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1.
Ann Otol Rhinol Laryngol ; 132(1): 110-114, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35156399

RESUMO

OBJECTIVE: To report a novel case of tracheal reconstruction using a serratus anterior-rib composite flap. METHODS: Case report and literature review. RESULTS: A 46-year-old male with a 4 cm anterior tracheal wall defect underwent reconstruction with a serratus anterior-rib composite flap. The patient experienced excellent results regarding phonation, swallowing, and cosmesis. CONCLUSION: The serratus anterior-rib composite flap appears to be a suitable candidate for tracheal reconstruction and merits further analysis in this context. The flap's intrinsic incorporation of a perfused rib segment allows for reliable reconstruction of the neotrachea and maintenance of proximal dynamic airway support.


Assuntos
Procedimentos Cirúrgicos Reconstrutivos , Retalhos Cirúrgicos , Masculino , Humanos , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Reconstrutivos/métodos , Traqueia/cirurgia , Tórax , Costelas
2.
Artigo em Inglês | MEDLINE | ID: mdl-36257570

RESUMO

Selenium deficiency can lead to multiple tissue and organ damage in the body and could coexist with chronic toxic exposures. Contamination from Bisphenol A (BPA) exposure can induce the occurrence of various injuries including pyroptosis. However, it is not clear whether selenium deficiency and BPA exposure affect tracheal tissue pyroptosis in chickens. To investigate whether selenium deficiency and BPA exposure induce chicken tracheal tissue pyroptosis via the NF-κB/NLRP3/Caspase-1 pathway and the effect of their combined exposure on tissue injury, we developed a model of relevant chicken tracheal injury. Sixty broilers were divided into four groups: the control group (C group), selenium-deficient group (SeD group), BPA-exposed group (BPA group) and combined exposure group (SeD + BPA group). The study examined the expression indicators of markers of pyroptosis (NLRP3&GSDMD), NF-κB pathway-related inflammatory factors (NF-κB, iNOS, TNF-α, COX-2), pyroptosis-related factors (ASC, Caspase-1, IL-1ß, IL-18), and some heat shock proteins and interleukins (HSP60, HSP90, IL-6, IL-17) in the samples. The results showed that the expression of the above indicators was significantly upregulated in the different treatment groups (P < 0.05). In addition, the expression levels of the above related indicators were more significantly up-regulated in the combined selenium-deficient and BPA-exposed group compared to the group in which they were individually exposed. It was concluded that selenium deficiency and BPA exposure induced tracheal tissue pyroptosis in chickens through NF-κB/NLRP3/Caspase-1 pathway, and BPA exposure exacerbated selenium deficiency-induced tracheal pyroptosis. The present study provides new ideas into studies related to the co-exposure of organismal micronutrient deficiency and chronic toxicants.


Assuntos
Piroptose , Selênio , Animais , NF-kappa B/metabolismo , Caspase 1/metabolismo , Caspase 1/farmacologia , Galinhas/metabolismo , Proteína 3 que Contém Domínio de Pirina da Família NLR/metabolismo , Selênio/farmacologia , Traqueia
3.
Ulus Travma Acil Cerrahi Derg ; 28(12): 1747-1753, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36453783

RESUMO

Mediastinal masses can compress the respiratory or cardiovascular system, especially when anteriorly located. Obtaining histological material for diagnosis poses a challenge due to the major risk of cardiorespiratory collapse following anesthetic procedure. Our case shows the utility of rescue with venovenous extracorporeal membrane oxygenation (VV-ECMO) after occurrence of such an event and demonstrates the feasibility of administering chemotherapy during VV-ECMO. A 4-year-old boy was referred to the pediatric oncology clinic of our hospital after a large mediastinal mass was observed on chest radiography ordered due to persistent cough. Computed tomography of the thorax revealed a 100×85 mm mass in the anterior mediastinum, surrounding the heart, and showed that there was compression to the trachea, bronchiole, and vascular structures. Percutaneous needle biopsy accompanied by ultrasonography was planned for diagnostic purposes. Low-dose ketamine and midazolam were administered for procedural sedation in the operating room. After the biopsy procedure, the patient developed sudden airway obstruction requiring intubation. Despite 100% oxygen support with a mechanical ventilator, pulse oximeter saturation remained below 80%. Chest X-ray revealed total collapse of the left lung, and the patient's oxygen saturation did not increase with selective left bronchial intubation. Bi-caval dual-lumen ECMO cannula was placed in the internal jugular vein and VV-ECMO was initiated, resulting in swift improvement in hypoxemia. The patients's anterior mediastinal mass shrank rapidly and left lung improved with chemotherapy. The patient remained on ECMO for a total of 9 days and was extubated 2 days after ECMO termination, followed by discharge to the pediatric oncology ward on the 20th day of pediatric intensive care unit stay. It is well known that large, anteriorly-located mediastinal masses carry a considerable risk of causing cardio-pulmonary collapse during procedures involving anesthesia. All life-saving options, including emergency ECMO, should be available before any planned invasive procedures in these patients.


Assuntos
Oxigenação por Membrana Extracorpórea , Neoplasias , Choque , Masculino , Humanos , Criança , Pré-Escolar , Tórax , Traqueia
4.
Zhonghua Yi Xue Za Zhi ; 102(44): 3487-3491, 2022 Nov 29.
Artigo em Chinês | MEDLINE | ID: mdl-36418245

RESUMO

Tracheobronchial fistula refers to a pathophysiological condition in which the trachea or bronchi forms abnormal connections with the adjacent cavities or organs such as pleural cavity, esophagus and stomach. It is also a challenging management condition. Tracheobronchial fistula can be caused by surgical and non-surgical issues. or can also be caused by tumor or non-tumor isuues. The most commonly characteristic clinical manifestations are "swallowing, drinking and eating related choking"; High-resolutionchest CT (HRCT), respiratory and digestive endoscopy and other auxiliary examinations are helpful to make a definite diagnosis. Clinical management includes the treatment of acute complications, fistula occlusion, and supportive treatment. In recent years, with the rapid development of endoscopic interventional techniques, most non-tumor tracheobronchial fistulas can be managed with minimally invasive procedures. In the future, the emerging 3D printing technology, tissue engineering, regenerative medicine and other technologies, will bring new hope to the treatment of tracheobronchial fistula.


Assuntos
Fístula , Humanos , Esôfago , Traqueia , Broncoscopia/métodos
5.
Medicine (Baltimore) ; 101(43): e31354, 2022 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-36316925

RESUMO

INTRODUCTION: Benign scarring central airway stenosis can be managed by high-pressure balloon dilatation, laser, surgery and stent implantation. The stenosis may have a high recurrence rate that necessitates repeated treatment. Pirfenidone (PFD) has anti-fibrosis effects and has been used in a variety of fibrosis diseases. Animal experiments suggested that PFD can prevent tracheal stenosis. PATIENT CONCERNS: Patients with scarring central airway stenosis usually have chest tightness, cough and dyspnea. DIAGNOSIS: Computed tomography scanning showed stenosis of the trachea and/or bronchus. Bronchoscopy revealed occlusion or stenosis of the trachea or bronchus. INTERVENTIONS: The use of PFD in combination with other interventional management was reported to treat 2 cases of tracheobronchial stenosis after injury in this study. In the combined use of PFD and interventional management, PFD could help to alleviate tracheobronchial stenosis, prolong the time interval of bronchoscopic interventional treatment, and reduce medical costs. OUTCOMES: The stenosis in the trachea and/or bronchus is relieved and the patients do not have any relevant symptoms.


Assuntos
Cicatriz , Tomografia Computadorizada por Raios X , Humanos , Constrição Patológica/diagnóstico , Cicatriz/patologia , Broncoscopia/métodos , Brônquios/patologia , Traqueia/diagnóstico por imagem , Stents
6.
BMC Anesthesiol ; 22(1): 333, 2022 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-36316640

RESUMO

BACKGROUND: Airway management of patients with direct airway trauma caused by penetrating neck injuries is always challenging. When a failed airway occurs and surgery access is difficult, it is crucial to find the optimal approach to save the life. We propose the concept "Cannot intubate, Cannot oxygenate, Difficult surgery access" to describe this emergency scenario. CASE PRESENTATION: We report a case of a 24-year-old woman who presented with partial tracheal rupture and pneumothorax caused by a knife stab injury to the neck. A "double setup" strategy, simultaneous preparation for orotracheal intubation and tracheotomy, was carried out before rapid sequence induction. A tracheotomy under local anesthesia or an awake intubation was not preferred in consideration that the patient had a high risk of being uncooperative owing to existing mental disease and potential smothering sensation during operation. During rapid sequence intubation, distal part of the tube penetrates the tear and creates a false lumen outside the trachea then a failed airway subsequently occurred. Rescue tracheotomy was successfully performed by an otolaryngology surgeon, with the help of limited ventilation using sequential bag-mask and laryngeal mask airway ventilation provided by an anesthesiologist, without severe sequelae. CONCLUSIONS: The endotracheal tube have a risk of penetrating the tear outside the trachea in patient with partial tracheal rupture during orotracheal intubation, and once it occurs, proceeding directly to an emergency invasive airway access with optimizing oxygenation throughout procedure might increase the chance of success in rescuing the airway.


Assuntos
Máscaras Laríngeas , Lesões do Pescoço , Doenças da Traqueia , Feminino , Humanos , Adulto Jovem , Adulto , Traqueia/diagnóstico por imagem , Traqueia/cirurgia , Traqueia/lesões , Ruptura/cirurgia , Intubação Intratraqueal/métodos , Manuseio das Vias Aéreas/métodos , Lesões do Pescoço/complicações , Lesões do Pescoço/cirurgia
7.
J Int Med Res ; 50(11): 3000605221133688, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36324254

RESUMO

Extracorporeal membrane oxygenation (ECMO) assists blood circulation and gas exchange via a heart-lung machine. ECMO is used mainly in intensive care units as bridging therapy until heart and respiratory failure can be addressed or until transplantation can be performed. ECMO is sometimes used during surgery under general anaesthesia, depending on the patient's underlying diseases and the nature of the operation. If the oxygen supply and carbon dioxide removal capacity are limited, venovenous (VV)-ECMO can be helpful. Here, we describe the use of VV-ECMO for surgical resection of an endotracheal mass through rigid bronchoscopy in a patient who developed decompensating dyspnoea due to central airway obstruction (CAO).


Assuntos
Obstrução das Vias Respiratórias , Oxigenação por Membrana Extracorpórea , Insuficiência Respiratória , Humanos , Obstrução das Vias Respiratórias/etiologia , Obstrução das Vias Respiratórias/cirurgia , Traqueia , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/terapia , Broncoscopia
8.
S Afr Fam Pract (2004) ; 64(1): e1-e7, 2022 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-36331206

RESUMO

Tracheal intubation in primary health care is a necessary skill and usually one that is necessary for appropriate emergency management of unstable patients. Primary care practitioners may not have an anaesthetist or critical care doctor available to help them in these emergencies and must manage these patients themselves. Often tracheal intubation may fail because of multiple possible factors and a different course of action may be needed to minimise the potential for harm to the patient. The primary care professional or family physician will have to manage this failed intubation. Primary health care facilities providing obstetric services must have guidelines and appropriate equipment for management of airway problems. This article will explore reasons for the failure of tracheal intubation and how this can be managed.


Assuntos
Intubação Intratraqueal , Traqueia , Gravidez , Feminino , Humanos , Anestesistas , Cuidados Críticos , Atenção Primária à Saúde
9.
Naturwissenschaften ; 109(6): 55, 2022 Nov 04.
Artigo em Inglês | MEDLINE | ID: mdl-36331664

RESUMO

All known species of the Triassic archosauromorph genus Tanystropheus are known to have had the longest neck in proportion to their torso. This feature is related to a series of ventilatory challenges since an increase in neck length also increases airway length and, therefore, the volume of stagnant air that does not reach the lungs, the dead space volume. Based on this challenge, the objective of the present study was to model the type of respiratory system of Tanystropheus able to meet its metabolic demands during the early Triassic period. The modeling was based on allometric relations for morphological and physiological ventilatory and metabolic variables, and to do so, the mean body mass of Tanystropheus was estimated based on three different methods. In addition, the tracheal airflow was also estimated based on the proportions of Tanystropheus elongated neck, the results of allometric modeling, and fundamental equations of fluid mechanics. The estimation of the body mass indicated that an animal of 3.6 m would possess a body mass of 50.6 ± 21.6 kg. Allometric modeling suggested that the respiratory system best suited to Tanystropheus' oxygen demands, especially during activity, would be a generic reptilian-like respiratory system composed of multicameral lungs. The best respiratory pattern to maintain adequate tracheal flow rates and effective pulmonary ventilation would be one ventilating the relatively narrower trachea at lower frequencies to deal with tracheal dead space volume.


Assuntos
Pulmão , Traqueia , Animais , Pulmão/fisiologia , Traqueia/fisiologia , Répteis
10.
Pan Afr Med J ; 42: 255, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36338560

RESUMO

Among multiple causes of tracheobronchial rent, most common is iatrogenic factor. Whenever there is surprise evidence of bronchial wall tear while doing lung surgery, tracheal tube extubation and postoperative management pose a challenge. We report a 16-year-old girl, weighing 27kg, a case of pulmonary Koch's who presented with hydropneumothorax on left side. She had a prolonged course on mechanical ventilation, was gradually weaned off and extubated in intensive care unit (ICU) with implantable cardioverter defibrillator (ICD) in-situ. However, chest X-ray continued to show loss of bronchovascular markings and high-resolution computed tomography (HRCT) thorax revealed multiple cavitatory lesions, hydropneumothorax from upper to lower lobe, ground glass opacities on left side and mediastinal shift towards right side. Hence, she was posted for left lung decortication. Decortication was done using one lung ventilation protocol with 28 Fr left sided double-lumen endobronchial tube (DLT). While checking for leaks before closure, it was noted that exhaled tidal volume was unacceptably low and a rent on left main bronchus of around 2x2 cm with scarred borders was detected. The rent was repaired with tissue patch suturing by the surgeons. After the procedure, DLT was exchanged with endotracheal tube (ETT) no 6. Patient was managed with elective ventilation post-operatively in ICU for 48 hours and extubated uneventfully. A vigilant monitoring of vital parameters and close communication with surgeons is important for detecting and managing any perioperative complication during lung surgery. Elective ventilation could play a significant role for healing a big rent in trachea-bronchial area.


Assuntos
Hidropneumotórax , Ventilação Monopulmonar , Feminino , Humanos , Adolescente , Brônquios/cirurgia , Ventilação Monopulmonar/métodos , Traqueia , Intubação Intratraqueal/métodos , Pulmão
11.
Bull Exp Biol Med ; 173(6): 790-793, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-36322314

RESUMO

A model of a chronic lung inflammation in SPF Sprague-Dawley rats was developed by repeated intratracheal administration of LPS in a dose of 0.4 mg/kg. On day 22 of the study, male rats treated with LPS have relative monocytopenia and reduced mean concentration of hemoglobin in the erythrocyte and the mean platelet volume in comparison with the control animals (saline). Intratracheal administration of LPS induced an inflammatory process in the lungs characterized by focal atelectasis, compensatory emphysematous expansion of subpleural pulmonary acini, focal mononuclear and neutrophilic perivascular and peribronchial infiltration, and minor focal mononuclear and neutrophilic infiltration of the alveolar walls. Against the background of LPS administration, germinal centers appeared in the lymphoid follicles of the white pulp of the spleen, and focal mononuclear infiltration of the tracheal mucosa and/or submucosa was observed in some animals.


Assuntos
Lipopolissacarídeos , Pneumonia , Ratos , Animais , Masculino , Lipopolissacarídeos/toxicidade , Ratos Sprague-Dawley , Pneumonia/induzido quimicamente , Pulmão , Traqueia
12.
Otolaryngol Clin North Am ; 55(6): 1253-1270, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36371139

RESUMO

Congenital tracheal stenosis is a rare but potentially life-threatening condition that is most commonly caused by complete tracheal rings. Slide tracheoplasty was initially introduced as a surgical treatment for congenital tracheal stenosis in 1989 and has significantly improved outcomes and overall survival rates for these patients. It has subsequently been adapted to treat other conditions such as laryngotracheal stenosis, tracheoesophageal fistula, and bronchial stenosis. This article reviews the history, the variety of applications, perioperative management, surgical techniques, potential complications, and new frontiers in slide tracheoplasty surgery.


Assuntos
Procedimentos Cirúrgicos Reconstrutivos , Estenose Traqueal , Humanos , Lactente , Constrição Patológica , Resultado do Tratamento , Estenose Traqueal/cirurgia , Traqueia/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Estudos Retrospectivos
13.
Clin Perinatol ; 49(4): 863-872, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36328604

RESUMO

Congenital diaphragmatic hernia is an anomaly that is often prenatally diagnosed and spans a wide spectrum of disease, with high morbidity and mortality associated with fetuses with severe defects. Congenital diaphragmatic hernia is thus an ideal target for fetal intervention. We review the literature on prenatal diagnosis, describe the history of fetal intervention for congenital diaphragmatic hernia, and discuss fetal endoscopic tracheal occlusion and the Tracheal Occlusion To Accelerate Lung growth trial results. Finally, we present preclinical studies for potential future directions.


Assuntos
Doenças Fetais , Terapias Fetais , Hérnias Diafragmáticas Congênitas , Gravidez , Feminino , Humanos , Hérnias Diafragmáticas Congênitas/diagnóstico por imagem , Hérnias Diafragmáticas Congênitas/cirurgia , Doenças Fetais/diagnóstico por imagem , Doenças Fetais/cirurgia , Traqueia , Feto , Ultrassonografia Pré-Natal , Pulmão/diagnóstico por imagem , Fetoscopia/métodos
14.
BMJ Case Rep ; 15(11)2022 Nov 04.
Artigo em Inglês | MEDLINE | ID: mdl-36332932

RESUMO

Spindle cell carcinoma is a subtype of sarcomatoid carcinoma, which has previously been described in various anatomical locations, though rarely in the trachea.We present the case of a woman in her 70s who presented with a sore throat and stridor. Fibreoptic nasendoscopy demonstrated a tracheal mass occupying 80% of the airway from the cricoid cartilage to the third tracheal ring, infiltrating the thyroid gland. Subsequent CT demonstrated pulmonary emboli and vertebral metastasis. Biopsy of the infiltrated thyroid confirmed the diagnosis of spindle cell carcinoma. The length of the tumour and metastasis at presentation made this surgically unresectable, and she was referred for a palliative stent but died after an acute deterioration.This pathology has been reported only five times previously in the literature, with management strategies varying greatly between patients. Primary tracheal tumours are difficult to manage as, due to their rarity, there are no clear guidelines.


Assuntos
Carcinoma , Sarcoma , Neoplasias de Tecidos Moles , Neoplasias da Glândula Tireoide , Neoplasias da Traqueia , Feminino , Humanos , Traqueia/diagnóstico por imagem , Traqueia/patologia , Neoplasias da Traqueia/diagnóstico por imagem , Neoplasias da Traqueia/cirurgia , Sarcoma/diagnóstico por imagem , Sarcoma/cirurgia , Carcinoma/patologia , Neoplasias de Tecidos Moles/patologia , Neoplasias da Glândula Tireoide/diagnóstico , Neoplasias da Glândula Tireoide/cirurgia , Neoplasias da Glândula Tireoide/patologia
15.
J Vis Exp ; (188)2022 10 18.
Artigo em Inglês | MEDLINE | ID: mdl-36342129

RESUMO

The biomechanical properties of the trachea directly affect the airflow and contribute to the biological function of the respiratory system. Understanding these properties is critical to understanding the injury mechanism in this tissue. This protocol describes an experimental approach to study the stress-relaxation behavior of porcine trachea that were pre-stretched to 0% or 10% strain for 300 s, followed by mechanical tensile loading until failure. This study provides details of the experimental design, data acquisition, analyses, and preliminary results from the porcine tracheae biomechanical testing. Using the detailed steps provided in this protocol and the data analysis MATLAB code, future studies can investigate the time-dependent viscoelastic behavior of trachea tissue, which is critical to understanding its biomechanical responses during physiological, pathological, and traumatic conditions. Furthermore, in-depth studies of the biomechanical behavior of the trachea will critically aid in improving the design of related medical devices such as endotracheal implants that are widely used during surgeries.


Assuntos
Fenômenos Fisiológicos Respiratórios , Traqueia , Suínos , Animais , Traqueia/cirurgia , Traqueia/fisiologia , Resistência à Tração , Estresse Mecânico , Fenômenos Biomecânicos , Elasticidade , Viscosidade
16.
J Int Med Res ; 50(11): 3000605221138453, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36446778

RESUMO

Primary pulmonary venous malformation is rare and usually presents as single or multiple round masses or nodules. Here, we present the first report of a case of venous malformation presenting as Mauritia arabica-like bronchial wall thickness that was initially misdiagnosed as bronchiectasis. A Chinese man in his late 20s presented complaining of hemoptysis for 10 days. Computed tomography demonstrated bronchiectasis and M. arabica-like bronchial wall thickening in the left lower lobe. He was unresponsive to medical treatment for bronchiectasis and underwent thoracoscopic left lower lobectomy. Histopathological examination revealed venous malformation around the bronchial walls with no bronchiectasis. Venous malformation should be considered in the differential diagnosis of bronchiectasis, especially in patients with the following triad of signs: no response to antibiotics, M. arabica-like bronchial wall thickness, and normal accompanying arteries.


Assuntos
Brônquios , Bronquiectasia , Masculino , Humanos , Traqueia , Hemoptise , Artérias
17.
Sci Rep ; 12(1): 20279, 2022 Nov 24.
Artigo em Inglês | MEDLINE | ID: mdl-36434016

RESUMO

Tracheas have a tubular structure consisting of cartilage rings continuously joined by a connective tissue membrane comprising a capillary network for tissue survival. Several tissue engineering efforts have been devoted to the design of scaffolds to produce complex structures. In this study, we successfully fabricated an artificial materials-free autologous tracheal analogue with engraftment ability by combining in vitro cell self-aggregation technique and in-body tissue architecture. The cartilage rings prepared by aggregating chondrocytes on designated culture grooves that induce cell self-aggregation were alternately connected to the connective tissues to form tubular tracheal analogues by subcutaneous embedding as in-body tissue architecture. The tracheal analogues allogeneically implanted into the rat trachea matured into native-like tracheal tissue by covering of luminal surfaces by the ciliated epithelium with mucus-producing goblet cells within eight months after implantation, while maintaining their structural integrity. Such autologous tracheal analogues would provide a foundation for further clinical research on the application of tissue-engineered tracheas to ensure their long-term functionality.


Assuntos
Engenharia Tecidual , Traqueia , Ratos , Animais , Engenharia Tecidual/métodos , Transplante Autólogo , Condrócitos , Regeneração
18.
Med Sci Monit ; 28: e937928, 2022 Nov 14.
Artigo em Inglês | MEDLINE | ID: mdl-36372993

RESUMO

BACKGROUND This study aimed to analyze the clinical characteristics of tracheobronchial foreign bodies in children in Shenzhen and to explore the diagnosis and treatment methods for special cases. MATERIAL AND METHODS This study included a total of 715 children who were diagnosed with tracheobronchial foreign bodies at Shenzhen Children's Hospital between October 2016 and October 2021. Data on sex, age, inducement, symptoms, foreign body type, foreign body location, foreign body retention time, foreign body history, and complications were recorded and analyzed. RESULTS Tracheal foreign bodies were found to occur primarily in children aged 0-2 years (90.6%). The overall incidence rates were 69.1% and 30.9% in boys and girls, respectively. Among them, 42.5% of the foreign bodies were detected in the left bronchus and 45.6% in the right bronchus. Inducements included playing while eating (n=398, 55.7%) and also crying (n=209, 29.2%). Operations were performed on 710 (99.3%) children, including 80 (11.2%) immediate surgeries and 2 tracheotomies. One child had no vital signs upon admission and died after emergency foreign body removal. All of the other children who underwent surgery recovered well postoperatively. CONCLUSIONS This study presents the characteristics and methods of diagnosis and treatment of tracheobronchial foreign bodies in pediatric patients in Shenzhen. Tracheobronchial foreign bodies are a major cause of accidental injury in infants and young children. In critical cases, airways should be immediately and rapidly cleared with multidisciplinary collaboration. In addition, public safety awareness should be strengthened, particularly among parents, teachers, and other child caregivers, to reduce and prevent instances of tracheobronchial foreign body accidents in children.


Assuntos
Broncoscopia , Corpos Estranhos , Lactente , Masculino , Feminino , Criança , Humanos , Pré-Escolar , Broncoscopia/métodos , Estudos Retrospectivos , Corpos Estranhos/epidemiologia , Corpos Estranhos/terapia , Brônquios , Traqueia/cirurgia
19.
BMC Anesthesiol ; 22(1): 360, 2022 11 24.
Artigo em Inglês | MEDLINE | ID: mdl-36424554

RESUMO

BACKGROUND: Patients undergoing oral and maxillofacial surgeries under general anesthesia usually require nasotracheal intubation. When presented with patients with equally patent nostrils, selection of the nostril to use for intubation is an important decision for facilitating intubation. The objective of this trial is to determine whether choice of nostril impacts nasotracheal intubation when using a video rigid stylet in patients undergoing oral and maxillofacial surgery. METHODS: Fifty patients scheduled for elective oral and maxillofacial surgery requiring nasotracheal intubation were randomly allocated into two groups to undergo nasotracheal intubation through the left nostril (Group L, n = 25) or the right nostril (Group R, n = 25). Intubation was performed by experienced anesthesiologists using a video rigid stylet. The primary endpoint was time to successful intubation, which was defined as the duration from when the tip of the stylet-tube assembly entered the selected nostril to when the tube entered the trachea. Secondary outcomes included: length of time for device insertion; length of time for tube insertion; total success rate; first-attempt success rate; number of intubation attempts; requirement of airway assisted maneuvers; incidence and severity of epistaxis. Intubation-related adverse events were monitored for up to postoperative 24 h. RESULTS: Median time (interquartile range) to tracheal intubation was 25.3 seconds (20.7 to 27.6) in Group L and 26.8 seconds (22.5 to 30.0) in Group R (median difference (MD) = 1.9; 95% confidence interval (CI) -1.8 to 5.7, P = 0.248). Nasotracheal intubation was successful in all patients in both groups and the first-attempt success rates in both groups were similar (Group L: 96% (24/25); Group R: 96% (24/25); relative risk (RR) 1.0; 95% CI 0.9 to 1.1; P > 0.999). No significant difference of requirement of assisted maneuvers was noted between the two groups (Group L: 36% (9/25); Group R: 28% (7/25); RR 0.8; 95% CI 0.3-1.8; P = 0.544). Furthermore, all patients showed a high quality of visualization of the glottis (Cormack and Lehane Grade I). For safety outcomes, the incidence and severity of epistaxis during intubation was comparable between the two groups. There were no significant differences between the selection of nostrils and intubation-related adverse events up to 24 h after surgery. CONCLUSIONS: When considering which nostril to use for intubation with video rigid stylet, either nostril can be used similarly. TRIAL REGISTRATION: Clinicaltrials.gov . Identifier: NCT05218590.


Assuntos
Epistaxe , Intubação Intratraqueal , Humanos , Epistaxe/etiologia , Traqueia , Glote , Anestesia Geral
20.
J Cardiothorac Surg ; 17(1): 287, 2022 Nov 16.
Artigo em Inglês | MEDLINE | ID: mdl-36384539

RESUMO

BACKGROUND: Tracheoesophageal fistula (TEF) is a rare but life-threatening complication after esophagectomy. A new gastrointestinal occluder device provides treatment for TEF patients. However, TEF-related pneumonia and respiratory failure increase the difficulty of anesthesia management, especially in airway management. CASE PRESENTATION: A 64-year-old man with thoracic esophageal cancer underwent esophagectomy and gastric tube reconstruction one year ago. The patient presented with recurrent cough and sputum after surgery. Gastroscopy revealed a fistula between the esophagogastric anastomotic site and membrane of the trachea. Therefore, the patient received implantation of a new gastrointestinal occluder device under gastroscopy combined with tracheoscopy. Airway management under general anesthesia was discussed with an interdisciplinary decision, and cuffed endotracheal tube with an inner diameter of 5.5 mm was chosen. This airway management ensured adequate oxygenation during the operation and provided sufficient space for the operation of the tracheoscope in the trachea. Finally, the TEF disappeared after the operation, and the patient was administered an oral diet on the first postoperative day. CONCLUSIONS: The implantation of a new gastrointestinal occluder device under gastroscopy combined with tracheoscopy provides a new treatment for TEF patients. This case report suggests that it is important to select an endotracheal tube with an appropriate inner diameter that can not only meet the requirements of ventilation but also does not affect the operation of tracheoscopy in the trachea.


Assuntos
Anestesia , Fístula Traqueoesofágica , Masculino , Humanos , Pessoa de Meia-Idade , Fístula Traqueoesofágica/cirurgia , Fístula Traqueoesofágica/etiologia , Traqueia , Intubação Intratraqueal/efeitos adversos , Esofagectomia/efeitos adversos
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