scholarly journals Transtracheal flow-regulated oxygen insufflation—a simple and safe method for prolonging safe apnoea time in difficult airway management: A report of two cases

2019 ◽  
Vol 47 (6) ◽  
pp. 553-560
Author(s):  
Sivan Wexler ◽  
Stavros N Prineas ◽  
Timothy A Suharto
Keyword(s):  
Airway Management ◽  
Airway Obstruction ◽  
Difficult Airway ◽  
Oxygen Delivery ◽  
Upper Airway ◽  
Upper Airway Obstruction ◽  
Difficult Airway Management ◽  
Airway Patency ◽  
Safe Method ◽  
Apnoeic Oxygenation

In the absence of upper airway patency, supraglottic methods of oxygen delivery become ineffective. We present two semi-elective difficult airway cases where oxygenation via the supraglottic route was deemed impractical due to upper airway obstruction. In order to facilitate safe airway management, apnoeic oxygenation was delivered via a narrow bore transtracheal cannula using a flow-regulated oxygen insufflator. The potential for safely prolonging apnoea time with this technique in both elective and emergency settings is discussed.

Airway management in vascular central airway obstruction: a literature review

2021 ◽  
Keyword(s):  
Literature Review ◽  
Airway Management ◽  
Airway Obstruction ◽  
Preoperative Planning ◽  
Upper Airway ◽  
Upper Airway Obstruction ◽  
Surgical Reconstruction ◽  
Central Airway Obstruction ◽  
Central Airway

Vascular central airway obstruction (CAO) is a rare cause of upper airway obstruction in adults. CAO occurs below the level where it is invisible in a laryngoscope. Doctors therefore should pay attention to the possibilities of vascular CAO when attempting to prevent and resolve catastrophic complications from upper airway obstruction such as cardiorespiratory collapse and hemoptysis, which requires a thoughtful preoperative planning of airway management before starting a surgical reconstruction.

Mouth and nose resistance in newborn kittens and puppies

1981 ◽  
Vol 51 (3) ◽  
pp. 641-645 ◽  
Author(s):  
J. P. Mortola ◽  
J. T. Fisher
Keyword(s):  
Mechanical Properties ◽  
Airway Obstruction ◽  
Flow Rate ◽  
Muscle Tone ◽  
Upper Airway ◽  
Upper Airway Obstruction ◽  
Upper Airways ◽  
Airway Patency ◽  
The Difference ◽  
Adult Cats

Newborn mammals, including infants, have difficulties in mouth breathing when the nasal passages are occluded. In this study we examined the possibility that differences in the passive mechanical properties of the upper airways could fully explain this behavior. Steady inspiratory flows through the upper airways in anesthetized supine newborn kittens and puppies resulted in upper airway obstruction, even at flows less than those occurring during resting breathing, suggesting that in the unanesthetized condition muscle tone plays an important role in maintaining upper airway patency. Mouth (Rm) and nose (Rn) resistances have been measured during steady expiratory flows with nostrils closed and mouth passively open or nostrils open and mouth closed. In all the newborns, Rn was substantially smaller than Rm. In contrast, the Rn/Rm in adult dogs is greater than unity. In adult cats Rn/Rm is above or below unity depending upon the flow rate, but the ratio is always larger than in newborn kittens. The difference between newborns and adults is entirely due to the small Rn of the newborn, as Rm is not greater in the newborn than in the adult. We conclude that the obligatory nose breathing behavior of newborns is not fully explained by the passive mechanical properties of the upper airways.

scholarly journals Recurrent Acute Upper Airway Obstruction after Anterior Cervical Fusion

1998 ◽  
Vol 26 (3) ◽  
pp. 305-307 ◽  
Author(s):  
A. Penberthy ◽  
N. Roberts
Keyword(s):  
Airway Obstruction ◽  
Difficult Airway ◽  
Endotracheal Intubation ◽  
Cervical Myelopathy ◽  
Surgical Repair ◽  
Upper Airway ◽  
Upper Airway Obstruction ◽  
Anterior Fusion ◽  
Dural Tear ◽  
Cervical Fusion

A 67-year-old man presented with cervical myelopathy for which a C3/4 discectomy and anterior fusion was performed. Recurrent episodes of acute upper airway obstruction necessitated laryngoscopy and endotracheal intubation. Drainage of a prevertebral collection of CSF and surgical repair of a dural tear corrected the obstructive symptoms. Management of the difficult airway is discussed.

scholarly journals A predictive formula for difficult endotracheal intubation in the emergency department

2020 ◽  
Author(s):  
En-Chih Liao ◽  
Wen-Han Chang ◽  
Ching-Hsiang Yu ◽  
Cheng-Ying Shen ◽  
Fang-Ju Sun ◽  
...  
Keyword(s):  
Emergency Department ◽  
Airway Obstruction ◽  
Difficult Airway ◽  
Endotracheal Intubation ◽  
Difficult Intubation ◽  
Upper Airway ◽  
High Body Mass Index ◽  
Upper Airway Obstruction ◽  
Binary Logistic Regression Model ◽  
Difficult Endotracheal Intubation

Abstract Background Current predictors for evaluating difficult endotracheal intubation had poor accessibility or sensitivity at the emergency department, so we evaluated the incidence and predictive factors, then built an easy-to-use predictive formula. Methods This was a 17-month prospective observational study. For the 110 patients, difficult airway was defined as Cormack & Lehane classification grade III and IV at first attempt of intubation. The univariate associations between patient characteristics and difficult endotracheal intubation were then analyzed, and the significantly associated factors were included in a multivariate binary logistic regression model then a predictive formula was generated. Generalized association plot (GAP) was used to show the relationship between each variable. Results The incidence of difficult intubation in our study was 35.5%. In the difficult airway group, significantly higher rates (p < 0.05) of high body mass index (BMI); double chin; thick, short neck; Mallampati difficulty; smaller inter-incisors distance; smaller thyromental distance; and upper airway obstruction were noted. Finally, a predictive formula for difficult intubation was successfully established by the combination of four predictors: BMI (odds ratio [OR] = 1.270), thyromental distance (OR = 0.614), upper airway obstruction (OR = 4.038), and Mallampati difficulty (OR = 5.163). A cut-off score of 4 provided the best sensitivity (79.5%) and specificity (81.7%)(95% CI: 0.794 to 0.938). Conclusions Our predictive formula could be used by emergency physicians to quickly identify and carefully manage patients with potentially difficult intubation. Early expert consultation could be sought when necessary.

scholarly journals The Percutaneous Transtracheal Jet Ventilation in a Patient with Partial Upper Airway Obstruction

2001 ◽  
Vol 8 (4) ◽  
pp. 223-226 ◽  
Author(s):  
KY Fung ◽  
MC Yuen ◽  
WK Tung
Keyword(s):  
Airway Obstruction ◽  
Difficult Airway ◽  
Upper Airway ◽  
Upper Airway Obstruction ◽  
Emergency Physicians ◽  
Jet Ventilation ◽  
Partial Upper Airway Obstruction ◽  
Set Up

Difficult airway is a challenging emergency problem for emergency physicians. We reported a patient with partial upper airway obstruction managed by percutaneous transtracheal jet ventilation (PTJV) before definite airway was secured. The development, the set up, the advantages, and the precautions of using PTJV are briefly described.

scholarly journals Acute Upper-Airway Obstruction by a Lingual Thyroglossal Duct Cyst and Implications for Advanced Airway Management

2013 ◽  
Vol 59 (7) ◽  
pp. e98-e102 ◽  
Author(s):  
K. O. Zimmerman ◽  
S. R. Hupp ◽  
A. Bourguet-Vincent ◽  
E. A. Bressler ◽  
E. M. Raynor ◽  
...  
Keyword(s):  
Airway Management ◽  
Airway Obstruction ◽  
Upper Airway ◽  
Thyroglossal Duct Cyst ◽  
Upper Airway Obstruction ◽  
Duct Cyst ◽  
Thyroglossal Duct ◽  
Advanced Airway

Corticosteroids in Airway Management

1983 ◽  
Vol 91 (6) ◽  
pp. 593-596 ◽  
Author(s):  
Donald B Hawkins ◽  
Dennis M Crockett ◽  
Tony K Shum
Keyword(s):  
Airway Management ◽  
Airway Obstruction ◽  
Intramuscular Injection ◽  
Upper Airway ◽  
Suppressive Effect ◽  
Upper Airway Obstruction ◽  
Blood Levels ◽  
High Concentration ◽  
Acute Airway Obstruction ◽  
Inflamed Tissue

Adrenal corticosteroids exert a strong suppressive influence on the basic inflammatory response that leads to tissue swelling. The corticosteroid effect is nonspecific. In upper airway obstruction caused by edema from infection, allergy, or trauma, corticosteroids will exert some degree of suppressive effect. The steroid effect is local and directly proportional to the concentration of steroids in the inflamed tissue. In upper airway obstruction steroids should be delivered to the inflamed tissue in high concentration with the least delay. Dexamethasone and methylprednisolone produce high blood levels within 15 to 30 minutes of intramuscular injection. Recommended initial doses for acute airway obstruction are dexamethasone, 1.0 to 1.5 mg/kg, or methylprednisolone, 5 to 7 mg/kg. The risk of harm from steroid therapy of 24 hours or less is negligible.

Neuromechanical control of upper airway patency during sleep

2007 ◽  
Vol 102 (2) ◽  
pp. 547-556 ◽  
Author(s):  
Susheel P. Patil ◽  
Hartmut Schneider ◽  
Jason J. Marx ◽  
Elizabeth Gladmon ◽  
Alan R. Schwartz ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Airway Obstruction ◽  
Critical Pressure ◽  
Upper Airway ◽  
Upper Airway Obstruction ◽  
Dynamic Responses ◽  
Airway Patency ◽  
Mechanical Loads ◽  
Obstructive Sleep

Obstructive sleep apnea is caused by pharyngeal occlusion due to alterations in upper airway mechanical properties and/or disturbances in neuromuscular control. The objective of the study was to determine the relative contribution of mechanical loads and dynamic neuromuscular responses to pharyngeal collapse during sleep. Sixteen obstructive sleep apnea patients and sixteen normal subjects were matched on age, sex, and body mass index. Pharyngeal collapsibility, defined by the critical pressure, was measured during sleep. The critical pressure was partitioned between its passive mechanical properties (passive critical pressure) and active dynamic responses to upper airway obstruction (active critical pressure). Compared with normal subjects, sleep apnea patients demonstrated elevated mechanical loads as demonstrated by higher passive critical pressures [−0.05 (SD 2.4) vs. −4.5 cmH2O (SD 3.0), P = 0.0003]. Dynamic responses were depressed in sleep apnea patients, as suggested by failure to lower their active critical pressures [−1.6 (SD 3.5) vs. −11.1 cmH2O (SD 5.3), P < 0.0001] in response to upper airway obstruction. Moreover, elevated mechanical loads placed some normal individuals at risk for sleep apnea. In this subset, dynamic responses to upper airway obstruction compensated for mechanical loads and maintained airway patency by lowering the active critical pressure. The present study suggests that increased mechanical loads and blunted neuromuscular responses are both required for the development of obstructive sleep apnea.

Sign in / Sign up

Export Citation Format

Share Document