The need for anaesthetic assessment in obstetric patients with airway abnormalities

2018 ◽  
Vol 33 ◽  
pp. 92-93 ◽  
Author(s):  
R.M. Blank ◽  
J.L. Rodriguez
Keyword(s):  
Anaesthetic Assessment ◽  
Airway Abnormalities

scholarly journals Airway Abnormalities in Adult Mucopolysaccharidosis and Development of Salford Mucopolysaccharidosis Airway Score

2021 ◽  
Vol 10 (15) ◽  
pp. 3275
Author(s):  
Chaitanya Gadepalli ◽  
Karolina M. Stepien ◽  
Reena Sharma ◽  
Ana Jovanovic ◽  
Govind Tol ◽  
...  
Keyword(s):  
Airway Disease ◽  
Lysosomal Storage ◽  
Cross Sectional ◽  
Airway Narrowing ◽  
3 Dimensional ◽  
Multiple Parameters ◽  
Validated Questionnaire ◽  
Dimensional Reconstruction ◽  
Cross Sectional Imaging ◽  
Airway Abnormalities

(1) Background: Mucopolysaccharidoses (MPS) are a heterogeneous group of lysosomal storage disorders caused by the absence of enzymes required for degradation of glycosaminoglycans (GAGs). GAGs deposition in tissues leads to progressive airway narrowing and/or tortuosity. Increased longevity of patients has posed newer problems, especially the airway. This study aims to characterise various airway abnormalities in adult MPS from a regional centre and proposes a method to quantify the severity of the airway disease. (2) Methods: Retrospective analysis by case notes review, clinical examination, endoscopy, cross-sectional imaging, 3-dimensional reconstruction, and physiological investigations were used to assess the airway abnormalities. Quantitative assessment of the airway severity was performed a validated questionnaire of 15 parameters to derive Salford Mucopolysaccharidosis Airway Score (SMAS). (3) Results: Thirty-one adult MPS patients (21M/ 9F; median 26.7 years; range 19–42 years) were reviewed. There were 9 MPS I, 12 MPS II, 2 MPS III, 5 MPS IV, 2 MPS VI, and 1 MPS VII. Airway abnormalities in each MPS type are described. Patients scoring more than 35 on SMAS had some form of airway intervention. The area under curve of 0.9 was noted at a score of 25, so SMAS more than 25 may predict a difficult airway and potential to have complications. Pearson’s correlation between SMAS and height, weight, BMI were poor (p < 0.05). (4) Conclusions: Airway abnormalities in adult MPS are varied and complex. Assessment of the airway should be holistic and include multiple parameters. An objective multidimensional score such as SMAS may help to predict and manage difficult airways warranting further investigation and validation.

Evaluation of Airway Complications in High-Risk Preterm Infants: Application of Flexible Fiberoptic Airway Endoscopy

PEDIATRICS ◽  
1995 ◽  
Vol 95 (4) ◽  
pp. 567-572
Author(s):  
Gregory J. Downing ◽  
Howard W. Kilbride
Keyword(s):  
High Risk ◽  
Preterm Infants ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Subglottic Stenosis ◽  
High Risk Population ◽  
Risk Population ◽  
Airway Complications ◽  
Airway Injury ◽  
Airway Abnormalities

Objectives. We sought to determine factors that would predict the development of subglottic stenosis (SGS) and tracheomalacia (TM) in preterm infants. The utility of a semiquantitative measurement of airway dimensions was assessed in relation to signs of airway complications. We also sought to determine from a high-risk population of infants those likely to have abnormal findings identified by bronchoscopic examination. Methods. Prospective airway endoscopy was performed for preterm infants who were intubated for 7 days or more or who demonstrated chronic oxygen needs beyond 28 days after birth and 36 weeks postconceptional age. Subjects were 117 preterm (less than 36 weeks' gestation) infants from two level III intensive care nurseries. Endoscopy was used to classify the type and degree of airway injury. Subglottic stenosis was defined subjectively and compared with an objective measurement using subglottic spatial relations described as a trans- subglottic/vocal cord ratio (TSG/VC). Clinical signs and symptoms and other risk factors were evaluated as significant predictors of SGS and TM, identified by bronchoscopy. Results. Moderate or severe airway abnormalities were identified in 32 patients (27.3%); 13 with SGS, 17 with TM, and 2 with both. All but one infant with TSG/VC less than 0.83 had signs and symptoms of airway dysfunction. Variables more commonly found in patients with SGS included greater number of intubations, use of inappropriately large endotracheal tubes, and longer duration of intubation. Higher averaged mean airway pressure during the first week after birth and lower gestational age were clinical features associated with TM. Conclusions. Flexible bronchoscopic evaluation of a high-risk population demonstrated a higher incidence of moderate or severe SGS or TM than previously suspected. Subglottic stenosis and TM appear to have different etiologies based on different factors associated with their development. The TSG/VC ratio correlated well with obstructive symptoms and may represent a means to quantitate clinically subglottic narrowing. Infants with chronic lung disease who have persistently elevated partial pressure of carbon dioxide, apnea, or phonation abnormalities are most likely to have airway abnormalities identifiable by bronchoscopy.

To begin …

2010 ◽  
Author(s):  
Stavros Prineas ◽  
Andrew F Smith
Keyword(s):  
Human Dimensions ◽  
Pain Clinic ◽  
Clinical Settings ◽  
Hospital Administrators ◽  
High Dependency ◽  
The World ◽  
Theatre Staff ◽  
Anaesthetic Assessment ◽  
The Many ◽  
Labour Suite

Communication is an innately fascinating and, on occasions, a somewhat mysterious topic. At its heart, it is the means of expressing, both to ourselves and to others, how we perceive the world and how we influence the world around us. It is a tool for exchanging information and meaning, but also a way to connect with others. While obviously a means to an end, it is also an end in itself—without the ability to share with others, life would be greatly impoverished. The many human dimensions of communication— the practical, the social, the linguistic, the lyrical, the subliminal, its ability to soothe and to injure, to inform, to entertain, to terrify—are what make this topic so challenging. Anaesthesia has come a very long way since the 1840s. The advent of safer and more selective drugs, coupled with ever more sophisticated technology, has made the practice of anaesthesia safer, yet also more complicated. The patients that we treat are often older, have multiple co-morbidities, and are undergoing procedures that would have been unthinkable 20 years ago. Yet with the increasingly complex workload have come the additional pressures of time and resource allocation. Patients are admitted on the day of surgery, leaving minimal time for anaesthetic assessment. Anaesthetists are frequently busy, isolated and unavailable when working in theatre, or find themselves working at multiple sites with little opportunity for interaction with colleagues. Similarly, theatre staff rarely work in the same operating room with the same team on a regular basis. The hospital administrators are under constant pressure as they strain to contain costs and reduce length of stay, while wards are increasingly understaffed and overworked. In the midst of all this, patients are left wondering who is actually caring for them, and if anyone is listening to their concerns. Anaesthetists play a crucial role in multi-professional teams in a wide variety of clinical settings of which theatre is only one. There is the high dependency unit (HDU), the labour suite, paediatrics, the chronic pain clinic—to name but a few. In almost every aspect of anaesthetic clinical practice the ability to communicate effectively is a vital component of patient care.

scholarly journals Further Observations in Cerebro-Costo-Mandibular Syndrome: Exploration with CT Imaging

2020 ◽  
Vol 10 (01) ◽  
pp. e21-e24
Author(s):  
Venkatraman Bhat ◽  
Vinay Belval ◽  
Santhosh Kumar ◽  
Onkar Auti
Keyword(s):  
Chest Wall ◽  
Structural Changes ◽  
Male Infant ◽  
Ct Imaging ◽  
Imaging Features ◽  
Small Nuclear Ribonucleoprotein ◽  
Wide Range ◽  
Nuclear Ribonucleoprotein ◽  
Osseous Defects ◽  
Airway Abnormalities

AbstractCerebro-costo-mandibular syndrome (CCMS) is a rare syndrome characterized by posterior rib ossification gaps and orofacial anomalies. Posterior rib ossification gaps are the hallmark of the disease and mimic multiple old rib fractures. The condition is caused by heterogeneous mutation of Small Nuclear Ribonucleoprotein Polypeptides B and B1 (SNRPB) gene on the chromosome 20p13. There is scanty literature regarding the extent of bony changes and the associated pulmonary-airway abnormalities on computed tomography (CT) imaging. In this case report, we presented a detailed CT imaging features of a case of CCMS in a male infant. This report highlighted on the nature of osseous defects, structural changes in the chest wall, airways, lungs, and a wide range of spinal anomalies. Some of our observations regarding the changes in the airway and chest wall are likely to have bearing on evaluating the prognosis and the need for respiratory support.

Simulated patient-based teaching of medical students improves pre-anaesthetic assessment

2020 ◽  
Vol 37 (5) ◽  
pp. 387-393 ◽  
Author(s):  
Joana M. Berger-Estilita ◽  
Robert Greif ◽  
Christoph Berendonk ◽  
Daniel Stricker ◽  
Kai P. Schnabel
Keyword(s):  
Medical Students ◽  
Simulated Patient ◽  
Anaesthetic Assessment

Respiratory Polysomnographic Findings in Patients Treated Primarily for Unilateral Cleft Lip and Palate

2017 ◽  
Vol 55 (2) ◽  
pp. 287-291 ◽  
Author(s):  
Davi Sandes Sobral ◽  
Gustavo Juliane Faller ◽  
Marcus Vinícius Martins Collares
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Sleep Apnea Syndrome ◽  
Mixed Dentition ◽  
Apnea Hypopnea Index ◽  
Craniofacial Anomalies ◽  
Obstructive Sleep ◽  
The Mean ◽  
Airway Abnormalities ◽  
Craniofacial Abnormality

Cleft lip and palate (CLP) is the most common congenital craniofacial abnormality. Obstructive sleep apnea syndrome (OSAS) is a highly prevalent but underdiagnosed disease and is frequently associated with craniofacial anomalies. There are few studies describing the sleep breathing pattern of children with CLP. This study sought to characterize the respiratory profile of 23 children with unilateral cleft lip and palate, aged 7-12 years, who had undergone cleft lip and nasal repair at age 3-4 months and palatoplasty at 12-15 months, with a particular focus on evaluating the presence of OSAS in children with CLP. Polysomnography was performed and findings were analyzed descriptively. We found a mean and median for apnea/hypopnea index (AHI) of 1.11/h (SD = 0.78) and 0.9/h, respectively. The mean obstructive apnea index (OAI) was 0.27/h (SD = 0.38) and the median, 0.1/h. Nearly 30% of patients had an AHI above 1.4 events/h. There was no significant oxyhemoglobin desaturation in the study group. In this group, the prevalence of OSAS was higher than in noncleft populations when compared to the normality values adopted. This sample of patients with unilateral cleft lip and palate exhibited an increased prevalence of OSAS during the mixed dentition stage. Although the results showed that OSAS was mild, we advise closer observation of these patients. Polysomnography is recommended for the assessment of children with airway abnormalities, to individualize the extent of treatment.

Sign in / Sign up

Export Citation Format

Share Document