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1.
Quintessence Int ; 52(1): 66-71, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-32954387

RESUMO

Implant dentistry is considered to be a safe and routine surgical procedure. However, cases of life-threatening hematoma of the floor of the mouth resulting in airway obstruction were previously reported as a complication of implant placement in the anterior mandible. Massive bleeding in this anatomical site may be caused by perforating the lingual cortex and/or damaging the lingual perimandibular vessels. In the long term, dental implants can fail, mainly due to peri-implantitis, and must be removed. Explantation procedure may occasionally become a complex challenge, with a risk for various complications.
Case report: This report presents the first case of life-threatening hematoma of the floor of the mouth, as a complication secondary to a failed attempt of dental implant removal at the anterior mandible. The proximity of the implant to the lingual vascular canal might have served as a cause for vascular damage during explantation.
Conclusions: Implant removal complications are scarcely described in the literature. Nonetheless, damaging blood vessels during explantation should not be underestimated. Computed tomography (CT) may be of value not only in preoperative implant planning but also before implant removal in jeopardized anatomical zones such as the anterior mandible. Lingual vascular canals should be looked for on computed tomography scans.

.


Assuntos
Obstrução das Vias Respiratórias , Implantes Dentários , Peri-Implantite , Implantação Dentária Endo-Óssea/efeitos adversos , Implantes Dentários/efeitos adversos , Hematoma/diagnóstico por imagem , Hematoma/etiologia , Humanos , Mandíbula/diagnóstico por imagem , Mandíbula/cirurgia , Soalho Bucal/diagnóstico por imagem
2.
Laryngoscope ; 131(2): 417-422, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-32652622

RESUMO

OBJECTIVES: To study a case series of preterm and extremely preterm infants, comparing their decannulation and survival rates after tracheostomy. METHODS: We performed a single-institution longitudinal study of preterm infants with a tracheostomy. Infants were categorized as premature (born > 28 weeks and < 37 weeks) and extremely premature (born ≤ 28 weeks). Decannulation and survival rates were determined using the Kaplan-Meier method. Neurocognitive quality of life (QOL) was reported as normal, mild/moderately, and severely impaired. Statistical significance was set at P < .05. RESULTS: This study included 240 patients. Of those, 111 were premature and 129 were extremely preterm. The median age (interquartile range) at tracheostomy was 4.8 months (0.4). Premature infants were more likely than extremely preterm to have airway obstruction (54% vs. 32%, P < .001); whereas extremely preterm infants were more likely to have bronchopulmonary dysplasia (68% vs. 15%, P < .001) and to be ventilation-dependent (68% vs. 54%, P < .001). The 5-year decannulation rate for premature infants was 46% and for extremely preterm was 64%. The 5-year survival rate post-tracheostomy for preterm was 79% and for extremely preterm was 73%. The log-rank test of equality showed that decannulation and survival were similar (P > .05) for both groups, even after controlling for potentially confounding factors like race, age, gender, birth weight, and age at tracheostomy. For neurocognitive QOL, 47% of patients survived with severely impaired QOL after tracheostomy. Preterm had 56% with severely impaired QOL and extremely preterm had 40% with severely impaired QOL (P = .03). CONCLUSION: This study demonstrated that the time to decannulation and the likelihood of survival did not vary among premature and extremely premature infants even when controlling for other confounding variables. LEVEL OF EVIDENCE: 3b Laryngoscope, 131:417-422, 2021.


Assuntos
Obstrução das Vias Respiratórias/cirurgia , Displasia Broncopulmonar/cirurgia , Doenças do Prematuro/cirurgia , Recém-Nascido Prematuro , Traqueostomia/mortalidade , Obstrução das Vias Respiratórias/mortalidade , Displasia Broncopulmonar/mortalidade , Feminino , Idade Gestacional , Humanos , Lactente Extremamente Prematuro , Recém-Nascido , Doenças do Prematuro/mortalidade , Estimativa de Kaplan-Meier , Estudos Longitudinais , Masculino , Qualidade de Vida , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do Tratamento
3.
Equine Vet J ; 53(1): 44-50, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32449540

RESUMO

BACKGROUND: Bits have often been incriminated as a cause of upper respiratory tract obstruction in horses; however, no scientific studies are available to confirm or refute these allegations. Clinical signs of dynamic laryngeal collapse associated with poll flexion (DLC) are induced when susceptible horses are ridden or driven into the bit. OBJECTIVE: To determine whether use of Dr Cook's™ Bitless Bridle, instead of a conventional snaffle bit bridle, would reduce the severity of DLC in affected horses measured objectively using inspiratory tracheal pressures. STUDY DESIGN: Intervention study using each horse as its own control in a block randomised order. METHODS: Nine Norwegian Swedish Coldblooded trotters previously diagnosed with DLC were exercised on two consecutive days using a standardised high-speed treadmill protocol with either a conventional bridle with a snaffle bit, or Dr Cook's™ Bitless Bridle. Head and neck position, rein tension, inspiratory tracheal pressure measurements, and laryngeal videoendoscopy recordings were obtained. A heart rate greater than 200 bpm, and similar degrees of poll flexion/head height, had to be achieved in both bridles for the individual horse's data to be included for comparison. RESULTS: Seven horses' data met the inclusion criteria. The change in mean inspiratory tracheal pressure between free and flexion phases in the bitless bridle (-15.2 ± 12.3 cmH2 O) was significantly greater (P < .001) than in the snaffle bit bridle (-9.8 ± 7.9 cmH2 O). Mean inspiratory pressure during the free phase was significantly (P < .001) more negative with the snaffle bit bridle (-32.3 ± 6.3 cmH2 O), vs the bitless bridle (-28.5 ± 6.9 cmH2 O). Mean pressures in flexion phase, snaffle bridle (-42.1 ± 10.8 cmH2 O), vs bitless bridle (-43.7 ± 15.6 cmH2 O) where not significantly different between bridles (P = .2). MAIN LIMITATION: Small sample size due to difficulty recruiting suitable clinical cases. CONCLUSIONS: This study could not provide any clear evidence that the effect of a snaffle bit in a horse's mouth influences the development or severity of DLC. Instead, head and neck angles induced by rein tension seem to be the key event in provoking DLC in susceptible horses.


Assuntos
Obstrução das Vias Respiratórias , Doenças dos Cavalos , Laringe , Obstrução das Vias Respiratórias/veterinária , Animais , Doenças dos Cavalos/prevenção & controle , Cavalos , Noruega , Suécia
4.
Medicine (Baltimore) ; 99(45): e23061, 2020 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-33157963

RESUMO

OBJECTIVE: This study is aims to compare the anesthetic safety of propofol combined with etomidate for painless gastroscopy. METHODS: Three hundred patients undergoing painless gastroscopy were randomly assigned to P, PE1, and PE2 groups. Patients were anesthetized with propofol (P group) or propofol combined with etomidate (volume ratio 1: 1, PE1 group; volume ratio 2: 1, PE2 group). The hemodynamics and adverse reactions were observed. The sleep quality satisfaction and nature of dreams were recorded. RESULTS: Compared with pre-anesthesia, the mean arterial pressure and heart rate of the 3 groups were significantly slower during the examination and at the end of the examination. PE1 group had a higher incidence of muscle spasm, body moving, choking, and deglutition. The incidence of hypoxemia and injection pain was higher in P group. P and PE2 group had higher sleep quality satisfaction and dream incidence after awaking. However, there was no difference in the nature of dreams among 3 groups. CONCLUSION: Our data indicate that the combination of 10 ml 1.0% propofol and 5 ml 0.2% etomidate for painless gastroscopy reduces adverse reactions while not affecting the patients respiratory function. Moreover, it is safe and effective, which is worthy of clinical application and promotion.


Assuntos
Anestésicos Intravenosos/efeitos adversos , Etomidato/efeitos adversos , Gastroscopia/métodos , Propofol/efeitos adversos , Adulto , Obstrução das Vias Respiratórias/induzido quimicamente , Anestésicos Intravenosos/administração & dosagem , Pressão Arterial/efeitos dos fármacos , Estudos de Casos e Controles , Quimioterapia Combinada , Etomidato/administração & dosagem , Feminino , Gastroscopia/tendências , Frequência Cardíaca/efeitos dos fármacos , Hemodinâmica/efeitos dos fármacos , Humanos , Hipóxia/induzido quimicamente , Incidência , Reação no Local da Injeção , Masculino , Pessoa de Meia-Idade , Mioclonia/induzido quimicamente , Propofol/administração & dosagem , Segurança , Espasmo/induzido quimicamente , Espasmo/epidemiologia , Resultado do Tratamento
5.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao ; 42(5): 706-710, 2020 Oct.
Artigo em Chinês | MEDLINE | ID: mdl-33131529

RESUMO

Bronchial mucoepidermoid carcinoma is a rare malignancy with varied disease courses.The symptoms are non-specific and mostly related to infection and airway obstruction secondary to the tumor.Bronchial mucoepidermoid carcinoma is difficult to be distinguished from pneumonia,tracheobronchitis,chronicobstructive pulmonary disease,asthma,and other respiratory diseases in its early stage.The age of onset is mostly between 20 and 55 years,and the disease is rarely seen in children.Confirmation of bronchial mucoepidermoid carcinoma depends on bronchoscopy and pathological biopsy,and this disease is often missed and misdiagnoed.


Assuntos
Neoplasias Brônquicas , Carcinoma Mucoepidermoide , Obstrução das Vias Respiratórias , Biópsia , Neoplasias Brônquicas/diagnóstico , Broncoscopia , Carcinoma Mucoepidermoide/diagnóstico , Criança , Erros de Diagnóstico , Humanos
7.
Probl Sotsialnoi Gig Zdravookhranenniiai Istor Med ; 28(Special Issue): 1202-1207, 2020 Oct.
Artigo em Russo | MEDLINE | ID: mdl-33219781

RESUMO

More and more often, medical workers have to provide assistance to patients with HIV infection with acute disorders of vital functions who require intensive care and resuscitation. The main task of clinicians is to quickly stop the symptoms of secondary diseases that have led to the complications (specific and nonspecific) so that the patient can start or continue antiviral therapy. The aim of this work was to present the first experience of successfully treatment of a patient with progressive HIV infection using stenting of the main bronchi with their critical tumor stenosis in complex treatment. Conducting temporary endoscopic recanalization of the lumen of the large airways made it possible to avoid transferring the patient to artificial ventilation of the lungs, to carry out the necessary complex of diagnostic and therapeutic procedures, to restore ventilation and aeration of the lungs, which led to an increase in blood oxygenation and some improvement in the patient's general well-being.


Assuntos
Obstrução das Vias Respiratórias , Infecções por HIV , Obstrução das Vias Respiratórias/etiologia , Obstrução das Vias Respiratórias/terapia , Algoritmos , Humanos
10.
Clin Exp Allergy ; 50(12): 1287-1293, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33034142

RESUMO

Prior to the COVID-19 pandemic, laryngoscopy was the mandatory gold standard for the accurate assessment and diagnosis of inducible laryngeal obstruction. However, upper airway endoscopy is considered an aerosol-generating procedure in professional guidelines, meaning routine procedures are highly challenging and the availability of laryngoscopy is reduced. In response, we have convened a multidisciplinary panel with broad experience in managing this disease and agreed a recommended strategy for presumptive diagnosis in patients who cannot have laryngoscopy performed due to pandemic restrictions. To maintain clinical standards whilst ensuring patient safety, we discuss the importance of triage, information gathering, symptom assessment and early review of response to treatment. The consensus recommendations will also be potentially relevant to other future situations where access to laryngoscopy is restricted, although we emphasize that this investigation remains the gold standard.


Assuntos
Obstrução das Vias Respiratórias/diagnóstico , Procedimentos Clínicos , Doenças da Laringe/diagnóstico , Consenso , Humanos , Reino Unido
11.
Arch. argent. pediatr ; 118(5): e491-e494, oct 2020. ilus
Artigo em Espanhol | LILACS, BINACIS | ID: biblio-1122539

RESUMO

Los pólipos pilosos nasofaríngeos son tumores benignos poco frecuentes. Se presenta el caso de esta patología en una paciente recién nacida, quien presentó cianosis y dificultad respiratoria por obstrucción de la vía aérea superior, durante las primeras 24 horas de vida. La paciente requirió maniobras de reanimación e intubación endotraqueal. Estudios diagnósticos confirmaron la presencia de una masa en la pared lateral de la faringe. Se realizó la extirpación quirúrgica exitosa con evolución satisfactoria de la paciente


Nasopharyngeal hairy polyps are rare benign tumors. We present a newborn case with a hairy polyp mass causing cyanosis and respiratory distress due to obstruction of the upper airway during the first 24 hours of life. The patient required resuscitation and endotracheal intubation. Diagnostic studies confirmed the presence of a mass in the lateral pharyngeal wall. Surgical treatment and removal of the mass was performed with satisfactory evolution of the patient


Assuntos
Humanos , Feminino , Recém-Nascido , Pólipos Nasais/diagnóstico por imagem , Ressuscitação , Pólipos Nasais/cirurgia , Doenças Nasofaríngeas , Cianose , Obstrução das Vias Respiratórias , Intubação Intratraqueal , Neoplasias
12.
Sci Rep ; 10(1): 16156, 2020 09 30.
Artigo em Inglês | MEDLINE | ID: mdl-32999366

RESUMO

The purpose of this study is to determine whether the brachycephalic obstructive airway syndrome (BOAS) is correlated to alterations in liver and spleen elasticity. Forty-eight brachycephalic and 22 mesocephalic dogs were submitted to a BOAS functional assessment, laboratory tests, abdominal ultrasound and liver and spleen Acoustic Radiation Force Impulse (ARFI) elastography. Dogs clinically affected by BOAS had higher values of liver stiffness (p < 0.001) than healthy dogs: medial lobes (1.57 ± 0.37 m/s), left and right lateral lobes (1.54 ± 0.50 m/s, 1.23 ± 0.28 m/s, respectively) and caudate lobe (1.28 ± 0.42 m/s). Compared to the mesocephalic group, the brachycephalic group (BOAS clinically affected and unaffected dogs) had higher spleen (2.51 ± 0.45 m/s; p < 0.001) and liver stiffness (p < 0.001): medial lobes (1.53 ± 0.37 m/s), left and right lateral lobes (1.47 ± 0.47 m/s, 1.20 ± 0.30 m/s, respectively) and caudate lobe (1.23 ± 0.40 m/s). Principal component analysis explained 70% of the variances composed by liver stiffness increase, erythrocytes and alanine aminotransferase reduction. Brachycephalic dogs had higher spleen and liver stiffness and a subacute inflammatory state, which represent another BOAS systemic effect. Consequently, these dogs can be at higher risk of hepatic disorders compared with mesocephalic dogs, similarly to humans affected by sleep apnea syndrome.


Assuntos
Obstrução das Vias Respiratórias/veterinária , Craniossinostoses/veterinária , Doenças do Cão/diagnóstico por imagem , Fígado/diagnóstico por imagem , Baço/diagnóstico por imagem , Obstrução das Vias Respiratórias/sangue , Obstrução das Vias Respiratórias/diagnóstico por imagem , Obstrução das Vias Respiratórias/etiologia , Alanina Transaminase/sangue , Animais , Estudos de Casos e Controles , Craniossinostoses/sangue , Craniossinostoses/complicações , Craniossinostoses/diagnóstico por imagem , Doenças do Cão/sangue , Cães , Técnicas de Imagem por Elasticidade , Estudos Prospectivos
13.
Acta otorrinolaringol. esp ; 71(5): 309-315, sept.-oct. 2020.
Artigo em Espanhol | IBECS | ID: ibc-195218

RESUMO

Este documento pretende ser una guía para los otorrinolaringólogos españoles que deseen realizar endoscopia del sueño inducido por fármacos, normalmente conocida como DISE de sus siglas en inglés drug-induced sleep endoscopy. Las indicaciones, el método de sedación y la valoración de los hallazgos se comentarán para tratar de unificar metodología y criterios


This document is intended as a guide for Spanish ENT specialists who want to perform drug-induced sleep endoscopy. Indications, sedation method and important findings are discussed to unify criteria and methodology


Assuntos
Humanos , Criança , Guias de Prática Clínica como Assunto , Endoscopia/métodos , Sedação Profunda/métodos , Apneia Obstrutiva do Sono/diagnóstico , Obstrução das Vias Respiratórias/diagnóstico , Endoscopia/normas , Sedação Profunda/normas
15.
Thorax ; 75(11): 965-973, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32895315

RESUMO

INTRODUCTION: Although home non-invasive ventilation (NIV) is increasingly used to manage patients with chronic ventilatory failure, there are limited data on the long-term outcome of these patients. Our aim was to report on home NIV populations and the long-term outcome from two European centres. METHODS: Cohort analysis including all patients established on home NIV from two European centres between 2008 and 2014. RESULTS: Home NIV was initiated in 1746 patients to treat chronic ventilatory failure caused by (1) obesity hypoventilation syndrome±obstructive sleep apnoea (OHS±OSA) (29.5%); (2) neuromuscular disease (NMD) (22.7%); and (3) obstructive airway diseases (OAD) (19.1%). Overall cohort median survival following NIV initiation was 6.6 years. Median survival varied by underlying aetiology of respiratory failure: rapidly progressive NMD 1.1 years, OAD 2.7 years, OHS±OSA >7 years and slowly progressive NMD >7 years. Multivariate analysis demonstrated higher mortality in patients with rapidly progressive NMD (HR 4.78, 95% CI 3.38 to 6.75), COPD (HR 2.25, 95% CI 1.64 to 3.10), age >60 years at initiation of home NIV (HR 2.41, 95% CI 1.92 to 3.02) and NIV initiation following an acute admission (HR 1.38, 95% CI 1.13 to 1.68). Factors associated with lower mortality were NIV adherence >4 hours per day (HR 0.64, 95% CI 0.51 to 0.79), OSA (HR 0.51, 95% CI 0.31 to 0.84) and female gender (HR 0.79, 95% CI 0.65 to 0.96). CONCLUSION: The mortality rate following initiation of home NIV is high but varies significantly according to underlying aetiology of respiratory failure. In patients with chronic respiratory failure, initiation of home NIV following an acute admission and low levels of NIV adherence are poor prognostic features and may be amenable to intervention.


Assuntos
Obstrução das Vias Respiratórias/mortalidade , Serviços de Assistência Domiciliar , Hipoventilação/mortalidade , Doenças Neuromusculares/mortalidade , Ventilação não Invasiva , Apneia Obstrutiva do Sono/mortalidade , Obstrução das Vias Respiratórias/fisiopatologia , Feminino , França/epidemiologia , Humanos , Hipoventilação/fisiopatologia , Masculino , Pessoa de Meia-Idade , Doenças Neuromusculares/fisiopatologia , Estudos Prospectivos , Testes de Função Respiratória , Apneia Obstrutiva do Sono/fisiopatologia , Análise de Sobrevida , Reino Unido/epidemiologia
16.
N Z Med J ; 133(1520): 120-124, 2020 08 21.
Artigo em Inglês | MEDLINE | ID: mdl-32994602

RESUMO

Spontaneous bleeding in the head and neck region is exceedingly rare, particularly in the absence of trauma or an underlying disorder. We describe a case of an atraumatic lingual haematoma in an 88-year-old male presenting with threatened airway obstruction. The only risk factor our patient had was Aspirin use. Our patient was able to be managed conservatively with observation in the hospital's high dependency unit (HDU) and intravenous steroid (Dexamethasone) and antibiotic (Amoxicillin + Clavulanic acid) therapy. We discuss this case to highlight the importance of recognising an impending airway emergency in the setting of deep space bleeding or swelling.


Assuntos
Obstrução das Vias Respiratórias/etiologia , Hematoma/complicações , Língua/patologia , Administração Intravenosa , Idoso de 80 Anos ou mais , Combinação Amoxicilina e Clavulanato de Potássio/uso terapêutico , Antibacterianos/uso terapêutico , Anti-Inflamatórios/administração & dosagem , Anti-Inflamatórios/uso terapêutico , Dexametasona/administração & dosagem , Dexametasona/uso terapêutico , Quimioterapia Combinada/métodos , Hematoma/tratamento farmacológico , Humanos , Masculino , Língua/irrigação sanguínea , Resultado do Tratamento
17.
Zhonghua Jie He He Hu Xi Za Zhi ; 43(9): 784-790, 2020 Sep 12.
Artigo em Chinês | MEDLINE | ID: mdl-32894913

RESUMO

Objectives: To evaluate the efficacy of interventional bronchoscopy for the treatment of scarring airway stenosis and to analyze the influencing factors related to the success rate. Methods: Between January 2013 to December 2016, 301 patients with scarring airway stenosis treated by interventional bronchoscopy in 18 tertiary hospitals were reviewed retrospectively. The methods of interventional bronchoscopy included electric knife cutting, laser cauterization, balloon dilation, cryotherapy, local drug usage and/or stenting. Airway stenosis characteristics and patients' performance status at baseline and after interventional bronchoscopy were recorded. The interval days between the first two interventional bronchoscopy treatment (maintained patency time) and the final treatment efficacy were recorded. Results: The clinical stability rate of interventional bronchoscopy for the treatment of scarring tracheal stenosis was 67.8% (204/301) . Stenosis sites (OR 1.548; 95% CI: 1.038-2.307, P=0.032) , dyspnea index (OR 2.140; 95% CI: 1.604-2.855, P<0.001) , and interventional method (OR 0.458; 95% CI: 0.267-0.787, P=0.005) were independent predictors associated with the efficacy of interventional bronchoscopy treatment. Stenosis sites (OR 1.508; 95% CI: 1.273-1.787, P<0.001) , stenosis grade (OR 1.581; 95% CI: 1.029-2.067, P=0.001) , anesthesia method (OR 1.581; 95% CI: 1.029-2.067, P<0.001) , and local drug usage (OR 1.304; 95% CI: 1.135-1.497, P<0.001) were independent predictors associated with the maintained patency time after first interventional bronchoscopy treatment. Conclusion: Interventional bronchoscopy is a useful treatment method for scarring airway stenosis. Enough attention should be paid to influencing factors in order to improve treatment efficacy during the treatment process.


Assuntos
Obstrução das Vias Respiratórias , Broncoscopia , China , Cicatriz , Constrição Patológica , Humanos , Estudos Retrospectivos , Resultado do Tratamento
18.
Rev Med Liege ; 75(9): 598-603, 2020 Sep.
Artigo em Francês | MEDLINE | ID: mdl-32909412

RESUMO

Penetration syndrome is common and dangerous. In front of any suspicion of inhalation of foreign bodies, an endoscopy is necessary and the anesthesia that accompanies this gesture is a real challenge given the complexity of the management and exposure of the airways. The anaesthesiologist is confronted with unsafe, partially obstructed airways and will have to share his workspace with surgeon colleagues while ensuring efficient ventilation and oxygenation. This is a real teamwork requiring close and permanent collaboration with the surgical team. Jet ventilation is a technique that is particularly useful and adapted to this type of operation. It offers undeniable advantages, such as continuity of the gesture, better visualization of the laryngeal structures and a clear operating field. Its use is constantly increasing. It is nevertheless a technique that requires regular training and is reserved for experienced anaesthesiologists in this field. This article covers the main principles of anaesthetic management of the penetration syndrome, highlighting the advantages of jet ventilation.


Assuntos
Obstrução das Vias Respiratórias , Anestesia , Manuseio das Vias Aéreas , Humanos , Respiração Artificial , Síndrome
19.
PLoS One ; 15(9): e0239223, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32941546

RESUMO

Brachycephalic airway syndrome (BAS) is a well-established cause of respiratory distress in dogs. BAS without surgical correction results in eventual laryngeal collapse. Arytenoid lateralization has been used to treat severe laryngeal collapse with some highly variable results. Chondromalacia and decreased stiffness of the arytenoid cartilage has been postulated a source of failure after arytenoid lateralization but no report of the histological characteristics and mechanical strength of arytenoid cartilage in brachycephalic dogs has been reported. Here we report histological and mechanical features in arytenoid cartilage of brachycephalic dogs. We identified the arytenoid cartilage in brachycephalic dogs presented degenerative histological characteristics and decreased load to failure and stiffness compared to that in non-brachycephalic dogs. Together, these observations suggest that degenerative condition of arytenoid cartilage in brachycephalic dogs could contribute to chondromalacia and mechanical weakness of arytenoid cartilage and result in cause of failure after arytenoid lateralization.


Assuntos
Obstrução das Vias Respiratórias/patologia , Cartilagem Aritenoide/patologia , Doenças do Cão/patologia , Resistência à Tração , Obstrução das Vias Respiratórias/veterinária , Animais , Cartilagem Aritenoide/química , Cães , Projetos Piloto
20.
Medicine (Baltimore) ; 99(32): e21521, 2020 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-32769890

RESUMO

RATIONALE: The establishment of lung isolation is often particularly challenging for the anesthesiologist in patients with difficult airway. Usually, orotracheal intubation with double lumen tube is the commonly used technique for achieving 1 lung anesthesia. Whereas, in patients with limited mouth opening and restricted cervical mobility, this technique becomes extremely difficult and hazardous. We report a case in which bronchial blocker placement was succeeded via both nostrils in a difficult airway due to restricted mouth opening. PATIENT CONCERNS: A 50-year-old, non-smoking female with a painless mass in the left upper lobe. She had a 10-year history of ankylosing spondylitis and squamous cell carcinoma of the floor of the mouth after 5 operations 4 years previously. DIAGNOSES: Left upper lobe adenocarcinoma, ankylosing spondylitis and oral squamous cell carcinoma. INTERVENTIONS: To achieve 1 lung anesthesia, both nostrils were used for extraluminal bronchial blocker placement. OUTCOMES: Initially, oral intubation was selected for establishing a patent airway but failed. Then switched to nasal canal for insertion, after several attempts, a conventional nasal intubation tube (internal diameter 6.0 mm) was placed via 1 nostril under topical anesthesia, with the aid of a flexible fiberoptic bronchoscope, and a bronchial blocker was advanced to the desired position via the other nostril. LESSONS: In difficult airway with limited mouth opening and restricted cervical mobility, multidisciplinary experts participated discussion is a prerequisite for contemplating a scientific plan. Preoperative computed tomography scan and 3-dimensional computed tomography reconstruction would be helpful in detecting the narrowest part of airway conduit and determining a safe, reliable, and feasible airway program.


Assuntos
Adenocarcinoma de Pulmão/terapia , Obstrução das Vias Respiratórias/terapia , Intubação/métodos , Neoplasias Pulmonares/terapia , Nariz , Ventilação Monopulmonar/métodos , Adenocarcinoma de Pulmão/complicações , Obstrução das Vias Respiratórias/complicações , Carcinoma de Células Escamosas/complicações , Carcinoma de Células Escamosas/terapia , Feminino , Humanos , Neoplasias Pulmonares/complicações , Pessoa de Meia-Idade , Boca/patologia , Neoplasias Bucais/complicações , Neoplasias Bucais/terapia , Espondilite Anquilosante/complicações , Espondilite Anquilosante/terapia
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