1/72. Percutaneous dilatational tracheostomy in a patient with thyroid cancer and severe airway obstruction.A patient with extensive metastatic thyroid cancer scheduled for palliative tracheostomy is presented. He had laryngeal dislocation with severe airway obstruction and few anatomical landmarks due to tumour infiltration and radiation. Successful percutaneous dilatational tracheostomy was performed under local anaesthesia.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/72. Negative pressure pulmonary oedema caused by biting and endotracheal tube occlusion--a case for oropharyngeal airways.A patient had general anaesthesia for laparoscopic surgery. She bit on and occluded her endotracheal tube during recovery from anaesthesia. Strong inspiratory efforts during airway obstruction caused negative pressure pulmonary oedema. The pulmonary oedema resolved within 24 hours. Use of an oropharyngeal airway as a bite block could have prevented this complication.- - - - - - - - - - ranking = 2keywords = anaesthesia (Clic here for more details about this article) |
3/72. Upper airway compression after arthroscopy of the temporomandibular joint.An unusual complication is presented following a temporomandibular arthroscopy carried out under general anaesthesia. Severe cervicofacial oedema occurred immediately after surgery which required prolonged endotracheal intubation. Retrospective analysis revealed a massive fluid escape in the surrounding tissues leading to laryngeal oedema.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
4/72. Wegener's granulomatosis: an unusual cause of upper airway obstruction.A 10-year-old child with a 2-month history of tracheitis presented with acute stridor, for which he required tracheostomy. granulation tissue was found in the subglottic region and he was treated with antibiotics and corticosteroids. A week after successful decannulation of his tracheostomy, his stridor recurred and, on endoscopy under general anaesthesia, circumferential granulomas extending into both main bronchi were found. A diagnosis of Wegener's granulomatosis was made and confirmed on histology.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
5/72. Rapidly developing airway obstruction resulting from achalasia of the oesophagus.Megaoesophagus resulting from achalasia is a rare but serious cause of airway obstruction. The exact aetiology remains unclear. Although 29 cases have previously been reported, the potential need for urgent treatment has not been sufficiently emphasized. Some forms of treatment with drugs or decompression with a fine tube have been advocated but emergency tracheal intubation may become necessary. A 90-year-old lady had a bolus of food lodged in her oesophagus but with no respiratory symptoms. The bolus was removed under anaesthesia. Six weeks later she suffered similar symptoms after eating but developed severe airway obstruction over 10 min. Emergency intubation of the trachea was necessary before removing the food bolus under general anaesthesia. This case demonstrates the urgency with which these patients may need to be treated. The condition can rapidly worsen due to swallowing of air and saliva.- - - - - - - - - - ranking = 2keywords = anaesthesia (Clic here for more details about this article) |
6/72. airway obstruction during general anaesthesia in a child with congenital tracheomalacia.Fibreoptic bronchoscopy is often used to diagnose tracheomalacia under local anaesthesia. However, in children, general anaesthesia may be required due to difficulty in obtaining co-operation. A 1-yr-old girl with a suspected congenital tracheomalacia was scheduled for diagnostic fibreoptic bronchoscopy. During induction of anaesthesia by inhalation of increasing concentration of sevoflurane, spontaneous breathing became irregular and a partial airway obstruction occurred. Because vecuronium relieved the airway obstruction, the airway was managed using a laryngeal mask. No further airway obstruction occurred during fibrescopy under controlled ventilation, but when spontaneous breathing resumed, marked airway obstruction occurred. The trachea was intubated immediately. Caution is required to manage the airway without tracheal intubation during general anaesthesia in the patient with tracheomalacia.- - - - - - - - - - ranking = 8keywords = anaesthesia (Clic here for more details about this article) |
7/72. Mediastinal mass obscured by a large pericardial effusion in a child: a potential cause of serious anaesthetic morbidity.Anaesthesia in the presence of a mediastinal mass is known to be hazardous. We report a case of a 5-year-old boy with a presumed postviral pericardial effusion presenting for pericardiocentesis under general anaesthesia. Cardiorespiratory collapse following induction of anaesthesia occurred due to an undiagnosed mediastinal tumour. The reasons for misdiagnosis, mechanisms for perioperative complications and optimal management are discussed. Mediastinal masses and underlying malignancy should always be considered in patients with large pericardial effusions.- - - - - - - - - - ranking = 2keywords = anaesthesia (Clic here for more details about this article) |
8/72. Traumatic aneurysm of the internal carotid artery in an infant: a surprise diagnosis.Isolated aneurysm of the extracranial section of the internal carotid artery has been reported in children but never, to our knowledge, in an infant. It can represent a major anaesthetic challenge with compromise of both airway and cerebral perfusion and the associated risks of rupture. We report on an 11-month-old infant, who had undergone an examination under anaesthesia of her nose and throat for epistaxis and gastrointestinal endoscopy due to apparent gastrointestinal bleeding shortly before presenting to us with signs of rapidly progressive upper airway obstruction. Emergency examination under anaesthesia revealed a large pulsatile mass in the posterior nasopharynx which, on subsequent radiological investigation, was revealed to be a large pseudoaneurysm of the right internal carotid artery, obstructing distal flow. An apparently minor episode of trauma had occurred around the time of the first nosebleed; she had allegedly fallen onto her face with a spoon in her mouth.- - - - - - - - - - ranking = 2keywords = anaesthesia (Clic here for more details about this article) |
9/72. Total intravenous anaesthesia for tracheobronchial stenting in children.Stenosis and malacia of the tracheobronchial tree, most often secondary to prolonged intubation, tracheostomy or following correction of a congenital cardiac lesion, present a significant therapeutic problem, especially when the lesions are extensive. The utilization of self-expanding tracheobronchial stents is a useful addition to the medical armamentarium for maintenance of airways in these patients with major airway stenosis and collapse. The majority of previous reported cases of tracheobronchial stenting have been performed under general anaesthesia with the help of rigid bronchoscopy under direct vision. We conducted two cases of tracheobronchial stenting in postoperative cardiosurgical babies under continuous propofol infusion taking advantage of cardiovascular stability during continuous infusion and rapid emergence after its discontinuation.- - - - - - - - - - ranking = 5keywords = anaesthesia (Clic here for more details about this article) |
10/72. Spontaneous breathing combined with high frequency ventilation during bronchoscopic resection of a large tracheal tumour.A patient with learning difficulties had a large tracheal tumour at the carina that caused severe respiratory distress. I.v. anaesthesia with propofol, spontaneous breathing through a tracheal tube, and high frequency jet ventilation were successfully employed during bronchoscopic resection of the tumour.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
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