1/2. pulmonary edema due to partial upper airway obstruction in a child.The case of an 8-year-old boy is reported, who developed acute pulmonary edema associated with acute subglottic swelling and subsequent partial upper airway obstruction after extubation and recovery from anaesthesia. The main factors responsible for the formation of pulmonary edema presumably are a large subatmospheric transpulmonary pressure gradient and hypoxia leading to translocation of circulating blood volume into the pulmonary vasculature and fluid shift across the alveolar-capillary membrane. Application of oxygen and CPAP or PEEP plus diuretic therapy will promote rapid clearance of the pulmonary edema.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/2. The hazard of acute epiglottitis.This report is based on a 3 1/2 year's study of 33 cases of acute epiglottitis with 3 child deaths. Suspicion of acute epiglottitis in children with respiratory distress is always an indication for rapid direct laryngoscopy under general anaesthesia with intubation, and preparation for tracheotomy and bronchoscopy. Should the diagnosis of acute epiglottitis not be excluded during this procedure, then a free airway should be ensured by endotracheal intubation, even in cases of apparently less severe character, where the procedure would seem to be more prophylactic than therapeutic. intubation is often very difficult. It is concluded that the patient should be received at the hospital by an E.N.T.--anaesthetic team conversant with the treatment of this potential killer.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |