1/16. Severe postoperative laryngeal oedema causing total airway obstruction immediately on extubation.We report a case of total upper airway obstruction occurring immediately after extubation after elective bi-maxillary osteotomy. The obstruction was caused by severe, progressive supraglottic oedema, which totally obscured the laryngeal inlet. No swelling had been present at initial laryngoscopy and intubation. Immediate re-intubation of the patient's trachea was difficult but life saving. Subsequent investigations revealed extensive soft tissue swelling, maximal at the level of the hyoid and extending downwards into the trachea. The cause of such severe oedema in this case is not certain, but may be related to vigorous submental liposuction carried out at the end of operation. We have found no other reports of total airway obstruction occurring immediately after extubation as a result of this cause. We review the appropriate literature, describe the postoperative management and suggest precautions in similar patients.- - - - - - - - - - ranking = 1keywords = trachea (Clic here for more details about this article) |
2/16. 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 = 0.5keywords = trachea (Clic here for more details about this article) |
3/16. New methods of dealing with the complications of panendoscopy.A 70-year-old man with chronic obstructive airways disease was scheduled to undergo panendoscopy following a course of radiotherapy for carcinoma of the larynx. He was anaesthetized using a propofol infusion and high frequency jet ventilation (HFJV). The jet ventilation catheter was left in situ at the end of the procedure. This enabled oxygenation to be maintained in the presence of post-operative laryngospasm by re-attaching the jet ventilator. Subsequently he developed respiratory failure, and a Bullard laryngoscope was used to visualize the vocal folds despite oedema of the tumour which made direct laryngoscopy impossible. A catheter was passed through the biopsy channel of the Bullard, enabling HFJV to be commenced. A conventional endotracheal tube was then railroaded over the catheter to facilitate conventional ventilation.- - - - - - - - - - ranking = 0.5keywords = trachea (Clic here for more details about this article) |
4/16. Percutaneous transtracheal jet ventilation as a guide to tracheal intubation in severe upper airway obstruction from supraglottic oedema.We report two cases of severe upper airway obstruction caused by supraglottic oedema secondary to adult epiglottitis and ludwig's angina. In the former case, attempts to intubate with a direct laryngoscope failed but were successful once percutaneous transtracheal jet ventilation (PTJV) had been instituted. In the case with ludwig's angina, PTJV was employed as a pre-emptive measure and the subsequent tracheal intubation with a direct laryngoscope was performed with unexpected ease. In both cases recognition of the glottic aperture was made feasible with PTJV by virtue of the fact that the high intra-tracheal pressure from PTJV appeared to lift up and open the glottis. The escape of gas under high pressure caused the oedematous edges of the glottis to flutter, which facilitated the identification of the glottic aperture. We believe that the PTJV should be considered in the emergency management of severe upper airway obstruction when this involves supraglottic oedema.- - - - - - - - - - ranking = 5.5keywords = trachea (Clic here for more details about this article) |
5/16. The dangers of minor blunt laryngeal trauma.Since the introduction of seat belts, laryngotracheal trauma has become a rare injury, comprising less than one per cent of blunt trauma cases seen at major trauma centres. However, a wide range of damage to the soft tissue and cartilaginous framework of the larynx may result from such injuries but signs of injury are easily overlooked leading to potentially serious consequences for the patient. We report a case of isolated blunt laryngeal trauma from a relatively minor injury which illustrates some of the problems resulting in these cases and review the treatment of blunt laryngeal trauma.- - - - - - - - - - ranking = 0.5keywords = trachea (Clic here for more details about this article) |
6/16. Upper airway compromise secondary to edema in Graves' disease.PURPOSE: We report an unusual case of upper airway compromise in a patient with Graves' disease. We speculate that this complication may be due, in part, to poorly controlled hyperthyroidism. CLINICAL FEATURES: A 26-yr-old female suffering from Graves' disease underwent a total thyroidectomy. Awake fibreoptic intubation was attempted because of a large goiter and orthopnea. Upper airway edema impeded the passage of an armored 7.5 mm endotracheal tube. She was subsequently intubated awake with a regular 7.5 mm endotracheal tube under direct laryngoscopy over an Eschmann bougie. The patient was extubated in the operating room over a tube exchanger. Two hours later she developed stridor and upper airway obstruction. Using direct laryngoscopy, she was reintubated with difficulty because of upper airway edema. At this time, she manifested signs of thyrotoxicosis which were managed medically. On postoperative day three she underwent a tracheostomy after failing a trial of extubation. The upper airway was edematous with minimal vocal cord movement. On postoperative day nine the tracheostomy was downsized and the patient was sent home. The vocal cords were still edematous with minimal movement. Three weeks later, she demonstrated normal right vocal cord movement and weak left vocal cord movement, and the tracheostomy was decannulated. CONCLUSIONS: Uncontrolled hyperthyroid patients with large goiters secondary to Graves' disease may develop edema of the upper airway. A high degree of vigilance for airway obstruction is necessary, with a carefully planned approach at each stage of the patient's hospital course to treat this potentially life-threatening situation.- - - - - - - - - - ranking = 1keywords = trachea (Clic here for more details about this article) |
7/16. Laryngeal oedema from a neck haematoma. A complication of internal jugular vein cannulation.Laryngeal oedema occurred after formation of a neck haematoma after attempted internal jugular vein cannulation. This resulted in complete respiratory obstruction and respiratory arrest and it was impossible to ventilate her lungs manually or intubate her trachea. Oxygenation of the patient was only possible using transtracheal ventilation.- - - - - - - - - - ranking = 1keywords = trachea (Clic here for more details about this article) |
8/16. Unilateral pulmonary edema following acute subglottic edema.Presented here is a case of unilateral pulmonary edema following acute subglottic edema after removal of an endotracheal tube. A 3-year-old boy, diagnosed as having nondiphtheric croup and pectus excavatum deformity, was scheduled for repair of a cleft lip. No complication occurred during the operation. After removal of the endotracheal tube, he showed dyspnea and cyanosis and was later found to have acute subglottic edema. After reintubation of the trachea, frothy pink fluid was discharged from the tube, and chest roentgenogram showed a right-sided alveolar infiltrate. Many factors may cause unilateral pulmonary edema, but it is suggested that acute subglottic edema and unilateral bronchial fragility strongly affected this episode.- - - - - - - - - - ranking = 1.5keywords = trachea (Clic here for more details about this article) |
9/16. Anaesthetic implications of hereditary angioneurotic oedema.Hereditary angioneurotic oedema (HANE) presents the danger of laryngeal oedema that may, among other causes, be triggered by the anaesthetist's manipulation of the patient's airway. Local and regional anaesthesia are usually recommended. This report pertains to a patient who successfully tolerated general endotracheal anaesthesia and whose management included prophylactic treatment with danazol and fresh-frozen plasma.- - - - - - - - - - ranking = 0.5keywords = trachea (Clic here for more details about this article) |
10/16. The pale epiglottitis--a misnomer or not?Several leading authors on acute epiglottitis have reported a pale appearance of the swelling of the epiglottis in otherwise seemingly classical cases of acute epiglottitis. In order to understand this phenomenon better, a thorough review of the literature was done but only scarce comments were gathered. There seems to be a spectrum of appearance of the epiglottis in acute epiglottitis, the erythema as well as the edema varying independently from mild to marked. A striking feature of this type of epiglottitis is that, despite seemingly appropriate treatment, a most treacherous evolution was reported: four out of 12 cases presented a severe sudden apnea and two others developed an abscess. Aggressive antibiotherapy and steroidotherapy are suggested as well as a prophylactic nasotracheal intubation.- - - - - - - - - - ranking = 0.5keywords = trachea (Clic here for more details about this article) |
| | Next -> |