Airway Management for a Pediatric Patient With a Tracheal Bronchus

Tracheal bronchus is an ectopic bronchus almost arising from the right side of the tracheal wall above the carina. The incidence of a tracheal bronchus is reported as 0.1 to 3%. We experienced a patient with tracheal bronchus that was incidentally found at induction of anesthesia. Endotracheal intubation in a patient with tracheal bronchus might cause obstruction of the tracheal bronchus, although in this case, ventilation was not impaired.

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Tracheal Bronchus: Classification, Endoscopic Analysis, and Airway Management

Otolaryngology ◽

10.1067/mhn.2002.122703 ◽

2002 ◽

Vol 126 (3) ◽

pp. 240-243 ◽

Cited By ~ 72

Author(s):

Andrew M. Doolittle ◽

Eric A. Mair

Keyword(s):

Congenital Anomaly ◽

Airway Management ◽

Main Bronchus ◽

Case Series ◽

Tracheal Bronchus ◽

Lobe Bronchus ◽

Retrospective Case ◽

Tracheal Diverticulum ◽

Pediatric Bronchoscopy ◽

The Right

OBJECTIVE: Tracheal bronchus ( bronchus suis) is an unusual congenital anomaly in which the right upper lobe has its origin in the trachea rather than distal to the carina. We sought to analyze the anatomy, presentation, and airway management principles of tracheal bronchi, and we present the first endoscopically documented tracheal diverticulum. STUDY DESIGN/METHODS: Retrospective case series. RESULTS: The tracheal bronchus is located at the junction of the mid and distal thirds of the right lateral trachea, is more common in males and children with other congenital anomalies, and may be associated with right main bronchus stenosis. Bronchoscopy provides a clear definitive view of the anomaly, which we found in 5 children during a 12-year period (0.5% of pediatric bronchoscopy procedures). We illustrate 3 types of tracheal bronchi: (1) vestigial tracheal diverticulum (newly described), (2) high apical lobe, and (3) fully developed supranumerary aerated tracheal bronchus. Endoscopic documentation of each type is presented. Children with tracheal bronchi may present with stridor, cough, and/or recurrent right-sided pneumonia and/or to have foreign body aspiration ruled out. Treatment is based on the severity of symptoms and ranges from observation to right upper lobectomy. CONCLUSIONS: Otolaryngologists should be aware of the tracheal bronchus, to include classification, endoscopic analysis, and airway management of this uncommon anomaly. Bronchoscopy with selected radiographic imaging allows the otolaryngologist to fully evaluate the child with a tracheal bronchus and to present timely therapeutic options. Tracheal bronchus is a congenital anomaly in which a right upper lobe bronchus has its origin in the trachea rather than at the carina. Bronchus suis, or “pig bronchus,” is an alternate name that is used because a tracheal bronchus is normal in swine and other ruminant animals. In approximately 1000 pediatric bronchoscopy procedures performed by the senior author during a 12-year period, only 5 children (approximately 0.5%) were identified with a tracheal bronchus. We present 3 representative cases to highlight salient features of each variant of the tracheal bronchus. A newly described “tracheal diverticulum” variant is presented. Tracheal bronchus classification based on endoscopic analysis assists with airway management for this uncommon anomaly.

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Magnet assisted endotracheal intubation as an alternative approach to difficult airway management

10.26226/morressier.57108e32d462b80290b4ae99 ◽

2016 ◽

Author(s):

Marta Grynovska

Keyword(s):

Airway Management ◽

Difficult Airway ◽

Endotracheal Intubation ◽

Difficult Airway Management ◽

Alternative Approach

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Developmentally anomalous cerebellar encephalocele arising within the cerebellopontine angle and extending into the adjacent skull base in a pediatric patient

Child s Nervous System ◽

10.1007/s00381-020-05020-8 ◽

2021 ◽

Author(s):

Forrest A. Hamrick ◽

Michael Karsy ◽

Carol S. Bruggers ◽

Angelica R. Putnam ◽

Gary L. Hedlund ◽

...

Keyword(s):

Skull Base ◽

Pediatric Patient ◽

Cerebellopontine Angle ◽

Resonance Imaging ◽

Middle Cerebellar Peduncle ◽

Cerebellar Tissue ◽

Cerebellar Peduncle ◽

Histopathologic Analysis ◽

The Right ◽

Internal Acoustic Canal

AbstractLesions of the cerebellopontine angle (CPA) in young children are rare, with the most common being arachnoid cysts and epidermoid inclusion cysts. The authors report a case of an encephalocele containing heterotopic cerebellar tissue arising from the right middle cerebellar peduncle and filling the right internal acoustic canal in a 2-year-old female patient. Her initial presentation included a focal left 6th nerve palsy. Magnetic resonance imaging was suggestive of a high-grade tumor of the right CPA. The lesion was removed via a retrosigmoid approach, and histopathologic analysis revealed heterotopic atrophic cerebellar tissue. This report is the first description of a heterotopic cerebellar encephalocele within the CPA and temporal skull base of a pediatric patient.

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Application of high-flow nasal oxygenation as a rescue therapy in difficult videolaryngoscopic intubation

SAGE Open Medical Case Reports ◽

10.1177/2050313x211010015 ◽

2021 ◽

Vol 9 ◽

pp. 2050313X2110100

Author(s):

Min Ho Lee ◽

Hyun Joo Kim

Keyword(s):

Airway Management ◽

Difficult Airway ◽

Endotracheal Intubation ◽

Difficult Intubation ◽

Rescue Therapy ◽

High Flow ◽

Mask Ventilation ◽

Induction Process ◽

Management Method ◽

Adequate Oxygenation

In difficult airway situations, the next step of the airway management method is selected according to the prior presence of difficulties in mask ventilation and endotracheal intubation. It is important for the practitioner to be calm, quick in judgment, and take action in cases of difficult intubation. Recently, high-flow nasal oxygenation has been rapidly introduced into the anesthesiology field. This technique could extend the safe apnea time to desaturation. Especially, it maintains adequate oxygenation even in apnea and allows time for intubation or alternative airway management. We report two cases in which high-flow nasal oxygenation was implemented in the middle of the induction process after quick judgment by clinicians. High-flow nasal oxygenation was successfully used to assist in prolonging the safe apnea time during delicate airway securing attempts.

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Crayon in the Orbit and Sinuses in a Pediatric Patient

Ear Nose & Throat Journal ◽

10.1177/01455613211018582 ◽

2021 ◽

pp. 014556132110185

Author(s):

Michela Borrelli ◽

Kristen A. Echanique ◽

Jeffrey Koempel ◽

Elisabeth H. Ference

Keyword(s):

Cerebrospinal Fluid ◽

Skull Base ◽

Pediatric Patient ◽

Cerebrospinal Fluid Leak ◽

Ethmoid Sinus ◽

Rare Occurrence ◽

Lamina Papyracea ◽

The Right ◽

Fluid Leak ◽

Type Of Injury

Penetrating transorbital injury with skull base involvement is a rare occurrence from a crayon. We report a case of a 2-year-old male who sustained a penetrating crayon injury through the right orbit and lamina papyracea into the posterior ethmoid sinus complicated by cerebrospinal fluid leak. There have been no other reported cases of this type of injury by a crayon.

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Combined Airwayscope and Fiberoptic Bronchoscopic Airway Management in a Patient With a Tracheal Bronchus

Journal of Cardiothoracic and Vascular Anesthesia ◽

10.1053/j.jvca.2014.10.003 ◽

2015 ◽

Vol 29 (2) ◽

pp. e19-e20

Author(s):

Hiroaki Murata ◽

Misao Yoshida ◽

Taiga Ichinomiya ◽

Itsuko Shibata ◽

Tetsuya Hara

Keyword(s):

Airway Management ◽

Tracheal Bronchus

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Pulmonary Complications after Airway Management with Laryngeal Masks or Endotracheal Intubation in Geriatric Patients Having Elective Surgery: The POLMA-EP Multi-Centre Randomized Trial

SSRN Electronic Journal ◽

10.2139/ssrn.3820554 ◽

2021 ◽

Author(s):

Liqun Yang ◽

Ling Zhu ◽

Xiao Shi ◽

Changhong Miao ◽

Hongbin Yuan ◽

...

Keyword(s):

Airway Management ◽

Randomized Trial ◽

Endotracheal Intubation ◽

Geriatric Patients ◽

Elective Surgery ◽

Pulmonary Complications ◽

Laryngeal Masks

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Use of Awake Flexible Fiberoptic Bronchoscopic Nasal Intubation in Secure Airway Management for Reconstructive Surgery in a Pediatric Patient with Burn Contracture of the Neck

Case Reports in Anesthesiology ◽

10.1155/2018/8981561 ◽

2018 ◽

Vol 2018 ◽

pp. 1-5

Author(s):

Tolga Totoz ◽

Kerem Erkalp ◽

Sirin Taskin ◽

Ummahan Dalkilinc ◽

Aysin Selcan

Keyword(s):

Airway Management ◽

Difficult Airway ◽

Pediatric Patient ◽

Reconstructive Surgery ◽

Management Technique ◽

Anesthesia Induction ◽

Nasal Intubation ◽

Stepwise Approach ◽

Patient Cooperation ◽

Trial Phase

Although the use of awake flexible fiberoptic bronchoscopic (FFB) intubation is a well-recognized airway management technique in patients with difficult airway, its use in smaller children with burn contractures or in an uncooperative older child may be challenging. Herein, we report successful management of difficult airway in a 7-year-old boy with burn contracture of the neck, by application of FFB nasal intubation in a stepwise approach, first during an initial preoperative trial phase to increase patient cooperation and then during anesthesia induction for the reconstructive surgery planned for burn scars and contractures. Our findings emphasize the importance of a preplanned algorithm for airway control in secure airway management and feasibility of awake FFB intubation in a pediatric patient with burn contracture of the neck during anesthesia induction for reconstructive surgery. Application of FFB intubation based on a stepwise approach including a trial phase prior to operation day seemed to increase the chance of a successful intubation in our patient in terms of technical expertise and increased patient cooperation and tolerance by enabling familiarity with the procedure.

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