Laryngospasm Caused by Removal of Nasogastric Tube after Tracheal Extubation: Case Report

Background: We report a case of laryngospasm during nasogastric tube removal. Laryngospasm is a severe airway complication after surgery and there have been no reports associated with the removal of nasogastric tubes. Case Report: After abdominal surgery, the patient was extubated the tracheal tube, and was removed the nasogastric tube. Thereafter patient went into respiratory arrest. We attempted to ventilate using a face mask, and then through a supraglottic device, but both attempts were unsuccessful. Finally, we re-intubated her and stabilized her vitals. Conclusion: When patients are in emerging from anesthesia, nasogastric tube withdrawal may cause irritation of the vocal cords by gastric acids, and thereby, provoke laryngospasm. This can be avoided by removing it before reversing anesthesia or after the patient is awake.

Iatrogenic tracheal rupture after extubation in the context of acute decompensated heart failure and cardiac device implantation: a case report

ABSTRACT Iatrogenic tracheal rupture is a life-threatening airway complication. It has a very low reported incidence and is more prevalent in women and patients over 50 years of age. The most frequent clinical manifestations of tracheal injury are subcutaneous emphysema and respiratory distress. We report a case of a 65-year-old woman with cardiac resynchronization therapy defibrillator implantation under general anesthesia. Shortly after extubation, dyspnea and subcutaneous emphysema appeared. The X-ray showed pneumomediastinum, pneumopericardium and pneumoperitoneum. The tracheal rupture was confirmed by bronchoscopy. After conservative treatment, the patient's well-being improved, and she was discharged from the hospital in a satisfactory condition.

Airway complication associated with injection of phosphatidylcholine and deoxycholic acid into the neck: a case report

The practice of delivering cosmetic injectables in the outpatient setting continues to grow in Australia.1 The increase in demand has seen a dramatic rise in the number of new cosmetic injectable clinics using telehealth prescribing services. Lipodissolve treatment is an example of a non-surgical procedure that aims to improve the appearance of a ‘double chin’ by injection of phosphatidylcholine (PC) and deoxycholic acid (DCA) into submental adipose tissue. We describe a case of an airway complication and hospitalisation secondary to the injection of Lipodissolve in the neck of a 23-year-old female.

Comparison of tracheal tube cuff pressure with two technique: fixed volume and minimal leak test techniques

Introduction: There is a correlation between endotracheal cuff pressure and airway complication; therefore, cuff pressure measurement is of an essential importance. The gold standard technique is measuring the cuff pressure by a calibrated manometer. However, there are several methods that injects air into balloon pilot and measures the cuff pressure. The aim of this study is to compare the tracheal cuff pressure measurement by two methods: fixed volume and minimal leak test (MLT). Methods: This descriptive study was performed at the emergency department on 110 patients. Patients were randomized into two groups. For one group, fixed volume technique and for the other group MLT was used. Results: Mean cuff pressure was 46.07±23.54 cmH2O in the fixed volume group and 33.72±9.14 cmH2O in the MLT group (P=0.05) which is significantly higher in the fixed volume group (P=0.028). In addition, 56.4% and 78.2% of the subjects had normal cuff pressure in the fixed volume group and MLT group, respectively; indicating a significantly higher rate in MLT group (P=0.025). Conclusion: Both techniques cause above normal intracuff pressure; however, MLT produces more acceptable pressure than fixed volume. It seems that the volume of 10 cc produces high pressures; therefore, fixed values may yield more appropriate results in lower volumes.

Craniofacial Parameters Cannot Predict Difficulty for Laryng Visualization in Children 1–4 Years Old

Airway assesment is an important measure to minimize airway complication, both in adults and children. Cormack-Lehane grading system is most widely used as guideline in predicting difficulty for larynx visualization in adults. However, not much had been found regarding guidelines for children. This study was conducted to find the association between craniofacial parameters and Cormack-Lehane (C-L) Score in children. This study is an analytic-descriptive study conducted to find the most significant craniofacial parameters (lower lip mental, tragus – lip distance, mental angle, mentohioid, and angulus distance) towards difficulty of larynx visualization in children aged 1–4 years old who had general anesthesia in Cipto Mangunkusumo hospital. The sample was obtained using the consecutive sampling method. Based on the inclusion criteria, we have collected 295 patients with the consent from the parents. Difficulty in laryngoscopy (Cormack-Lehane III and IV) was found in 8.1% patients. There was no significant association beteween five craniofacial parameters and Cormack-Lehane score with p values of each craniofacial parameters of 0.679, 0.173, 0.590, 0.251, and 0.884, respectively. The craniofacial parameter explained in this study cannot be used as a measurement tool for predicting of laryngoscopy difficulty in children age 1–4 years old.

Acute Hereditary Angioedema With Airway Compromise: Avoiding Airway Intervention With C1 Inhibitor Concentrate

Introduction: Hereditary angioedema (HAE) is an autosomal dominant disease caused by deficiency of the plasma protein C1 inhibitor (C1-INH). Patients classically present with recurrent localized subcutaneous or submucosal edema lasting for 2 to 5 days, severe abdominal pain, or acute airway obstruction which can be fatal. Case presentations: We highlight 2 patients with acute airway compromise secondary to HAE who were successfully treated with plasma-derived C1-INH concentrates. Conclusions: The timely administration of plasma-derived C1-INH concentrates for the acute treatment of HAE has been proven to be effective in both patients in aborting an airway complication. A high index of suspicion is required for the early diagnosis and treatment of this potentially fatal condition.