594: MANAGEMENT OF AN INTRAMURAL ESOPHAGEAL HEMATOMA CAUSING AIRWAY COLLAPSE

Abstract Background Excessive dynamic airway collapse (EDAC) is an uncommon cause of high airway pressure during mechanical ventilation. However, EDAC is not widely recognized by anesthesiologists, and therefore, it is often misdiagnosed as asthma. Case presentation A 70-year-old woman with a history of asthma received anesthesia with sevoflurane for a laparotomic cholecystectomy. Under general anesthesia, she developed wheezing, high inspiratory pressure, and a shark-fin waveform on capnography, which was interpreted as an asthma attack. However, treatment with a bronchodilator was ineffective. Bronchoscopy revealed the collapse of the trachea and main bronchi upon expiration. We reviewed the preoperative computed tomography scan and saw bulging of the posterior membrane into the airway lumen, leading to a diagnosis of EDAC. Conclusions Although both EDAC and bronchospasm present as similar symptoms, the treatments are different. Bronchoscopy proved useful for distinguishing between these two entities. Positive end-expiratory pressure should be applied and bronchodilators avoided in EDAC.

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Central Airway Collapse Is Related to Obesity but Not Asthma

10.1164/ajrccm-conference.2020.201.1_meetingabstracts.a4428 ◽

2020 ◽

Author(s):

S.A. Bhatawadekar ◽

U. Peters ◽

R.R. Walsh ◽

C.M. Kinsey ◽

N. Daphtary ◽

...

Keyword(s):

Airway Collapse ◽

Central Airway

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Giant vallecular cyst: an impending threat for airway collapse

BMJ Case Reports ◽

10.1136/bcr-2021-244666 ◽

2021 ◽

Vol 14 (6) ◽

pp. e244666

Author(s):

Surya Ravichandran ◽

Puducherry Ravichandran Subhashini ◽

Kalaiarasi Raja ◽

Arun Alexander

Keyword(s):

Airway Collapse

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Tracheomalacia/Tracheobronchomalacia and Hyperdynamic Airway Collapse

Immunology and Allergy Clinics of North America ◽

10.1016/j.iac.2012.10.005 ◽

2013 ◽

Vol 33 (1) ◽

pp. 23-34 ◽

Cited By ~ 18

Author(s):

Eugene M. Choo ◽

Joseph C. Seaman ◽

Ali I. Musani

Keyword(s):

Airway Collapse

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Submucosal Esophageal Hematoma Following Sclerotherapy: A Rare Complication

Canadian Journal of Gastroenterology ◽

10.1155/1990/715941 ◽

1990 ◽

Vol 4 (1) ◽

pp. 23-25 ◽

Cited By ~ 1

Author(s):

Ram Singh ◽

YK Chawla ◽

Upjeet Kaur ◽

Neelam Malik ◽

JB Dilawari

Keyword(s):

Cirrhotic Patient ◽

Esophageal Stricture ◽

Rare Complication ◽

Intramural Hematoma ◽

Esophageal Variceal ◽

Esophageal Hematoma

A cirrhotic patient who developed an intramural hematoma of the esophagus as a complication of esophageal variceal sclerotherapy is reported. The hematoma resolved spontaneously within two weeks without any residual complications such as esophageal stricture.

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Tracheobronchomalacia: Comparison between End-expiratory and Dynamic Expiratory CT for Evaluation of Central Airway Collapse

Radiology ◽

10.1148/radiol.2352040309 ◽

2005 ◽

Vol 235 (2) ◽

pp. 635-641 ◽

Cited By ~ 117

Author(s):

Ronaldo H. Baroni ◽

David Feller-Kopman ◽

Mizuki Nishino ◽

Hiroto Hatabu ◽

Stephen H. Loring ◽

...

Keyword(s):

Airway Collapse ◽

Central Airway

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Spontaneous Intramural Esophageal Hematoma Diagnosis by CT Scanning

Journal of Clinical Gastroenterology ◽

10.1097/00004836-198710000-00012 ◽

1987 ◽

Vol 9 (5) ◽

pp. 546-548 ◽

Cited By ~ 11

Author(s):

F. Schweiger ◽

W. T. Depew

Keyword(s):

Ct Scanning ◽

Esophageal Hematoma

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Much Ado about Sleep: Current Concepts on Mechanisms and Predisposition to Pediatric Obstructive Sleep Apnea

Children ◽

10.3390/children8111032 ◽

2021 ◽

Vol 8 (11) ◽

pp. 1032

Author(s):

Ashley L. Saint-Fleur ◽

Alexa Christophides ◽

Prabhavathi Gummalla ◽

Catherine Kier

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Upper Airway ◽

Biomechanical Properties ◽

Primary Role ◽

Airway Narrowing ◽

Airway Collapse ◽

Upper Airway Collapse ◽

Obstructive Sleep ◽

Review Current

Obstructive Sleep Apnea (OSA) is a form of sleep-disordered breathing characterized by upper airway collapse during sleep resulting in recurring arousals and desaturations. However, many aspects of this syndrome in children remain unclear. Understanding underlying pathogenic mechanisms of OSA is critical for the development of therapeutic strategies. In this article, we review current concepts surrounding the mechanism, pathogenesis, and predisposing factors of pediatric OSA. Specifically, we discuss the biomechanical properties of the upper airway that contribute to its primary role in OSA pathogenesis and examine the anatomical and neuromuscular factors that predispose to upper airway narrowing and collapsibility.

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O037 Genioglossus motor control following the return to sleep after brief arousal

SLEEP Advances ◽

10.1093/sleepadvances/zpab014.036 ◽

2021 ◽

Vol 2 (Supplement_1) ◽

pp. A16-A16

Author(s):

A Dawson ◽

J Avraam ◽

C Nicholas ◽

A Kay ◽

J Trinder ◽

...

Keyword(s):

Motor Units ◽

Firing Frequency ◽

Nasal Mask ◽

Persistent Activity ◽

Genioglossus Muscle ◽

Single Motor Units ◽

Airway Collapse ◽

Obstructive Sleep ◽

Persistent Firing ◽

Healthy Participants

Abstract Rationale Arousal from sleep has been shown to elicit a prolonged increase in genioglossus muscle activity that persists following the return to sleep and may protect against airway collapse. We hypothesised that this increased genioglossal activity following return to sleep after an arousal is due to persistent firing of inspiratory single motor units (SMUs) recruited during the arousal. Methods 34 healthy participants were studied overnight while wearing a nasal mask/pneumotachograph to measure ventilation and with 4 intramuscular genioglossus SMU electrodes. During stable N2 and N3 sleep, auditory tones were played to induce brief (3-15s) AASM arousals. Ventilation and genioglossus SMUs were quantified for 5 breaths before the tone, during the arousal and for 10 breaths after the return to sleep. Results A total of 1089 tones were played and gave rise to 236 SMUs recorded across arousal and the return to sleep in 20 participants (age 23±4.2 years and BMI 22.5±2.2kg/m2). Ventilation was elevated above baseline during arousal and the first post-arousal breath (p<0.001). The peak firing frequency of expiratory and tonic SMUs was unchanged during arousal and return to sleep, whereas inspiratory modulated SMUs were increased during the arousal and for 4 breaths following the return to sleep (p<0.001). Conclusions The prolonged increase in genioglossus activity that occurs on return to sleep after arousal is a result of persistent activity of inspiratory SMUs. Strategies to elevate inspiratory genioglossus SMU activity may be beneficial in preventing/treating obstructive sleep apnea.

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