor, dysphagia and a sore throat. Clinical and radiological examination was normal. During induction of anaesthesia for a planned microlaryngoscopy, the patient developed complete upper airway obstruction that was overcome by applying positive pressure via a facepiece until awake. He subsequently developed respiratory failure, requiring mechanical ventilatory support. An elective tracheostomy was inserted for his symptoms. Neurological opinion confirmed the diagnosis of multiple system atrophy with akinetic rigid syndrome. We review this obscure condition and how it may occasionally present to anaesthetists. [source] Subclinical pulmonary dysfunction in spinocerebellar ataxias 1, 2 and 3ACTA NEUROLOGICA SCANDINAVICA, Issue 5 2010S. J. Sriranjini Sriranjini SJ, Pal PK, Krishna N, Sathyaprabha TN. Subclinical pulmonary dysfunction in spinocerebellar ataxias 1, 2 and 3. Acta Neurol Scand: 2010: 122: 323,328. © 2009 The Authors Journal compilation © 2009 Blackwell Munksgaard. Objectives,,, Evaluation of pulmonary function in patients with spinocerebellar ataxias (SCA) 1, 2 and 3 without clinical evidence of pulmonary dysfunction. Methods,,, Thirty patients (F:M = 7:23; age: 35 ± 11.3 years; SCA1 , 13, SCA2 , 9 and SCA3 , 8) without clinical manifestations of respiratory dysfunction and 30 controls underwent pulmonary function tests. The percentage predicted values of forced vital capacity (FVC), volume of air exhaled during first second of FVC (FEV1), peak expiratory flow rate (PEFR) and maximal voluntary ventilation (MVV), actual values of maximal inspiratory and expiratory pressures (MIP and MEP in mmHg), and ratios of actual values of FEV1/FVC (%) and FEV1/PEFR (ml/l/min) were analyzed. Results,,, Compared with controls SCA patients had significant reductions of FVC (71.1 ± 17.5 vs 85.5 ± 18.7; P < 0.01), PEFR (51.5 ± 20.7 vs 77.1 ± 24.9; P < 0.001), MVV (64.4 ± 21.6 vs 97.2 ± 22.7; P < 0.001), MIP (27.7 ± 16.8 vs 50.1 ± 15.1; P < 0.001) and MEP (38.1 ± 18.7 vs 74.7 ± 16.0; P < 0.001), elevation of FEV1/PEFR (10.5 ± 2.8 vs 7.4 ± 2.1; P < 0.001), but no significant change of FEV1 and FEV1/FVC. FEV1/PEFR correlated positively with illness duration and MVV negatively with severity of illness. Conclusions,,, The present study showed subclinical restrictive type of pulmonary dysfunction in SCA, and possible presence of upper airway obstruction. Chest physiotherapy and breathing exercises should be introduced early in management of SCA. [source] | |||||||||||||||||||||||||