Management of a Patient With Tracheal Stenosis After Previous Tracheotomy

2021 ◽  
Vol 68 (4) ◽  
pp. 224-229
Author(s):  
Kazumi Takaishi ◽  
Shinji Kawahito ◽  
Hiroshi Kitahata
Keyword(s):  
General Anesthesia ◽  
Tracheal Stenosis ◽  
Preoperative Evaluation ◽  
Nasotracheal Intubation ◽  
Preoperative Assessment ◽  
3 Dimensional ◽  
History Of ◽  
Nebulized Epinephrine ◽  
Dimensional Assessment ◽  
Emergency Tracheotomy

Tracheal stenosis after tracheotomy can cause difficult airway management and respiratory complications. It is difficult to predict tracheal stenosis after tracheotomy based on a patient's symptoms as the symptoms of tracheal stenosis appear only after they become severe. In patients with a history of previous tracheotomy, it is important to consider the risk factors for tracheal stenosis. Detailed preoperative evaluation of patients with a history of previous tracheotomy is essential and should include 3-dimensional assessment of the airway. We report the preoperative assessment and perioperative management of an 83-year-old woman at high risk for tracheal stenosis due to a previous emergency tracheotomy who was scheduled to undergo general anesthesia for a right maxillectomy for squamous cell carcinoma. Preoperative anteroposterior chest radiograph revealed findings indicative of tracheal stenosis. Additional detailed examinations of the stenotic area were conducted with computed tomography imaging and bronchofiberscopy. General anesthesia with nasotracheal intubation was performed, and although there were no adverse intraoperative events, stridor after extubation was observed. Nebulized epinephrine was administered via an ultrasound nebulizer and effectively improved the patient's postoperative transient dyspnea.

scholarly journals Detection and Management of Intraoperative Pneumothorax during Laparoscopic Cholecystectomy

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Mohammed Heyba ◽  
Areej Rashad ◽  
Abdul-Aziz Al-Fadhli
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
General Anesthesia ◽  
Preoperative Assessment ◽  
Definitive Treatment ◽  
Diagnostic Tools ◽  
Low Oxygen ◽  
Good Communication ◽  
Chest Auscultation ◽  
History Of ◽  
High Index Of Suspicion

Intraoperative pneumothorax is a rare but potentially lethal complication during general anesthesia. History of lung disease, barotrauma, and laparoscopic surgery increase the risk of developing intraoperative pneumothorax. The diagnosis during surgery could be difficult because the signs are often nonspecific. We report a case of a middle-aged gentleman who developed right pneumothorax during an elective laparoscopic cholecystectomy. The patient had no risk factors for adverse events during the preoperative assessment (ASA1). The patient underwent general anesthesia and was put on mechanical ventilation. The first signs of abnormality immediately after surgical port insertion were tachycardia and low oxygen saturation in addition to sings of airway obstruction. The diagnosis of pneumothorax was made clinically by chest auscultation and later confirmed by intraoperative chest radiograph. Supportive treatment was started immediately through halting the surgery and manually ventilating the patient using 100% oxygen. Definitive treatment was then done by inserting an intercostal tube. After stabilizing the patient, the surgery was completed; then, the patient was extubated and shifted to the surgical ward. Postoperative computed tomography (CT) scan was done and showed only minimal liver laceration. The patient was discharged after removing the intercostal tube and was stable at the follow-up visit. Therefore, it is important to have a high index of suspicion to early detect and treat such complication. In addition, good communication with the surgeon and use of available diagnostic tools will aid in the proper management of such cases.

Surgical Management of Patients With 22q11.2 Deletion Syndrome

2019 ◽  
Vol 4 (5) ◽  
pp. 857-869
Author(s):  
Oksana A. Jackson ◽  
Alison E. Kaye
Keyword(s):  
Surgical Management ◽  
Preoperative Evaluation ◽  
Preoperative Assessment ◽  
22Q11.2 Deletion Syndrome ◽  
Deletion Syndrome ◽  
22Q11.2 Deletion ◽  
Surgical Decision ◽  
Obstructive Sleep ◽  
Spine Abnormalities ◽  
Speech Assessment

Purpose The purpose of this tutorial was to describe the surgical management of palate-related abnormalities associated with 22q11.2 deletion syndrome. Craniofacial differences in 22q11.2 deletion syndrome may include overt or occult clefting of the palate and/or lip along with oropharyngeal variances that may lead to velopharyngeal dysfunction. This chapter will describe these circumstances, including incidence, diagnosis, and indications for surgical intervention. Speech assessment and imaging of the velopharyngeal system will be discussed as it relates to preoperative evaluation and surgical decision making. Important for patients with 22q11.2 deletion syndrome is appropriate preoperative screening to assess for internal carotid artery positioning, cervical spine abnormalities, and obstructive sleep apnea. Timing of surgery as well as different techniques, common complications, and outcomes will also be discussed. Conclusion Management of velopharyngeal dysfunction in patients with 22q11.2 deletion syndrome is challenging and requires thoughtful preoperative assessment and planning as well as a careful surgical technique.

An Adapted Measure of Teacher Self-Efficacy for Preservice Teachers: Exploring its Validity Across two Countries

2014 ◽  
Vol 28 (3) ◽  
pp. 83-92 ◽  
Author(s):  
Franziska Pfitzner-Eden ◽  
Felicitas Thiel ◽  
Jenny Horsley
Keyword(s):  
Preservice Teachers ◽  
Self Efficacy ◽  
Confirmatory Factor Analyses ◽  
3 Dimensional ◽  
Multiple Group ◽  
Three Samples ◽  
Confirmatory Factor ◽  
Teacher Self Efficacy ◽  
Dimensional Assessment ◽  
Metric Measurement

Teacher self-efficacy (TSE) is an important construct in the prediction of positive student and teacher outcomes. However, problems with its measurement have persisted, often through confounding TSE with other constructs. This research introduces an adapted TSE instrument for preservice teachers, which is closely aligned with self-efficacy experts' recommendations for measuring self-efficacy, and based on a widely used measure of TSE. We provide first evidence of construct validity for this instrument. Participants were 851 preservice teachers in three samples from Germany and New Zealand. Results of the multiple-group confirmatory factor analyses showed a uniform 3-factor solution for all samples, metric measurement invariance, and a consistent and moderate correlation between TSE and a measure of general self-efficacy across all samples. Despite limitations to this study, there is some first evidence that this measure allows for a valid 3-dimensional assessment of TSE in preservice teachers.

scholarly journals Depth Electrode Guided Anterior Insulectomy: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Mauricio Mandel ◽  
Layton Lamsam ◽  
Pue Farooque ◽  
Dennis Spencer ◽  
Eyiyemisi Damisah
Keyword(s):  
Right Hemisphere ◽  
Preoperative Evaluation ◽  
Epileptiform Activity ◽  
Neurological Deficits ◽  
Depth Electrodes ◽  
Depth Electrode ◽  
Patient Reported ◽  
Frontal Operculum ◽  
History Of ◽  
Electroencephalogram Eeg

Abstract The insula is well established as an epileptogenic area.1 Insular epilepsy surgery demands precise anatomic knowledge2-4 and tailored removal of the epileptic zone with careful neuromonitoring.5 We present an operative video illustrating an intracranial electroencephalogram (EEG) depth electrode guided anterior insulectomy.  We report a 17-yr-old right-handed woman with a 4-yr history of medically refractory epilepsy. The patient reported daily nocturnal ictal vocalization preceded by an indescribable feeling. Preoperative evaluation was suggestive of a right frontal-temporal onset, but the noninvasive results were discordant. She underwent a combined intracranial EEG study with a frontal-parietal grid, with strips and depth electrodes covering the entire right hemisphere. Epileptiform activity was observed in contact 6 of the anterior insula electrode. The patient consented to the procedure and to the publication of her images.  A right anterior insulectomy was performed. First, a portion of the frontal operculum was resected and neuronavigation was used for the initial insula localization. However, due to unreliable neuronavigation (ie, brain shift), the medial and anterior borders of the insular resection were guided by the depth electrode reference. The patient was discharged 3 d after surgery with no neurological deficits and remains seizure free.  We demonstrate that depth electrode guided insular surgery is a safe and precise technique, leading to an optimal outcome.

scholarly journals Postoperative Urinary Retention Following General Anesthesia for Endoscopic Nasal Surgery in Men Aged Older Than 60 Years: A Retrospective Study

2021 ◽  
pp. 014556132110331
Author(s):  
Yong Won Lee ◽  
Bum Sik Kim ◽  
Jihyun Chung
Keyword(s):  
General Anesthesia ◽  
Incidence Rate ◽  
Urinary Retention ◽  
Nasal Surgery ◽  
Prostate Hyperplasia ◽  
Postoperative Urinary Retention ◽  
Asa Classification ◽  
History Of ◽  
Male Patients ◽  
Endoscopic Nasal Surgery

Objectives: Postoperative urinary retention (POUR) is influenced by many factors, and its reported incidence rate varies widely. This study aimed to investigate the occurrence and risk factors for urinary retention following general anesthesia for endoscopic nasal surgery in male patients aged >60 years. Methods: A retrospective review of medical records between January 2015 and December 2019 identified 253 patients for inclusion in our study. Age, body mass index (BMI), a history of diabetes/hypertension, American Society of Anesthesiologists (ASA) classification, and urologic history were included as patient-related factors. Urologic history was subdivided into 3 groups according to history of benign prostate hyperplasia (BPH)/lower urinary tract symptoms (LUTS) and current medication. The following was analyzed as perioperative variables for POUR development: duration of anesthesia and surgery; amount of fluid administered; rate of fluid administration; intraoperative requirement for fentanyl, ephedrine, and dexamethasone; postoperative pain; and analgesic use. Preoperatively measured prostate size and uroflowmetry parameters of patients on medication for symptoms were compared according to the incidence of urinary retention. Results: Thirty-seven (15.7%) patients developed POUR. Age (71.4 vs 69.6 years), BMI (23.9 vs 24.9 kg/m2), a history of diabetes/hypertension, ASA classification, and perioperative variables were not significantly different between patients with and without POUR. Only urologic history was identified as a factor affecting the occurrence of POUR ( P = .03). The incidence rate among patients without urologic issues was 5.9%, whereas that among patients with BPH/LUTS history was 19.8%. Among patients taking medication for symptoms, the maximal and average velocity of urine flow were significantly lower in patients with POUR. Conclusions: General anesthesia for endoscopic nasal surgery may be a potent trigger for urinary retention in male patients aged >60 years. The patient’s urological history and urinary conditions appear to affect the occurrence of POUR.

Endograft Planning without Preoperative Arteriography: A Clinical Feasibility Study

2000 ◽  
Vol 7 (1) ◽  
pp. 8-15 ◽  
Author(s):  
Hugh G. Beebe ◽  
Boonprasit Kritpracha ◽  
Sharon Serres ◽  
John P. Pigott ◽  
Charles I. Price ◽  
...  
Keyword(s):  
3D Model ◽  
Preoperative Evaluation ◽  
Spiral Ct ◽  
Side Branch ◽  
Aortic Aneurysms ◽  
Slice Thickness ◽  
Technical Success Rate ◽  
3 Dimensional ◽  
Procedural Time ◽  
Procedural Success

Purpose: To investigate an alternative method of preprocedural planning for aortic endografting based solely on spiral computed tomography (CT) with 3-dimensional (3D) reconstruction without preoperative arteriography. Methods: From August 1997 to April 1998, 25 consecutive patients with abdominal aortic aneurysms (AAA) were evaluated for endovascular repair by spiral CT scans (2-mm slice thickness) and computerized 3D model construction. No additional imaging for planning was performed. The aortoiliac dimensions, thrombus load, calcification, and vessel tortuosity were measured and evaluated from the 3D model of the aortoiliac segment. These data were used for selecting the patients; the configuration, diameter, and length of the endograft; and the attachment sites for deployment. Results: Primary procedural success was 92% (23/25). All endografts were deployed as planned, and there were no conversions to open repair. Six patients required adjunctive procedures for delivery system access or for iliac aneurysm exclusion, as predicted by the 3D model. Mean procedural time was 91 minutes (range 24 to 273). Two (8%) type II (side branch) endoleaks both sealed spontaneously within 1 month. No graft-related complications or death occurred, for a 30-day technical success rate of 100%. Conclusions: This computerized 3D model provided accurate data for preoperative evaluation of the aortoiliac segment for endovascular AAA repair. Satisfactory technical outcomes for aortic endografts can be achieved without the use of preprocedural invasive imaging.

scholarly journals Excessive dynamic airway collapse during general anesthesia: a case report

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Shunichi Murakami ◽  
Shunsuke Tsuruta ◽  
Kazuyoshi Ishida ◽  
Atsuo Yamashita ◽  
Mishiya Matsumoto
Keyword(s):  
General Anesthesia ◽  
Airway Pressure ◽  
Positive End Expiratory Pressure ◽  
Computed Tomography Scan ◽  
Case Presentation ◽  
Airway Lumen ◽  
Asthma Attack ◽  
Airway Collapse ◽  
History Of ◽  
Tomography Scan

Abstract Background Excessive dynamic airway collapse (EDAC) is an uncommon cause of high airway pressure during mechanical ventilation. However, EDAC is not widely recognized by anesthesiologists, and therefore, it is often misdiagnosed as asthma. Case presentation A 70-year-old woman with a history of asthma received anesthesia with sevoflurane for a laparotomic cholecystectomy. Under general anesthesia, she developed wheezing, high inspiratory pressure, and a shark-fin waveform on capnography, which was interpreted as an asthma attack. However, treatment with a bronchodilator was ineffective. Bronchoscopy revealed the collapse of the trachea and main bronchi upon expiration. We reviewed the preoperative computed tomography scan and saw bulging of the posterior membrane into the airway lumen, leading to a diagnosis of EDAC. Conclusions Although both EDAC and bronchospasm present as similar symptoms, the treatments are different. Bronchoscopy proved useful for distinguishing between these two entities. Positive end-expiratory pressure should be applied and bronchodilators avoided in EDAC.

scholarly journals Balloon tracheoplasty for tracheal stenosis after prolonged intubation: a simple procedure, but is it effective?

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
Abdallah Nosair ◽  
Mahmoud Singer ◽  
Mohamed Elkahely ◽  
Rezk Abu-Gamila ◽  
Waleed Adel
Keyword(s):  
Tracheal Stenosis ◽  
Balloon Dilatation ◽  
Simple Procedure ◽  
Symptomatic Relief ◽  
Additional Treatment ◽  
Prolonged Intubation ◽  
Midterm Outcome ◽  
History Of ◽  
Balloon Tracheoplasty

Abstract Background Tracheal stenosis following prolonged intubation is a relatively rare but serious problem. This condition is usually managed by surgical or endoscopic interventions. Bronchoscopic balloon dilatation for tracheal stenosis is considered a valuable tool used for the management of tracheal stenosis. In this article, we try to evaluate the role of balloon tracheoplasty in the management of tracheal stenosis and to assess the number of dilatation sessions usually needed as well as the short to midterm outcome. Results This study involved 40 patients with tracheal stenosis diagnosed by computed tomography (neck and chest) and bronchoscopy at the Security Force Hospital in Riyadh, KSA, between January 2013 and August 2018. Patients’ data were retrospectively reviewed and analyzed. Patients’ age ranged between 18 and 60 years. Thirty patients were males (75%); those patients underwent balloon tracheoplasty via dilatation of areas of narrowing using catheter balloon insufflation guided by fiber-optic bronchoscope. Ninety-five percent of the patients had initial success with acceptable dilatation of the stenotic area and improvement of the symptoms. There were no technical or major problems which resulted from the procedure, and no patient complained of severe pain or severe discomfort after the procedure. From the total of 81 BBD sessions, no in-hospital mortality is related to the procedure itself, and ICU stay ranged between 1 and 5 days post-procedure. Among those 40 patients, 16 patients (40%) needed one session, 10 patients (25%) needed two sessions, 8 patients (20%) needed three sessions, and 6 patients (15%) needed more than three sessions of balloon dilatation. Conclusion Balloon tracheoplasty is a simple, safe method and could be a promising and effective approach that offers immediate symptomatic relief for tracheal stenosis in cases with a history of prolonged intubation. It is worth mentioning that BBD is considered as a temporary measure, and most of the cases will need definitive or additional treatment either resection or stent placement.

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