1
|
Wuthe S, Veraar C, Jantsch-Watzinger U, Skhirtladze-Dworschak K, Schweiger T, Hoetzenecker K, Tschernko E, Dworschak M. Use of Laryngeal Mask Airway With Continuous Transcutaneous PCO 2 monitoring for Crico-tracheal Resection Requiring Intermittent Prolonged Apnea in a Pregnant Woman. J Cardiothorac Vasc Anesth 2024:S1053-0770(24)00272-6. [PMID: 38876814 DOI: 10.1053/j.jvca.2024.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 04/03/2024] [Accepted: 04/10/2024] [Indexed: 06/16/2024]
Affiliation(s)
- Sophie Wuthe
- Department of Anesthesiology, Intensive Care Medicine and Pain Medicine; Division of Cardiac-, Thoracic-, and Vascular Anesthesia and Intensive Care Medicine, Medical University of Vienna, Austria
| | - Cecilia Veraar
- Department of Anesthesiology, Intensive Care Medicine and Pain Medicine; Division of Cardiac-, Thoracic-, and Vascular Anesthesia and Intensive Care Medicine, Medical University of Vienna, Austria
| | - Ursula Jantsch-Watzinger
- Department of Anesthesiology, Intensive Care Medicine and Pain Medicine; Division of Cardiac-, Thoracic-, and Vascular Anesthesia and Intensive Care Medicine, Medical University of Vienna, Austria
| | - Keso Skhirtladze-Dworschak
- Department of Anesthesiology, Intensive Care Medicine and Pain Medicine; Division of Cardiac-, Thoracic-, and Vascular Anesthesia and Intensive Care Medicine, Medical University of Vienna, Austria
| | - Thomas Schweiger
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Konrad Hoetzenecker
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Edda Tschernko
- Department of Anesthesiology, Intensive Care Medicine and Pain Medicine; Division of Cardiac-, Thoracic-, and Vascular Anesthesia and Intensive Care Medicine, Medical University of Vienna, Austria
| | - Martin Dworschak
- Department of Anesthesiology, Intensive Care Medicine and Pain Medicine; Division of Cardiac-, Thoracic-, and Vascular Anesthesia and Intensive Care Medicine, Medical University of Vienna, Austria.
| |
Collapse
|
2
|
Miller KM, Liang KY, Nero N, Benninger MS, Nelson RC, Tierney WS, Lorenz RR, Bryson PC. Surgical Management of Airway Stenosis During Pregnancy: A Scoping Review. Laryngoscope 2024; 134:1014-1022. [PMID: 37632727 DOI: 10.1002/lary.30994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 07/11/2023] [Accepted: 08/03/2023] [Indexed: 08/28/2023]
Abstract
OBJECTIVE There are several options for surgical management of subglottic stenosis, including endoscopic and open procedures. However, treatment algorithms, outcomes, and anesthetic management of subglottic stenosis during pregnancy are not well described. DATA SOURCES MEDLINE, EMBASE, and the Cochrane databases. REVIEW METHODS A scoping review of management of subglottic stenosis during pregnancy was performed, and then reported in compliance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Inclusion criteria consisted of those with subglottic or tracheal stenosis aged greater than 18 years, those in whom management was performed during pregnancy, and those who reported delivery related outcomes. RESULTS After systematic review and detailed search of 330 identified articles, 15 articles met inclusion criteria and were included in the final analysis. All studies were case reports or case series (level 4 evidence). This study identified 27 patients. The median age was 29 and the median gestational age at intervention was 28 weeks. Left lateral positioning and fetal heart rate monitoring were used in nearly every case. The most common intervention performed was endoscopic balloon dilation. In many cases, jet ventilation or transnasal humidified rapid insufflation ventilatory exchange was satisfactory for maintenance of the airway. Three women ultimately required tracheostomy prior to labor and delivery. There was no fetal death or complications reported in these studies, and all but one woman proceeded to deliver at term. CONCLUSION Endoscopic balloon dilation during pregnancy is safe and effective, resulting in optimized respiratory outcomes for the mother and safe delivery of the fetus. The third trimester appears to be safe for airway intervention. Laryngoscope, 134:1014-1022, 2024.
Collapse
Affiliation(s)
| | - Kevin Y Liang
- Cleveland Clinic, Head & Neck Institute, Cleveland, Ohio, U.S.A
| | - Neil Nero
- Cleveland Clinic, Education Institute, Cleveland, Ohio, U.S.A
| | | | | | | | - Robert R Lorenz
- Cleveland Clinic, Head & Neck Institute, Cleveland, Ohio, U.S.A
| | - Paul C Bryson
- Cleveland Clinic, Head & Neck Institute, Cleveland, Ohio, U.S.A
| |
Collapse
|
3
|
Miller EJ, Huning EYS. Subglottic tracheal stenosis complicating pregnancy: A case report. Obstet Med 2022; 15:205-207. [PMID: 36262817 PMCID: PMC9574454 DOI: 10.1177/1753495x21990220] [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: 07/27/2020] [Revised: 11/22/2020] [Accepted: 12/30/2020] [Indexed: 09/03/2023] Open
Abstract
The case presented details an uncommon case of subglottic tracheal stenosis exacerbated by pregnancy. We outine the multidisciplinary management involved and the outcomes for the pregnancy. The case serves as a reminder that shortness of breath in pregnancy has a broad differential diagnosis, and stridor is always abnormal.
Collapse
|
4
|
Kanzara T, Rotman A, Kinshuck A, Al Yaghchi C, Tan MY, Yu C, Sandu G. Endoscopic management of idiopathic subglottic stenosis in pregnancy. Obstet Med 2021; 14:225-229. [PMID: 34880935 DOI: 10.1177/1753495x21991407] [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: 06/23/2020] [Accepted: 12/30/2020] [Indexed: 11/15/2022] Open
Abstract
Aims To describe the use of laser, endoscopic balloon dilatation with jet ventilation anaesthesia in the treatment of pregnant women with idiopathic subglottic stenosis. Materials and methods This is a case review of pregnant women with idiopathic subglottic stenosis, presenting to a tertiary referral centre with worsening breathlessness. Data were extracted from patient case notes. Results Four women underwent surgical management of subglottic stenosis in pregnancy. One patient required two procedures during the course of their pregnancy due to restenosis. All women had improvement in symptoms post-operatively and went on to deliver healthy babies at term. Conclusion Endoscopic balloon dilatation of idiopathic subglottic stenosis is a safe and viable treatment option in pregnancy and should be offered as first-line treatment in symptomatic women.
Collapse
Affiliation(s)
- Todd Kanzara
- ENT Department, Aintree University Hospital, Liverpool, UK
| | - Anthony Rotman
- National Centre for Airway Reconstruction, Imperial College Healthcare NHS Trust, London, UK
| | | | - Chadwan Al Yaghchi
- National Centre for Airway Reconstruction, Imperial College Healthcare NHS Trust, London, UK
| | - Min Yi Tan
- National Centre for Airway Reconstruction, Imperial College Healthcare NHS Trust, London, UK
| | - Christina Yu
- National Centre for Airway Reconstruction, Imperial College Healthcare NHS Trust, London, UK
| | - Guri Sandu
- National Centre for Airway Reconstruction, Imperial College Healthcare NHS Trust, London, UK
| |
Collapse
|
5
|
Tapias LF, Rogan TJ, Wright CD, Mathisen DJ. Pregnancy-associated idiopathic laryngotracheal stenosis: presentation, management and results of surgical treatment. Eur J Cardiothorac Surg 2021; 59:122-129. [PMID: 33038218 DOI: 10.1093/ejcts/ezaa296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 07/02/2020] [Accepted: 07/12/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Idiopathic laryngotracheal stenosis (ILTS) is an uncommon problem arising mostly in women. In some, it arises during or is exacerbated by pregnancy. Experience with management of patients with this rare association is limited. This study seeks to evaluate the management of patients with pregnancy-associated ILTS and compare outcomes to cases not associated with pregnancy. METHODS Retrospective review of 15 patients undergoing surgical treatment of pregnancy-associated ILTS from 1971 to 2013. Variables of interest and airway outcomes were compared to patients with non-pregnancy-associated ILTS. RESULTS Pregnancy-associated ILTS was observed in 15/263 (5.7%) patients. Symptoms developed during their first pregnancy. When compared to non-pregnancy patients, these patients were younger (37 vs 47 years; P = 0.0003), had more prior tracheostomies (26.7% vs 10.9%; P = 0.085) and had more preoperative airway dilatations (86.7% vs 57.7%; P = 0.030). All patients completed pregnancy without complications and ultimately underwent laryngotracheal resection. The expression of hormonal receptors in the surgical specimens was similar in both groups (oestrogen receptors: 100% vs 75% and progesterone receptors: 71.4% vs 72.1%, in pregnancy and non-pregnancy patients, respectively). Airway outcomes were good/excellent in 13 (86.7%) patients with pregnancy-associated ILTS and 225 (90.7%) patients without pregnancy association (P = 0.642), and did not change when adjusting for other risk factors. CONCLUSIONS Pregnancy-associated ILTS is rare. The pathophysiology is unclear, but appearance of symptoms during pregnancy may suggest hormonal factors. To minimize foetal risk, dilatation during pregnancy followed by laryngotracheal resection after delivery is the preferred treatment. Pregnancy association does not seem to affect outcomes with expected satisfactory results in most patients.
Collapse
Affiliation(s)
- Luis F Tapias
- Division of Thoracic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Thomas J Rogan
- Division of Thoracic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Cameron D Wright
- Division of Thoracic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Douglas J Mathisen
- Division of Thoracic Surgery, Massachusetts General Hospital, Boston, MA, USA
| |
Collapse
|
6
|
Schulze MG, Young MG. Tracheal Dilatation of an Idiopathic Subglottic Stenosis in a Near-Term Parturient at 36 Weeks of Gestation Using SponTaneous Respiration Using Intravenous Anesthesia and Hi-Flow Nasal Oxygen: A Case Report. A A Pract 2021; 15:e01450. [PMID: 33882046 DOI: 10.1213/xaa.0000000000001450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Hi-flow nasal oxygen (HFNO) has revolutionized tubeless field anesthesia for airway surgery without the complications of jet ventilation. However, its use in third trimester parturients undergoing open airway surgery has been limited to an apneic technique (Transnasal Humidified Rapid-Insufflation Ventilatory Exchange [THRIVE]) in current publications. We used SponTaneous Respiration using IntraVEnous anesthesia and Hi-flow nasal oxygen (STRIVE Hi) in the management of tracheal dilatation in a near-term parturient at 36 weeks of gestation. Transferring this established protocol for spontaneous ventilation in the obstructed airway onto near-term parturients may mitigate the risks of apnea with hypercapnia, subsequent acidosis, and potential fetal harm.
Collapse
Affiliation(s)
- Melanie G Schulze
- From the Department of Anaesthesia, Mater Hospital Brisbane, Brisbane, Queensland, Australia
| | | |
Collapse
|
7
|
Fang S, Pai B H P. Successful management of subglottic stenosis in pregnancy. BMJ Case Rep 2021; 14:14/3/e236466. [PMID: 33762270 PMCID: PMC7993347 DOI: 10.1136/bcr-2020-236466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Evaluation and management of subglottic stenosis in pregnancy is challenging. It often is not only a multidisciplinary approach between obstetricians, otolaryngologists (ENT surgeons) and anesthesiologists, but also requires a thorough understanding of possible foreseen complications by the patient as well. Hence, whenever we are presented with a challenging case requiring multidisciplinary approach involving team of physicians from different specialties, it is routine practice to huddle regarding the preoperative, intraoperative and postoperative management and care. We present a case of a 37-year-old woman with a known history of idiopathic subglottic stenosis, 16 weeks' pregnant, G4P1, with a surgical history significant for two previous subglottic dilations in the past and who now presented with an audible stridor and shortness of breath on activity. We highlighted the unique challenges encountered and the corresponding management adopted. This is a case of successful management of symptomatic worsening of subglottic stenosis managed during pregnancy.
Collapse
Affiliation(s)
- Shenghao Fang
- Department of Anesthesiology, Perioperative and Pain Medicine, Mount Sinai West And Morningside Hospitals, Mount Sinai Health System, New York, New York, USA
| | - Poonam Pai B H
- Department of Anesthesiology, Perioperative and Pain Medicine, Mount Sinai West And Morningside Hospitals, Mount Sinai Health System, New York, New York, USA
| |
Collapse
|
8
|
Management of subglottic stenosis in pregnancy using advanced apnoeic ventilatory techniques. The Journal of Laryngology & Otology 2019; 133:399-403. [DOI: 10.1017/s0022215119000690] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjectiveTo describe the use of balloon dilation with non-invasive ventilation in the treatment of pregnant patients with idiopathic subglottic stenosis.MethodsThe medical charts of four consecutive patients who underwent jet ventilation or high-flow nasal cannula oxygenation with balloon dilation for the treatment of idiopathic subglottic stenosis during pregnancy were reviewed.ResultsObjective improvement of subglottic stenosis was seen in all four cases, with end-result Myer–Cotton grade 1 lesions down from pre-procedure grade 3 lesions. Patients also reported subjective improvements in symptomatology, with no further airway issues. All patients delivered normally, at term.ConclusionLaryngeal dilation with continuous radial expansion pulmonary balloons using non-invasive ventilation for the treatment of idiopathic subglottic stenosis in pregnant patients is safe and efficacious, and should be the first line treatment option for this patient population. The improvement in symptoms, and lack of labour and pregnancy complications, distinguish this method of treatment from others reported in the literature.
Collapse
|