1/27. Anterior mediastinal masses: an anaesthetic challenge.A patient with a large anterior mediastinal mass with minimal respiratory symptoms presented for a diagnostic biopsy of the mass. A pre-operative thoracic computed tomographic scan demonstrated narrowing of the distal trachea, and right and left main stem bronchi. An awake intubation was done. Thiopentone and muscle relaxant were given and surgery commenced. High airway pressure developed and ventilation became difficult, although oxygenation remained satisfactory throughout. Anaesthetic implications are discussed. We recommend that patients with more than 50% obstruction of the airway at the level of the lower trachea and main bronchi have their femoral vessels cannulated in readiness for cardiopulmonary bypass.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/27. Localized tracheomalacia as a complication of the Cole tracheal tube.The Cole tracheal tube is designed for use in neonates. Subglottic stenosis is a recognized complication of prolonged use of the tube. We report a case of tracheomalacia as a further complication of prolonged use of the tube. A 4-month-old infant with a history of repeated failed extubation and multiple medical problems was found to have an unusual region of severe inspiratory collapse localized to the upper 1 cm of the trachea. This was felt to be the result of pressure from the shoulder of the Cole tube which had been used for prolonged intubation. A tracheostomy was performed to bypass the collapse, but the infant subsequently died due to other medical problems.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
3/27. Elective extracorporeal membrane oxygenation: an improved perioperative technique in the treatment of tracheal obstruction.The surgical management of children with tracheal stenosis and obstruction is complicated by the perioperative needs of pressure ventilation and indwelling endotracheal tubes. These factors predispose to surgical failure and anastomotic breakdown, restenosis. and pneumomediastinum. The use of extracorporeal membrane oxygenation (ECMO) to manage ventilation during tracheal repair allows better visualization at the surgical site and obviates the need for indwelling endotracheal tubes and high-pressure ventilation. Six children were treated with elective ECMO at a tertiary care hospital. All 6 underwent successful surgical repair, and 4 of the 6 were ultimately extubated. There were no significant complications at the surgical site. There was 1 death from postoperative complications, and 2 patients required tracheotomy. One tracheotomy was performed for upper airway obstruction secondary to retrognathia, and this patient was subsequently decannulated. Medical complications were confined to 2 patients and included sepsis, hyperbilirubinemia, seizure disorder, renal failure, intracranial hemorrhage, and hydrocephalus. Elective ECMO provides a reliable perioperative technique for airway management of children with tracheal stenosis or obstruction. This technique offers the advantage of improved visibility at the operative site and eliminates the need for high-pressure ventilation, thereby likely reducing the risk of perioperative morbidity.- - - - - - - - - - ranking = 3keywords = pressure (Clic here for more details about this article) |
4/27. Unexpected tracheomalacia in marfan syndrome during general anesthesia for correction of scoliosis.IMPLICATIONS:We experienced an unexpected tracheomalacia exhibiting CO2 retention and an increased peak inspiratory pressure after beginning an operation; it was confirmed with fiberoptic bronchoscopy. If there are no problems in the circuit or tube when the patient shows CO2 retention and increases in peak inspiratory pressure, the fiberoptic bronchoscope is helpful- - - - - - - - - - ranking = 2keywords = pressure (Clic here for more details about this article) |
5/27. Complete airway obstruction in a ventilated patient after oesophageal dilatation.A case of instrumental perforation of the oesophagus is presented. This caused systemic sepsis, requiring tracheal intubation and positive pressure ventilation. Sudden unexpected life-threatening airway obstruction was caused by distal tracheal compression by a peritracheal abscess. The aetiology and management of distal tracheal obstruction is discussed.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
6/27. life-threatening pulmonary oedema secondary to tracheal compression.We present a case of negative pressure pulmonary oedema due to an overlooked cause. A 45-year-old female patient presented to the emergency department unconscious with severe pulmonary oedema. Subsequent investigations revealed a thyroid goitre causing significant tracheal compression. This case report highlights an extremely rare but potentially dangerous sequela of upper airway obstruction.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
7/27. Vascularized hemitracheal autograft for laryngotracheal reconstruction: a new surgical technique based on the thyroid gland as a vascular carrier.BACKGROUND: The management of extensive laryngotracheal stenosis has been a challenge confronting head and neck surgeons for over a century. The key to the successful restoration of a stable airway is providing a cartilaginous infrastructure to provide support to withstand both the negative and positive lumenal pressures produced during normal respiration and deglutition. We introduce a novel technique for restoration of such defects. methods: The blood supply to the thyroid gland by way of the inferior thyroid artery and the superior thyroid artery and vein are mobilized for transfer. One half to two thirds of the circumference of the adjacent tracheal rings are mobilized on the basis of the requirements of the stenotic segment. This mucochondrial composite tracheal flap is advanced superiorly to the ipsilateral "laryngeal" region where insetting of the cartilage and the mucosa is performed. Primary reconstruction or, more likely, a staged repair of the secondary tracheal defect is performed. RESULTS: Three case reports are presented. The patients were successfully decannulated postoperatively, continue to have an adequate voice, and are tolerating a diet (3-27 months postreconstruction). CONCLUSION: A new surgical technique for reconstruction of benign laryngotracheal stenoses is introduced to restore phonatory capability and a stable airway. The composite thyroid-tracheal graft based on the inferior and superior thyroid arterial pedicles allows a single-staged, primary reconstruction of the hemilarynx with a well-vascularized composite thyrotracheal flap that allows resurfacing as well as replacement of the infrastructure of the glottis and subglottis. This technique would be an excellent method to restore the cricoid ring following partial resection for primary cartilaginous tumors.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
8/27. Traumatic rupture of the thoracic aorta: diagnosis on fibreoptic bronchoscopy.The diagnosis of thoracic aortic rupture can be difficult, especially in the presence of other life-threatening injuries. We present a case in which the presence of major intraabdominal trauma shifted clinical attention away from the mediastinum. During bronchoscopy, which was performed to investigate high intraoperative airway pressures, unexpected tracheal and carinal compression were discovered. Thoracic aortography revealed aortic rupture distal to the left subclavian artery. Successful repair was subsequently achieved.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
9/27. Esophageal tracheoplasty for congenital tracheal stenosis.Two infants with congenital long tracheal stenosis underwent operation by means of an esophageal tracheoplasty. The first patient had previously undergone tracheal reconstruction using the pericardium. Although ventilation improved somewhat following this procedure, the pericardial patch suddenly ruptured 12 days after the operation, requiring an immediate esophageal tracheoplasty. The esophageal portion of the reconstructed trachea epithelialized 1 month later, with the lumen maintaining its proper size. However, the patient died 3 months after the second tracheoplasty. The cause of death was thought to be due to complications arising from prolonged high-pressure use of mechanical ventilation. He had been on a respirator for 6 months before the first tracheoplasty. The second patient has been doing well with no recurring respiratory problems for 25 months now. Her reconstructed trachea has adapted with her growth. This technique should be considered along with other forms of treatment for tracheal reconstruction because it is relatively simple and pliable.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
10/27. Rigid bronchoscopic dilatation of postintubation tracheal stenosis.BACKGROUND: Postintubation tracheal stenosis (PITS) occurs due to excessive pressure on the trachea by the cuff of the endotracheal tube which leads to local ischaemic necrosis of the tracheal cartilage and excessive growth of granulation tissue. The recognition of its aetiology and modifications in the design and management of endotracheal tubes have led to a diminished incidence of PITS. The management modalities that have been employed for the management of PITS include stenting, surgical resection and reconstruction, percutaneous dilatation, rigid bronchoscopic dilatation, fibreoptic assisted balloon dilatation and Nd:YAG (neodymium: yttritium-aluminum garnet) laser therapy with or without stenting. methods: Three female patients with a history of varying periods of endotracheal intubation after a period of acute respiratory failure who developed symptoms of tracheal stenosis 1-2 weeks post-extubationare presented. The mean age was 24 /- 12.49 years (range = 14-38 years). RESULTS: All the three patients were successfully managed by frequent, rigid bronchoscopy and gradual dilatation until the resolution of the tracheal stenosis and the return of pulmonary function tests (PFT) to normal. CONCLUSIONS: Rigid bronchoscopic dilation in patients with PITS provides safe, effective tracheal dilatation and improved pulmonary function in the medium term.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
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