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Iijima Y, Takaoka Y, Motono N, Uramoto H. Temporary tracheotomy for post-intubation laryngeal edema after lung cancer surgery: a case report. J Cardiothorac Surg 2023; 18:88. [PMID: 36941666 PMCID: PMC10026421 DOI: 10.1186/s13019-023-02187-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 03/12/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND In the post-intubation period, laryngeal edema is one of the most severe complications, which can cause significant morbidity and even death. Herein, we report a case in which we performed a temporary tracheostomy during surgery because of the risk of postoperative laryngeal edema, successfully avoiding post-intubation laryngeal edema complications. CASE PRESENTATION A 78-year-old man underwent surgery for left upper lobe lung cancer. He had a history of chemoradiotherapy for laryngeal cancer, bronchial asthma, and chronic obstructive pulmonary disease. He was diagnosed with grade 1 laryngeal edema using computed tomography, and there was a risk of developing post-intubation laryngeal edema. Additionally, there was a decrease in laryngeal and pulmonary functions; therefore, postoperative aspiration pneumonia was judged to be a fatal risk. A temporary tracheostomy was performed during surgery to avoid postoperative intubation laryngeal edema. He was found to have exacerbated laryngeal edema, which is a serious complication of airway stenosis. CONCLUSIONS Temporary tracheostomy should be considered to avoid airway stenosis due to post-intubation laryngeal edema in patients with laryngeal edema after radiotherapy.
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Affiliation(s)
- Yoshihito Iijima
- Department of Thoracic Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada-Machi, Kahoku-gun, Ishikawa, 920-0293, Japan.
| | - Yuki Takaoka
- Department of Head and Neck Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada-machi, Kahoku-gun, Ishikawa, 920-0293, Japan
| | - Nozomu Motono
- Department of Thoracic Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada-Machi, Kahoku-gun, Ishikawa, 920-0293, Japan
| | - Hidetaka Uramoto
- Department of Thoracic Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada-Machi, Kahoku-gun, Ishikawa, 920-0293, Japan
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Kim H, Jung H, Hwang SM, Yang WS. Preoperative rigid laryngoscopic examination and modified jaw thrust manoeuver during fibreoptic-assisted tracheal intubation for general anaesthesia. BMJ Case Rep 2021; 14:14/5/e232826. [PMID: 34039537 DOI: 10.1136/bcr-2019-232826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Preoperative laryngoscopic examination of the airway informs general anaesthesia management and planning. However, the same glottic opening view cannot always be obtained during direct laryngoscopy of anaesthetised patients. In this case report, a patient underwent preoperative rigid laryngoscopy due to medical history, and no problems were anticipated in performing tracheal intubation; however, the direct laryngoscopic view was a Grade 4 on the Cormack-Lehane Scale after anaesthesia induction. A jaw thrust manoeuvre to facilitate fibreoptic-assisted nasotracheal intubation was not feasible. In order to compensate, a modified method of jaw thrust was implemented, where both thumbs were placed on the floor of the patient's mouth, leading to a successful result. Safe airway management should be implemented with proper planning based on a careful preoperative evaluation.
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Affiliation(s)
- Hyunjee Kim
- Department of Anesthesiology and Pain Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Hoon Jung
- Department of Anesthesiology and Pain Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Seong Min Hwang
- Department of Anesthesiology and Pain Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Woo Seok Yang
- Department of Anesthesiology and Pain Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
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Patel RC, Kubicki SL, Cohen PR, MacFarlane DF. Melatonin-Associated Facial Swelling in an Oncology Patient: Case Report and Review of Swelling of the Face in Individuals With Head and Neck Cancer. Cureus 2020; 12:e10866. [PMID: 33178519 PMCID: PMC7652014 DOI: 10.7759/cureus.10866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Facial swelling has several etiologies. In patients with head and neck malignancies, this can include primary disease progression or iatrogenic causes. A 66-year-old man presented with increased facial swelling and erythema for 18 months. He had a history of baseline postoperative facial lymphedema following head and neck surgery and radiotherapy for desmoplastic melanoma approximately 20 years ago. However, his facial edema acutely worsened 18 months prior to presentation. A medication review revealed that he was regularly taking melatonin for the past two years. Approximately two weeks after cessation of melatonin therapy, the patient’s facial appearance returned to baseline. In conclusion, it is important for clinicians to perform a thorough medication review for patients with facial swelling and erythema.
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Affiliation(s)
- Ravi C Patel
- Dermatology, MD Anderson Cancer Center, Houston, USA
| | - Shelby L Kubicki
- Dermatology, University of Texas McGovern Medical School, Houston, USA
| | - Philip R Cohen
- Dermatology, San Diego Family Dermatology, National City, USA
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Dong PV, ter Horst L, Krage R. Emergency percutaneous transtracheal jet ventilation in a hypoxic cardiopulmonary resuscitation setting: a life-saving rescue technique. BMJ Case Rep 2018; 2018:bcr-2017-222283. [DOI: 10.1136/bcr-2017-222283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Twohig EM, Leader R, Shaw RJ, Charters P. Staged extubation to manage the airway after operations on the head and neck. Br J Oral Maxillofac Surg 2016; 54:1030-1032. [PMID: 26975572 DOI: 10.1016/j.bjoms.2016.02.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 02/19/2016] [Indexed: 12/20/2022]
Abstract
Management of the airway after operations on the head and neck is potentially problematic. We describe leaving a guidewire in the trachea after successful extubation in two patients, to make reintubation easier if the airway was later compromised.
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Affiliation(s)
- Eoin M Twohig
- Regional Maxillofacial Unit, Aintree University Hospital, Longmoor Lane, Liverpool, Merseyside, L9 7AL.
| | - Ross Leader
- Regional Maxillofacial Unit, Aintree University Hospital, Longmoor Lane, Liverpool, Merseyside, L9 7AL.
| | - Richard J Shaw
- Regional Maxillofacial Unit, Aintree University Hospital, Longmoor Lane, Liverpool, Merseyside, L9 7AL.
| | - Peter Charters
- Regional Maxillofacial Unit, Aintree University Hospital, Longmoor Lane, Liverpool, Merseyside, L9 7AL.
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Single cannula versus double cannula tracheostomy tubes in major oral and oropharyngeal resections. The Journal of Laryngology & Otology 2015; 130:388-92. [PMID: 26707289 DOI: 10.1017/s0022215115003412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To compare the outcomes of two types of tracheostomy tubes used in major head and neck surgery. METHODS A retrospective study was conducted of prospectively collected data. The post-operative safety and adequacy of a single cannula tracheostomy tube was compared to a double cannula tracheostomy tube in patients undergoing tracheostomy during major oral and oropharyngeal resections. RESULTS Out of 46 patients with the single cannula tube, 7 (15 per cent) experienced significant obstruction warranting immediate tube removal, while another 9 (20 per cent) needed a change of tube or tube re-insertion for continued airway protection. In contrast, out of 50 patients with the double cannula tube, the corresponding numbers were 0 (p = 0.004) and 1 (2 per cent; p = 0.007) respectively. CONCLUSION Insertion of a double cannula (instead of a single cannula) tracheostomy tube in the course of major oral and oropharyngeal resections offers better airway protection during the post-operative period.
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Wong P, Iqbal R, Light KP, Williams E, Hayward J. Head and neck surgery in a tertiary centre: Predictors of difficult airway and anaesthetic management. PROCEEDINGS OF SINGAPORE HEALTHCARE 2015. [DOI: 10.1177/2010105815615995] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction: The management of head and neck surgical patients is associated with increased morbidity and mortality, and so anticipating the difficult airway is important. Methods: We undertook a prospective survey on consecutive adult patients scheduled on the elective operating lists of four head and neck consultant surgeons. Data were collected over a 36 month period. Data included: patient characteristics; routine predictors of difficulty in airway management (bedside tests of the airway, a history of previous surgery or radiotherapy and the presence of airway symptoms); laryngoscopy grade; method of anaesthesia and airway management; and any airway complications arising during induction of anaesthesia and extubation. Results: The ‘study’ group consisted of 818 patients. The ‘direct laryngoscopy’ group contained 674 patients, that is, patients who had direct laryngoscopy and could therefore be classified as easy or difficult intubation. The prevalence of difficult intubation was 12.6%. Factors or tests that were statistically significantly associated with difficult intubation were: history of difficult airway; previous head or neck radiotherapy treatment; presence of airway symptoms; presence of moderate or severe limited neck movement; and short interdental distance. The sensitivity, specificity and positive predictive values were: history of difficult airway 16.5%, 98.6% and 63.6%; previous radiotherapy 12.9%, 96.6% and 35.5%; airway symptoms 42.9%, 69.6% and 15.9%; moderate/severe neck limitation 16.7%, 97.2% and 46.7%; Mallampati score 3 or 4, 38.8%, 83.8% and 25.8%; and interdental distance 9.4%, 98.8% and 53.3%, respectively. The Bonfils intubation fibrescope was the most commonly used indirect laryngoscopy device (63.9% of all such cases). Twenty-six patients (3.2%) had complications during their initial airway management after induction of anaesthesia. There was one case of ‘cannot intubate, cannot oxygenate’, which required an emergency tracheostomy. Conclusion: The prevalence of difficult intubation in head and neck surgical patients was higher than in the general population, but predictive tests for difficult intubation have poor to moderate value. In our study, rates of difficult face mask ventilation, failed intubation and complications during induction and extubation were low. However, serious morbidity, although rare, can still be encountered. Head and neck surgical patients can be managed safely in a tertiary centre where there is appropriate surgical and anaesthetic expertise in managing difficult airways.
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Affiliation(s)
- Patrick Wong
- Department of Anaesthesiology, Singapore General Hospital, Singapore
| | - Rehana Iqbal
- Department of Anaesthesia, St George’s Hospital, London, UK
| | | | | | - James Hayward
- Department of Anaesthesia, Worthing District General Hospital, West Sussex, UK
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Graboyes EM, Bradley JP, Kallogjeri D, Cavallone LF, Nussenbaum B. Prognosis and Patterns of Failure for the Extubation of Patients Who Remain Intubated After Head and Neck Surgery. Ann Otol Rhinol Laryngol 2014; 124:179-86. [DOI: 10.1177/0003489414549576] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Objective: This study aimed to analyze the rate of failure, patterns of failure, and prognostic factors for patients who remain intubated after head and neck surgery and then undergo delayed extubation. Methods: Retrospective chart review of all otolaryngology patients who remained intubated after head and neck surgery and then underwent delayed extubation between 2006 and 2013. The incidence and patterns of extubation failure were analyzed. Univariable logistic regression analysis was performed to identify risk factors for postextubation failure. Results: Fifteen of the 129 patients (12%) who remained intubated after head and neck surgery and underwent delayed extubation subsequently failed and required either repeat intubation or an emergency surgical airway. The most common reasons for failure were hemorrhage (47%) and upper airway edema (33%). Failure typically occurred within 6 hours of extubation. Twenty-seven percent of the patients who failed extubation (4/15) required an emergency surgical airway. On univariable logistic regression analysis, ligation of a major neck vessel predicted extubation failure (odds ratio = 5.20; 95% confidence interval, 1.48-18.23). Conclusion: Postextubation failure in carefully selected patients undergoing delayed extubation after head and neck surgery is infrequent and most commonly due to postoperative bleeding. Prospective data are required to facilitate safe and quality care for these patients.
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Affiliation(s)
- Evan M. Graboyes
- Washington University in St Louis School of Medicine, Department of Otolaryngology–Head and Neck Surgery, St Louis, Missouri, USA
| | - Joseph P. Bradley
- Washington University in St Louis School of Medicine, Department of Otolaryngology–Head and Neck Surgery, St Louis, Missouri, USA
| | - Dorina Kallogjeri
- Washington University in St Louis School of Medicine, Department of Otolaryngology–Head and Neck Surgery, St Louis, Missouri, USA
| | - Laura F. Cavallone
- Washington University in St Louis School of Medicine, Department of Anesthesiology, St Louis, Missouri, USA
| | - Brian Nussenbaum
- Washington University in St Louis School of Medicine, Department of Otolaryngology–Head and Neck Surgery, St Louis, Missouri, USA
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Singhal S, Chopra V, Kiran S, Verma M. Life-threatening upper airway obstruction associated with prior radiotherapy. South Asian J Cancer 2014; 2:219. [PMID: 24455637 PMCID: PMC3889040 DOI: 10.4103/2278-330x.119915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Sanjay Singhal
- Chest Specialist and Trained in Critical Care, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - V Chopra
- Consultant Anesthesia, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - S Kiran
- Consultant anesthesia and Intensivist, Command Hospital, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Mranalini Verma
- Department of Radiation Oncology, SGPGIMS, Lucknow, Uttar Pradesh, India
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Chung MK, Choi J, Lee JK, Jeong JI, Lee WY, Jeong HS. Preservation of the External Jugular Venous Drainage System in Neck Dissection. Otolaryngol Head Neck Surg 2009; 141:730-6. [PMID: 19932846 DOI: 10.1016/j.otohns.2009.08.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2009] [Revised: 08/20/2009] [Accepted: 08/31/2009] [Indexed: 11/28/2022]
Abstract
OBJECTIVE: To investigate whether preserving the external jugular vein (EJV) in neck dissection reduces postoperative edema of the face and neck. STUDY DESIGN: A prospective, randomized controlled trial. SETTING: A tertiary hospital. SUBJECTS AND METHODS: Thirty-eight subjects were randomly assigned to two groups: EJV preservation versus sacrifice during neck dissection after stratification according to the neck dissection extent and type, the previous treatment, the primary site, and the reconstruction type. The relative soft-tissue thickness was evaluated by follow-up computed tomography (CT) scans at one week and four to five weeks postoperatively and compared with preoperative findings. The preserved EJV patency was also determined by contrast enhancement of EJV on follow-up CT scans. In addition, the scores for pain/discomfort on the upper neck/face and laryngeal edema were recorded at each time point. RESULTS: Relative soft-tissue thickness reached up to 160 percent of preoperative status at the hyoid and cricoid levels at one week postoperatively but resolved at four to five weeks. EJV preservation reduced the soft-tissue thickness significantly compared with EJV sacrifice ( P < 0.05) at one week postoperatively, particularly at the mandible and hyoid level. All preserved EJVs remained patent at one week, and 18 of 19 remained patent at four to five weeks. In addition, EJV preservation diminished the discomfort/pain of the upper neck/face compared with EJV sacrifice at one week ( P = 0.036). The extent of laryngeal edema did not differ between the two groups. CONCLUSION: EJV preservation may reduce immediate postoperative neck edema and pain/discomfort related to neck dissection.
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Affiliation(s)
- Man Ki Chung
- Department of Otorhinolaryngology–Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeesun Choi
- Department of Otorhinolaryngology–Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae-Kwon Lee
- Department of Otorhinolaryngology–Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong In Jeong
- Department of Otorhinolaryngology–Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won Yong Lee
- Department of Otorhinolaryngology–Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Han-Sin Jeong
- Department of Otorhinolaryngology–Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Umesh G, Ellango A, Jasvinder K, Kini G. Immediate postoperative airway obstruction secondary to airway edema following tumor excision from the neck. J Anesth 2009; 23:609-12. [PMID: 19921378 DOI: 10.1007/s00540-009-0798-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2009] [Accepted: 05/25/2009] [Indexed: 11/29/2022]
Abstract
A 46-year-old woman was scheduled for excision of a malignant peripheral nerve sheath tumor from the neck. The tumor had caused deviation of the trachea to the left and partial obstruction of the superior vena cava. Her upper airway at laryngoscopy after induction of anesthesia was normal. During tumor resection there were transient phases characterized by the complete disappearance of the peripheral oxygen saturation (Sp(O2)) and radial artery tracings. At the end of the operation, the trachea was extubated after ensuring adequate antagonization of neuromuscular blockade. However, immediately post-extubation, she showed signs of acute airway obstruction that necessitated reintubation of the trachea. Laryngoscopy revealed significant edema of the upper airway and vocal cords, requiring a smaller size tracheal tube. Many reports suggest the development of significant airway edema 24 h after such surgery. Our report highlights the fact that this can happen in the immediate postoperative period also. Some authors suggest that, in such surgery, extubation should routinely be done over pediatric tube exchangers. Routine leak testing and direct laryngoscopic/fiberoptic evaluation of the upper airway prior to extubation may also help. While our report reaffirms these points, it also stresses the importance of intraoperative monitoring for the compression of the great vessels, which may serve as a useful indicator of the early development of airway edema.
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Affiliation(s)
- Goneppanavar Umesh
- Department of Anaesthesiology, Kasturba Medical College, Manipal, Karnataka State, India
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Unusual case of difficult double-lumen endotracheal tube removal. J Clin Anesth 2009; 21:514-6. [DOI: 10.1016/j.jclinane.2008.10.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2007] [Revised: 10/13/2008] [Accepted: 10/30/2008] [Indexed: 11/18/2022]
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Extubation difficile : critères d’extubation et gestion des situations à risque. ACTA ACUST UNITED AC 2008; 27:46-53. [DOI: 10.1016/j.annfar.2007.10.026] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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