scholarly journals Functional Upper Airway Obstruction

1998 ◽  
Vol 26 (2) ◽  
pp. 216-218 ◽  
Author(s):  
A. Norton ◽  
G. Roberton
Keyword(s):  
Airway Obstruction ◽  
Surgical Intervention ◽  
Correct Diagnosis ◽  
Upper Airway ◽  
Upper Airway Obstruction ◽  
Functional Disorders ◽  
Vocal Cords ◽  
Functional Dysphonia ◽  
Acute Airway Obstruction ◽  
Appropriate Therapy

Functional disorders of the vocal cords can present with acute, dramatic upper airway obstruction, with features mimicking asthma or functional dysphonia. We report the case of an eighteen-year-old female with acute airway obstruction initially misdiagnosed as asthma. Laryngoscopy, bronchoscopy and psychiatric assessment confirmed a diagnosis of functional disorder of the vocal cords. Although a diagnosis of exclusion, it must be borne in mind in order to reduce unnecessary medical therapy and surgical intervention. It is only with the correct diagnosis that patients can receive appropriate therapy.

scholarly journals Concurrent Negative-Pressure Pulmonary Edema (NPPE) and Takotsubo Syndrome (TTS) after Upper Airway Obstruction

2019 ◽  
Vol 2019 ◽  
pp. 1-4
Author(s):  
Evan Harmon ◽  
Sebastian Estrada ◽  
Ryan J. Koene ◽  
Sula Mazimba ◽  
Younghoon Kwon
Keyword(s):  
Airway Obstruction ◽  
Pulmonary Edema ◽  
Negative Pressure ◽  
Upper Airway ◽  
Upper Airway Obstruction ◽  
Takotsubo Syndrome ◽  
Negative Pressure Pulmonary Edema ◽  
Acute Airway Obstruction ◽  
Increased Risk ◽  
Life Threatening

Upper airway obstruction is a potentially life-threatening emergency often encountered in the acute care, perioperative, and critical care settings. One important complication of acute obstruction is negative-pressure pulmonary edema (NPPE). We describe two cases of acute upper airway obstruction, both of which resulted in flash pulmonary edema complicated by acute hypoxic respiratory failure. Though NPPE was suspected, these patients were also found to have Takotsubo syndrome (TTS). Neither patient had prior cardiac disease, and both subsequently had a negative ischemic workup. Because TTS is a condition triggered by hyperadrenergic states, the acute airway obstruction alone or in combination with NPPE was the likely explanation for TTS in each case. These cases highlight the importance of also considering cardiogenic causes of pulmonary edema in the setting of upper airway obstruction, which we suspect generates a profound catecholamine surge and places patients at increased risk of TTS development.

scholarly journals The Contentious Management of Anaplastic Thyroid Carcinoma with Acute Airway Obstruction during COVID-19 Pandemic

2021 ◽  
pp. 1-11
Author(s):  
Ahmad Izani Mohd Safian ◽  
Kamaruddin Ibrahim ◽  
Seoparjoo Azmel Mohd Isa ◽  
Norhafiza Mat Lazim ◽  
Irfan Mohamad
Keyword(s):  
Thyroid Carcinoma ◽  
Airway Obstruction ◽  
Fatal Outcome ◽  
Upper Airway ◽  
Anaplastic Thyroid Carcinoma ◽  
Upper Airway Obstruction ◽  
Acute Airway Obstruction ◽  
Assessment And Treatment ◽  
Patient Will ◽  
Unknown Status

There are many important concerns and issues raised in managing acute airway obstruction cases with regards to the current COVID-19 pandemic. As a further matter, a patient with a huge thyroid mass in anaplastic thyroid carcinoma (ATC) presenting with impending airway obstruction poses treatment challenges, as immediate active intervention is necessary despite the risk of spreading of COVID-19 viruses. The unknown status of COVID-19 of the patient will add additional concerns during active assessment and treatment as patients with this undifferentiated thyroid carcinoma commonly deteriorate fast. This carcinoma may also invade the trachea and result in upper airway obstruction leading to a fatal outcome. Therefore, an appropriate treatment strategy is essential. This report highlights a case of an ATC patient who presented with diffuse cemented-hard anterior neck, whereby the whole management of ATC with acute airway obstruction during this COVID-19 pandemic is purely contentious and challenging. The issue of providing artificial ventilation either via intubation or tracheostomy is made more complicated as the patient presents with an acute upper airway obstruction whilst the COVID-19 status is unknown. While endotracheal intubation approach was not easy, the trachea was also difficult to be identified externally due to the huge ‘cemented-hard’ mass plastered over the compressed trachea. Due to the advanced disease, surgical intervention was not an option.

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.

Management of upper airway obstruction in Pierre Robin sequence

1997 ◽  
Vol 111 (12) ◽  
pp. 1155-1156 ◽  
Author(s):  
A. P. Bath ◽  
P. D. Bull
Keyword(s):  
Airway Obstruction ◽  
Surgical Intervention ◽  
Neonatal Period ◽  
Upper Airway ◽  
Upper Airway Obstruction ◽  
Pierre Robin Sequence ◽  
Severe Respiratory Distress ◽  
Feeding Difficulties ◽  
Robin Sequence ◽  
Pierre Robin

AbstractPierre Robin sequence (PRS) presents in the neonatal period with upper airway obstruction and feeding difficulties. Infants with pronounced micrognathia may fail to thrive because of chronic airway obstruction, or experience severe respiratory distress. This is potentially fatal and surgical intervention in these cases is necessary. We present our series of cases with severe PRS requiring surgical relief of their airway obstruction, and the reasons for preferring tracheostomy over glossopexy.

scholarly journals False-positive Cuff Leak Test Due to Glossoptosis: A Case Report

2020 ◽  
Author(s):  
Shunsaku Goto ◽  
Jun-ya Ishikawa ◽  
Masafumi Idei ◽  
Takeshi Nomura
Keyword(s):  
Airway Obstruction ◽  
False Positive ◽  
Upper Airway ◽  
High Flow ◽  
Upper Airway Obstruction ◽  
Leak Test ◽  
Vocal Cords ◽  
Case Presentation ◽  
Cuff Leak ◽  
Jaw Thrust Maneuver

Abstract BackgroundThe cuff leak test (CLT) can sometimes be falsely positive. We report a case with a visually confirmed false-positive cuff leak test caused by upper airway obstruction due to glossoptosis. Case presentationA 62-year-old woman was diagnosed with subarachnoid hemorrhage due to a ruptured aneurysm and underwent high-flow bypass and trapping. Postoperatively, she was admitted to our intensive care unit under mechanical ventilation. On postoperative days 11 and 13, she had positive CLTs under sedation. We observed only mild to moderate edema around the vocal cords and tracheal tube cuff using a bronchoscope and muscle relaxant. Bronchoscopy showed glossoptosis; hence, a jaw-lift maneuver was performed and the CLT turned negative. The false-positive CLT was thought to be due to glossoptosis. She was extubated on postoperative day 15 without post-extubation stridor. She was discharged on postoperative day 41.ConclusionsUpper airway obstruction due to glossoptosis can cause false positive CLT. We should consider a jaw-thrust maneuver to avoid a false positive when performing CLT on a sedated patient.

scholarly journals Localized Advanced Hürthle Cell Carcinoma with Symptomatic Intrathoracic Goiter

2011 ◽  
Vol 2011 ◽  
pp. 1-3
Author(s):  
Kabir Ahmed ◽  
Darren Swartz ◽  
Deepu Daniel ◽  
Craig Crespi ◽  
Andrew Rosenthal ◽  
...  
Keyword(s):  
Airway Obstruction ◽  
Cell Carcinoma ◽  
Surgical Intervention ◽  
Upper Airway ◽  
Upper Airway Obstruction ◽  
Indication For Surgery ◽  
Intrathoracic Goiter ◽  
Hürthle Cell ◽  
Hürthle Cell Carcinoma ◽  
Hurthle Cell Carcinoma

Intrathoracic goiters are divided into two categories: primary and secondary. Intrathoracic goiters (IG) can cause upper airway obstruction. The presence of obstructive symptoms secondary to increased thyroid growth and tracheal compression is major indication for surgery; however, goiters do not always require immediate surgical attention. In addition, although some diagnostic tests indicate upper airway obstruction, many patients remain asymptomatic. Surgeries to remove IG are performed routinely however, they are not without risk. In some cases, intrathoracic goiters present as thyroid cancers. Very rare cancers such as Hürthle cell carcinoma (HCC) can create a challenge for the surgeon when surgical intervention is vital.

scholarly journals Surgical Anatomy of the Tonsils

2021 ◽  
Author(s):  
Gülay Açar
Keyword(s):  
Airway Obstruction ◽  
Surgical Intervention ◽  
Sleep Apnea Syndrome ◽  
Upper Airway ◽  
Surgical Anatomy ◽  
Optimal Choice ◽  
Upper Airway Obstruction ◽  
Lymphoid Tissues ◽  
Waldeyer’S Ring ◽  
Iatrogenic Complications

The tonsils represent a circular band of mucosa associated with lymphoid tissues, Waldeyer’s ring, which is located at the entrance of the upper aerodigestive tract, with a significant role in the immune defense system. Waldeyer’s ring is composed of the pharyngeal, tubal, palatine, and lingual tonsils acting as secondary lymphoid tissues. Particularly, the palatine tonsils are the largest of the tonsils with deep branching crypts and contain B and T lymphocytes and M cell which plays a role in the uptake and transport of antigens. Because of the tonsil enlargement during childhood, upper airway obstruction and obstructive sleep apnea syndrome are mostly seen. Knowledge of the surgical anatomy of the tonsils and variations of the neurovascular and muscular structures around it allows optimal choice of surgical technique to avoid iatrogenic complications during tonsillectomy. Recent medical studies reported that a detailed understanding of the anatomic risk factors in upper airway obstruction allows to predict treatment response to surgical intervention. Due to the penetration of benign or malign lesions of the tonsil into the lateral wall of the pharynx, transoral robotic approach to this region is necessary to identify the surgical anatomic landmarks which are required to perform safe and effective surgical intervention.

Utility of sleep nasendoscopy versus microlaryngotracheobronchoscopy in the diagnosis of paediatric upper airway obstruction

2021 ◽  
pp. 1-3
Author(s):  
G Khong ◽  
S Sood ◽  
H Jones ◽  
S Sharma ◽  
S De
Keyword(s):  
Airway Obstruction ◽  
Surgical Intervention ◽  
Upper Airway ◽  
Sleep Apnoea ◽  
Upper Airway Obstruction ◽  
Paediatric Hospital ◽  
Obstructive Sleep ◽  
Hospital Patients ◽  
Physiological Sleep ◽  
Sleep Nasendoscopy

Abstract Objective To describe the utility of sleep nasendoscopy in determining the level of upper airway obstruction compared to microlaryngotracheobronchoscopy. Methods A retrospective observational study was conducted at a tertiary level paediatric hospital. Patients clinically diagnosed with upper airway obstruction warranting surgical intervention (i.e. with obstructive sleep apnoea or laryngomalacia) were included. These patients underwent sleep nasendoscopy in the anaesthetic room; microlaryngotracheobronchoscopy was subsequently performed and findings were compared. Results Twenty-seven patients were included in the study. Sleep nasendoscopy was able to induce stridor or stertor, and to detect obstruction at the level of palate and pharynx, including tongue base collapse, that was not observed with microlaryngotracheobronchoscopy. Only 47 per cent of patients who had prolapse or indrawing of arytenoids on sleep nasendoscopy had similar findings on microlaryngotracheobronchoscopy. However, microlaryngotracheobronchoscopy was better in diagnosing shortened aryepiglottic folds. Conclusion This study demonstrates the utility of sleep nasendoscopy in determining the level and severity of obstruction by mimicking physiological sleep dynamics of the upper airway.

Site of Upper Airway Obstruction in Infants Following an Acute Life-Threatening Event

PEDIATRICS ◽  
1993 ◽  
Vol 91 (3) ◽  
pp. 595-601
Author(s):  
N. R. Ruggins ◽  
A. D. Milner
Keyword(s):  
Airway Obstruction ◽  
Upper Airway ◽  
Periodic Breathing ◽  
Upper Airway Obstruction ◽  
Vocal Cords ◽  
Life Threatening ◽  
Life Threatening Event

Twenty-five patients were screened following an acute life-threatening event for the presence of obstructive and mixed apnea. Simultaneous cardiorespiratory monitoring with fiberoptic laryngoscopy was performed to identify the site of upper airway obstruction during these episodes. In 3 of these subjects, who had been born prematurely, obstruction was observed at the laryngeal level, with the arytenoid masses and aryepiglottic folds closing over across the vocal cords. Such closure was also observed during periodic breathing, which was found to be prominent in 4 of the infants studied. The possible role of laryngeal reflexes as a mechanism for these events is discussed.

The use of mini-tracheostomy and high frequency jet ventilation in the management of acute airway obstruction

1986 ◽  
Vol 100 (10) ◽  
pp. 1199-1202 ◽  
Author(s):  
S. J. Squires ◽  
M. C. Frampton
Keyword(s):  
Airway Obstruction ◽  
High Frequency ◽  
Upper Airway ◽  
Upper Airway Obstruction ◽  
Operating Theatre ◽  
Optimal Conditions ◽  
Jet Ventilation ◽  
High Frequency Jet Ventilation ◽  
Acute Airway Obstruction

AbstractA case is described in which upper airway obstruction was successfully treated using cri-cothyroidotomy in association with high frequency jet ventilation. This procedure allowed time for the patient to be transferred to the operating theatre for formal tracheostomy under optimal conditions. It is suggested that the Portex ‘Mini-trach’ kit, though primarily designed for tracheobronchial toilet, can be used to provide a satisfactory and safe airway during the resuscitation of an obstructed patient, particularly if jet ventilation is available.

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