Fibre-optic intubation in oncological head and neck emergencies

2005 ◽  
Vol 119 (8) ◽  
pp. 634-638 ◽  
Author(s):  
Bipin Thomas Varghese ◽  
Mallika Balakrishnan ◽  
Renju Kuriakose
Keyword(s):  
Airway Obstruction ◽  
Head And Neck ◽  
Case Series ◽  
Upper Airway ◽  
Surgical Oncology ◽  
Fibre Optic ◽  
Operator Experience ◽  
Valuable Adjunct ◽  
Case Series Study ◽  
Oncology Centre

Objective: Although fibre-optic bronchoscopic intubation is well recognized as the most valuable adjunct for elective management of the difficult airway its precise role in oncological head and neck emergencies has not been evaluated. The objective of this study was to evaluate the role of fibre-optic intubation in such emergencies.Methods: This was a consecutive case series study by a single surgeon (the otolaryngologist) and anaesthetist team, taking place in a regional tertiary-referral head and neck surgical oncology centre. A series of 17 consecutive oncological head and neck emergency patients underwent fibre-optic intubation with a Portex endotracheal tube of inner diameter ≥7 mm, with the aid of a 6-mm (EB-1830T2) Pentax fibre-optic video bronchoscope. The study assessed occurrence of: avoidance of tracheostomy in bleeding emergencies; a well placed, uncomplicated tracheostomy in airway obstruction; and successful intubation.Results: Two cases were decannulated completely. All cases were successfully intubated and a tracheostomy was avoided in all cases in which emergency intubation was required and the patient was bleeding. We conclude that fibre-optic bronchoscopic intubation is a viable option in head and neck oncological emergencies due to upper airway obstruction and tumour bleeding. Clinical and endoscopic judgement and operator experience are the key factors determining success.

scholarly journals Chronic Lymphocytic Leukemia as an Unusual Cause of Rapid Airway Compromise

2017 ◽  
Vol 2017 ◽  
pp. 1-4
Author(s):  
Adrian R. Bersabe ◽  
Joshua T. Romain ◽  
Erin E. Ezzell ◽  
John S. Renshaw
Keyword(s):  
Chronic Lymphocytic Leukemia ◽  
Airway Obstruction ◽  
Head And Neck ◽  
Cervical Lymphadenopathy ◽  
Upper Airway ◽  
Lymphocytic Leukemia ◽  
Upper Airway Obstruction ◽  
Airway Compromise ◽  
History Of ◽  
Prevalent Form

Chronic Lymphocytic Leukemia (CLL) is the most prevalent form of non-Hodgkin’s lymphoma (NHL) in Western countries predominantly affecting adults over the age of 65. CLL is commonly indolent in nature but can present locally and aggressively at extranodal sites. Although CLL may commonly present with cervical lymphadenopathy, manifestation in nonlymphoid regions of the head and neck is not well described. CLL causing upper airway obstruction is even more uncommon. We describe a case of a patient with known history of CLL and stable lymphocytosis that developed an enlarging lymphoid base of tongue (BOT) mass resulting in rapid airway compromise.

Is sleep nasendoscopy a valuable adjunct to clinical examination in the evaluation of upper airway obstruction?

2008 ◽  
Vol 266 (5) ◽  
pp. 691-697 ◽  
Author(s):  
Richard J. D. Hewitt ◽  
Arjun Dasgupta ◽  
Arvind Singh ◽  
Chirajit Dutta ◽  
Bhik T. Kotecha
Keyword(s):  
Airway Obstruction ◽  
Clinical Examination ◽  
Upper Airway ◽  
Upper Airway Obstruction ◽  
Valuable Adjunct ◽  
Sleep Nasendoscopy

Sleep Fluoroscopy for Localization of Upper Airway Obstruction in Children

1996 ◽  
Vol 105 (9) ◽  
pp. 678-683 ◽  
Author(s):  
Sharon E. Gibson ◽  
Janet L. Strife ◽  
Charles M. Myer ◽  
David M. O'Connor
Keyword(s):  
Airway Obstruction ◽  
Upper Airway ◽  
Endoscopic Examination ◽  
Upper Airway Obstruction ◽  
Pediatric Airway ◽  
Valuable Adjunct ◽  
Neuromuscular Abnormalities ◽  
Multiple Levels ◽  
A Site ◽  
Airway Abnormalities

The management of children with upper airway obstruction (UAO) in whom previous airway surgeries or concomitant craniofacial or neuromuscular abnormalities exist is complicated by potential obstruction at multiple sites. Sleep fluoroscopy (SF) provides adynamic representation of relative degrees of obstruction at multiple levels of the pediatric airway. Fifty-five SF studies were performed on 50 infants and children to localize obstructive sites. Correlation was assessed with findings on direct laryngoscopy and bronchoscopy under spontaneous ventilation. In 24 (44%), endoscopic and SF findings correlated exactly. The SF studies identified a site of UAO in 11 patients with normal findings on endoscopic examination and multiple sites of UAO in 16 others. Two thirds of these occurred at the hypopharynx and tongue base. The SF studies failed to detect 5 airway abnormalities in 4 patients. The sensitivity of SF for endoscopically verified laryngotracheal lesions was lowest for glottic (67%) and subglottic (70%) locations and higher for tracheal (92%) and supraglottic (100%) sites. Sleep fluoroscopy altered the course of treatment in 26 (52%) children. It appears to be a valuable adjunct to endoscopy in the identification and management of pediatric UAO when hypopharyngeal collapse or multiple levels of obstruction are suspected.

Acute airway obstruction due to ruptured aneurysmal arterio–venous fistula: common carotid artery to internal jugular vein

1995 ◽  
Vol 109 (6) ◽  
pp. 562-564 ◽  
Author(s):  
V. Nandapalan ◽  
D. G. O'Sullivan ◽  
M. Siodlak ◽  
P. Charters
Keyword(s):  
Carotid Artery ◽  
Airway Obstruction ◽  
Head And Neck ◽  
Internal Jugular Vein ◽  
Jugular Vein ◽  
Upper Airway ◽  
Neck Region ◽  
External Carotid Artery ◽  
External Carotid ◽  
Acute Airway Obstruction

AbstractFistulae between major vessels in the head and neck are uncommon. In both civilian and wartime reports, the total number of traumatic arterio–venous fistulae in head and neck region account for less than four per cent of all arterial injuries. Fourteen cases of congenital communication between the external carotid artery and external or internal jugular vein have been reported. We report and discuss the management of a case of ruptured carotico–jugular fistula secondary to infection which presented as acute upper airway obstruction. This appears to be the first description of such a case in the literature.

scholarly journals Inhalation Insufflation Technique with Local Anaesthetic Spray without Intubation and Opioids for Paediatric Upper Airway Surgery - Observational Case Series Study

2019 ◽  
Vol 13 (1) ◽  
pp. 44-46
Author(s):  
Vasanth Rao Kadam
Keyword(s):  
Local Anaesthetic ◽  
Case Series ◽  
Upper Airway ◽  
Anaesthetic Management ◽  
Spontaneous Respiration ◽  
Inhalation Technique ◽  
Upper Airway Surgery ◽  
Airway Surgery ◽  
Paediatric Patients ◽  
Case Series Study

Background: Anaesthetic management of upper airway surgery in paediatric is challenging. Total intravenous anaesthesia with opioid or inhalation technique with spontaneous respiration has been used but studies are limited on inhalation technique. This study aimed to use tubeless inhalation insufflation technique without opioids at a tertiary centre. Methods: All paediatric patients coming for elective upper airway surgery to the centre, were included. Mask induction was with 5-8% sevoflurane in O2 and maintenance with 2-3%, via a nasopharyngeally placed Endotracheal Tube (ETT) or catheter on spontaneous ventilation with flow between 8-10 l/min. Lidocaine up to 5 mg/kg was then sprayed to the mucosa of larynx and trachea. Once adequate depth was attained, suspension laryngoscope was placed by a surgeon for surgery. Some complications were observed i.e inadequate anaesthesia requiring rescue drugs like opioids or propofol, intubation, desaturation events from laryngospasm and delayed recovery. Surgical technique involved was diagnostic and therapeutic for the upper airway lesions. Results: Fifteen paediatric patients (2 months to 7 yrs) were included in the study with tubeless anaesthesia. None of them required intubation during the procedure. The mean time from induction of anaesthesia to unconsciousness was 15 ± 3 s and attainment of necessary anaesthetic depth for surgery was 4.7 ± 0.90 min. None had desaturation events or required opioids. However, propofol was required in one and delayed anaesthetic recovery was observed in one patient. Conclusion: This study on tubeless anaesthesia with Local Anaesthetic (LA) spray with spontaneous inhalation insufflation technique provided an opioid-free, interference-free operative field without airway compromise, not requiring intubation, therefore, further studies are required.

scholarly journals CT and MRI Findings of Glomangiopericytoma in the Head and Neck: Case Series Study and Systematic Review

2019 ◽  
Vol 41 (1) ◽  
pp. 155-159
Author(s):  
C.H. Suh ◽  
J.H. Lee ◽  
M.K. Lee ◽  
S.J. Cho ◽  
S.R. Chung ◽  
...  
Keyword(s):  
Systematic Review ◽  
Head And Neck ◽  
Case Series ◽  
Mri Findings ◽  
Case Series Study ◽  
Series Study ◽  
Ct And Mri

Evaluation of Unilateral Arytenoid Lateralization for the Treatment of Laryngeal Paralysis in 14 Cats

2010 ◽  
Vol 46 (6) ◽  
pp. 418-424 ◽  
Author(s):  
Brian Thunberg ◽  
Gary C. Lantz
Keyword(s):  
Postoperative Complications ◽  
Airway Obstruction ◽  
Median Duration ◽  
Clinical Signs ◽  
Case Series ◽  
Upper Airway ◽  
Common Cause ◽  
Laryngeal Paralysis

Laryngeal paralysis is a relatively common cause of upper airway obstruction in middle-aged to older, large-breed dogs; however, it is rare in the cat. The purpose of this study is to describe a series of cats diagnosed with laryngeal paralysis treated by unilateral arytenoid lateralization. Fourteen cats met the criteria of the study. Intraoperative and postoperative complications were seen in 21% (three of 14) and 50% (seven of 14) of cases, respectively. Median duration of follow-up was 11 months (range 3 weeks to 8 years). None of these cats had recurrence of clinical signs. Based on this brief case series, unilateral arytenoid lateralization appeared to be a suitable method for treating laryngeal paralysis in cats. Additional studies are warranted to determine the type and frequency of long-term complications.

Miscellaneous conditions

2005 ◽  
pp. 431-450
Author(s):  
Patricia Sylla
Keyword(s):  
At Risk ◽  
Airway Obstruction ◽  
Head And Neck ◽  
Sore Throat ◽  
Foreign Bodies ◽  
Upper Airway ◽  
Neck Surgery ◽  
Head And Neck Surgery

Airway obstruction 432 Foreign bodies (FBs) 434 Stridor 438 Epistaxis (non-traumatic) 439 Urticaria and angioedema 440 Dizzyness/'vertigo' 441 Sore throat 442 Drugs and dressings commonly used in head and neck surgery 444 The upper airway is at risk when the following findings are present: •...

Head and Neck Manifestations of Beckwith-Wiedemann Syndrome

1995 ◽  
Vol 113 (3) ◽  
pp. 262-265 ◽  
Author(s):  
Frank L. Rimell ◽  
Andrew M. Shapiro ◽  
David L. Shoemaker ◽  
Margaret A. Kenna
Keyword(s):  
At Risk ◽  
Airway Obstruction ◽  
Head And Neck ◽  
Upper Airway ◽  
Cor Pulmonale ◽  
Congenital Disorder ◽  
Upper Airway Obstruction ◽  
Tongue Reduction ◽  
Adenoidal Hypertrophy

Beckwith-Wiedemann syndrome is a congenital disorder manifested by organomegaly, omphalocele, hypoglycemia, and macroglossia. We have found a significant number of these children to be at risk for upper airway obstruction during infancy or childhood. In this review of 13 children, 2 required tracheotomy during infancy for cor pulmonale caused by macroglossia. Seven of nine children older than 1 year required tonsillectomy and adenoidectomy to relieve upper airway obstruction. Although macroglossia can be a cause of airway obstruction in infants with Beckwith-Wiedemann syndrome, we have found that airway obstruction during childhood is related to tonsillar and adenoidal hypertrophy and not to macroglossia. Anterior tongue reduction is reserved for the correction of malocclusion, articulation errors, or cosmesis, whereas tonsillectomy and adenoidectomy may be curative of obstructive symptoms.

Failed tracheostomy under local anaesthesia…plan B?

2006 ◽  
Vol 120 (10) ◽  
pp. 882-884 ◽  
Author(s):  
B Maiya ◽  
H L Smith
Keyword(s):  
Airway Obstruction ◽  
Local Anaesthesia ◽  
Upper Airway ◽  
Management Plan ◽  
Upper Airway Obstruction ◽  
Fibre Optic ◽  
Short History ◽  
Recent Onset ◽  
Relative Contraindication ◽  
History Of

Severe stridor of recent onset is a challenge to deal with because of the lack of investigations on which to base the management plan. We describe a case of an elderly lady who presented to us with a short history of severe stridor. We encountered unanticipated difficulties with tracheostomy under local anaesthesia as the thyroid was replaced by a diffuse mass and the airway had to be secured by an awake fibre-optic intubation. Awake fibre-optic intubation is thought to be a relative contraindication in acute upper airway obstruction, but occasionally tracheostomy under local anaesthesia may not be possible and in experienced hands an awake fibre-optic intubation is a reasonable alternative.

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