Cases reported "Laryngismus"

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1/28. Complete upper airway obstruction during awake fibreoptic intubation in patients with unstable cervical spine fractures.

    PURPOSE: To describe the presentation and management of complete upper airway obstruction with life threatening arterial oxygen desaturation that occurred during attempted awake fibreoptic intubation in two patients presenting with unstable C-spine injury. CLINICAL FEATURE: Complete upper airway obstruction occurred during awake fibreoptic intubation of two men (ASA II; 68 & 55 yr old) presenting with unstable C-spine fractures. In both cases, bag and mask ventilation with CPAP failed to relieve the progressive hypoxemia. A surgical airway was established urgently to oxygenate the two patients who were suffering progressive life-threatening oxygen desaturation. One patient had trans-cricothyroid jet ventilation performed through a 16G intravenous cannula prior to an urgent tracheostomy. In the other patient, an emergency tracheostomy was inserted. Interestingly, both patients had been sedated in the Neurosurgical intensive care Unit with morphine and benzodiazepines before their scheduled surgeries. The most likely etiology for the complete upper airway obstruction was laryngospasm due to inadequate topicalization of the airway and additional sedation given in the operating room. Neither patients suffered any new neurological deficits following these events. They went on to have uneventful surgeries. CONCLUSION: This case report suggest that prior to awake fibreoptic intubation, oxygenation, adequate topicalization with testing to verify the lack of pharyngeal and laryngeal responses and careful assessment of sedation levels in the operating room are prudent for a safe endoscopic intubation.
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ranking = 1
keywords = upper
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2/28. Postoperative pulmonary edema.

    BACKGROUND: Noncardiogenic pulmonary edema may be caused by upper airway obstruction due to laryngospasm after general anesthesia. This syndrome of "negative pressure pulmonary edema" is apparently well known among anesthesiologists but not by other medical specialists. methods: We reviewed the cases of seven patients who had acute pulmonary edema postoperatively. RESULTS: There was no evidence of fluid overload or occult cardiac disease, but upper airway obstruction was the most common etiology. Each patient responded quickly to therapy without complications. CONCLUSIONS: Of the seven patients with noncardiogenic postoperative pulmonary edema, at least three cases were associated with documented laryngospasm causing upper airway obstruction. This phenomenon has been reported infrequently in the medical literature and may be underdiagnosed. Immediate recognition and treatment of this syndrome are important. The prognosis for complete recovery is excellent.
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ranking = 0.42857142857143
keywords = upper
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3/28. airway management in ludwig's angina.

    A 37-year-old 91 kg man presented with features of ludwig's angina. Anaesthesia for incision and drainage of his submandibular abscess was undertaken by two specialist anaesthetists with an otorhinolaryngological surgeon prepared for immediate tracheostomy. After preoxygenation, gas induction with sevoflurane in oxygen was followed by a gush of pus into the oral cavity and laryngospam causing acute upper airway obstruction. This resolved with 25 mg of suxamethonium and an endotracheal tube was passed into the trachea with difficulty. Options for management of the difficult airway in ludwig's angina are discussed.
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ranking = 0.14285714285714
keywords = upper
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4/28. Bronchogenic cysts: a case report.

    The otolaryngologist has a reference frame for congenital stridor that rarely includes diagnosis of a bronchogenic cyst. The life-threatening potential of this lesion makes consideration and recognition imperative. Representing less than 5% of the mediastinal childhood masses in the infant, respiratory distress most often initiates diagnostic studies leading to identification and extirpation. The case presentation highlights the clinical course. The diagnostic hallmark of this case was the delayed onset of stridor with subsequent progression. Thereafter, a chest film and barium swallow suggested the diagnosis. In newborns, however, such cysts may not be evident on routine chest films and, nonetheless, cause significant respiratory distress from airway compression. Surgical extirpation should be affected as soon as possible after the diagnosis is entertained in order to insure against a sudden respiratory death.
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ranking = 0.037136246104328
keywords = chest
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5/28. Use of rapacuronium in a child with spinal muscular atrophy.

    We report the case of an 18-month-old girl with spinal muscular atrophy (SMA) that received 1 mg x kg(-1) rapacuronium for laryngospasm during induction of anaesthesia. Within 15 min, we observed some diaphragmatic recovery and, after emergence from anaesthesia, the child demonstrated adequate respiratory efforts. However, the child showed diminished strength of the upper extremity muscles. Since the preoperative workup had revealed bulbar symptoms and laryngeal function could not be easily assessed, the patient was kept intubated until upper extremity strength had returned to preoperative levels. Small doses of midazolam had been given to reduce the patient's anxiety but the patient was extubated within 5 h without any complications. Train of four (TOF) monitoring of the right adductor pollicis muscle, performed during anaesthetic recovery, was equivocal. In SMA, muscle groups are differentially affected so that TOF responses may be inconclusive and not reflect the state of the upper airway muscles. To our knowledge, this is the first report of use of a nondepolarizing neuromuscular blocking agent in a child with SMA.
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ranking = 0.42857142857143
keywords = upper
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6/28. Complicated negative pressure pulmonary oedema in a child with cerebral palsy.

    A 3-year-old child with cerebral palsy developed postextubation upper airway obstruction secondary to laryngospasm and/or masseteric spasm,which may have been triggered by the muscular spasticity and the slow recovery from inhalational anaesthesia associated with cerebral palsy. This upper airway obstruction was followed by negative pressure pulmonary oedema. The patient improved on mechanical ventilation; however, his condition was complicated with the occurrence of bilateral pneumothoraces. After release of the pneumothoraces and reexpansion of the lungs, the child developed reexpansion pulmonary oedema, culminating in acute lung injury.
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ranking = 0.28571428571429
keywords = upper
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7/28. Spontaneous negative pressure changes: an unusual cause of noncardiogenic pulmonary edema.

    The principal physiologic mechanism underlying the formation of negative pressure pulmonary edema (NPPE) is thought to be the creation of excessive negative intrathoracic force from inspiration against a critical obstruction of the upper airway. The increased subatmospheric transpulmonary pressures result in transudation of fluid from the pulmonary capillaries to the interstitium and alveoli. The clinical picture is that of pulmonary edema. Aggressive diagnostic and therapeutic intervention can be avoided if the syndrome is recognized early. This report highlights the clinical features of NPPE and serves as a reminder to the clinician that although NPPE can cause significant morbidity, conservative supportive therapy typically results in a good outcome.
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ranking = 0.14285714285714
keywords = upper
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8/28. Childhood airway manifestations of lymphangioma: a case report.

    lymphangioma is a congenital malformation of the lymphatic system, often involving areas of the head and neck. The involved structures may include enlarged tongue and lips, swelling of the floor of the mouth, and direct involvement of the upper respiratory tract. The definitive treatment for lymphangioma is surgery, often during the first years of life. Despite surgical removal, lymphangioma may persist. Anesthetic concerns include bleeding, difficulty visualizing the airway, extrinsic and intrinsic pressure on the airway causing distortion, and enlarged upper respiratory structures, including the lips, tongue, and epiglottis. This is a case report of a 9-year-old patient with lymphangioma who had impacted teeth and a suspected odontogenic cyst. There seems to be little information on the optimal anesthetic management for this age group. The challenges with airway management, including bleeding, laryngospasm, and a difficult intubation, are outlined. awareness of potential airway involvement and possible complications is necessary to provide a safe anesthetic to a patient with lymphangioma. A review of the literature, airway management techniques, and current airway equipment will be discussed.
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ranking = 0.28571428571429
keywords = upper
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9/28. Negative-pressure pulmonary edema: a rare complication of upper airway obstruction in children.

    Negative-pressure pulmonary edema is a rare but life-threatening complication of upper airway obstruction. Because negative-pressure pulmonary edema may occur in a large spectrum of pathologies associated with upper airway obstruction, awareness of this condition is crucial during daily clinical practice. We report a case of negative-pressure pulmonary edema during anesthetic recovery to highlight this condition. CASE: A 2-year-old boy was scheduled for orchidopexy under general anesthesia. Shortly after an uneventful operation, the patient presented airway obstruction. Serious oxygen desaturation and bradycardia ensued, during inefficient attempts at positive-pressure ventilation. After emergency intubation, copious pink secretions emerged from the airway. pulmonary edema was confirmed by clinical examination, pulse oximetry, and chest radiography. The finding of pulmonary edema was resolved within 24 hours after mechanical ventilation and positive end-expiratory pressure. The child suffered no sequelae. This report highlights the clinical features of negative-pressure pulmonary edema and serves as a reminder to the pediatrician who must be able to recognize and initiate treatment for conditions that are uncommon but life-threatening.
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ranking = 0.87571098019502
keywords = upper, chest
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10/28. Bilateral negative airway pressure pulmonary edema (NPPE)--a case report--.

    A case of negative pressure bilateral pulmonary edema in a 28 years old healthy female patient, scheduled for diagnostic pelvic laparoscopy for infertility. Following extubation and apparent recovery from anesthesia, she had strong inspiratory efforts due to airway obstruction caused by coughing and laryngeal spasm, that lead to negative pressure bilateral pulmonary edema. The pulmonary edema disappeared within few hours. She was breathing spontaneously through CPAP system (mask-bag-expiratory valve). diuretics and lungs physiotherapy helped in controlling patient's complication.
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ranking = 3.715169918534
keywords = breathing
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