A Case of Nasal Mucosa Cautery With Reintubation Under Pharyngeal Suction for Massive Epistaxis After Extubation

2021 ◽  
Vol 68 (4) ◽  
pp. 235-237
Author(s):  
Yukiko Arai ◽  
Akari Hasegawa ◽  
Aki Kameda ◽  
Saki Mitani ◽  
Takuya Uchida ◽  
...  
Keyword(s):  
Nasal Cavity ◽  
Endotracheal Tube ◽  
Nasal Mucosa ◽  
Pulmonary Aspiration ◽  
Muscle Relaxants ◽  
Suction Catheter ◽  
Mask Ventilation ◽  
Drug Selection ◽  
Sphenopalatine Foramen ◽  
Dexmedetomidine Infusion

We describe a case of massive epistaxis that occurred after removal of a nasal endotracheal tube, prompting emergent reintubation. Mask ventilation could not be performed because the nasal cavity was packed with gauze and the airway was being evacuated with a suction catheter. Therefore, instead of inhalational anesthetics and muscle relaxants, boluses of midazolam and remifentanil were administered, and reintubation was promptly performed. Sedation was maintained with dexmedetomidine infusion and midazolam. Nasal cautery was performed near the left sphenopalatine foramen. The patient was extubated without agitation or additional hemorrhage. Immediate recognition of the potential for airway loss, sufficient control of active bleeding, and drug selection in accordance with the emergent circumstances enabled prompt resecuring of the airway without pulmonary aspiration of blood.

scholarly journals TRACHEAL STENOSIS SURGERY

2010 ◽  
Vol 17 (04) ◽  
pp. 638-642
Author(s):  
SHAFAQ AHMED ◽  
SARFRAZ JANJUA
Keyword(s):  
Laryngeal Mask Airway ◽  
Endotracheal Tube ◽  
Tracheal Stenosis ◽  
Nasogastric Tube ◽  
High Frequency ◽  
Laryngeal Mask ◽  
Alternative Methods ◽  
High Frequency Ventilation ◽  
Suction Catheter ◽  
Mask Ventilation

Objective: To highlight the problems and solutions in airways management in patients with tracheal stenosis undergoing surgical interventions and to highlight the alternative methods of airway control where high frequency ventilatory facility is not available. Study Design: Case series study. Place and Duration: Combined Military Hospital Rawalpindi from 1st Jan 2004 to 30th June 2007. Patients and Methods: Twenty nine patients of both sex and all age groups presenting with difficulty in breathing due to tracheal stenosis undergoing surgical intervention on trachea have been included. All the patients were managed under general anaesthesia. Nasogastric tube 10 Fr, suction catheter, laryngeal mask airway or mask ventilation was used for initial ventilation where conventional endotracheal tube of even smallest size did not work. Results: Small size endotracheal tube were used in twenty four patients. Difficulty was faced in five patients. In these patients endotracheal tube of smallest size available could not be passed and we had to provide ventilation by innovative measures like nasogastric tube 10Fr in one, suction catheter 10Fr in two, laryngeal mask airway in one and mask ventilation in one. There was no mortality. Conclusions: Adequate ventilation during tracheal stenosis surgery can be very difficult in some cases. Therefore a thorough understanding, a tier of flexible plans and a variety of ventilating means should be arranged before administering anaesthesia.Nasogastric tube 10Fr or suction catheter of similar size are suitable alternative if facility for high frequency ventilation is not available.

Effects of Muscle Relaxants on Mask Ventilation in Anesthetized Persons With Normal Upper Airway Anatomy

2013 ◽  
Vol 57 (1) ◽  
pp. 16
Author(s):  
Aya Ikeda ◽  
Shiroh Isono ◽  
Yumi Sato ◽  
Hisanori Yogo ◽  
Jiro Sato ◽  
...  
Keyword(s):  
Upper Airway ◽  
Muscle Relaxants ◽  
Mask Ventilation ◽  
Airway Anatomy

scholarly journals Middle turbinate angiofibroma in an elderly woman

2009 ◽  
Vol 66 (7) ◽  
pp. 583-586 ◽  
Author(s):  
Aleksandar Peric ◽  
Nenad Baletic ◽  
Snezana Cerovic ◽  
Biserka Vukomanovic-Djurdjevic
Keyword(s):  
Nasal Cavity ◽  
Elderly Woman ◽  
Anterior Part ◽  
Middle Turbinate ◽  
Immunohistochemical Analysis ◽  
Vascular Tumors ◽  
Male Adolescents ◽  
Sphenopalatine Foramen ◽  
First Case ◽  
Left Middle

Background. Angiofibromas are histologically benign vascular tumors, originating from the nasopharynx, near by the area of sphenopalatine foramen. These neoplasms occur typically in male adolescents. Reports of primary extranasopharyngeal angiofibromas have appeared sporadically in the literature in English. We present the first case of an elderly woman with tumor arising from the middle turbinate, diagnosed as angiofibroma. Case report. A 63-year-old female presented with left-sided nasal obstruction and epistaxis. Endoscopic evaluation revealed a polypoid mass arising from the anteroinferior portion of the left middle turbinate. Computed tomography (CT) scan showed a soft-tissue opacity that filled the anterior part of the left nasal cavity. After the endoscopic excision of the mass, postoperative pathohistological and immunohistochemical analysis confirmed the diagnosis of an angiofibroma. Two years later, the patient was free of symptoms and without endoscopic evidence of recurrence. Conclusion. Extranasopharyngeal angiofibromas arising from the nasal cavity are extremely rare tumors. Immunohistochemical analysis is very important in all doubtful cases, especially in those with atypical location.

Abstract 59: The Incidence Of Pulmonary Aspiration With Laryngeal Mask Airway Use During Cardiopulmonary Resuscitation And Positive Pressure Ventilation In Swine.

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Brian Suffoletto ◽  
James Menegazzi ◽  
Eric Logue ◽  
David Salcido
Keyword(s):  
Laryngeal Mask Airway ◽  
Cardiopulmonary Resuscitation ◽  
Positive Pressure Ventilation ◽  
Validation Cohort ◽  
Pulmonary Aspiration ◽  
Laryngeal Mask ◽  
Positive Pressure ◽  
Suction Catheter ◽  
Chest Compressions ◽  
Lung Expansion

Objective: Pulmonary aspiration of gastric contents occurs 20 –30% of the time during cardiopulmonary resuscitation (CPR) of cardiac arrest. This is due to loss of protective airway reflexes, pressure changes generated during CPR, and positive pressure ventilation (PPV). Even though the American Heart Association (AHA) has recommended the laryngeal mask airway (LMA) as an acceptable alternative airway for use by EMS personnel, concerns over the capacity of the device to protect from pulmonary aspiration remain. We sought to determine the incidence of aspiration after LMA placement, CPR and PPV. Methods: We conducted a prospective study on 16 consecutive post-experimental mixed-breed domestic swine of either sex (mean mass 25.7 ±1.4 kgs). A standard size-4 LMA was modified so that a vacuum catheter could be advanced into and past the LMA diaphragm. The LMA was placed into the hypopharynx and its position confirmed using End-tidal CO 2 and direct visualization of lung expansion. Fifteen milliliters of heparinized blood were instilled into the pharynx. After 5 PPVs with a mechanical ventilator, chest compressions were performed for 60s with asynchronous ventilations continuing at a rate of 12 per minute. After chest compressions, a suction catheter was inserted through the cuff and suction applied for approximately 1 minute. The catheter was removed and inspected for signs of blood. The LMA cuff was deflated and the LMA removed. The intima of the LMA diaphragm was inspected for signs of blood. In a validation cohort of 4 animals, the LMA was reinserted, a cricothyrotomy performed and 5 mL of blood instilled directly into the trachea. Results: There were 0/16 (95% CI=0 –17%) with a positive tests for the presence of blood in both the vacuum catheter and the intima of the LMA diaphragm. In the validation cohort, all four were positive for blood in both the vacuum catheter and the intima of the LMA diaphragm. Conclusions: In this simple model of regurgitation of after LMA placement, there was no sign of pulmonary aspiration, and no evidence that blood had passed beyond the seal created by the LMA cuff. Concerns over aspiration with LMA use may be unfounded. Future studies should determine the frequency of pulmonary aspiration after LMA placement in the clinical setting.

AIDS and Suctioning Newborn Infants

PEDIATRICS ◽  
1988 ◽  
Vol 82 (3) ◽  
pp. 520-521
Author(s):  
PAUL M. KEMPEN
Keyword(s):  
Endotracheal Tube ◽  
Endotracheal Intubation ◽  
Negative Pressure ◽  
Newborn Infants ◽  
Upper Airway ◽  
Suction Catheter ◽  
Meconium Aspiration ◽  
Endotracheal Suction ◽  
Suction Device ◽  
Recommended Therapy

To the Editor.— The current recommended therapy for patients with meconium aspiration consists of extensive suctioning of the oropharynx and nasopharynx after delivery of the head, with subsequent endotracheal intubation and deep suction with the endotracheal tube as the suction catheter. The upper airway is commonly cleared with a bulb syringe and/or a Delee suction device. With both the Delee and the currently recommended endotracheal suction methods, the physician's mouth is the source of negative pressure.

Acoustic reflections during rhinometry: spatial resolution and sound loss

1998 ◽  
Vol 84 (3) ◽  
pp. 1030-1039 ◽  
Author(s):  
Ole Hilberg ◽  
Benny Lyholm ◽  
Axel Michelsen ◽  
Ole F. Pedersen ◽  
Oluf Jacobsen
Keyword(s):  
Nasal Cavity ◽  
Nasal Mucosa ◽  
Complex Geometry ◽  
Sampling Frequency ◽  
Acoustic Measurements ◽  
Viscous Loss ◽  
Low Pass ◽  
Physical Limitations ◽  
Made In

The accuracy of the acoustic reflections method for the evaluation of human nasal airway geometry is determined by the physical limitations of the technique and also by the in vivo deviations from the assumptions of the technique. The present study 1) examines the sound loss caused by nonrigidity of the nasal mucosa and viscous loss caused by complex geometry and its influence on the estimation of the acoustic area-distance function; 2) examines the optimal relation between sampling frequency and low-pass filtering, and 3) evaluates advantages of breathing He-O2 during the measurements on accuracy. Measurements made in eight plastic models, with cavities exactly identical to the “living” nasal cavities, revealed only minor effects of nonrigidity of the nasal mucosa. This was confirmed by an electrical analog model, based on laser vibrometry admittance measurements of the nasal mucosa, which indicated that the error in the acoustic measurements caused by wall motion is insignificant. The complex geometry of the nasal cavity per se (i.e., departure from circular) showed no significant effects on the measurements. Low-pass filtering of the signal is necessary to cut off cross modes arising in the nasal cavity. Computer simulations and measurements in models showed that the sampling frequency should be approximately four times the low-pass filtering frequency (i.e., twice the Nyquist frequency) to avoid influence on the result. No advantage was found for the the use of He-O2vs. air in the nasal cavity.

Rhinitis following intraoperative gastro-oesophageal reflux in a dog

2019 ◽  
Vol 7 (2) ◽  
pp. e000792 ◽  
Author(s):  
Eugenia Flouraki ◽  
George Kazakos ◽  
Ioannis Savvas ◽  
Dimitra Pardali ◽  
Katerina Adamama-Moraitou
Keyword(s):  
Nasal Cavity ◽  
Nasal Mucosa ◽  
Pelvic Fracture ◽  
Surgical Repair ◽  
Cent Oxygen ◽  
Moderate Amount ◽  
Oesophageal Mucosa ◽  
Gastric Contents ◽  
Food Particles ◽  
Nasopharyngeal Mucosa

A four-month-old, male dog underwent surgical repair of femoral and pelvic fracture. The dog was premedicated with acepromazine combined with morphine; anaesthesia was induced with propofol to effect and maintained with isoflurane in 100 per cent oxygen. One hour after induction the dog regurgitated and gastric contents emerged through the nares. At the end of the surgery rhinoscopy and oesophagoscopy were performed. The oesophageal mucosa was apparently normal, while posterior and retrograde rhinoscopy revealed diffused hyperaemia and oedema of the nasal cavity and nasopharyngeal mucosa; food particles and moderate amount of mucous exudates were also seen. Copious lavage was performed, and administration of antibiotics, metoclopramide, cimetidine and sucralfate was initiated. Nasal mucosa was re-evaluated four days later. No abnormalities were detected in both nasal cavities and nasopharynx. The development of rhinitis following regurgitation during anaesthesia should be considered as a possible complication.

scholarly journals Specificity, Size, and Frequency of Spaces That Characterize the Mechanism of Bulk Transepithelial Transport of Prions in the Nasal Cavities of Hamsters and Mice

2016 ◽  
Vol 90 (18) ◽  
pp. 8293-8301 ◽  
Author(s):  
A. E. Kincaid ◽  
J. I. Ayers ◽  
J. C. Bartz
Keyword(s):  
Nasal Cavity ◽  
Nasal Mucosa ◽  
Lymphatic Vessels ◽  
Brain Homogenate ◽  
Transepithelial Transport ◽  
India Ink ◽  
Prion Transmission ◽  
Different Strains ◽  
Species Specific ◽  
Bulk Transport

ABSTRACTInhalation of infected brain homogenate results in transepithelial transport of prions across the nasal mucosa of hamsters, some of which occurs rapidly in relatively large amounts between cells (A. E. Kincaid, K. F. Hudson, M. W. Richey, and J. C. Bartz, J. Virol 86:12731–12740, 2012, doi:http://dx.doi.org/10.1128/JVI.01930-12). Bulk transepithelial transport in the nasal cavity has not been studied to date. In the present study, we characterized the frequency, size, and specificity of the intercellular spaces that mediate the bulk transport of inhaled prions between cells of mice or hamsters following extranasal inoculation with mock-infected brain homogenate, different strains of prion-infected brain homogenate, or brain homogenate mixed with India ink. Infected or mock-infected inoculum was identified within lymphatic vessels of the lamina propria and in spaces of >5 μm between a small number of cells of the nasal mucosa in >90% of animals from 5 to 60 min after inhalation. The width of the spaces between cells, the amount of the inoculum within the lumen of lymphatic vessels, and the timing of the transport indicate that this type of transport was taking place through preexisting spaces in the nasal cavity that were orders of magnitude wider than what is normally reported for paracellular transport. The indiscriminate rapid bulk transport of brain homogenate in the nasal cavity results in immediate entry into nasal cavity lymphatics following inhalation. This novel mechanism may underlie the recent report of the early detection of prions in blood following inhalation and has implications for horizontal prion transmission.IMPORTANCEThe results of these studies demonstrate that the nasal mucosa of mice and hamsters is not an absolute anatomical barrier to inhaled prion-infected or uninfected brain homogenate. Relatively large amounts of infected and uninfected brain homogenate rapidly cross the nasal mucosa and enter the lumen of lymphatic vessels following inhalation. These bulk transepithelial transport events were relatively rare but present in >90% of animals 5 to 60 min following inhalation. This novel mechanism of bulk transepithelial transport was seen in experimental and control hamsters and mice, indicating that it was not species specific or in response to prion exposure. The indiscriminate bulk intercellular transport of inhaled pathogens across the nasal mucosa followed by entry into the lymphatic system may be a mechanism that underlies the entry and spread of other toxins and pathogens in olfactory system-driven animals.

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