A rare case of acquired tracheo-esophageal fistula in adult

Acquired trachea-esophageal fistula (TEF) is a rare condition caused by cuffed tracheal tube, surgical trauma and blunt injuries. Surgical approach for the treatment is successful in surgical units with specialized TEF surgery. Herein, we presented such a rare case of post intubation acquired TEF in a 23 year old female patient who presented with cough and regurgitation of food 7 days after extubation. Patient had history of organophosphate poison ingestion after which she was intubated in emergency room and kept on mechanical ventilation for 11 days. Upper gastrointestinal endoscopy, fibre optic bronchoscopy and computed tomography scan of neck and chest revealed the presence of TEF, 2.5 cm below glottis. Patient was managed with elective single step surgical approach after which patient recovered well. Fistula resection with crico-tracheal anastomosis with primary closure of esophageal defect and suture line buttressed using strap muscle flap cover was done.

Principles of Anesthesia and Airway Management in Head and Neck Surgery

This topic aims to discuss key aspects of anesthetic and airway management for head and neck surgery. Airway management is a central part of patient care and management in Head and Neck Surgery. Common challenges in Head and Neck surgery are shared airway, distorted airway anatomy due to existing pathology; risk of airway obstruction, disconnection or loss of airway intra-operatively; risk of soiling of the airway due to bleeding and surgical debris; and the potential for airway compromise post-operatively. The option for airway management technique is influenced by patient’s factors, anesthetic needs, and surgical requirements. Intubation technique necessitating either a small or large cuffed tracheal tube with a throat pack provides the highest level of airway protection Non-intubation or open airway techniques involve mask ventilation, apneic techniques, and insufflation techniques, or the use of a laryngeal mask airway. Lastly, jet ventilation techniques may be conducted via a supraglottic, subglottic or transtracheal routes. It is essential to have clear airway management plans including rescue airway strategies that should be communicated with the surgeons and patients at the earliest opportunity.

Preliminary investigation into the ventilatory effects of midazolam in isoflurane-anaesthetised goats

The ventilatory effects of intravenous midazolam (MDZ) were evaluated in isoflurane- anaesthetised goats. Eight female goats aged 2–3 years were fasted from food and water for 12 h. Anaesthesia was then induced using a face mask with isoflurane in oxygen, whilst the trachea was intubated with a cuffed tracheal tube and anaesthesia maintained with isoflurane at 1.5% end-tidal concentration. Ventilation was spontaneous. The goats were treated with either a saline placebo (PLC) or MDZ intravenously at 0.2 mg/kg. Analysis of variance for repeated measures was used for the analysis of data. Significance was taken at the 0.05 level. Differences between treatments were not statistically significant (p > 0.05) for tidal volume, ventilation rate, tidal volume/kg (VT/kg) and end-tidal carbon dioxide partial pressure. Within treatments, VT and VT/kg differed 5 min after MDZ administration; this was statistically significant (p < 0.05). The occurrence of apnoea in the MDZ-treated goats was statistically significant (p = 0.04) compared with the PLC treated goats. Intravenous MDZ at 0.2 mg/kg administered to isoflurane-anaesthetised goats may result in transient apnoea and a mild decrease in VT and VT/kg.