Adenotonsillectomy
Mark A. Richardson, Norman R. Friedman in Clinician’s Guide to Pediatric Sleep Disorders, 2016
Extubation before the return of laryngeal and pharyngeal reflexes may result in upper-airway obstruction in children with obstructive apnea after pharyngeal surgery. Therefore, extubation should be performed in a setting where the patient has a return of laryngeal reflexes to protect the airway, while trying to avoid excessive coughing or agitation in the presence of the endotracheal tube. The insertion of an oral and/or nasopharyngeal airway can help maintain an airway if upper-airway obstruction on extubation is anticipated. Brown et al. (106) have reported the use of endotracheal intubation and mechanical ventilation for several days after an adenotonsillectomy in children with severe OSAS and cor pulmonale. Patients with risk factors such as obesity, neurological disorders, asthma, or those less than three years of age may be predisposed to persistent respiratory difficulties in the immediate postoperative period and may require the respiratory assistance of continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BiPAP) after an adenotonsillectomy (41,107).
Weaning from Mechanical Ventilation
Stephen M. Cohn, Alan Lisbon, Stephen Heard in 50 Landmark Papers, 2021
Recent efforts have focused on processes for caring for the patient after extubation to prevent reintubation. The use of non-invasive ventilation as a rescue modality in patients with respiratory failure following extubation fails to prevent reintubation and is associated with increased mortality [6]. However, extubation directly to non-invasive ventilation before any failure has occurred has been studied, and for patients with chronic obstructive lung diseases demonstrated a decrease in the rates of post-extubation respiratory failure and 90-day mortality [7]. More recently, extubation directly to a high-flow nasal cannula for patients with a high risk of post-extubation respiratory failure was found to be effective in preventing respiratory failure and in reducing the rate of reintubation [8].
Paediatric laryngeal disorders
Declan Costello, Guri Sandhu in Practical Laryngology, 2015
Successful extubation relies on optimal respiratory function. Lung function should always be optimised prior to consideration of extubation, as any compromise may lead to failure. In the very premature, therefore, the preferential management may require the neonate to remain ventilated for a prolonged period of time, allowing lung function to improve. As the neonate approaches their expected delivery date with a corresponding improvement in lung function, extubation can be more successful. Prolonged intubation may well have implications for the neonatal subglottis, but this can be investigated and treated once extubation has been achieved.1 A period of expectant intubation can also minimise the problems that occur with repeated attempts at intubation following failed extubations. This period of ‘laryngeal rest’ is often overlooked as a management option. In these cases, when extubation is finally planned, a 24–48-hour period of steroid cover is beneficial prior to the subsequent attempt.
Effects of high-flow nasal oxygen cannula versus other noninvasive ventilation in extubated patients: a systematic review and meta-analysis of randomized controlled trials
Published in Expert Review of Respiratory Medicine, 2022
Kaiyuan Guo, Gang Liu, Wei Wang, Guancheng Guo, Qi Liu
For patients who have received mechanical ventilation, extubation is an important milestone in recovery; however, this procedure also causes patients to face the related risks of complications, extubation failure, and worsened prognosis. The causes of extubation failure mainly include vocal cord dysfunction, laryngospasm, laryngeal edema, and airway trauma, which affect the upper-airway patency [31]. Additionally, extubation failure could also be caused by excessive airway secretions, reduced ability to protect the airway, aspiration, encephalopathy and residual effects of sedative or neuromuscular blockade [31]. To prevent these outcomes and increase the success rate of extubation, the modalities of COT, HFNC, and NIV are commonly used to support breathing [32]. Although COT does not provide respiratory support, it is advantageous in patients without postoperative respiratory failure for prophylactic use [10]. As for the focus of this study, the strengths of HFNC and NIV might manifest mainly for critically ill patients, partially because of the pressure support effect. The air flow of HFNC meets the resistance of the nasal cavity, which can produce a positive pressure effect of about 3 cmH2O during the whole respiratory cycle, the level of pressure depends on the inspiratory flow [33]. The difference is that NIV can offer different levels of positive pressure support according to the patient’s needs. As a result, the respiratory support effect of HFNC cannot be greater than that of NIV.
Comparison between combined regional nasal block and general anesthesia versus general anesthesia with dexmedetomidine during endoscopic sinus surgery
Published in Egyptian Journal of Anaesthesia, 2023
Moustafa Atef Moustafa Hamouda, Nahed E. Salama, Samia A. Hassan, Eman M. Aboseif, Rehab A. Abdelrazik
After steady-state anesthesia in both groups was obtained, but still the ACS>3, an additional dose of fentanyl (1 µg/kg) was given once suspected intraoperative pain. Cis-atracurium byselate (0.15 mg/kg) was given at 30 minutes intervals to maintain muscle relaxation. Bradycardia (heart rate < 50 beats/min) was treated with atropine (0.01–0.02 mg/kg). When severe hypotension occurred (MAP < 65 mmHg), a fluid challenge (lactated Ringer’s solution 3–4 ml/kg) and intravenous ephedrine (Initial dose: 0.05–0.1 mg/kg IV bolus, additional boluses were administered as needed, not to exceed a total dosage of 50 mg). At the end of surgery, the oropharyngeal pack was removed, dexmedetomidine infusion was stopped, sevoflurane was discontinued. Residual neuromuscular block was antagonized with neostigmine 0.05 mg/kg and atropine sulphate 0.02 mg/kg. Extubation was done only when the patients became fully awake (spontaneous eye opening, obeying verbal command and or tube localization), with satisfactory muscle power to support spontaneous regular ventilation with full tidal volume. In the postoperative settings, all patients were given a standard analgesic regimen with 1 gm paracetamol/8 h, patients with VAS score>3 at any point were given Ketorolac (30 mg) as a rescue analgesic by intravenous infusion with maximum dose 120 mg/day.
Oxygen uptake on-kinetics during six-minute walk test predicts short-term outcomes after off-pump coronary artery bypass surgery
Published in Disability and Rehabilitation, 2019
Isadora Salvador Rocco, Marcela Viceconte, Hayanne Osiro Pauletti, Bruna Caroline Matos-Garcia, Natasha Oliveira Marcondi, Caroline Bublitz, Douglas William Bolzan, Rita Simone Lopes Moreira, Michel Silva Reis, Nelson Américo Hossne, Walter José Gomes, Ross Arena, Solange Guizilini
After the surgical procedure, all patients were transferred to the cardiac surgical intensive care unit. The same analgesic protocol was administered with 100 mg of tramadol chlorhydrate four times a day administered until the fifth day after surgery. Patients underwent the same daily rehabilitation protocol until hospital discharge. While under mechanical ventilation, patients were ventilated at 12–14 breaths/min, with an inspired oxygen fraction to keep arterial oxygen saturation above 90%, the positive end-expiratory pressure of 8 cm H2O and pressure support to maintain a tidal volume of 8 ml/kg of predicted body weight. Extubation procedures followed the established protocol of the intensive care unit. Chest tubes were routinely removed on the second post-operative day and patients were submitted to chest X-ray daily.
Related Knowledge Centers
- Breathing
- Respiratory Tract
- Trachea
- Tracheal Tube
- Tracheotomy
- Larynx
- Catheter
- Mechanical Ventilation
- Intubation
- Cricothyrotomy