A retrospective case study of laryngeal edema causing airway obstruction immediately post COVID-19 vaccination

<p><strong>Background:</strong> Laryngeal edema is defined as abnormal accumulation of fluid and swelling in the tissues of the larynx commonly associated with laryngeal injuries and allergic causes. The objective of this study is for the prompt recognition and management of laryngeal edema caused by an anaphylaxis reaction after receiving the COVID-19 vaccination from Pfizer-BioNTech, which is extremely important in view of its high morbidity and mortality rate.</p><p><strong>Methods:</strong> A retrospective case reviews was conducted for all health care workers in Sabah who were administered COVID-19 vaccination from Pfizer-BioNTech from February 2021-April 2021.</p><p><strong>Results:</strong> The mean age of study population in present study was found to be 33 years. Total of 42 patients were admitted during the period of 6 weeks out of 5000 health care workers who were vaccinated. Females constituted 64.3% of the study population while males constituted 35.7%. The clinical signs of laryngeal edema were dysphagia; the sensation of a lump in the throat; a feeling of tightness in the throat; voice changes, including hoarseness and roughness; and dyspnea within the period of 3 to 5 minutes post Pfizer COVID-19 vaccination. All patients received appropriate management using standard guidelines.</p><p><strong>Conclusions:</strong> The administration of the COVID-19 vaccination from Pfizer-BioNTech is life-threatening, however, its identification may aid in prompt emergency management in the future. Referral to an otorhinolaryngologist is necessary for patients who experience immediate or severe reactions.</p>

Removal of a bullet lying between carotid arteries, following a gunshot injury

Gunshot injuries can be very threatening to the patient's life. A bullet in the neck area after a gunshot usually causes tissue damage and bleeding because of the presence of vital structures in this region. We present the case of a young man that arrived emergently to our hospital because of gunshot injury in the right neck area and the right shoulder. He was hemodynamically stable, with no laryngeal edema or hematoma. The cervical radiography showed a foreign body lying on the right side of the spine, in front of the third cervical vertebra. The CT scanning revealed a metallic foreign body, lying between the internal carotid artery and the external carotid artery, without causing bleeding in the surrounding tissues. A bullet was also found in the right shoulder area. A barium esophagography showed no contrast agent escape. An emergency operation was performed, under general anesthesia. The metallic bullet was found under an enlarged submandibular lymph node and was removed. The bullet removal caused vessel intraoperative bleeding, that was repaired satisfactory. No postoperative complications were noticed and patient was discharged home.

Asphyxia and fight against it with strumectomy

One of the serious complications of strumectomy is asphyxiation. It can occur both in patients with Graves' disease and in simple goiter, either reflexively, or as a result of the onset of laryngeal edema.

Difficult Airway Management in Pediatric with a Large Cystic Hygroma Colli Undergoing One-Stage Excision Surgery

Background: A large cystic hygroma colli is a complicating factor in airway management in pediatric. Proper preparation, planning, and anticipation can reduce the risk of complications, morbidity, and mortality during difficult airway management. The fundamental principle of difficult airway management is to maintain adequate oxygenation and avoid hypoxemia by maintaining spontaneous ventilation. Case: A 22-month-old girl, weighing 9 kg, diagnosed with a large cystic hygroma colli who underwent single-stage excision surgery. Cystic hygroma was experienced since birth and with age, the cysts enlarge to a size of 25 x 17 x 12 cm which extends towards the face and shoulders. The patient did not experience stridor and symptoms of airway obstruction. The chest x-ray reveals no expansion of the cyst into the chest cavity and showed minimal tracheal deviation to the right. The difficult airway management was accomplished while maintaining the patient's spontaneous breathing. Sedation and analgesia obtained with intravenous administration of dexmedetomidine, ketamine, and nebulized lidocaine. A video laryngoscope is used to facilitate intubation. Awake extubation was performed after confirming that there was no risk of complications of laryngeal edema, laryngeal nerve injury, and tracheomalacia using a cuff-leak test. Conclusion: Maintaining spontaneous breathing, optimal levels of sedation and analgesia by administering dexmedetomidine, ketamine, and nebulizing lidocaine, and the use of a video laryngoscope can provide successful management of difficult airways due to a large cystic hygroma colli in pediatric patients.

Related Adverse Events after Immunotherapy in Patient with NK/T-Cell Lymphoma: a Case Report

A 29-year-old male with pathologically confirmed extranodal NK/T cell lymphoma of the tonsil, nasal type was admitted to Xinhua hospital affiliated to Shanghai Jiao Tong University School of Medicine. The patient was provided with several cycles of anti-PD-1 immunotherapy and obtained a Complete Response (CR) outcome. Despite the response, the patient also suffered from severe adverse effects, including a worsening pulmonary inflammation and severe laryngeal edema. A tracheotomy was performed to remove the white pseudo-membrane of laryngeal. via pathological analysis, necrosis of granuloma lymphoid cells and rhabdomous granuloma was found in this removed section. Meantime, a large amount of Candida nivaria, Klebsiella pneumoniae, and carbapenem-resistant Enterobacter was present in the patient’s sputum culture. The level of inflammatory cytokines (e.g., TNF-a, IL-1, IL-6, IL-17 and IFN-γ,) also increased significantly, indicating immune-related adverse events. Subsequently, the doctors adjusted immunotherapy to single-agent chemotherapy with additional anti-fungal and anti-bacterial infection treatment. The infection was well under control after these adjustments. 18F-FDG PET/ CT recorded the series of changes in the course of the patient from the start of immunotherapy.

Hereditary angioedema

A 14-year-old African American female presented to the emergency department with spontaneous, sudden-onset lip swelling for 1 h. On examination, there was significant water-bag edema of the upper lip extending to the philtrum and premaxilla. Nasopharyngeal laryngoscopy revealed a patent airway without edema. She was initiated on intravenous dexamethasone, famotidine, and diphenhydramine, after which her edema improved but did not resolve. She was subsequently transferred to a local pediatric hospital and upon further testing she was found to have a C1 esterase inhibitor de novo gene mutation. Angioedema causes localized, non-pitting edema of the dermis, subcutaneous and submucosal tissue, and often manifests in the lips, face, mouth, and throat. Signs of laryngeal involvement include change in voice, stridor, dysphagia, and dyspnea. When laryngeal edema is present, it may necessitate definitive airway management and patients should be monitored in the intensive care unit.

Sudden unexpected death due to hereditary angioedema — A case report

Angioedema related to deficiency of the C1- esterase inhibitor protein (C1-inh) is characterized by lack of response to therapies, which include antihistamines, steroids and epinephrine. In case of laryngeal edema, mortality rate is an estimated mammoth 30 percent. The first case of such acquired form of angioedema related to the deficiency in C1- esterase inhibitor was published in 1972. In the present case, we entail details of one such case.,

Rapid-flow expulsion maneuver in subglottic secretion clearance to prevent ventilator-associated pneumonia: a randomized controlled study

Background Following endotracheal intubation, clearing secretions above the endotracheal tube cuff decreases the incidence of ventilator-associated pneumonia (VAP); therefore, subglottic secretion drainage (SSD) is widely advocated. Our group developed a novel technique to remove the subglottic secretions, the rapid-flow expulsion maneuver (RFEM). The objective of this study was to explore the effectiveness and safety of RFEM compared with SSD. Methods This study was a single-center, prospective, randomized and controlled trial, conducted at Respiratory Intensive Care Unit (ICU) of Beijing Chao-Yang Hospital, a university-affiliated tertiary hospital. The primary outcome was the incidence of VAP, assessed for non-inferiority. Results Patients with an endotracheal tube allowing drainage of subglottic secretions (n = 241) were randomly assigned to either the RFEM group (n = 120) or SSD group (n = 121). Eleven patients (9.17%) in the RFEM group and 13 (10.74%) in the SSD group developed VAP (difference, − 1.59; 95% confidence interval [CI] [− 9.20 6.03]), as the upper limit of 95% CI was not greater than the pre-defined non-inferiority limit (10%), RFEM was declared non-inferior to SSD. There were no statistically significant differences in the duration of mechanical ventilation, ICU mortality, or ICU length of stay and costs between groups. In terms of safety, no accidental extubation or maneuver-related barotrauma occurred in the RFEM group. The incidence of post-extubation laryngeal edema and reintubation was similar in both groups. Conclusions RFEM is effective and safe, with non-inferiority compared to SSD in terms of the incidence of VAP. RFEM could be an alternative method in first-line treatment of respiratory ICU patients. Trial registration This study has been registered on ClinicalTrials.gov (Registration Number: NCT02032849, https://clinicaltrials.gov/ct2/show/NCT02032849); registered on January 2014

Red meat causing delayed anaphylactic airway edema: a case report

<p class="abstract">The goals of emergency management of angioedema include prevention of spontaneous eruption, maintaining and securing the airway and to stop the progression of the disease. Laryngeal edema is one of the life-threatening complications of angioedema that can be managed by endotracheal intubation or emergency tracheostomy or cricothyrotomy. Recently, delayed onset food induced anaphylactic reactions are being recognised widely due to better clinical knowledge and technology that can substantiate the diagnosis. The classical finding of anaphylaxis to only proteins have been disproved and delayed onset food allergy (i.e.) 3-6 hours after ingestion of food has been attributed to specific carbohydrate moieties in glycolipids and glycoproteins such as Galactose-α-1,3-galactose found in red meat (beef, pork and lamb). Even though it is seen rarely in the Indian population, it should be a part of the diagnostic algorithm in order to prevent fatal complications. Hereby reporting 39 years old male with undiagnosed red meat allergy presented with features of foreign body sensation throat and laryngeal oedema and managed conservatively with steroids and nebulisation.</p>