Acute Respiratory Obstruction due to Accidental Inhalation of Perlite: A Novel Mechanism for Upper Airway Occlusion with Cast Formation

2020 ◽  
Vol 65 (4) ◽  
pp. 1354-1359
Author(s):  
Marianne Tiemensma ◽  
Robert W. Fitzpatrick ◽  
Mark D. Raven ◽  
Roger W. Byard
Keyword(s):  
Upper Airway ◽  
Respiratory Obstruction ◽  
Airway Occlusion

Upper Airway Obstruction in Infectious Mononucleosis

1980 ◽  
Vol 89 (5) ◽  
pp. 430-433 ◽  
Author(s):  
Judith A. Wolfe ◽  
Lee D. Rowe
Keyword(s):  
Airway Obstruction ◽  
Infectious Mononucleosis ◽  
Upper Airway ◽  
Lymphoid Hyperplasia ◽  
Unusual Complication ◽  
Recent Experience ◽  
Respiratory Obstruction ◽  
Swallowing Function ◽  
Bulbar Paralysis ◽  
Upper Respiratory

Life-threatening upper respiratory obstruction is an unusual complication of infectious mononucleosis. Although the majority of fatalities result from progressive bulbar paralysis or the Guillain-Barré syndrome, airway impairment primarily occurs as a result of pharyngeal lymphoid hyperplasia and associated faucial arch edema. Recent experience in a young child with infectious mononucleosis who exhibited progressive hypersomnolence, sleep apnea, and stridor during sleep is presented. In addition, a retrospective analysis of 72 cases of respiratory complications of infectious mononucleosis provides guidelines for specific airway management. Mild upper respiratory obstruction with persistent fever, severe odynophagia, and malaise is treated with parenteral corticosteroids. Immediate tonsillectomy using a halothane and oxygen induction technique is recommended for severe airway occlusion. Tracheotomy is currently reserved for those patients with progressive alveolar hypoventilation, hypercarbia, atelectasis, and bulbar paralysis. In general, tonsillectomy is well-tolerated, eliminating airway obstruction, improving swallowing function, and rapidly resolving pharyngeal discomfort.

1. Fatal Acute Hepatitis in Infectious Mononucleosis in a Forensic Setting

2005 ◽  
Vol 45 (3) ◽  
pp. 261-264 ◽  
Author(s):  
Anny Sauvageau ◽  
Stéphanie Racette
Keyword(s):  
Acute Hepatitis ◽  
Infectious Mononucleosis ◽  
Splenic Rupture ◽  
Upper Airway ◽  
Neurological Complications ◽  
Bleeding Complications ◽  
Respiratory Obstruction ◽  
First Case ◽  
Secondary Infections ◽  
Forensic Setting

Mononucleosis is generally considered a benign, self-limited disease. However, though uncommon, fatal complications are sometimes encountered. Deaths from liver failure, splenic rupture, respiratory obstruction, neurological complications, secondary infections and bleeding complications have been described. In the forensic setting, there are a few reports of sudden and unexplained deaths from splenic rupture and upper airway obstruction. We report here the first case of sudden and unexplained death from acute hepatitis in infectious mononucleosis presenting as a suspicious death.

scholarly journals Tracheal perforation managed by temporary tracheostomy in a horse : clinical communication

2005 ◽  
Vol 76 (2) ◽  
Author(s):  
M.N. Saulez ◽  
N.M. Slovis ◽  
A.T. Louden
Keyword(s):  
Airway Obstruction ◽  
Conservative Management ◽  
Local Anaesthesia ◽  
Upper Airway ◽  
Upper Airway Obstruction ◽  
Cervical Region ◽  
Respiratory Obstruction ◽  
Clinical Communication ◽  
Severe Emphysema ◽  
Upper Respiratory

Tracheal trauma with resultant rupture is uncommonly reported in veterinary literature. We report the case of a 16-year-old Thoroughbred gelding that sustained a 1 cm longitudinal perforation of the dorsal tracheal membrane in the proximal cervical region. The horse subsequently developed dyspnoea due to acute upper respiratory obstruction secondary to severe emphysema of the guttural pouches. A temporary tracheostomy caudal to the site of tracheal perforation was performed under local anaesthesia. This procedure helped relieve the upper airway obstruction and aided resolution of the injury by diverting air away from the site of tracheal perforation. After conservative management, the gelding recovered completely.

scholarly journals Airway inflammation in patients affected by obstructive sleep apnea

2016 ◽  
Vol 65 (2) ◽  
Author(s):  
R. Sabato ◽  
P. Guido ◽  
F.G. Salerno ◽  
O. Resta ◽  
A. Spanevello ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Airway Inflammation ◽  
Systemic Inflammation ◽  
Inflammatory Mediators ◽  
Upper Airway ◽  
Airway Hyperreactivity ◽  
Variable Degree ◽  
Airway Occlusion ◽  
Obstructive Sleep

Obstructive sleep apnea (OSA) is characterised by repetitive episodes of upper airway occlusion during sleep. OSA has been shown to be associated with a variable degree of nasal inflammation, uvula mucosal congestion and airway hyperreactivity. The upper airway inflammation, whose clinical importance is uncertain, is characterised by leukocytes infiltration and interstitial oedema. In addition, recent data has shown the presence of neutrophilic inflammation in the lower airways. The current opinion is that airway inflammation is caused by the local, repeated mechanical trauma related to the intermittent airway occlusion typical of the disease. Another potential mechanism involves the intermittent nocturnal hypoxemia that through the phenomenon of the ischemia- reperfusion injury may induce the production of oxygen free radicals and therefore cause local and systemic inflammation. Finally, a state of low-grade systemic inflammation may be related to obesity per se with the pro-inflammatory mediators synthesised in the visceral adipose cells. Several authors stress the role of circulating and local inflammatory mediators, such as proinflammatory cytokines, exhaled nitric oxide, pentane and 8-isoprostane as the determinants of inflammation in OSA.

scholarly journals Geniohyoid muscle function in awake canines

2003 ◽  
Vol 95 (2) ◽  
pp. 810-817 ◽  
Author(s):  
M. Yokoba ◽  
H. G. Hawes ◽  
P. A. Easton
Keyword(s):  
Muscle Function ◽  
Breathing Pattern ◽  
Muscle Length ◽  
Upper Airway ◽  
Mechanical Action ◽  
Emg Activity ◽  
Airway Occlusion ◽  
Lateral Decubitus ◽  
The Right ◽  
Emg Electrodes

The geniohyoid (Genio) upper airway muscle shows phasic, inspiratory electrical activity in awake humans but no activity and lengthening in anesthetized cats. There is no information about the mechanical action of the Genio, including length and shortening, in any awake, nonanesthetized mammal during respiration (or swallowing). Therefore, we studied four canines, mean weight 28.8 kg, 1.5 days after Genio implantation with sonomicrometry transducers and bipolar electromyogram (EMG) electrodes. Awake recordings of breathing pattern, muscle length and shortening, and EMG activity were made with the animal in the right lateral decubitus position during quiet resting, CO2-stimulated breathing, inspiratory-resisted breathing (80 cmH2O · l-1 · s), and airway occlusion. Genio length and activity were also measured during swallowing, when it shortened, showing a 9.31% change from resting length, and its EMG activity increased 6.44 V. During resting breathing, there was no phasic Genio EMG activity at all, and Genio showed virtually no movement during inspiration. During CO2-stimulated breathing, Genio showed minimal lengthening of only 0.07% change from resting length, whereas phasic EMG activity was still absent. During inspiratory-resisted breathing and airway occlusion, Genio showed phasic EMG activity but still lengthened. We conclude that the Genio in awake, nonanesthetized canines shows active contraction and EMG activity only during swallowing. During quiet or stimulated breathing, Genio is electrically inactive with passive lengthening. Even against resistance, Genio is electrically active but still lengthens during inspiration.

Effects of Recurrent Laryngeal Nerve Transection and Vagotomy on Respiratory Contraction of the Cricothyroid Muscle

1989 ◽  
Vol 98 (5) ◽  
pp. 373-378 ◽  
Author(s):  
Gayle E. Woodson
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Superior Laryngeal Nerve ◽  
Upper Airway ◽  
Vocal Folds ◽  
Laryngeal Nerve ◽  
Electromyographic Activity ◽  
Airway Occlusion ◽  
Cricothyroid Muscle ◽  
Bilateral Vagotomy ◽  
Posterior Cricoarytenoid

The cricothyroid muscle (CT) appears to be an accessory muscle of respiration. Phasic inspiratory contraction is stimulated by increasing respiratory demand. Reflex activation of the CT may be responsible for the paramedian position of the vocal folds, and hence airway obstruction, in patients with bilateral recurrent laryngeal nerve (RLN) paralysis. Previous research has demonstrated the influence of superior laryngeal nerve (SLN) afferents on CT activity. The present study addresses the effects of vagal and RLN afferents. Electromyographic activity of the CT and right posterior cricoarytenoid muscle was monitored in anesthetized cats during tracheotomy breathing and in response to tracheal or upper airway occlusion in the intact animal. This was repeated following left RLN transection, bilateral vagotomy, and bilateral SLN transection. Vagotomy abolished CT response to tracheal occlusion and markedly reduced the response to upper airway occlusion. Vocal fold position following RLN transection appeared to correlate with CT activity; however, observed changes were minor.

Control of respiratory activity of the genioglossus muscle in micrognathic infants

1986 ◽  
Vol 61 (4) ◽  
pp. 1523-1533 ◽  
Author(s):  
J. L. Roberts ◽  
W. R. Reed ◽  
O. P. Mathew ◽  
B. T. Thach
Keyword(s):  
Upper Airway ◽  
Esophageal Pressure ◽  
Progressive Increase ◽  
Emg Activity ◽  
Nasal Breathing ◽  
Airway Patency ◽  
Tongue Muscle ◽  
Airway Occlusion ◽  
Pharyngeal Airway ◽  
Obstructive Sleep

The genioglossus (GG) muscle activity of four infants with micrognathia and obstructive sleep apnea was recorded to assess the role of this tongue muscle in upper airway maintenance. Respiratory air flow, esophageal pressure, and intramuscular GG electromyograms (EMG) were recorded during wakefulness and sleep. Both tonic and phasic inspiratory GG-EMG activity was recorded in each of the infants. On occasion, no phasic GG activity could be recorded; these silent periods were unassociated with respiratory embarrassment. GG activity increased during sigh breaths. GG activity also increased when the infants spontaneously changed from oral to nasal breathing and, in two infants, with neck flexion associated with complete upper airway obstruction, suggesting that GG-EMG activity is influenced by sudden changes in upper airway resistance. During sleep, the GG-EMG activity significantly increased with 5% CO2 breathing (P less than or equal to 0.001). With nasal airway occlusion during sleep, the GG-EMG activity increased with the first occluded breath and progressively increased during the subsequent occluded breaths, indicating mechanoreceptor and suggesting chemoreceptor modulation. During nasal occlusion trials, there was a progressive increase in phasic inspiratory activity of the GG-EMG that was greater than that of the diaphragm activity (as reflected by esophageal pressure excursions). When pharyngeal airway closure occurred during a nasal occlusion trial, the negative pressure at which the pharyngeal airway closed (upper airway closing pressure) correlated with the GG-EMG activity at the time of closure, suggesting that the GG muscle contributes to maintaining pharyngeal airway patency in the micrognathic infant.

Respiratory timing during NREM sleep in patients with occlusive sleep apnea

1986 ◽  
Vol 61 (4) ◽  
pp. 1444-1448 ◽  
Author(s):  
E. Onal ◽  
M. Lopata
Keyword(s):  
Sleep Apnea ◽  
Eye Movement ◽  
Upper Airway ◽  
Nrem Sleep ◽  
Afferent Input ◽  
Curvilinear Relationship ◽  
Neural Drive ◽  
Airway Occlusion ◽  
Timing Mechanisms ◽  
The Right

To study respiratory timing mechanisms in patients with occlusive apnea, inspiratory and expiratory times (TI and TE) were calculated from the diaphragmatic electromyogram obtained in seven patients during non-rapid-eye-movement (NREM) sleep. Peak diaphragmatic activity (EMGdi) had a curvilinear relationship with TI during the ventilatory and occlusive phases such that TI shortened as EMGdi decreased during the ventilatory phase (r = 0.87, P less than 0.05) and it prolonged as EMGdi increased during the occlusive phase (r = 0.89, P less than 0.02). However, EMGdi vs. TI for the occlusive phase was shifted to the right of that for the ventilatory phase, reflecting the relatively longer TI during upper airway occlusion. TI also had a linear relationship with pleural pressure (r = 0.94, P less than 0.001) that remained unchanged during the ventilatory and occlusive phases such that it prolonged as negative inspiratory pressure increased. These results indicate that respiratory timing is continuously modified in patients with occlusive apnea as inspiratory neural drive fluctuates during NREM sleep and suggest that this modification is due to the net effects of changing inspiratory neural drive and afferent input predominantly from upper airway mechanoreceptors.

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