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Upper airway bronchoscopic interpretation
Published in Don Hayes, Kara D. Meister, Pediatric Bronchoscopy for Clinicians, 2023
Anita Deshpande, Cherie A. Torres-Silva, Catherine K. Hart
When evaluating the posterior oral cavity and oropharynx, the endoscopist should take care to identify the palatine tonsils and their size and contribution to oropharyngeal collapse (Figure 4.3). Glossoptosis and lingual tonsillar hypertrophy (Figure 4.4) are also important in the evaluation of obstructive sleep apnea. With the flexible endoscope in place just inferior to the soft palate, a jaw thrust maneuver should be performed to assist in differentiation between these two conditions, as jaw thrust should improve an obstruction caused by glossoptosis (Figure 4.5). Symmetry of the vallecula should also be assessed. Masses located at the base of the tongue can include a lingual thyroglossal duct cyst (Figure 4.6) or a lingual thyroid, either of which can cause potential airway displacement and subsequent respiratory distress.9
Anesthesia for pediatric trauma
Published in David E. Wesson, Bindi Naik-Mathuria, Pediatric Trauma, 2017
The goals of airway management in the pediatric trauma patient include achieving adequate oxygenation and ventilation along with protection of the patient’s airway reflexes. The first priority within the Primary Survey is to evaluate and maintain the integrity of the airway. If the patient’s condition permits, a comprehensive airway evaluation should be performed. In the conscious child, the ability to vocalize is reassuring and may suggest a patent airway. In the unconscious child, the airway must be assessed quickly to confirm if breathing is present. If the patient has an obstructed airway, performing a jaw-thrust maneuver may reduce or eliminate the airway obstruction [14]. An oropharyngeal airway may also be considered to temporarily maintain upper airway patency until a definitive airway has been established. A nasopharyngeal airway should be used with caution particularly if midfacial injuries are suspected. Suctioning should also be considered if secretions are present. Verifying that airway obstruction is not related to inappropriate placement of the cervical collar is also indicated.
Esophageal anastomoses: sutured and stapled
Published in Larry R. Kaiser, Sarah K. Thompson, Glyn G. Jamieson, Operative Thoracic Surgery, 2017
Jon shenfine, Glyn G. Jamieson
By whichever method, once the purse string is in place, an appropriately sized staple anvil is sited. If too small, this will cause “bunching” of the esophageal wall, jeopardize the join, or lead to stricturing, so this should be no smaller than 25 mm. Once in position, the purse-string suture is tied snugly and firmly to the shaft of the anvil with flat half-hitch knots. If there is any concern over the purse string at this point, a second purse string is easily placed with the anvil in situ.The third alternative is the use of the OrVil device (Medtronic, Minneapolis, US). This consists of a tilted circular anvil head, which is supplied attached to an orogastric tube. The esophagus is mobilized above the intended point of transection to allow the anvil to sit comfortably in the esophageal stump. Stay sutures are not necessary. The esophagus is divided with a single- use reloadable linear stapler with a 4.8 mm staple load. The anesthetist inserts a well-lubricated 25 mm OrVil (Medtronic) per oral, ensuring that the black line of the orogastric tube remains posterior at all times. This places the anvil in the correct orientation to allow smooth passage through the pharynx and cricopharyngeus. The operating surgeon watches carefully to ensure that the tip of the tubing comes to lie centrally over the anterior staple line of the esophageal stump. Diathermy is then used to open the esophagus just over the tip of the tube. The tube is grasped and gently pulled down as the anesthetist guides the anvil over the back of the tongue and into the pharynx. Resistance is felt as the anvil crosses both cricopharyngeus and as it descends past the endotracheal tube cuff. A jaw thrust maneuver and slight deflation of the cuff may also help passage. The anvil is pulled through until it is sitting in the esophageal stump. One limb of the suture attached to the anvil can now be cut, allowing the orogastric tubing to detach and be discarded (see Figure 29.11).
Comparison of the supraglottic airway device BlockBusterTM and laryngeal mask airway Supreme in anaesthetised, paralyzed adult patients: a multicenter randomized controlled trial
Published in Expert Review of Medical Devices, 2022
Xue Gao, Ju-Hui Liu, Chun-Mei Chen, Yong Wang, Zhong-Yu Wang, Chun-Ling Yan, Ming-Zhang Zuo, Yu Cao, Xin Qiao, Ya-Qi Huang, Pei-Chang Liu, Hui Zhang, Jia-Qiang Zhang, Jun-Mei Shen, Chao Li, Yi Wang, Yan-Yan Sun, Jian-Nan Song, Xi-Zhe Zhang, Yun-Long Zhang, Xiao-Ting Luo, Lu-Nan Wu, Ye Zhang, Li Shi, Yuan Zhang, Fu-Shan Xue, Ming Tian
The positioning of the device in the upper airway was considered satisfactory when ventilation test was positive (peak inspiratory pressure <20 cmH2O, normal chest movements, and PETCO2 waveforms), OLP was greater than 20 cmH2O, and fiberscopic view was optimal (grades 1 and 2). If the positioning of the device was considered unsatisfactory, airway manipulations including neck flexion or extension, jaw thrust plus up-down maneuver, increase or decrease cuff volume and reinsertion would be performed to adjust device positioning. The ‘up-down maneuver’ was carried out by rotating the inflated device out of the oropharynx approximately 6 cm and then reinserting the device to free the epiglottis [16]. Jaw thrust plus ‘up-down maneuver’ in this study was a modified ‘up-down maneuver’ proposed by us based on the structural features of the SAD BlockBusterTM, in which the two thumbs performed the ‘up-down maneuver,’ while the other fingers made the jaw thrust maneuver. After airway manipulations were completed, the above tests were repeatedly performed to determine if the positioning of the device was satisfactory.
Same day endoscopic retrograde cholangio-pancreatography immediately after endoscopic ultrasound for choledocholithiasis is feasible, safe and cost-effective
Published in Scandinavian Journal of Gastroenterology, 2021
Wisam Sbeit, Anas Kadah, Amir Shahin, Tawfik Khoury
None of the patients had anesthesia related severe adverse events in both groups. However, we were not able to retrieve mild desaturation episodes that were managed with jaw-thrust maneuver, without the need for mechanical respiratory support. Similarly, the mortality rate was zero in our cohort. Notably, the length of hospitalization was significantly lower in group A as compared to group B (7.4 ± 2.9 vs. 9.7 ± 3.9 days, p = .0003) (Figure 1). The mean time interval between performing EUS and ERCP in group B was 3.7 ± 1.6 days. Of note, 2 out of the 45 patients (4.4%) in group B developed complication while awaiting ERCP performance, the first patient had exacerbation of heart failure manifested as pulmonary edema and atrial fibrillation and the second patient developed new onset heart failure. The mean cost of same day EUS and ERCP as been calculated by the length of hospitalization was significantly lower in group A as compared to group B (7680.9$ ± 3071.4$vs. 10089.4$ ± 4053.4$, p = .0003) (Figure 2).
Dexmedetomidine-ketamine versus propofol-ketamine for sedation during upper gastrointestinal endoscopy in hepatic patients (a comparative randomized study)
Published in Egyptian Journal of Anaesthesia, 2021
Wael Sayed Algharabawy, Rasha Gamal Abusinna, Tamer Nabil AbdElrahman
in terms of the occurrence of side effects, both groups had comparable rates of bradycardia, tachycardia, hypotension, laryngeal spasm, nausea, vomiting, and postoperative cognitive dysfunction. The incidence of bradycardia in both groups was comparable (six patients in group (KD) versus four patients in group (KP), which was managed by stopping the procedure and administering 0.01 mg/kg atropine once). Only two patients in group KP experienced tachycardia, which was treated with an extra bolus dose of ketamine to increase the depth of sedation and analgesia. The incidence of hypotension was higher in group KP than in group KD, but the difference was not statistically significant (three patients in group (KD) versus five patients in group (KP), which was managed with a 250 mL ringer solution and a 6 mg ephedrine increment once). The prevalence of oxygen desaturation was statistically higher in group KP than in group KD (9 patients, and 3 patients respectively). All patients were managed by chin-lift or jaw-thrust maneuver and increasing oxygen flow to 6–10 L/min without the need for a nasal airway or manual ventilation. Unwanted movements were statistically more common in group KD than in group KP (6 patients, and two patients respectively). Three patients in group KD and two patients in group KP experienced nausea/vomiting in the recovery room and were given 4 mg ondansetron once. There were no patients who experienced laryngeal spasms or post-procedural psychotic symptoms (Table 10).