Treatment of Iatrogenic Subglottic Stenosis by Therapeutic Fibreoptic Bronchoscopy

Endotracheal intubation is a common procedure in intensive care unit. It still qualifies as an invasive procedure. Prolonged endotracheal intubation or intubation with cuffed endotracheal tube in a newborn or young infant is a risk factor for the development of subglottic stenosis. It usually presents with stridor in childhood. The most likely mechanism of subglottic stenosis is an injury of tracheal mucosa, with secondary scar healing that consequently leads to the development of some degree of subglottic stenosis. Depending on the degree of subglottic stenosis, patients may be asymptomatic for a long time or symptoms can occur within several weeks. The incidence of stenosis is very low if intubation lasts less than a week. Sometimes the patient may develop severe subglottic stenosis after short-term endotracheal intubation. Intubation with cuffed endotracheal tube in newborn results in pressure necrosis and sloughing followed by subglottic stenosis. This article presents a case of a patient (Baby A) who had intubation with cuffed tube which landed to airway problem and stenosis and was managed successfully by taking help from an expert pediatric pulmonologist of a neighbouring country. Journal of Armed Forces Medical College Bangladesh Vol.13(2) 2017: 64-68

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Subglottic Ulceration and Healing following Endotracheal Intubation in the Neonate: A Morphometric Study

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348949210101003 ◽

1992 ◽

Vol 101 (10) ◽

pp. 815-820 ◽

Cited By ~ 23

Author(s):

Stephen J. Gould ◽

Martin Young

Keyword(s):

Endotracheal Tube ◽

Endotracheal Intubation ◽

Ulcer Healing ◽

Squamous Epithelium ◽

Subglottic Stenosis ◽

Acute Injury ◽

Morphometric Study

In neonates, acquired subglottic stenosis is the most serious long-term complication of endotracheal intubation and is due primarily to posttraumatic fibrosis of the infant larynx. We have examined 78 larynges, 75 of which were intubated, from infants ranging in gestation from 22 to 40 weeks, and who survived from a few hours to up to 300 days. Each larynx was morphometrically assessed for the extent of acute injury, indicated by the percentage of epithelial loss, and healing, indicated by the percentage of a subglottic ulcer covered by metaplastic squamous epithelium. Results show that acute injury is almost invariable, and up to 100% of the subglottic epithelium may be lost within a few hours of intubation, but that progression of injury is relatively short-lived. Ulcer healing starts after a few days, rapidly progresses from day 10, and in the majority of cases is complete after 30 days. This study suggests that long-standing acute injury in the subglottis is the exception rather than the rule, even with the endotracheal tube remaining in place.

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GAMBARAN LAMA KERJA ROKURONIUM PADA PASIEN YANG MENJALANI ANESTESIA UMUM DI INSTALASI BEDAH SENTRAL RSUP. PROF. DR. R. D. KANDOU MANADO

e-CliniC ◽

10.35790/ecl.2.2.2014.5028 ◽

2014 ◽

Vol 2 (2) ◽

Author(s):

Ni Wayan Ira L. Dewi ◽

Harold Tambajong ◽

Diana Ch. Lalenoh

Keyword(s):

Endotracheal Tube ◽

Endotracheal Intubation ◽

Muscle Relaxant ◽

Muscle Relaxation ◽

Muscle Paralysis ◽

Tube Insertion ◽

Common Procedure ◽

Duration Of Action ◽

Muscle Relaxant Drug ◽

Descriptive Method

Abstrak: Intubasi endotrakeal merupakan salah satu tindakan yang sering dilakukan, khususnya pada pasien yang menjalani operasi dengan anestesia umum. Intubasi endotrakeal dilakukan dengan memasukan pipa endotrakeal ke dalam trakea. Keberhasilan pemasangan pipa endotrakeal tergantung beberapa hal seperti relaksasi otot, kedalaman anestesia, dan keterampilan operator. Penggunaan obat pelumpuh otot khusunya pelumpuh otot non-depolarisasi lebih sering digunakan karena menghasilkan kondisi intubasi yang cepat dengan efek samping yang lebih minimal. Rokuronium merupakan salah satu obat pelumpuh otot yang banyak digunakan di Indonesia. Lama kerja obat perlu diketahui dengan pasti agar relaksasi otot cukup optimal untuk dilakukannya pembedahan dan derajat kelumpuhan otot dapat dipertahankan dengan melakukan penambahan dosis obat. Penelitian ini bertujuan untuk mengetahui lama kerja dari obat pelumpuh otot rokuronium agar dapat menentukan waktu penambahan dosis obat yang tepat. Penelitian ini menggunakan metode deskriptif dengan sampel sebanyak 10 orang. Hasil penelitian didapatkan lama kerja rokuronium yaitu 34,90 menit. Lama kerja pada laki-laki lebih lama daripada perempuan. Kelompok berat badan 66-75 kg dan kelompok umur 41-47 tahun memiliki lama kerja yang paling panjang. Kata kunci: Lama kerja, rokuronium. Abstract: Endotracheal intubation is one of the most common procedure, especially on a patient undergoing surgery with general anesthesia. Endotracheal intubation is done by inserting endotracheal tube into trachea. The success of endotracheal tube insertion depends on several things such as muscle relaxation, the depth of anesthesia, and the operator’s skill. The use of muscle relaxant drugs especially non-depolarization muscle relaxant is more frequently because it produces rapid intubation conditions with minimal side effect. Rocuronium is a muscle relaxant drug that is widely used in Indonesia. Duration of action of drugs need to be known for certain so the optimal muscle relaxation sufficient to do the surgery and the degree of muscle paralysis can be maintained by adding a dose of the drug. This study aims to determine the duration of action of rocuronium in order to determine the time to administer proper dose addition. This study used a descriptive method with a sample of 10 people. The results showed that the duration of action of rocuronium is 34,90 minutes. The duration of action on men is longer than women. Longest duration of action occurs on 66-75 Kg weight group and 41-47 age group Keyword: Duration of action, rocuronium.

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Treatment of Acquired Subglottic Stenosis

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348947308200613 ◽

1973 ◽

Vol 82 (6) ◽

pp. 822-826 ◽

Cited By ~ 20

Author(s):

Lyle G. Waggoner ◽

Walter M. Belenky ◽

Charles E. Clark

Keyword(s):

Cardiac Surgery ◽

Endotracheal Tube ◽

Triamcinolone Acetonide ◽

Endotracheal Intubation ◽

Conservative Management ◽

Subglottic Stenosis ◽

Assisted Respiration

Four children, who had undergone major cardiac surgery, were treated for severe subglottic stenosis following prolonged endotracheal intubation and assisted respiration. Following removal of the endotracheal tube, all required tracheotomy after varying lengths of time. An adequate airway and good voice was obtained in each with injections of triamcinolone acetonide suspension combined with hyaluronidase, and gentle dilatations. This treatment greatly reduced the needed time of tracheotomy maintenance from that required with the previously recommended conservative management consisting of dilatations only. It also avoided the use of alloplastic stents which frequently resulted in a deformed larynx and poor voice.

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Facilitating Submental Endotracheal Intubation with an Endotracheal Tube Exchanger

Anesthesia & Analgesia ◽

10.1097/00000539-200001000-00044 ◽

2000 ◽

Vol 90 (1) ◽

pp. 222-223 ◽

Cited By ~ 34

Author(s):

Pierre Drolet ◽

Michel Girard ◽

Jean Poirier ◽

Yvan Grenier

Keyword(s):

Endotracheal Tube ◽

Endotracheal Intubation

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Direct Laryngoscopy and Endotracheal Intubation Complicated by Anterior Tracheal Laceration Secondary to Protrusion of Preloaded Endotracheal Tube Stylet

A & A Case Reports ◽

10.1213/xaa.0000000000000235 ◽

2016 ◽

Vol 6 (4) ◽

pp. 77-79 ◽

Cited By ~ 1

Author(s):

Matthew A. Warner ◽

Jonathan F. Fox

Keyword(s):

Endotracheal Tube ◽

Endotracheal Intubation ◽

Direct Laryngoscopy ◽

Tracheal Laceration

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Successful anesthetic management in a child after traumatic rupture of left main bronchus by a single-lumen cuffed-endotracheal tube

Annals of Cardiac Anaesthesia ◽

10.4103/0971-9784.142066 ◽

2014 ◽

Vol 17 (4) ◽

pp. 292 ◽

Cited By ~ 1

Author(s):

Hamed Elgendy ◽

Tariq Jilani

Keyword(s):

Endotracheal Tube ◽

Main Bronchus ◽

Anesthetic Management ◽

Left Main Bronchus ◽

Traumatic Rupture ◽

Left Main ◽

Cuffed Endotracheal Tube ◽

Single Lumen

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Evaluation of Pleural Fluid Adenosine Deaminase Activity in Tubercular Pleural Effusion in a Military Hospital

Journal of Armed Forces Medical College Bangladesh ◽

10.3329/jafmc.v11i2.39826 ◽

2019 ◽

Vol 11 (2) ◽

pp. 69-75

Author(s):

Md Kabir Uddin ◽

Md Abdul Ali Mia ◽

Mamun Mostafi ◽

Mimi Parvin ◽

Mainul Ahmed Chowdhury

Keyword(s):

Pleural Effusion ◽

Early Diagnosis ◽

Surrogate Marker ◽

Invasive Procedure ◽

Armed Forces ◽

Diagnostic Tools ◽

Military Hospital ◽

Specific Marker ◽

Predictive Values ◽

Adenosine Deaminase Activity

Introduction: Tubercular pleural effusion (TPE) is one of the common extra pulmonary tuberculosis which many a times become difficult to make definite diagnosis on account of low sensitivity and/or specificity of non-invasive diagnostic tools. Even pleural biopsy cannot establish all the diagnosis; rather after patient shows unwillingness to invasive procedure. A reliable sensitive and specific marker is required for early diagnosis of TPE as Bangladesh is a high Tuberculosis burden country. Adenine deaminase (ADA) may be a useful surrogate marker. Objective: To find out a reliable sensitive and specific marker for early diagnosis of TPE as Bangladesh is a high Tuberculosis burden country. Materials and Methods: This study carried out ADA estimations in 170 cases of pleural effusion at Combined Military Hospital (CMH) Dhaka. Efforts were made to reach diagnosis by other means. Results: ADA level was found in tubercular pleural effusion ranges from 25 to 180 with a mean 71.51 ±33.1. It ranges 3 U/L to 170U/L with non-tubercular effusion with a mean 20.96±16.71. The sensitivity of ADA is 90.9% and specificity is 95.7% in diagnosing TPE. The positive and negative predictive values are 90.91 % and 95.65% respectively. Conclusion: ADA is found cheap, sensitive and a useful surrogate marker. However, it is not a confirmatory diagnostic tool but can be used as a reliable adjunct to other investigations. Journal of Armed Forces Medical College Bangladesh Vol.11(2) 2015: 69-75

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Is there an optimal place to hold the endotracheal tube during direct laryngoscopy? Protocol for a Randomised Controlled Trial

10.21203/rs.3.rs-423901/v1 ◽

2021 ◽

Author(s):

Manisha Sahoo ◽

Swagata Tripathy ◽

Nitasha Mishra

Keyword(s):

Endotracheal Tube ◽

Endotracheal Intubation ◽

Controlled Trial ◽

Scientific Evidence ◽

Intubation Difficulty ◽

The Mean ◽

Randomised Controlled ◽

Difficulty Score ◽

Clinical Trials Registry ◽

Rate Of Success

Abstract Background: Laryngoscopic endotracheal intubation (LEI) is a widely performed lifesaving technique. There are evidence and guidelines to help decide the optimal sized endotracheal tube (ET), laryngoscope, depth of insertion, and patient position for successful endotracheal intubation. We hypothesize that after glottic visualization, the point at which the ET is held will affect the time, ease, and success of the technique due to a difference in visualization and torque. We aim to compare two sites of holding the ET after optimal laryngeal-inlet visualization: time to intubation, rate of success of first pass intubation, intubation difficulty and complications.Methods: Supervised intubations on ASA 1-2 patients (>18 years) posted for surgery under general anesthesia performed by anesthesia trainees (experience <18 months) will be included. Patients with an anticipated difficult airway or unanticipated difficulty - CL grade > three or requiring the use of airway adjuncts will be excluded. A computer-generated numbers list will randomize patients; allocation concealed with opaque sealed envelopes. ET marked at the selected site will be handed to the intubator by the theatre-technician once she/he confirms the optimum laryngoscopic view. The entire procedure will be video recorded. Two blinded assessors will independently review the videos to document the time to intubation (TTI defined as the time from holding the ET to the removal of laryngoscope from the mouth after successful intubation) and intubation difficulty score. Postoperative sore throat and hoarseness will be recorded.Sample size: 54 experienced anesthetists were video-recorded during intubating. The site of holding ET and TTI were analyzed. The mean site was 3 SD 2.5 cm from the tip, yielding two sites for the study- 19 cm (Gr 1) and 24 cm (Gr 2). To detect a 20% difference in intubation time between groups, the confidence of 95%, and power 85%, we will need 298 patients: 180 per group after accounting for data loss.Discussion: This will be the first study to assess whether holding the tube at a particular site has any impact on the ease and time taken for intubation. This study's findings will provide the first scientific evidence for an appropriate place for holding the ET during LEI, which we feel will help trainees improve their LEI technique.Trial registration: CTRI/2019/09/021201, Clinical Trials Registry India. http://ctri.nic.in/Clinicaltrials/advsearch.php. Registered 12th September 2019,

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