scholarly journals Bronchospasm during Anesthesia Induction in A Patient with Undiagnosed Asthma

2020 ◽  
Vol 8 (6) ◽  
Author(s):  
Bo Sung Kim ◽  
Jae Chan Choi
Keyword(s):  
Allergic Rhinitis ◽  
Vital Signs ◽  
Good Control ◽  
Anesthesia Induction ◽  
Current Case ◽  
Asthma Symptoms ◽  
Asthma Patients ◽  
Life Threatening ◽  
Undiagnosed Asthma ◽  
Pathophysiologic Mechanisms

In large study of 9287 children undergoing general anesthesia, the incidence of perioperative bronchospasm is 2.1 percent. During anesthesia in patients with well-controlled asthma, airway complications such as bronchospasm are rare. However, poorly controlled asthma is closely related to the pathophysiologic mechanisms of nonallergic and allergic bronchospasm. More than 80% of asthma patients have allergic rhinitis, and 10-40% of allergic rhinitis patients have asthma.    We report a case of a 10-year-old male with undiagnosed asthma who developed bronchospasm during induction of anesthesia. This patient had been treated for allergic rhinitis before surgery. Unexpected bronchospasm occurred immediately after induction of anesthesia and was treated with salbutamol nebulizer and intravenous dexamethasone. In addition, a massive hypotension-suspected anaphylactic reaction occurred and was treated with intravenous epinephrine, after which airway pressure and vital signs improved. For safety, the operation was canceled, anesthesia was discontinued, and the patient was discharged without specific complications. Asthma was diagnosed upon further evaluation two weeks after discharge.   Because this patient had been treated for allergic rhinitis before surgery, asthma should have been diagnosed before surgery. If asthma symptoms before anesthesia were well-controlled using a bronchodilator, steroid, etc., bronchospasm could have been prevented during anesthesia in the current case.   This case suggests that, when possible, asthma should be diagnosed before surgery in allergic rhinitis patients. This case also suggests that anesthesia should be performed after good control of asthma symptoms before surgery to prevent life-threatening perioperative events.

scholarly journals The effectiveness of target therapy in patients with severe allergic asthma

2019 ◽  
Vol 91 (12) ◽  
pp. 57-62
Author(s):  
O V Skorokhodkina ◽  
A R Valeeva ◽  
A V Luntsov ◽  
V A Pozdnyak
Keyword(s):  
Allergic Rhinitis ◽  
Effective Treatment ◽  
Allergic Asthma ◽  
Target Therapy ◽  
Biologic Treatment ◽  
Partial Control ◽  
Asthma Symptoms ◽  
Systemic Corticosteroids ◽  
Severe Allergic Asthma ◽  
Asthma Patients

The purpose of study was to analyze own clinical experience and assess the effectiveness in treatment of severe very poorly controlled allergic asthma patients with omalizumab. The effectiveness of biologic treatment with omalizumab was analyzed in 10 patients with severe very poorly controlled allergic asthma. It has been shown that indication of anti-IgE therapy in case of severe allergic asthma resulted in decrease of day and night asthma symptoms, symptoms of allergic rhinitis, dose of other anti - inflammatory asthma medications, discontinuation of systemic corticosteroids which led to good and partial control of the disease. Anti-IgE therapy is a highly effective treatment in asthma patients with atopic phenotype.

Necrotizing Fasciitis Occurred in the Lymphedematous leg

2021 ◽  
pp. 153473462110230
Author(s):  
Hisako Hara ◽  
Makoto Mihara ◽  
Takeshi Todokoro
Keyword(s):  
Case Report ◽  
Necrotizing Fasciitis ◽  
Lower Limb ◽  
Gynecologic Cancer ◽  
Vital Signs ◽  
Ethics Committee ◽  
Secondary Lymphedema ◽  
Delayed Treatment ◽  
Institutional Ethics ◽  
Life Threatening

Lymphedema is a chronic edema that sometimes occurs after treatment of gynecologic cancer, and cellulitis often occurs concomitantly with lymphedema. On the other hand, necrotizing fasciitis (NF) is a relatively rare, but life-threatening disease. The symptoms in cellulitis and NF are very similar. In this case report, we describe a case in which the diagnosis of NF in a lymphedematous limb was difficult. A 70-year-old woman had secondary lymphedema in bilateral legs and consulted our department. On the first day of lymphedema therapy, the patient complained of vomiting, diarrhea, and fever (37.7 °C) without local fever in the legs. She was diagnosed with acute gastroenteritis. On the next day, swelling and pain in her left leg occurred and her blood pressure was 59/44 mmHg. She was diagnosed with cellulitis accompanied by lower limb lymphedema and septic shock. On the second day, blisters appeared on the left leg, and computed tomography showed NF. We performed debridement under general anesthesia and her vital signs improved postoperatively. Streptococcus agalactiae (B) was detected in blood culture, and we administered bixillin and clindamycin. Postoperatively, necrosis in the skin and fat around the left ankle gradually spread, and it took 5 months to complete epithelialization. The diagnosis was more difficult than usual NF because patients with lymphedema often experience cellulitis. Clinicians should always think of NF to avoid mortality due to delayed treatment. This case report was approved by the institutional ethics committee.

Determinants of pyelonephritis onset in patients with obstructive urolithiasis

2021 ◽  
pp. 039156032110352
Author(s):  
Georges Abi Tayeh ◽  
Ali Safa ◽  
Julien Sarkis ◽  
Marwan Alkassis ◽  
Nour Khalil ◽  
...  
Keyword(s):  
Emergency Department ◽  
Renal Colic ◽  
Demographic Data ◽  
Vital Signs ◽  
Kidney Injury ◽  
Stone Size ◽  
Positive Urine ◽  
Life Threatening ◽  
Fat Stranding ◽  
Obstructive Pyelonephritis

Background: Acute obstructive pyelonephritis due to urolithiasis represents a medico-surgical emergency that can lead to life-threatening complications. There are still no established factors that reliably predict progression toward acute pyelonephritis in patients presenting with a simple renal colic. Objective: To investigate clinical and paraclinical factors that are associated with the onset of acute obstructive pyelonephritis. Methods: Patients presenting to the emergency department for renal colic with obstructive urolithiasis on imaging were enrolled in the study. Demographic data, vital signs, medical comorbidities, blood test results, urinalysis, and radiological findings were recorded. Obstructive pyelonephritis was defined by the presence of two or more of the following criteria: fever, flank pain or costovertebral angle tenderness, and a positive urine culture. Results: Seventeen patients out of 120 presenting with renal colic, were diagnosed with acute obstructive pyelonephritis (14%). Parameters that were associated with the onset of obstructive pyelonephritis were: diabetes ( p = 0.03), elevated CRP ( p = 0.01), stone size (>5 mm) ( p = 0.03), dilatation of renal pelvis ( p = 0.01), peri-renal fat stranding ( p = 0.02), and positive nitrites on urinalysis ( p < 0.01). Hyperleukocytosis, acute kidney injury, multiple stones, pyuria (>10/mm3), hypertension, and were not associated with the onset of obstructive pyelonephritis. Conclusion: This study showed that known diabetic status, elevated CRP, positive urine nitrites, stone size (>5 mm), pyelic dilatation, and peri-renal fat stranding were associated with the onset of pyelonephritis in patients presenting to the emergency department with obstructive urolithiasis.

scholarly journals A modern approach to the combination treatment of allergic rhinitis

2018 ◽  
pp. 92-95
Author(s):  
S. A. Karpischenko ◽  
G. V. Lavrenova ◽  
E. I. Muratova
Keyword(s):  
Allergic Rhinitis ◽  
Disease Incidence ◽  
The Body ◽  
Bronchial Obstruction ◽  
Common Disease ◽  
Nasal Breathing ◽  
Modern Approach ◽  
Life Threatening ◽  
Adults And Children ◽  
Consistent Increase

Allergic rhinitis is a common disease that significantly worsens the patient’s quality of life. In some cases, the disease can be life threatening. Severe attacks of bronchial obstruction may occur in patients with allergic rhinitis. The widespread prevalence of allergic rhinitis in adults and children, consistent increase in disease incidence constitutes a great medical and social issue. Treatment for allergic rhinitis should be aimed at reaching increased remission duration, preventing the exacerbation of the disease and educating patients to maintain control over the symptoms of the disease. A challenge that otolaryngologists and allergists face is to restore nasal breathing in patients with allergic rhinitis. The updated approach to the challenge is to suggest treatment that takes into account the pathophysiological mechanisms that occur not only in the mucous membrane of the nasal cavity, but throughout the body, in particular, in the intestine.

scholarly journals PENANGANAN PERIOPERATIF PADA ASMA

2013 ◽  
Vol 5 (1) ◽  
Author(s):  
Christina Suhartono ◽  
Harold F Tambajong ◽  
Diana Ch. Lalenoh
Keyword(s):  
Perioperative Management ◽  
Smooth Muscles ◽  
Special Treatment ◽  
Asthma Symptoms ◽  
Asthma Attack ◽  
Asthma Patients ◽  
Post Operation ◽  
Laboratory Examinations ◽  
Keywords Asthma ◽  
Selection Of

Abstract: The management of a patient with asthma during surgery requires a special treatment based on thorough clinical and laboratory examinations to reduce complications during surgery and the post-operative state. Asthma is characterized by a difficulty in breathing due to spastic contractions of bronchiolar smooth muscles, which partially block the bronchioles’ airways. The evaluation of asthma patients before anesthesia and surgical procedures is essential to prevent or control the occurence of asthma attacks during intra-operation and post-operation. Patients with histories of chronic asthma or frequent exacerbations of asthma have to be treated to achieve an optimal condition or a condition in which asthma symptoms are minimal. Patients with frequent bronchospasms should be treated. The selection of drugs and anesthetic procedures should be considered meticulously to avoid a stimulation of  bronchospasm or an asthma attack. Keywords: asthma, perioperative management, patient.   Abstrak: Pengelolaan pasien dengan penyakit asma selama pembedahan membutuhkan penanganan khusus berdasarkan pemeriksaan klinis dan laboratorium yang saksama untuk mengurangi komplikasi selama dan pasca pembedahan. Asma adalah kesukaran bernapas yang ditandai dengan kontraksi spastik otot polos bronkiolus, yang menyumbat bronkiolus secara parsial. Evaluasi pasien asma sebelum tindakan anestesia dan pembedahan sangat penting untuk mencegah atau mengendalikan kejadian serangan asma, baik selama pembedahan maupun pasca pembedahan. Pasien dengan riwayat asma berulang atau kronis memerlukan pengobatan hingga tercapai kondisi yang optimal untuk dilakukan operasi atau kondisi dimana gejala-gejala asma sudah minimal. Pasien dengan  bronkospasme berulang harus diobati terlebih dahulu. Pemilihan obat-obatan dan tindakan anestesia perlu dipertimbangkan dengan cermat untuk menghindari terjadinya bronkospasme atau serangan asma. Kata kunci: asma, penanganan perioperatif, pasien.

scholarly journals Non-contact monitoring of agitation and use of a sheltering device in patients with dementia in emergency departments: a feasibility study (Preprint)

2019 ◽  
Author(s):  
Lisa Kroll ◽  
Nikolaus Böhning ◽  
Heidi Müßigbrodt ◽  
Maria Stahl ◽  
Pavel Halkin ◽  
...  
Keyword(s):  
Feasibility Study ◽  
Real Life ◽  
Vital Signs ◽  
Safety Issues ◽  
Positive Effects ◽  
Real Life Setting ◽  
Life Threatening ◽  
Monitoring Devices ◽  
Study Setting ◽  
Technical Reliability

BACKGROUND Agitation is common in geriatric patients with dementia (PWD) admitted to an emergency department (ED) and is associated with a higher risk of an unfavourable clinical course. Hence, monitoring of vital signs and enhanced movement is essential in these patients during their stay in the ED. Since PWD rarely tolerate fixed monitoring devices, non-contact monitoring systems might represent appropriate alternatives. OBJECTIVE To study the reliability of a non-contact monitoring system (NCMSys) and of a tent-like device (“Charité Dome”, ChD), aimed to shelter PWD from the busy ED-environment. Further, effects of the ChD on wellbeing and agitation of PWD will be measured. METHODS Both devices were attached to patient’s bed. Tests on technical reliability and other safety issues of the NCMSys and the ChD were performed at the iDoc-institute. A feasibility study evaluating the reliability of the NCMSys with and without the ChD was performed in the real-life setting of an ED and on a geriatric-gerontopsychiatric ward. Technical reliability and other safety issues were tested with six healthy volunteers. For the feasibility study 19 patients were included (ten males and nine females; mean age: 77.4 (55-93) years of which 14 were PWD. PWD inclusion criteria were age ≥55 years, a dementia diagnosis as well as a written consent (by patients themselves or by a custodian). Exclusion criteria were acute life-threatening situations and a missing consent. RESULTS Heart rate, changes in movement and sound emissions were measured reliably by the NCMSys, whereas patient movements affected respiratory rate measurements. The ChD did not impact patients’ vital signs or movements in our study setting. However, 53% of the PWD (7/13) and most of the patients without dementia (4/5) benefited from its use regarding their agitation and overall wellbeing. CONCLUSIONS NCMSys and ChD work reliably in the clinical setting and have positive effects on agitation and wellbeing. The results of this feasibility study encourages prospective studies with longer durations to further evaluate this concept for monitoring and prevention of agitation in PWD in the ED. CLINICALTRIAL ICTRP: “Charité-Dome-Study - DRKS00014737”

scholarly journals Can nasal nitric oxide be a biomarker to differentiate allergic and non-allergic rhinitis?

2021 ◽  
Vol 37 (1) ◽  
Author(s):  
A. F. Kalpaklioglu ◽  
A. Baccioglu ◽  
S. A. Yalim
Keyword(s):  
Nitric Oxide ◽  
Allergic Rhinitis ◽  
Severe Disease ◽  
Female Gender ◽  
Non Invasive ◽  
Nasal Nitric Oxide ◽  
Nasal Symptoms ◽  
Asthma Patients ◽  
Duration Of Disease ◽  
Non Allergic Rhinitis

Abstract Background Nasal nitric oxide (nNO), a noninvasive indicator for eosinophilic airway inflammation, has not been adequately studied in different types of rhinitis. The aim of this study was to compare nNO levels between allergic (AR) and non-allergic rhinitis (NAR). Patients were included based on their chronic nasal symptoms. Total nasal symptoms score (TNSS) were evaluated. nNO was measured transnasally with a flow of 5 ml/s from the nostril with an NO analyzer (NIOX MINO; Aerocrine, Sweden). Results were evaluated as parts per billion (ppb). Results Four hundred forty-three patients (277 F/166 M)—337 with AR (76%) and 106 with NAR (24%)—were assessed. Patients with AR had significantly higher TNSS, more severe disease, and longer duration of disease compared to NAR group. Allergic rhinitis had significantly higher nNO levels than NAR (370 ppb vs 290 ppb) (p = 0.001). Likewise, significant differences were observed in female gender, in patients with BMI ≥ 25 kg/m2 and those without sinusitis between the two groups. When nNO were further evaluated in comorbid asthma, patients with AR w/o asthma had the highest TNSS and had significantly higher nNO level (p < 0.001). NAR+A group, with the longest duration of rhinitis, was significantly older and had the lowest nNO level (p < 0.001). Conclusions This study showed that nNO levels were significantly higher in AR patients than NAR. Although there is no recommended standard threshold for nNO, this study confirmed the utility of nNO in differentiating AR and NAR in addition to its known fast and non-invasive advantages.

Modular Technical Concepts for Ambulatory Monitoring of Risk Patients Based on Multiple Parameters and an Automatic Alarm Function

2016 ◽  
Vol 4 (1) ◽  
pp. 1-9
Author(s):  
Jörg Piper ◽  
Birgit Müller
Keyword(s):  
Data Acquisition ◽  
Ambulatory Monitoring ◽  
Vital Signs ◽  
Data Acquisition System ◽  
Acquisition System ◽  
False Alarms ◽  
Multiple Parameters ◽  
Risk Patients ◽  
Life Threatening ◽  
Long Term Prognosis

Technical concepts of a multi-parameter-based system are described which can be used for continuous ambulatory monitoring of several vital signs. When critical or fatal events are detected, an automatic alarm is generated including information about the patient´s position (global positioning system, GPS) and additional messages. A lot of vital parameters are continuously monitored by “bio detectors” which are connected with a mobile data acquisition system carried by the patient. This data acquisition system interacts with a mobile phone so that an alarm can immediately be sounded in cases of critical or fatal events. Other episodes relevant for the patient´s long-term prognosis without leading to life-threatening outcomes can be stored for elective analyses without generating an alarm. Moreover, patients can manually give an alarm on demand. Potential false alarms can be manually canceled. In further stages of development these technical components could interact with electronic control systems of cars so that cars could be immediately stopped if the driver becomes unconscious.

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