1/9. Wegener's granulomatosis: an unusual cause of upper airway obstruction.A 10-year-old child with a 2-month history of tracheitis presented with acute stridor, for which he required tracheostomy. granulation tissue was found in the subglottic region and he was treated with antibiotics and corticosteroids. A week after successful decannulation of his tracheostomy, his stridor recurred and, on endoscopy under general anaesthesia, circumferential granulomas extending into both main bronchi were found. A diagnosis of Wegener's granulomatosis was made and confirmed on histology.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/9. 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) |
3/9. Wheeze and mediastinal mass: a challenging patient.airway obstruction is a recognized complication in children with mediastinal masses. They typically present with difficulty in breathing and associated respiratory noises. General anaesthesia in these patients can lead to complete airway obstruction with fatal consequences. Successful management in the ED necessitates rapid recognition of the underlying problem and appropriate intervention. We report the case of a 7-year-old boy presenting with respiratory collapse and describe the management that led to successful resuscitation.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
4/9. An unusual cause of stridor following anaesthesia requiring tracheostomy.A 75-year-old woman underwent panendoscopy and excision of a neck "lump". After antagonism of residual neuromuscular block and extubation of the trachea, she developed recurrent upper airway obstruction and stridor, necessitating a permanent tracheostomy. The possibility of vagal nerve involvement or injury should always be considered during excision of neck lumps. Preoperative indirect, atraumatic laryngoscopy by experienced surgeons is essential, as are tracheal intubation and vigilant postoperative observation.- - - - - - - - - - ranking = 4keywords = anaesthesia (Clic here for more details about this article) |
5/9. Stridor in an adult. An unusual presentation of functional origin.A 34-year-old woman with a recent history of a influenza-like illness and signs of bronchopneumonia presented with many of the features of acute epiglottitis, a condition which still carries a high mortality in adults. Urgent laryngoscopy and bronchoscopy under inhalational anaesthesia were negative. The results of arterial blood gases, taken when stridor was at its worst, revealed marked hypocapnia and respiratory alkalosis. We conclude that the resultant acute reduction of serum ionised calcium produced stridor as a result of tetany of the vocal cords. Similar cases from the literature and the role of emotional factors in the aetiology are discussed.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
6/9. The anaesthetic management of an infant with frontometaphyseal dysplasia (Gorlin-Cohen syndrome).We describe an infant with frontometaphyseal dysplasia, who presented to us twice for anaesthesia for orthopaedic surgery. These patients have facial asymmetry, mandibular hypoplasia, bradycardia, restrictive lung disease, primary pulmonary hypertension, skeletal abnormalities and difficult endotracheal intubation. The patient also showed laryngeal stridor because of laryngomalacia, vocal cord paralysis and subglottic stenosis. light premedication along with atropine, ECG and blood pressure monitoring, gradual inhalational induction and intubation of the spontaneously breathing patient, careful positioning and postoperative CPAP are recommended.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
7/9. Electrocardiographic signs of pulmonary hypertension in children who snore.Two children presented with sleep disturbances due to enlarged tonsils and adenoids. One child died during induction of anaesthesia, and postmortem examination showed hypertrophy of the right ventricle and atrium. As a result a prospective survey was carried out of children undergoing tonsillectomy or adenoidectomy, or both. During a nine-month period an electrocardiogram was taken in 92 children. Three electrocardiograms (3.3%) showed evidence of right heart strain. The children with abnormal electrocardiograms had symptoms of sleep disturbance with apnoea, snoring, and daytime somnolence. These symptoms and the electrocardiographic changes were reserved by adenotonsillectomy. The prevalence of pulmonary hypertension in children with enlarged tonsils and adenoids is still underestimated. When signs and symptoms of sleep disturbance, particularly snoring, are present an electrocardiogram should be obtained and a cardiologist's opinion sought before embarking on routine surgery in view of the potentially fatal consequences.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
8/9. Paradoxical vocal cord motion in the recovery room: a masquerader of pulmonary dysfunction.PURPOSE: We report a case of paradoxical vocal cord motion as an unusual cause of postoperative stridor and wheezing. A means of diagnosis and management is discussed. CLINICAL FINDINGS: A 71-yr-old man developed paradoxical vocal cord motion following uncomplicated hip replacement. He was treated with standard therapy for postoperative stridor and wheezing. After extensive evaluation, a flexible fibreoptic laryngoscope was used and the vocal cords noted to move paradoxically. This was the cause of his postoperative stridor and wheezing. Paradoxical vocal cord motion should be suspected as a cause of postoperative stridor and wheezing when the airway is easily maintained by a bag and mask, there is previous history of psychological problems, and there exists an unexplained history of previous postoperative airway distress. The definitive diagnosis may be made using a fibreoptic laryngoscope. In this patient, intubation was deferred and a plan of conservative therapy pursued. CONCLUSION: Paradoxical vocal cord motion is an unusual cause of postoperative respiratory distress. A definitive diagnosis may be made by the use of a flexible fibreoptic laryngo-scope using topical anaesthesia.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
9/9. airway obstruction due to arytenoid prolapse in a child.In paediatric patients, obstruction of the upper airway is still a common problem during general anaesthesia. This case report documents the susceptibility of arytenoids to prolapse in paediatric patients during halothane anaesthesia. The use of video endoscopy provides an excellent tool for visualizing this type of airway obstruction; and continuous positive airway pressure is an effective treatment for clearing the airway.- - - - - - - - - - ranking = 2keywords = anaesthesia (Clic here for more details about this article) |