Large tumours occupying one half of the thoracic cavity are rare and may cause life-threatening complications by compression or invasion of vital structures that results in cardiovascular and/or respiratory insufficiency. In-depth preoperative planning is necessary after assessment of perioperative risk of hemithoracic masses. By providing lung isolation, one-lung ventilation technique provides improved surgical conditions compared to conventional dual-lung ventilation for thoracic surgery. As double-lumen tubes are not available for smaller children, balloon-tipped bronchial blockers remain the technique of choice, especially under the age of 6 years. Huge intrathoracic masses in small children with radiological and clinical findings suggesting airway compression are high risk for airway complications. Fibreoptic bronchoscope-guided intubation should be preferred in view of tracheobronchial compression by the mass and placement of an endobronchial blocker helps in one-lung ventilation in small children. The management of these tumours is challenging and should be performed only in specialised centres.
{"title":"Airway management of a giant thoracic ganglioneuroma causing airway obstruction in a 3-year-old child","authors":"Alok Kumar, Simrandeep Singh, N. Tiwari, A. Joshi","doi":"10.4103/arwy.arwy_7_22","DOIUrl":"https://doi.org/10.4103/arwy.arwy_7_22","url":null,"abstract":"Large tumours occupying one half of the thoracic cavity are rare and may cause life-threatening complications by compression or invasion of vital structures that results in cardiovascular and/or respiratory insufficiency. In-depth preoperative planning is necessary after assessment of perioperative risk of hemithoracic masses. By providing lung isolation, one-lung ventilation technique provides improved surgical conditions compared to conventional dual-lung ventilation for thoracic surgery. As double-lumen tubes are not available for smaller children, balloon-tipped bronchial blockers remain the technique of choice, especially under the age of 6 years. Huge intrathoracic masses in small children with radiological and clinical findings suggesting airway compression are high risk for airway complications. Fibreoptic bronchoscope-guided intubation should be preferred in view of tracheobronchial compression by the mass and placement of an endobronchial blocker helps in one-lung ventilation in small children. The management of these tumours is challenging and should be performed only in specialised centres.","PeriodicalId":7848,"journal":{"name":"Airway Pharmacology and Treatment","volume":"3 1","pages":"77 - 80"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86168293","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A 35-year-old male weighing 94 kg developed significant oropharyngeal and perilaryngeal oedema with sepsis in the postoperative period following mandibular advancement surgery. He needed change of an existing nasotracheal tube to the orotracheal route in the intensive care unit (ICU). The procedure had to be abandoned in the ICU for fear of losing the airway in this patient requiring high inspired oxygen concentration of 60% and positive end expiratory pressure of 8.0 cm H2O. The changeover of tube was safely achieved in the operation theatre by utilising the splinting effect of the existing nasotracheal tube that helped to keep the oedematous epiglottis lifted while an airway exchange catheter (AEC) was placed by its side under videolaryngoscopic guidance. Railroading the new orotracheal tube over the preplaced AEC after withdrawing the nasal tube while receiving oxygen at 4 litres per minute helped to accomplish the safe exchange of the tracheal tube.
一名35岁男性，体重94公斤，在下颌骨推进手术后出现明显的口咽和咽周围水肿并脓毒症。他需要在重症监护病房(ICU)将现有的鼻气管管改为口气管管。该患者吸入氧浓度高达60%，呼气末正压为8.0 cm H2O，由于担心失去气道，不得不在ICU放弃该手术。在手术室中，利用现有鼻气管管的夹板作用，在视频喉镜引导下将气道交换导管(AEC)放置在会厌旁的同时，帮助保持水肿的会厌的悬吊，安全地完成了导管的转换。在取出鼻管并以每分钟4升的速度吸氧后，将新的口气管管置于预先放置的AEC上，有助于完成气管管的安全交换。
{"title":"Redefining exchange of tracheal tube from nasal to oral in high risk sepsis patient","authors":"R. Khan, A. Haris, Abdullah Al Jadidi, N. Kaul","doi":"10.4103/arwy.arwy_13_22","DOIUrl":"https://doi.org/10.4103/arwy.arwy_13_22","url":null,"abstract":"A 35-year-old male weighing 94 kg developed significant oropharyngeal and perilaryngeal oedema with sepsis in the postoperative period following mandibular advancement surgery. He needed change of an existing nasotracheal tube to the orotracheal route in the intensive care unit (ICU). The procedure had to be abandoned in the ICU for fear of losing the airway in this patient requiring high inspired oxygen concentration of 60% and positive end expiratory pressure of 8.0 cm H2O. The changeover of tube was safely achieved in the operation theatre by utilising the splinting effect of the existing nasotracheal tube that helped to keep the oedematous epiglottis lifted while an airway exchange catheter (AEC) was placed by its side under videolaryngoscopic guidance. Railroading the new orotracheal tube over the preplaced AEC after withdrawing the nasal tube while receiving oxygen at 4 litres per minute helped to accomplish the safe exchange of the tracheal tube.","PeriodicalId":7848,"journal":{"name":"Airway Pharmacology and Treatment","volume":"58 1","pages":"81 - 84"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81380433","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rajnish Kumar, P. Kumari, P. Kandrakonda, Saras Singh
{"title":"Awake fibreoptic intubation in an adult with retrognathia: An anaesthetic challenge","authors":"Rajnish Kumar, P. Kumari, P. Kandrakonda, Saras Singh","doi":"10.4103/arwy.arwy_14_22","DOIUrl":"https://doi.org/10.4103/arwy.arwy_14_22","url":null,"abstract":"","PeriodicalId":7848,"journal":{"name":"Airway Pharmacology and Treatment","volume":"54 1","pages":"94 - 95"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74846858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Priyanka Karnik, N. Dave, S. Rawlani, Vaibhav Dhabe
{"title":"Discretion is the better part of valour: Non-operating room anaesthesia for tissue diagnosis of a mediastinal mass","authors":"Priyanka Karnik, N. Dave, S. Rawlani, Vaibhav Dhabe","doi":"10.4103/arwy.arwy_5_22","DOIUrl":"https://doi.org/10.4103/arwy.arwy_5_22","url":null,"abstract":"","PeriodicalId":7848,"journal":{"name":"Airway Pharmacology and Treatment","volume":"105 1","pages":"92 - 93"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82886955","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Anaesthesia for otorhinolaryngological procedures has always been challenging in view of a shared and often difficult airway. A 55-year-old male, a known case of carcinoma right maxilla, presented to us following right total maxillectomy, bilateral anterior and posterior ethmoidectomy, sphenoidectomy and right supraomohyoid neck dissection. He needed a revision maxillectomy in view of a residual lesion predominantly in the right superior nasal cavity and maxillary sinus. Mouth opening was restricted to 1.5 cm making direct laryngoscopy impossible. The mass in the right nasal cavity had eroded and caused deviation of the nasal septum completely towards the left, making nasal fibrescopy also difficult. We successfully managed the airway using the technique of asleep oral fibreoptic-guided intubation.
{"title":"“Never burn your bridges” – A difficult airway scenario","authors":"Juhi Sharma, Tushar Mittal","doi":"10.4103/arwy.arwy_25_22","DOIUrl":"https://doi.org/10.4103/arwy.arwy_25_22","url":null,"abstract":"Anaesthesia for otorhinolaryngological procedures has always been challenging in view of a shared and often difficult airway. A 55-year-old male, a known case of carcinoma right maxilla, presented to us following right total maxillectomy, bilateral anterior and posterior ethmoidectomy, sphenoidectomy and right supraomohyoid neck dissection. He needed a revision maxillectomy in view of a residual lesion predominantly in the right superior nasal cavity and maxillary sinus. Mouth opening was restricted to 1.5 cm making direct laryngoscopy impossible. The mass in the right nasal cavity had eroded and caused deviation of the nasal septum completely towards the left, making nasal fibrescopy also difficult. We successfully managed the airway using the technique of asleep oral fibreoptic-guided intubation.","PeriodicalId":7848,"journal":{"name":"Airway Pharmacology and Treatment","volume":"102 1","pages":"85 - 87"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81892442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"An alternate way of fixing endotracheal tube during cleft lip and cleft palate surgery in children","authors":"S. Nayak, Ankur Khandelwal, B. Das","doi":"10.4103/arwy.arwy_22_22","DOIUrl":"https://doi.org/10.4103/arwy.arwy_22_22","url":null,"abstract":"","PeriodicalId":7848,"journal":{"name":"Airway Pharmacology and Treatment","volume":"38 1","pages":"96 - 97"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87564858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sarfaraz Ahmad, S. Naaz, Rajnish Kumar, Neeraj Kumar
{"title":"Awake intubation with i-scope videolaryngoscope in a case of limited mouth opening","authors":"Sarfaraz Ahmad, S. Naaz, Rajnish Kumar, Neeraj Kumar","doi":"10.4103/arwy.arwy_24_22","DOIUrl":"https://doi.org/10.4103/arwy.arwy_24_22","url":null,"abstract":"","PeriodicalId":7848,"journal":{"name":"Airway Pharmacology and Treatment","volume":"27 1 1","pages":"98 - 99"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78164179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Obstructive sleep apnoea (OSA) in children is associated with the development of perioperative adverse respiratory events. The aim of our study was to find out the incidence of perioperative adverse respiratory events, to identify the risk predictors and to determine the appropriate anaesthetic agents in children with OSA. Methods: After obtaining approval from the the Institutional Review Board, 189 children with OSA who had undergone adenotonsillectomy between 2004 and 2009 were selected from a retrospective review of case files. Variables recorded included demographic data, coexistent medical illnesses, anaesthetic techniques (including induction agents and muscle relaxants) and perioperative analgesia. The severity of OSA was determined based on polysomnographic criteria. Adverse events including difficult airway, desaturation due to bronchospasm or laryngospasm, postoperative desaturation and unplanned intensive care unit (ICU) admission occurring up to 24 h postoperatively were recorded. Results: The incidence of perioperative respiratory adverse events was 19.6%. Severe OSA (odds ratio [OR] 5.8; 95% confidence interval [CI] 1.8–18.53; P = 0.003) and moderate OSA (OR 3.9; 95% CI 1.1–13.1; P = 0.029) were independent risk factors associated with complications. There was no correlation between the intraoperative anaesthetic techniques or use of perioperative opioid analgesics and the perioperative adverse respiratory events. Conclusions: Preoperative diagnosis of OSA using polysomnography has been shown to identify children who are at increased risk of perioperative adverse respiratory events in children. In our review, 19.6% of children with OSA were at risk. The use of a severity index may better identify children at higher risk.
{"title":"Perioperative adverse respiratory events in children with obstructive sleep apnoea","authors":"S. Thampi, S. Chong, D. Pawar","doi":"10.4103/arwy.arwy_10_22","DOIUrl":"https://doi.org/10.4103/arwy.arwy_10_22","url":null,"abstract":"Background: Obstructive sleep apnoea (OSA) in children is associated with the development of perioperative adverse respiratory events. The aim of our study was to find out the incidence of perioperative adverse respiratory events, to identify the risk predictors and to determine the appropriate anaesthetic agents in children with OSA. Methods: After obtaining approval from the the Institutional Review Board, 189 children with OSA who had undergone adenotonsillectomy between 2004 and 2009 were selected from a retrospective review of case files. Variables recorded included demographic data, coexistent medical illnesses, anaesthetic techniques (including induction agents and muscle relaxants) and perioperative analgesia. The severity of OSA was determined based on polysomnographic criteria. Adverse events including difficult airway, desaturation due to bronchospasm or laryngospasm, postoperative desaturation and unplanned intensive care unit (ICU) admission occurring up to 24 h postoperatively were recorded. Results: The incidence of perioperative respiratory adverse events was 19.6%. Severe OSA (odds ratio [OR] 5.8; 95% confidence interval [CI] 1.8–18.53; P = 0.003) and moderate OSA (OR 3.9; 95% CI 1.1–13.1; P = 0.029) were independent risk factors associated with complications. There was no correlation between the intraoperative anaesthetic techniques or use of perioperative opioid analgesics and the perioperative adverse respiratory events. Conclusions: Preoperative diagnosis of OSA using polysomnography has been shown to identify children who are at increased risk of perioperative adverse respiratory events in children. In our review, 19.6% of children with OSA were at risk. The use of a severity index may better identify children at higher risk.","PeriodicalId":7848,"journal":{"name":"Airway Pharmacology and Treatment","volume":"22 1","pages":"70 - 76"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77793101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Kolisambeevi, Femitha Pournami, A. Prithvi, Anand Nandakumar, Jyothi Prabhakar, Naveen Jain
Background: Descriptions of course of illness during prolonged intensive care is as essential as studying outcomes in extremely low gestational age neonates (ELGANs). Understanding the expected trajectory of respiratory illness aids in the recognition of risk factors followed by appropriate counselling and resource allocation. We studied the patterns of respiratory illness in ELGAN over the first 2 weeks and its association with bronchopulmonary dysplasia (BPD). Methodology: Levels of respiratory care in ELGAN from 2017 to 2021 were analysed. They were classified into four groups (pragmatically at the bedside) based on oxygen requirements as Category 1: persistent low needs (PL) – FIO2 <0.3 on day 3, and FIO2 <0.3 at 2 weeks, Category 2: progressive worsening (PW) – FIO2 <0.3 on day 3, worsening to >0.3 at 2 weeks, Category 3: persistent high needs (PH) – FIO2 >0.3 on day 3, continuing to need >0.3 at 2 weeks and Category 4: progressive improvement (PI) – FIO2 >0.3 on day 3, improving to <0.3 at 2 weeks. The proportion of infants in each group who developed BPD was also determined. Results: Seventy-four survivors of 91 live-born ELGAN were included, of whom 29.7% developed BPD. Most infants were in PL category (83.8%). Those in the worse categories (PW and PH) constituted only 4.05%. The association of classification as worse patterns (PW or PH) with BPD was not statistically significant, but the numbers were very small. Conclusions: Major proportion of ELGAN were categorised into reassuring archetypes of respiratory requirements. Drawing conclusions about the association with BPD may need analysis of a larger number of infants.
{"title":"Measuring what matters: Respiratory archetypes in extreme preterm neonates","authors":"A. Kolisambeevi, Femitha Pournami, A. Prithvi, Anand Nandakumar, Jyothi Prabhakar, Naveen Jain","doi":"10.4103/arwy.arwy_11_22","DOIUrl":"https://doi.org/10.4103/arwy.arwy_11_22","url":null,"abstract":"Background: Descriptions of course of illness during prolonged intensive care is as essential as studying outcomes in extremely low gestational age neonates (ELGANs). Understanding the expected trajectory of respiratory illness aids in the recognition of risk factors followed by appropriate counselling and resource allocation. We studied the patterns of respiratory illness in ELGAN over the first 2 weeks and its association with bronchopulmonary dysplasia (BPD). Methodology: Levels of respiratory care in ELGAN from 2017 to 2021 were analysed. They were classified into four groups (pragmatically at the bedside) based on oxygen requirements as Category 1: persistent low needs (PL) – FIO2 <0.3 on day 3, and FIO2 <0.3 at 2 weeks, Category 2: progressive worsening (PW) – FIO2 <0.3 on day 3, worsening to >0.3 at 2 weeks, Category 3: persistent high needs (PH) – FIO2 >0.3 on day 3, continuing to need >0.3 at 2 weeks and Category 4: progressive improvement (PI) – FIO2 >0.3 on day 3, improving to <0.3 at 2 weeks. The proportion of infants in each group who developed BPD was also determined. Results: Seventy-four survivors of 91 live-born ELGAN were included, of whom 29.7% developed BPD. Most infants were in PL category (83.8%). Those in the worse categories (PW and PH) constituted only 4.05%. The association of classification as worse patterns (PW or PH) with BPD was not statistically significant, but the numbers were very small. Conclusions: Major proportion of ELGAN were categorised into reassuring archetypes of respiratory requirements. Drawing conclusions about the association with BPD may need analysis of a larger number of infants.","PeriodicalId":7848,"journal":{"name":"Airway Pharmacology and Treatment","volume":"782 1","pages":"65 - 69"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80660578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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