1/5. The use of the laryngeal mask airway in children with subglottic stenosis.patients with tracheal stenosis have a high incidence of difficult or failed tracheal intubation. airway management with the laryngeal mask airway during fibreoptic laryngoscopy was used in two children with acquired subglottic stenosis during spontaneous breathing. The laryngeal mask airway may be superior to tracheal intubation or use of a face mask during anaesthesia management in severe subglottic stenosis. ventilation may be improved and the use of a laryngeal mask airway can reduce or eliminate some of the problems associated with the other methods of airway management, such as further damage to stenotic tissue and gastric distention.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/5. Double trouble: prolapsing epiglottis and unexpected dual pathology in an infant.A 3-week-old full-term female neonate was admitted with a 4-day history of episodic stridor, desaturations and difficult feeding. Initial assessment using fluoroscopy suggested distal tracheomalacia. Inhalational induction for examination under anaesthesia of the upper airway at 4 weeks of age caused almost complete airway obstruction due to severe anterior, or epiglottic, laryngomalacia. This airway obstruction was unresponsive to continuous positive airway pressure, the use of an oropharyngeal airway and hand ventilation and required urgent tracheal intubation using suxamethonium. Epiglottopexy, a relatively unknown procedure, was performed uneventfully 2 days later, with complete relief of the respiratory compromise. However, the infant remained desaturated postoperatively. A ventilation perfusion scan subsequently revealed multiple pulmonary arteriovenous malformations, unsuitable for embolization and requiring nocturnal home oxygen therapy. review at 3 months of age found a thriving infant with no airway obstruction and good epiglottic positioning on examination under anaesthesia. Although the patient's oxygen requirements had diminished, the long-term outcome remains uncertain.- - - - - - - - - - ranking = 2keywords = anaesthesia (Clic here for more details about this article) |
3/5. Severe upper airway obstruction and difficult intubation in cicatricial pemphigoid.Upper airway obstruction in cicatricial pemphigoid is rarely seen by the anaesthetist. A case of severe dyspnoea due to progressive laryngeal obstruction is presented. Tracheal intubation during induction of general anaesthesia for permanent tracheostomy was extremely difficult and was successfully performed by introducing a size 12 French suction catheter through the stenotic laryngeal orifice. Adequate ventilation was achieved by using the oxygen flush valve to deliver oxygen intermittently through the catheter.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
4/5. Unsuspected difficult intubation caused by a laryngeal web.We report a case of unsuspected difficult intubation in an adult caused by laryngeal web formation in the anterior commissure of the larynx. After induction of anaesthesia, most parts of the posterior commissure of the vocal cords were seen clearly at laryngoscopy, but a 7.5-mm internal diameter (id) tracheal tube could not be advanced below the level of the vocal cords because of resistance. intubation was re-attempted several times after oxygenation by mask with trials of smaller tubes. Finally, a 5.0-mm id cuffed tube was passed successfully through the vocal cords, and secured in place. Because of the unexpected difficulties in intubation, an otolaryngologist was consulted to examine the larynx with a microscope. A web of 0.5 cm in the anterior commissures was found which caused subglottic stenosis.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
5/5. Subglottic stenosis in a child: a complication of prolonged endotracheal intubation.A 1 1/2 year old Nigerian child sustained traumatic rupture of the diaphragm which was repaired under endotracheal anaesthesia. A red rubber endotracheal tube was used for the surgery and a nasotracheal tube was let in situ for 4 days. A post intubation subglottic stenosis which developed was managed with a tracheostomy and a series of 8 tracheal dilatations under hatothane within a period of 5 months. Appropriate choice of tubes and attention to details of humidification may have prevented this serious complication.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |