1/23. Anterior mediastinal masses: an anaesthetic challenge.A patient with a large anterior mediastinal mass with minimal respiratory symptoms presented for a diagnostic biopsy of the mass. A pre-operative thoracic computed tomographic scan demonstrated narrowing of the distal trachea, and right and left main stem bronchi. An awake intubation was done. Thiopentone and muscle relaxant were given and surgery commenced. High airway pressure developed and ventilation became difficult, although oxygenation remained satisfactory throughout. Anaesthetic implications are discussed. We recommend that patients with more than 50% obstruction of the airway at the level of the lower trachea and main bronchi have their femoral vessels cannulated in readiness for cardiopulmonary bypass.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/23. Bronchial casts in children with cardiopathies: the role of pulmonary lymphatic abnormalities.Expectoration of bronchial casts, a condition also called plastic bronchitis, is very rare in children. Bronchial casts may be associated with bronchopulmonary diseases associated with mucus hypersecretion, bronchopulmonary bacterial infections, congenital and acquired cardiopathies, or pulmonary lymphatic abnormalities. A classification based on anatomy and pathology has been proposed which identifies an "acellular" group associated with congenital cardiopathies and palliative surgery. We report on 3 cases with bronchial casts associated with cardiopathy. Observations suggest that the formation of bronchial casts may result from lymphatic leakage into the bronchi. The 3 cases on which we report were immunodeficient and had pulmonary lymphatic abnormalities. The bronchial casts contained lymphocytes and lipids, as determined by histologic examination. In the absence of congenital pulmonary or diffuse lymphatic dysplasia associated with cardiopathy, the principal factors resulting in the formation of bronchial casts appear to be surgical trauma to the lymphatic channels surrounding the bronchi, pleural adhesions, and high systemic venous blood pressure. The prognosis for these patients is poor, and possibilities for treatment are limited.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
3/23. Aorto-bronchial fistula after implantation of a self-expanding bronchial stent in a patient with aortic dissection.We report a case of aorto-bronchial fistula after implantation of a self-expanding stent into the left main bronchus compressed by a dissected descending aorta. A 66-year-old female, who underwent Stanford type-B aortic dissection two years previously, was admitted to our hospital for the treatment of a newly developed false lumen that originated from the ascending aorta and extended to the aortic bifurcation. She was unable to be weaned from the respirator after the graft replacement of the ascending aorta. Fiberoptic bronchoscopic examination revealed complete obstruction of the left main bronchus by extrinsic compression. A self-expanding nitinol stent was implanted in the left main bronchus five days after the operation. Her respiratory condition improved remarkably, allowing her to be successfully weaned from the respirator. Her clinical course was uneventful until she suddenly died from massive hemoptysis 20 days after stent implantation. A communication of 5 mm in diameter between the dissected descending aorta and the left main bronchus was seen at autopsy. Permanent application of a self-expanding nitinol stent to relieve extrinsic compression of a left main bronchus by a dissected descending aorta is not recommended because pressure necrosis might lead to fatal aorto-bronchial fistula.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
4/23. Non-invasive diagnosis of tracheobronchomalacia using a modified ventilation radioisotope lung scan.The use of radionuclide ventilation lung scan to characterise the physiological effects of tracheobronchomalacia is a novel application of this non-invasive technique. In the reported case the right upper lobe was found to be not ventilated below a pressure of 20 cm H2O despite evidence from a dynamic tracheobronchogram of the right upper lobe bronchus opening at the lower pressure of 15 cm H2O.- - - - - - - - - - ranking = 2keywords = pressure (Clic here for more details about this article) |
5/23. Traumatic rupture of the thoracic aorta: diagnosis on fibreoptic bronchoscopy.The diagnosis of thoracic aortic rupture can be difficult, especially in the presence of other life-threatening injuries. We present a case in which the presence of major intraabdominal trauma shifted clinical attention away from the mediastinum. During bronchoscopy, which was performed to investigate high intraoperative airway pressures, unexpected tracheal and carinal compression were discovered. Thoracic aortography revealed aortic rupture distal to the left subclavian artery. Successful repair was subsequently achieved.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
6/23. The use of bronchotomy and retrograde dilatation to repair acquired obliterative bronchial obstruction.A case is presented of acquired obliterative mainstem bronchial obstruction with total ipsilateral lung atelectasis and contralateral lung hyperexpansion. The condition failed to improve after a suitable trial of positive airway pressure and medical management. Penetration of the obstructing lesion bia bronchotomy and a distal retrograde approach successfully opened the airway and the patient has been symptom-free for more than 9 months. This unique approach may be useful in other selected patients with similar acquired lesions.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
7/23. Chest tube suction-associated unilateral negative pressure pulmonary edema in a lung transplant patient.We describe a 29-yr-old male, status post-bilateral lung transplant, who developed unilateral negative pressure pulmonary edema induced by chest tube suction in association with bilateral bronchial anastomotic strictures. We conclude that negative pressure pulmonary edema may occur secondary to high levels of negative pressure applied to the intrapleural space via chest tubes in the presence of partial large airway obstruction. Post-lung transplant patients may be especially at risk because of compromised lymphatic drainage.- - - - - - - - - - ranking = 7keywords = pressure (Clic here for more details about this article) |
8/23. Relief of bronchial obstruction using a Fogarty catheter in a patient with bronchomalacia.tracheobronchomalacia can be latent without showing any clinical manifestations and may be incidentally found during anesthesia. In such cases, hypoxia may occur during anesthesia. We experienced obstruction of the left main bronchus caused by bronchomalacia that was incidentally found during open-heart surgery in a 4-yr-old patient. We could not reopen the airway by routine techniques, such as positive pressure, and had great difficulty in weaning the patient from cardiopulmonary bypass. The use of a Fogarty catheter allowed the relief of airway obstruction and weaning from cardiopulmonary bypass.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
9/23. Endoscopic observation of peripheral airway lesions.Peripheral airways of 2 mm or less in diameter were observed in 142 patients by means of an ultrathin bronchofiberscope measuring 1.8 mm in outside diameter. On the basis of the observed and photographed endoscopic findings, an endoscopic classification of peripheral airway lesions was proposed. The endoscopic findings showed changes in the bronchial wall consisting of reddening, pallor, absence of mucosal luster, edema, engorgement of blood vessels, irregular mucosal surface, and elevated mucosa. In the lumen, stenosis, obstruction, ectasis, and deformation due to pressure were recognized, in addition to excessive secretion and pigmentation as morphologic abnormalities or abnormal findings at bifurcation.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
10/23. Prolonged positive airway pressure for severe neonatal tracheobronchomalacia.A very low birthweight preterm baby with respiratory distress at birth was found to have severe congenital tracheobronchomalacia. continuous positive airway pressure was given through an endotracheal tube without tracheostomy for 15 weeks before unassisted respiration could be maintained. diagnosis was made and progress monitored by laryngobronchoscopy on three occasions.- - - - - - - - - - ranking = 5keywords = pressure (Clic here for more details about this article) |
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