Early Tracheostomy Change in Neonates: Feasibility and Benefits

Objectives To compare outcomes of early and late tracheostomy change in neonatal patients. Early tracheostomy change (ETC) occurred 3 to 4 days after surgery, and late tracheostomy change (LTC) occurred 5 to 7 days after surgery. Study Design Retrospective cohort. Setting Tertiary neonatal/pediatric intensive care unit. Methods A retrospective review of patients who underwent tracheostomy from 2015 to 2019 was performed for infants <1 year old. Data were recorded regarding age at tracheostomy, days until tracheostomy tube change, postoperative complications, and total number of days on sedative or paralytic drugs. Results Forty-six patients were included: 18 (39%) were male, with a mean age of 140 days (SD, 78). Of these, 28 (61%) received ETC. There were no accidental decannulation events in either group. Wound breakdown developed in 4 (14%) patients with ETC versus 5 (28%) with LTC ( P = .3). Use of FlexTend tracheostomy tubes was associated with decreased odds of breakdown (odds ratio, 0.03; P = .01). Postoperatively, 46 (100%) patients received sedation, and 12 (26%) received paralysis. Mean duration of paralysis was 0.5 days in ETC as opposed to 2.2 days in LTC ( P = .02) on univariate analysis, but the significance was not maintained on multivariate regression ( P = .07). Conclusions ETC appears to be feasible in children less than a year of age. There does not appear to be an increased risk of accidental decannulation events or false passage tracts. Further investigations are warranted to investigate safety and possible impact on wound breakdown.

A Rare Case of Intrauterine Adhesion Caused by Intrauterine Fallopian Tube Incarceration

Hysteroscopy is widely used for the detection and treatment of intrauterine adhesion. Such technique, however, sometimes has limitations and even second damages. We report a rare case of severe intrauterine adhesion caused by uterine perforation with a fallopian tube incarceration. A 24-year-old woman underwent severe intrauterine adhesion and secondary infertility caused by fallopian tube incaceration into the uterine cavity after postpartum curettage. First hysteroscopy created a false passage through the previous uterine perforation, entered into the cavity of incarcerated fallopian tube, and led to iatrogenic hydrosalpinx. Secondary hysteroscopy combined with laparoscopy revealed a connection between the right tubal lumen and the uterine cavity by the false passage, released the adhesion, and reconstructed the uterine cavity. Early recognition of uterine perforation or tissue incarcerarion is significant in preventing further damage.

Anesthetic Management for Emergent Repair of Tracheoinnominate Fistula

We present a case of a 30-year-old female, who had tracheostomy revision complicated by false passage into the subcutaneous space and pneumothorax. Six days later, she developed massive bleeding from the mouth, nose, and tracheostomy site. Approximately 2 liters of blood was lost. With high suspicion for tracheo-innominate fistula, she was emergently brought to the operating room for fistula repair. Her anesthetic management was initially focused on maintaining spontaneous ventilation with inhalation agents until surgical exposure was adequate. An endotracheal tube was then placed under guidance of a video-laryngoscope. The tracheostomy tube was then removed over a Cook catheter to maintain secure passage in case of airway collapse. The oral endotracheal tube was then inserted distal to the arterial and tracheal defect. The patient’s bleeding was stopped, the fistula was repaired, and she was transferred back to the intensive care unit, but she died several days later due to multi-organ failure.

Tracheostomy in paediatric patients

<p class="abstract"><strong>Background:</strong> The objective of the study was to evaluate paediatric tracheostomies in the Department of ENT, GMC.</p><p class="abstract"><strong>Methods:</strong> The present prospective study was performed in the Department of ENT, GMC Jammu from January 2018 to 2020 on 20 paediatric patients (&lt;17 years of age). All children were evaluated with respect to age, indication of tracheostomy, complications (intra-operative and post-operative) and mortality. </p><p class="abstract"><strong>Results:</strong> The most common indication for tracheostomy was prolonged intubation (85%). Intraoperative complication in the form of creation of false passage was seen in 1 patient (5%). The most common early post-operative complication was tube obstruction (20%). Late complication in the form of stomal granulation was seen in 2 patients (10%).</p><p class="abstract"><strong>Conclusions:</strong> Over the years, more specific indications for tracheostomy are followed and better results are observed. Paediatric tracheostomy at our institute was associated with less procedure related morbidity and mortality.</p>

Combined direct visual and imaging guided percutaneous renal access using on shot tract dilation, a case series of novel methods of tract dilatation

Background: Percutaneous nephrolithotomy , (PCNL) is a common urological procedure for dilatation of access during one shot PNL. Methods : Our research is over twenty one cases of one shot visually guided tract dilation PCNL who referred to Sina Hospital between 2017,2018. They all underwent surgery using a specific 28 F dilatators with a customized central lumen which accepts a 4.5 F semi rigid ureteroscope to visually confirm the puncture of target calyx and passing a guide wire. This instrument complex was passed as a one shot dilator after withdrawal of the puncture needle. Results: The mean duration time form insertion of a needle into target calyx until securing a guide –wire inside the collecting system (pelvis, ureter) and the mean time form needle withdrawal to successful dilation and sheath placement were 95 and 252 seconds respectively. There were no intraoperative or postoperative complications a result of this technique. There was no false passage or failed accesses .Total fluoroscopy time for percutaneous access was reduced considerably. Conclusions: Use of modified ureteroscope kit during PNL, for visually confirmed Percutaneous nephrolithotomy , (PCNL) is feasible especially on complex calycealstones or pelvicalyceal Anatomies occasions.