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Park JH, Park G, Hwang KH, Cho HC, Kim J, Oh S, Jeong HS. Prevalence and risk factors of postoperative laryngeal edema in patients undergoing neck dissection. Eur Arch Otorhinolaryngol 2024; 281:4341-4350. [PMID: 38689037 DOI: 10.1007/s00405-024-08671-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 04/08/2024] [Indexed: 05/02/2024]
Abstract
PURPOSE Postoperative laryngeal edema (PLE) is a common complication in patients undergoing head and neck surgery, leading to symptoms such as odynophagia, dysphagia, or potential airway obstruction. However, the prevalence and risk factors of PLE in patients undergoing neck dissection (ND) have not been well investigated. METHODS A retrospective analysis was conducted in three steps. Initially, a pilot study of 50 consecutive ND patients revealed a preliminary PLE prevalence of 0.34. Then, the medical records of an additional 295 ND patients were reviewed to estimate the prevalence of PLE with a total width of 95% confidence interval (CI) of ± 5%. Finally, multivariable logistic regression analyses were performed to identify risk factors for PLE (n = 343). RESULTS PLE occurred in 29.4% [95%CI 24.4-34.4%] of patients undergoing any type of ND, with the most common symptoms of odynophagia (75.0%) and dyspnea (11.1%). Hospital stay was just one day longer in PLE patients, responding well with short-term steroid treatment (p = 0.0057). In multivariable analyses, no significant association was found between PLE occurrence and airway management. However, body mass index and the American Society of Anesthesiologists classification correlated with PLE. More importantly, surgery for oro-hypopharynx or supraglottis tumors (odds ratio, OR = 3.019, [95%CI 1.166-7.815]) and lymph node level 2(3) ND (OR = 4.214 to 5.279, [95%CI 1.160-20.529]) were significant risk factors for PLE. CONCLUSIONS PLE developed in approximately 30% of ND patients, causing uncomfortable symptoms. Early diagnosis and intervention of PLE in high-risk patients can improve patient care and outcomes.
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Affiliation(s)
- Joo Hyun Park
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Samsung Medical Center, Sungkyunkwan University, Seoul, Republic of Korea
| | - Goeun Park
- Biomedical Statistics Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Kyu Hyeon Hwang
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Samsung Medical Center, Sungkyunkwan University, Seoul, Republic of Korea
| | - Hee Chun Cho
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Samsung Medical Center, Sungkyunkwan University, Seoul, Republic of Korea
| | - Junyoung Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Samsung Medical Center, Sungkyunkwan University, Seoul, Republic of Korea
| | - Subi Oh
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Samsung Medical Center, Sungkyunkwan University, Seoul, Republic of Korea
| | - Han-Sin Jeong
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Samsung Medical Center, Sungkyunkwan University, Seoul, Republic of Korea.
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Talapatra A, Mathew S, Kanakalakshmi ST, Rani R. Effect of fluticasone-impregnated throat packs on postoperative sore throat (POST) and hoarseness of voice: A randomized clinical trial. F1000Res 2024; 12:1352. [PMID: 38434667 PMCID: PMC10905143 DOI: 10.12688/f1000research.139742.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/03/2024] [Indexed: 03/05/2024] Open
Abstract
Background Post-operative sore throat (POST) is one of the most common complaints post-endotracheal intubation and can be decreased through various interventions. This study aimed to determine the effect of fluticasone-impregnated versus saline throat packs on the occurrence and severity of POST and voice hoarseness. Methods This prospective, randomized, double-blinded trial was conducted on patients undergoing nasosinus surgeries at Kasturba Medical College and Hospital. Patients were randomized to groups based on a computer-generated table of random numbers post-intubation after placing a definite length of oropharyngeal packs into group F (fluticasone) who received four puffs of fluticasone furoate-soaked throat packs and group C (control) wherein normal saline-soaked throat packs were used. Determining the incidence of POST and voice hoarseness was the primary outcome; severity of POST and voice hoarseness, patient satisfaction scores at 24 hours post-surgery and adverse events were secondary outcomes. Results Overall, 86 patients were randomized and 43 patients were included in each group. Incidence of POST (%) and voice hoarseness (%) were 55.8, 55.6, 55.8, 53.4 and 30.2, 28, 28, 28 in group C. Incidence of POST (%) and voice hoarseness (%) were 37.2, 37.2, 37.2, 34.8 and 14, 14, 14,14 in group F at 1, 2, 6 and 24 hours, respectively, however, the p values were not found to be significant at any time interval. There was no significant difference in terms of severity of POST and voice hoarseness, patient satisfaction scores between the groups and there were no reported adverse events. Conclusions In patients undergoing nasosinus surgery under general anesthesia with endotracheal intubation, fluticasone furoate-impregnated throat packs failed to show any significant reduction in the incidence and severity of POST as well as hoarseness of voice, and even though it was not statistically significant, the fluticasone impregnated group had higher patient satisfaction scores. Registration CTRI ( CTRI/2020/09/027946; 22/09/2020).
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Affiliation(s)
- Arjun Talapatra
- Department of Anaesthesiology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Shaji Mathew
- Department of Anaesthesiology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Sushma Thimmaiah Kanakalakshmi
- Department of Anaesthesiology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Rama Rani
- Department of Anaesthesiology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
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Hintong T, Chongvisal S, Pipanmekaporn T, Unchiti K. A Randomized Comparison of Effects of Budesonide Spray and K-Y Gel as an Endotracheal Tube Cuff Lubricant on Incidence of Postoperative Sore Throat. J Perianesth Nurs 2023:S1089-9472(22)00546-9. [PMID: 36610870 DOI: 10.1016/j.jopan.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 10/05/2022] [Accepted: 10/06/2022] [Indexed: 01/06/2023]
Abstract
PURPOSE Postoperative sore throat (POST) is a frequent postoperative complication. Pre-induction budesonide inhalation is effective in POST prevention. However, it requires inhaler equipment and patient cooperation. Budesonide spraying on the endotracheal (ETT) cuff is simple and can be performed on most patients requiring endotracheal intubation. This study aims to compare the effects of budesonide spray and K-Y gel as an ETT cuff lubricant on the incidence and severity of POST. DESIGN Randomized and triple-blinded study. METHODS One hundred patients undergoing elective non-cardiac surgery were randomly allocated into the budesonide group (n = 50) and the K-Y gel group (n = 50). In the budesonide group, 200 mcg of budesonide was sprayed on the cuff of the ETT. For the K-Y gel group, the ETT cuff was lubricated with K-Y gel. A visual analog scale was used to assess the severity of POST at 2, 6, and 24 hours after surgery. Other complications of tracheal intubation and adverse effects of budesonide were also recorded. FINDINGS Compared to the K-Y gel group, the budesonide group had a significantly lower overall incidence of POST (30% versus 54%, P = .032) and reduced the risk of POST by 24% (relative risk reduction = 24%, 95% CI, 5.23-42.77, P = .012) as well as the incidence of hoarseness (8.6% vs 34%, P = .001) and cough (0% vs 8%, P = 0.041). No incidence of drug-related side effects was reported in both groups. CONCLUSIONS Spraying budesonide on the ETT cuff significantly reduces the incidence and severity of POST.
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Affiliation(s)
- Thanoo Hintong
- Department of Anesthesia, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Sasawat Chongvisal
- Department of Anesthesia, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Tanyong Pipanmekaporn
- Department of Anesthesia, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Kantarakorn Unchiti
- Department of Anesthesia, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
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Li YQ, Yu GC, Shi LK, Zhao LW, Wen ZX, Kan BT, Jian XD. Clinical analysis of pipeline dredging agent poisoning: A case report. World J Clin Cases 2022; 10:10201-10207. [PMID: 36246832 PMCID: PMC9561560 DOI: 10.12998/wjcc.v10.i28.10201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 07/20/2022] [Accepted: 08/23/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Pipeline dredging agents are new household deep cleaning products used to dredge blockages in kitchen and bathroom pipeline caused by grease, hair, vegetable residue, paper cotton fibre, and other organic substances. Pipeline dredging agents are corrosive chemicals that can cause poisoning through corrosive damage to the digestive tract; however, this has not been reported clinically. Therefore, this report emphasises that oral pipeline dredging agent poisoning can cause corrosive damage to the digestive tract and may have serious health consequences.
CASE SUMMARY A 68-year-old man consumed liquor (200 mL) at approximately 13:00 on April 22, 2021. At approximately 16:00, his family found him unresponsive with blackened lips, blood spots in the corners of the mouth, and blood stains on the ground, as well as an empty bottle of a pipeline dredging agent. One hour later, he was admitted to the emergency department of a local hospital. Considering the empty bottle, he was suspected to have sustained severe corrosive damage to the digestive tract and was transferred to our department at 23:15 on April 22, 2021. He developed dysphagia and intermittent fever and experienced difficulty in opening his mouth throughout his hospital stay. The patient’s condition gradually stabilised. However, he suddenly developed respiratory failure on day 12, and endotracheal intubation and ventilator-assisted ventilation were performed. However, the patient died after 1.5 h despite emergency rescue efforts.
CONCLUSION Pipeline dredging agents are highly corrosive and may cause corrosive damage to the digestive tract and asphyxia upon consumption.
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Affiliation(s)
- Ya-Qian Li
- Department of Poisoning and Occupational Diseases, Emergency Medicine, Qilu Hospital of Shandong University, Jinan 250012, Shandong Province, China
| | - Guang-Cai Yu
- Department of Poisoning and Occupational Diseases, Emergency Medicine, Qilu Hospital of Shandong University, Jinan 250012, Shandong Province, China
| | - Long-Ke Shi
- Department of Poisoning and Occupational Diseases, Emergency Medicine, Qilu Hospital of Shandong University, Jinan 250012, Shandong Province, China
- School of Public Health, Shandong University, Jinan 250012, Shandong Province, China
| | - Li-Wen Zhao
- Department of Poisoning and Occupational Diseases, Emergency Medicine, Qilu Hospital of Shandong University, Jinan 250012, Shandong Province, China
- School of Public Health, Shandong University, Jinan 250012, Shandong Province, China
| | - Zi-Xin Wen
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong Province, China
| | - Bao-Tian Kan
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong Province, China
| | - Xiang-Dong Jian
- Department of Poisoning and Occupational Diseases, Emergency Medicine, Qilu Hospital of Shandong University, Jinan 250012, Shandong Province, China
- School of Public Health, Shandong University, Jinan 250012, Shandong Province, China
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Jahshan F, Abu Ammar A, Ertracht O, Eisenbach N, Daoud A, Sela E, Atar S, Zussman E, Fichtman B, Harel A, Gruber M. Local Delivery of Mometasone Furoate from an Eluting Endotracheal Tube Reduces Airway Morbidity Following Long-Term Animal Intubation. ACS APPLIED BIO MATERIALS 2021; 4:4131-4139. [PMID: 35006827 DOI: 10.1021/acsabm.0c01526] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND upper airway complications are common sequelae of endotracheal tube (ETT) intubation, and systemic corticosteroids are considered a mainstay treatment for this problem. Drug-eluting ETT may present an attractive option for topical steroid delivery while avoiding systemic side effects and improving the therapeutic outcome. The objective of the present study is to evaluate the reduction of tube-related tracheal morbidity via a self-designed steroid-eluting ETT with controlled sustained release properties in an animal model. METHODS steroid-eluting ETTs were coated by poly(lactic-co-glycolic acid) -electrospun nanofibers loaded with mometasone furoate (MF) as a model drug. Animals were randomly assigned into three equal groups: non-intubated, blank-ETT, and loaded-ETT. The intubation interval was 1 week. Specimens were analyzed by histology, specific fibrosis staining, and scanning electron microscopy (SEM). RESULTS the blank-ETT group exhibited a significant increase in tracheal mucosal thickness compared to the loaded-ETT and control groups. Average tracheal mucosal thickness was 112 ± 34, 242 ± 49, and 113 ± 43 μm in the control, blank-ETT, and loaded-ETT groups, respectively. The blank-ETT group exhibited a significant increase in tracheal fibrosis compared to the loaded-ETT and control groups. Relative fibrosis values were 0.07 ± 0.05, 0.154 ± 0.1, and 0.0984 ± 0.084% for the control, blank-ETT, and loaded-ETT groups, respectively. While SEM imaging showed normal surface structures in the control group, intubated blank-ETT rats showed severe surface structural damage, whereas only mild damage was observed in the loaded-ETT group. CONCLUSIONS local sustained release of MF via a self-designed drug-eluting ETT is a potential therapeutic approach which may significantly reduce tube-related upper airway morbidity.
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Affiliation(s)
- Forsan Jahshan
- Department of Otolaryngology-Head and Neck Surgery, Galilee Medical Center, Nahariya 2210001, Israel
| | - Aiman Abu Ammar
- Department of Pharmaceutical Engineering, Azrieli College of Engineering Jerusalem, Jerusalem 9103501, Israel
| | - Offir Ertracht
- Eliachar Research Laboratory, Galilee Medical Center, Nahariya 2210001, Israel
| | - Netanel Eisenbach
- Department of Otolaryngology-Head and Neck Surgery, Galilee Medical Center, Nahariya 2210001, Israel
| | - Amani Daoud
- Department of Otolaryngology-Head and Neck Surgery, Galilee Medical Center, Nahariya 2210001, Israel
| | - Eyal Sela
- Department of Otolaryngology-Head and Neck Surgery, Galilee Medical Center, Nahariya 2210001, Israel
| | - Shaul Atar
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed 1311502, Israel
| | - Eyal Zussman
- NanoEngineering Group, Department of Mechanical Engineering, Technion, Israel Institute of Technology, Haifa 3200003, Israel
| | - Boris Fichtman
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed 1311502, Israel
| | - Amnon Harel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed 1311502, Israel
| | - Maayan Gruber
- Department of Otolaryngology-Head and Neck Surgery, Galilee Medical Center, Nahariya 2210001, Israel.,Eliachar Research Laboratory, Galilee Medical Center, Nahariya 2210001, Israel.,Azrieli Faculty of Medicine, Bar-Ilan University, Safed 1311502, Israel
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Singh AK, Dhungel S, Bhattarai K, Roychoudhury A. Do the Benefits of Systemic Corticosteroids Outweigh Adverse Effects During Maxillofacial Trauma Surgery? A Systematic Review and Meta-Analysis. J Oral Maxillofac Surg 2021; 79:1530.e1-1530.e21. [PMID: 33745861 DOI: 10.1016/j.joms.2021.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 01/08/2023]
Abstract
PURPOSE Perioperative systemic corticosteroids are widely used in maxillofacial trauma surgery to prevent postoperative complications, but potentially perceived benefits are speculative rather than evidence-based. The purpose of our systematic review and meta-analysis was to assess the effects of perioperative systemic corticosteroids on clinically significant outcomes in patients undergoing maxillofacial trauma surgery. METHODS We searched Medline, Embase, CENTRAL, Clinical trial registry, and grey literature as well as references of included trials. Our primary outcomes were facial edema and pain after the surgery. Our secondary outcomes were postoperative nausea and vomiting, neurosensory disturbance, functional recovery, wound infections, and other adverse events. RESULTS Of the 94 trials retrieved, 13 were included (n = 652). Perioperative steroid use was associated with reduced pain and facial edema. We observed a decrease in postoperative nausea and vomiting with the use of systemic corticosteroids (n = 184, OR = 0.53, [0.28, 1.02], I2 = 0%). Four trials reported infections and impaired wound healing associated with steroids (n = 160. OR = 3.37, [1.43. 7.94], I2 = 2%). The 13 trials had an unclear risk of bias. CONCLUSIONS Systemic corticosteroids reduced facial edema and postoperative pain, but impaired wound healing was also reported. The use of systemic steroids in maxillofacial trauma surgery is thus supported only by weak evidence and further research is advocated.
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Affiliation(s)
- Ashutosh Kumar Singh
- Associate Professor, Department of Oral and Maxillofacial Surgery, College of Medical Sciences Teaching Hospital, Bharatpur, Nepal.
| | - Safal Dhungel
- Assistant Professor, Department of Oral and Maxillofacial Surgery, College of Medical Sciences Teaching Hospital, Bharatpur, Nepal
| | - Kushal Bhattarai
- Assistant Professor, Department of Biochemistry, College of Medical Sciences Teaching Hospital, Bharatpur, Nepal
| | - Ajoy Roychoudhury
- Professor and HOD, Department of Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India
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Yu J, Ren L, Min S, Yang Y, Lv F. Nebulized pharmacological agents for preventing postoperative sore throat: A systematic review and network meta-analysis. PLoS One 2020; 15:e0237174. [PMID: 32776966 PMCID: PMC7416917 DOI: 10.1371/journal.pone.0237174] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 07/21/2020] [Indexed: 12/17/2022] Open
Abstract
Postoperative sore throat is one of the most common complications following endotracheal intubation. Nebulization therapy, a preferable and safety method of drug delivery, has been shown to be effective in postoperative sore throat prevention in many studies. However, the relative efficacy of various nebulized agents remains unknown. In this review, we aimed to quantify and rank order the efficacy of available nebulized agents for various postoperative sore throat-related outcomes. A comprehensive literature search of PubMed, EMBASE, CENTRAL and Google Scholar was conducted to identify eligible studies from inception to 25 May 2020. Incidence of postoperative sore throat 1hour and 24hours postoperatively and severity of postoperative sore throat 24 hours postoperatively were the primary outcomes. We conducted a Bayesian network meta-analysis to combine direct and indirect evidence to estimate the relative effects between treatments as well as the probabilities of ranking for treatments based on their protective effects. We identified 32 trials assessing 6 interventions. Overall inconsistency and heterogeneity were acceptable. Nebulized corticosteroids, magnesium, and ketamine differed from non-analgesic methods on the three primary outcomes. Based on the surface under the cumulative ranking curve, nebulized corticosteroids ranked first in almost all outcomes among the nebulized drugs. Considering only high-quality and 2-arm design studies, nebulized corticosteroids still seemed best. In conclusion, prophylactic use of nebulized corticosteroids, magnesium, and ketamine can effectively prevent postoperative sore throat, and nebulized corticosteroids appears to be the overall best approach.
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Affiliation(s)
- Jian Yu
- Department of Anesthesiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Li Ren
- Department of Anesthesiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Su Min
- Department of Anesthesiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - You Yang
- Department of Anesthesiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Feng Lv
- Department of Anesthesiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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8
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Li H, Yue Y, Qu Y, Mu D. Lidocaine for postoperative sore throat: a meta-analysis of randomized controlled trials. Minerva Anestesiol 2020; 86:546-553. [DOI: 10.23736/s0375-9393.20.14170-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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9
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Muderris T, Tezcan G, Sancak M, Gul F, Ugur G. Oral flurbiprofen spray for postoperative sore throat and hoarseness: a prospective, randomized, double-blind, placebo-controlled study. Minerva Anestesiol 2019; 85:21-27. [DOI: 10.23736/s0375-9393.18.12703-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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10
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Hurtado Nazal C, Araneda Vilches A, Vergara Marín C, García Contreras K, Napolitano Valenzuela C, Badía Ventí P. Vocal cord paralysis after endotracheal intubation: an uncommon complication of general anesthesia. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ENGLISH EDITION) 2018. [PMID: 29628155 PMCID: PMC9391721 DOI: 10.1016/j.bjane.2017.12.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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11
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Boonekamp C, Voruz F, Fehlmann C. Accidental aspiration of a solid tablet of sodium hydroxide. BMJ Case Rep 2018; 2018:bcr-2018-224213. [PMID: 29930183 PMCID: PMC6020962 DOI: 10.1136/bcr-2018-224213] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Sodium hypochlorite is a corrosive, highly alkaline (pka=7.52) household product. Ingestion of sodium hypochlorite liquid is common, showing toxicity on the oesophagus and stomach. Nevertheless, cases of sodium hypochlorite ingestions in pellet are rare and the management of them is unknown. We report the case of a 65-year-old man who accidentally swallowed a bleach tablet of 3.5 g. Six hours later, the patient developed an aphonia associated with dysponea stage IV, motivating a nasofibroscopy showing glottis and supraglottic necrosis and oedema for which the patient received intravenous steroids, was intubated and then underwent a tracheotomy. After 2 weeks under tracheotomy, local evolution was favourable allowing a removal of the cannula and a return back home.
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Affiliation(s)
- Caroline Boonekamp
- Department of General Internal Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - François Voruz
- Department of Otolaryngology and Head and Neck Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Christophe Fehlmann
- Department of General Internal Medicine, Geneva University Hospitals, Geneva, Switzerland.,Emergency departement, Geneva University Hospitals, Geneva, Switzerland
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12
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Hurtado Nazal C, Araneda Vilches A, Vergara Marín C, García Contreras K, Napolitano Valenzuela C, Badía Ventí P. [Vocal cord paralysis after endotracheal intubation: an uncommon complication of general anesthesia]. Rev Bras Anestesiol 2018; 68:637-640. [PMID: 29628155 DOI: 10.1016/j.bjan.2017.12.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 10/20/2017] [Accepted: 12/28/2017] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND General anesthesia is a safe, frequent procedure in clinical practice. Although it is very unusual in procedures not related to head and or neck surgery, vocal cord paralysis is a serious and important complication. Incidence has been associated with patient age and comorbidities, as well as the position of the endotracheal tube and cuff. It can become a dangerous scenario because it predisposes aspiration. OBJECTIVES To present a case and analyze the risk factors associated with increased risk of vocal cord paralysis described in the literature. CASE REPORT 53 year-old diabetic man, who developed hoarseness in the postoperative period after receiving general anesthesia for an elective abdominal laparoscopic surgery. Otolaryngological evaluation showed left vocal cord paralysis. CONCLUSIONS Vocal cord paralysis can be a serious complication of general anesthesia because of important voice dysfunction and risk of aspiration. The management is not yet fully established, so prevention and early diagnosis is essential.
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Affiliation(s)
- Claudia Hurtado Nazal
- Pontificia Universidad Católica de Chile, Facultad de Medicina, División de Anestesiología, Santiago, Chile.
| | - Andrea Araneda Vilches
- Pontificia Universidad Católica de Chile, Facultad de Medicina, División de Anestesiología, Santiago, Chile
| | - Carolina Vergara Marín
- Pontificia Universidad Católica de Chile, Facultad de Medicina, División de Anestesiología, Santiago, Chile
| | | | - Carla Napolitano Valenzuela
- Pontificia Universidad Católica de Chile, Facultad de Medicina, División de Cirugía, Departamento de Otorrinolaringología, Santiago, Chile
| | - Pedro Badía Ventí
- Pontificia Universidad Católica de Chile, Facultad de Medicina, División de Cirugía, Departamento de Otorrinolaringología, Santiago, Chile
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13
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Abu Ammar A, Gruber M, Martin P, Stern O, Jahshan F, Ertracht O, Sela E, Srouji S, Zussman E. Local delivery of mometasone furoate from an eluting endotracheal tube. J Control Release 2018; 272:54-61. [PMID: 29331580 DOI: 10.1016/j.jconrel.2018.01.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 01/06/2018] [Accepted: 01/08/2018] [Indexed: 12/15/2022]
Abstract
Laryngeal and tracheal morbidity is a common complication of endotracheal tube (ETT)-based airway management, and manifests as local irritation, inflammation, and edema. Systemic corticosteroids are commonly administered to manage these conditions; however, their efficacy is inadequate and limited by potential severe side effects. In the present study, a steroid delivery system for local therapy was developed to generate relatively high local drug concentrations and to improve drug efficacy. ETTs were coated with electrospun poly (lactic-co-glycolic acid) (PLGA) nanofibers loaded with mometasone furoate (MF), creating a microscale thick layer. MF exhibited sustained release from coated ETTs over 14days in vitro. An in vivo efficacy study in rats demonstrated the therapeutic benefit of MF-coated ETTs over bare ETTs, as measured by reduced laryngeal mucosal thickness and submucosal laryngeal edema. The fiber coating remained intact during tube intubation and extubation, demonstrating good adhesion to the tubes even after 24h in aqueous solution at 37°C. These findings demonstrate the potential of drug-loaded ETTs to revolutionize the standard of care for endotracheal intubation.
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Affiliation(s)
- Aiman Abu Ammar
- NanoEngineering Group, Faculty of Mechanical Engineering, Technion - Israel Institute of Technology, Haifa 3200003, Israel
| | - Maayan Gruber
- Department of Otolaryngology-Head and Neck Surgery, Galilee Medical Center, Nahariya 2210001, Israel; Faculty of Medicine in the Galilee, Bar-Ilan University, Safed 1311502, Israel
| | - Patrick Martin
- NanoEngineering Group, Faculty of Mechanical Engineering, Technion - Israel Institute of Technology, Haifa 3200003, Israel
| | - Ohad Stern
- NanoEngineering Group, Faculty of Mechanical Engineering, Technion - Israel Institute of Technology, Haifa 3200003, Israel
| | - Forsan Jahshan
- Department of Otolaryngology-Head and Neck Surgery, Galilee Medical Center, Nahariya 2210001, Israel
| | - Offir Ertracht
- Eliachar Research Laboratory, Galilee Medical Center, Nahariya 2210001, Israel
| | - Eyal Sela
- Department of Otolaryngology-Head and Neck Surgery, Galilee Medical Center, Nahariya 2210001, Israel; Faculty of Medicine in the Galilee, Bar-Ilan University, Safed 1311502, Israel
| | - Samer Srouji
- Faculty of Medicine in the Galilee, Bar-Ilan University, Safed 1311502, Israel; Institute of Oral and Maxillofacial Surgery and Oral Medicine, Galilee Medical Center, Nahariya 2210001, Israel
| | - Eyal Zussman
- NanoEngineering Group, Faculty of Mechanical Engineering, Technion - Israel Institute of Technology, Haifa 3200003, Israel.
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