Use of a ProSeal™ laryngeal mask airway and a Ravussin cricothyroidotomy needle in the management of laryngeal and subglottic stenosis causing upper airway obstruction

Radiofrequency ablation of bilateral splanchnic nerves in a 15-year-old patient with visceral abdominal pain cancer

Pain, a prevalent and debilitating symptom in cancer patients, significantly diminishes the quality of life for both individuals and their families. Addressing this critical issue, our study presents the case of a 15-year-old diagnosed with synchronous multifocal multicentric osteosarcoma. We utilized radiofrequency ablation of bilateral splanchnic nerves, a strategy of multimodal pain and palliative care. This approach not only proved to be safe and effective but also markedly improved the patient's quality of life. Our findings shine a light of hope, emphasizing the paramount importance of innovative pain management in pediatric oncology, especially in the final stages of life. This case report highlights the unwavering dedication to excellence in relieving suffering, offering hope for patients grappling with cancer.

Difficult airway associated with bifid glottis and coexistent subglottic stenosis in a patient with Pallister-Hall syndrome: a case report

Background

Pallister–Hall syndrome is a rare disorder characterized by hypothalamic hamartoma, hypopituitarism, bifid epiglottis, and micrognathia.

Case presentation

We describe the airway management under general anesthesia of a 15-year-old female with Pallister–Hall syndrome whose airway was compromised with bifid epiglottis and acquired subglottic stenosis. The three options considered for airway management were tracheal intubation, a supraglottic device, and surgical tracheotomy. Tracheal intubation provides a secured airway, but extubation can be difficult. A supraglottic device minimizes airway injury, but it does not completely protect the airway from aspiration.

Conclusions

The patient’s airway was successfully managed using a supraglottic device with aspiration prophylaxis. Airway management devices should be selected according to each patients’ individual circumstances.

Electronic supplementary material

The online version of this article (10.1186/s40981-018-0158-1) contains supplementary material, which is available to authorized users.

Anaesthetic management of acute airway obstruction

The acutely obstructed airway is a medical emergency that can potentially result in serious morbidity and mortality. Apart from the latest advancements in anaesthetic techniques, equipment and drugs, publications relevant to our topic, including the United Kingdom's 4th National Audit Project on major airway complications in 2011 and the updated American Society of Anesthesiologists' difficult airway algorithm of 2013, have recently been published. The former contained many reports of adverse events associated with the management of acute airway obstruction. By analysing the data and concepts from these two publications, this review article provides an update on management techniques for the acutely obstructed airway. We discuss the principles and factors relevant to the decision-making process in formulating a logical management plan.

Airway exchange catheters use in the airway management of neonates and infants undergoing surgical treatment of laryngeal stenosis

BACKGROUND

Congenital and acquired upper airway obstruction in infants commonly manifests as an acute, potentially life-threatening condition or a slow and gradual deterioration and can be a challenge to the pediatric anesthesiologist. This case series reports the nonconventional use of pediatric airway exchange catheters emergent and short-term airway management and lung ventilation in neonates and infants with severe laryngotracheal stenosis.

CASE SERIES

After the approval of local Institutional Review Board, 11 consecutive patients presenting with severe laryngotracheal stenosis exceeding 70% were prospectively studied. Median (range) age and weight were 32 days (0-96) and 2.7 kg (2.1-3.4), respectively. Induction of anesthesia consisted of sevoflurane 5% in oxygen followed by sevoflurane 3% in an air/oxygen mixture (Fio2 = 0.5). Spontaneous ventilation was maintained in all patients. The trachea was intubated using an Airway Exchange Catheter with an inner diameter of 1.6 mm (Cook Airway Exchange Catheters, Cook Medical, Bloomington, IN). An Airway Exchange Catheter was inserted through the stenosis and manually assisted ventilation was confirmed using capnography. Median (range) ventilation duration was 28 minutes (12-61 mins). In one neonate, the Airway Exchange Catheter failed to ensure proper ventilation and an emergency tracheostomy was performed. Respiratory distress was likely due to a significant increase in airway resistance at the stenosis level or distal accumulation of secretions.

CONCLUSION

Airway exchange catheters represent a useful additional tool for short-term advanced airway management for both oxygenation and ventilation in neonates and infants presenting with severe laryngotracheal stenosis.

A complication of transtracheal jet ventilation and use of the Aintree intubation catheter during airway resuscitation

We report the management of a patient requiring surgical laryngoscopy with a view to laser resection of an epiglottic recurrence of laryngeal cancer. Previous attempts at tracheal intubation and awake nasal fibreoptic intubation had failed. During a previous anaesthetic the patient had been both 'impossible to intubate and to ventilate'. Neck scarring potentially complicated access for transtracheal jet ventilation. Nevertheless, a cricothyroid catheter was placed and surgery performed during low frequency 'volume' jet ventilation. Upper airway obstruction developed during the procedure, preventing exhalation, which led to raised intrathoracic pressure, cardiovascular collapse and barotrauma. The airway was re-established by insertion of an LMA Proseal. Fibreoptic placement of an Aintree intubation catheter through this allowed re-oxygenation and exchange for a cuffed tracheal tube. Some hours after the procedure, re-intubation was necessary. This was achieved using the Aintree intubation catheter as an aid to nasal fibreoptic intubation and as a tube exchanger. Novel roles of the Aintree intubation catheter and LMA Proseal in this case are discussed. Complications of transtracheal jet ventilation as well as possible methods for avoiding them are also reviewed.