Laryngeal complications after tracheal intubation and tracheostomy.
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ABSTRACT:
SUBMITTER: Wallace S
PROVIDER: S-EPMC8212164 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:BackgroundTracheostomy and endotracheal intubation can result in subglottic tracheal stenosis, and predisposition to keloid scar formation can increase stenosis risk after tracheal injury. This study aims to compare the incidence and severity of subglottic tracheal stenosis in keloid and non-keloid patients following iatrogenic tracheal injury, in particular tracheostomy.MethodsFrom 2012 to 2017, 218 573 patients were intubated for surgery; 2276 patients received tracheostomy in People's Hospital of Zhengzhou University, China. Among these patients, 133 patients, who developed tracheal stenosis after intubation and/or tracheostomy, were divided into keloid or non-keloid groups; their Myer and Cotton grading of tracheal stenosis, time-to-onset of airway stenosis, and treatment outcome were assessed and compared.ResultsThe percentages of high grade (Myer and Cotton grading III/IV) tracheal stenosis were higher among keloid patients than non-keloid patients (intubation: 83.3% vs 25.7%; tracheostomy: 77.7% vs 33.3%). Time-to-onset of airway stenosis following intubation (tracheostomy) was 27 ± 5 (38 ± 13) and 41 ± 7 (82 ± 14) days for keloid and non-keloid patients, respectively (P < 0.01). The incidence of tracheal stenosis is higher in keloid than non-keloid subjects (19.4% vs 1.82%, P < 0.001). Keloid patients also required more frequent treatment (P < 0.01) of longer duration, yet cure rate was significantly lower (P < 0.01).ConclusionsOur study suggests that tracheostomized patients with keloid phenotype are more susceptibility to develop iatrogenic tracheal stenosis of greater severity and with poorer treatment outcome. Greater cautions may be required when performing tracheostomy in keloid subjects. More substantive analysis is warranted to establish keloid phenotype as a risk factor for tracheal stenosis.
| S-EPMC6619028 | biostudies-literature
Project description:Background and Aims:Supraglottic airways (SGAs) are generally used for airway management; but can also be used as a conduit for tracheal intubation. Our primary aim was to evaluate i-Gel and laryngeal mask airway (LMA) classic as conduits for tracheal intubation using ventilating bougie by assessing number of attempts and time for insertion of SGAs, ventilating bougie and endotracheal tube (ETT), and total intubation time. Material and Methods:A randomized clinical trial was carried out in 58 patients requiring general anesthesia and endotracheal intubation for planned surgery. They were randomly divided into Group I and Group C. After induction of anesthesia, i-Gel was inserted in Group I and LMA Classic in Group C; ventilating bougie was passed through SGA followed by the removal of SGA and railroading of ETT over ventilating bougie. Parameters observed were number of attempts and time taken for device insertion, total intubation time, and hemodynamic variables. Results:Twenty-nine patients were included in each group. First attempt success rate for SGA insertion (86.2% in Group I and 75.9% in Group C (P = 0.5)), ventilating bougie insertion (79.32% in Group I and 82.8% in Group C (P = 0.99)) and ETT insertion (100% in Group I and 96.5% in Group C) was not different in the two groups. Total intubation time was 93.3 ± 9.0 s in Group I and 108. 96 ± 16.5 s in Group C (P < 0.0001). Conclusions:i-Gel and LMA Classic both can be used as a conduit for tracheal intubation using ventilating bougie with stable hemodynamic parameters.
| S-EPMC5791259 | biostudies-literature
Project description:A term male newborn infant was apneic at birth, and endotracheal intubation was unsuccessful. He was stabilized for transport with a laryngeal mask airway. Laryngoscopy revealed tracheal atresia with intrathoracic distal tracheoesophageal fistula. A laryngeal mask airway may provide ventilation in tracheal atresia patients with a fistula.
| S-EPMC8416395 | biostudies-literature
Project description:The word tracheostomy derived from two greek words meaning 'I cut the trachea' has been known for about 3500 yrs. The process has evolved over the years and has undergone revolutionary changes in the methodology, instrumentation and indications. Although tracheostomy is now commonly used the complication rate remains high. In our series it was 48% which is comparable with other series. The purpose of this paper is to discuss the complications of tracheostomy with special attention to their management and prevention.
| S-EPMC5531884 | biostudies-other
Project description:BackgroundTracheal rupture is a rare but life-threatening complication that most commonly occurrs after blunt trauma to the chest, but which may also complicate tracheal intubation. We report a case of post-intubation tracheal rupture after cataract surgery under general anesthesia treated conservatively.Case presentationFour hours after extubation, a 67 year-old woman developed subcutaneous emphysema of the facial, bilateral laterocervical and upper anterior chest. Tracheobronchial fiberendoscopy showed a posterior tracheal transmural rupture 4 cm long located 2.5 cm above the carina that opened in inspiration. The location of the lesion and features of the patient favoured conservative treatment with antibiotic cover. The patient made a full and uncomplicated recovery and was discharged fourteen days after the original injury.ConclusionTwo therapeutic strategies are currently employed for post-intubation tracheal rupture: a non-surgical strategy for small injuries and a surgical strategy for larger injuries. This case report presented the non-surgical therapeutic strategy of a large tracheal injury.
| S-EPMC2579287 | biostudies-literature
Project description:Background:Several studies have identified side effects of general anesthesia with endotracheal intubation, such as laryngeal pain, dysphonia, and postoperative nausea and vomiting (PONV). The laryngeal mask airway (LMAw) is believed to decrease these side effects. The aim of this trial was to compare postoperative discomfort, emergence delirium, and recovery time of patients who received either an LMAw or nasotracheal intubation (NTI). Patients and methods:A total of 70 children were randomly assigned to the LMAw group (n=35) or the NTI group (n=35). Both groups underwent mask induction with 8% sevoflurane. The NTI group received muscle relaxant, whereas the LMAw group did not. Postoperative laryngeal pain, dental pain, dysphonia, and PONV were assessed immediately and at 1 hour and 6 hours postoperatively. The Wong-Baker Faces Scale was used to evaluate the patients' self-reported pain. In addition, decayed, missing, and filled teeth (dft/DMFT) values, dental procedure type, number of dental procedures, duration of the dental operation, duration of anesthesia, recovery time, emergence delirium, pediatric dentist's access to the mouth, and parents' satisfaction levels were recorded. Data were analyzed using descriptive statistics, chi-square tests, and two-sample t-tests. Results:The incidence of postoperative laryngeal pain was significantly higher in the NTI group immediately (97.2% vs. 8.5%, P=0.00), 1 hour (94.2% vs. 0%, P=0.00), and 6 hours postoperatively (25.7% vs. 0%, P=0.00). There were no statistically significant differences between the two groups in dental pain scores, dft/DMFT values, duration of anesthesia, duration of the dental operation, number of dental procedures, the incidence of PONV, or pediatric dentist's access to the mouth (P>0.05). Emergence delirium and recovery time were significantly higher in the NTI group (P<0.05). Conclusion:The LMAw provided a more comfortable postoperative period than NTI for children who underwent full-mouth dental rehabilitation under general anesthesia.
| S-EPMC5757964 | biostudies-literature
Project description:BackgroundPercutaneous dilatational tracheostomy (PDT) is increasingly popular within intensive care units for patients who need prolonged ventilatory support. Significant complications are rare.Case presentationOur patient suffered tracheal ring fracture and early tracheomalacia following this procedure. These complications are demonstrated in our accompanying video.ConclusionContrary to common beliefs, tracheal rings are commonly fractured during the PDT procedure. The consequent granulation can lead to tracheal stenosis and tracheomalacia.
| S-EPMC1242107 | biostudies-literature
Project description:Water is known to have lubricating properties, thus it is used for lubrication of tracheal tubes to reduce airway injuries caused by intubation. However, there is no definite evidence to substantiate the beneficial effects of lubricating tracheal tubes using water for attenuating airway injuries. Moreover, the lubrication pretreatment may cause contamination of the tube, leading to respiratory infections. Therefore, this trial aims to assess whether no pretreatment of tracheal tubes does not increase post-intubation airway complications as compared with water lubrication of tubes.This is a prospective, double-blind, single-center, parallel-arm, noninferiority, randomized controlled trial to be conducted in participants aged 20-80 years who are undergoing elective surgery under general anesthesia with orotracheal intubation. Participants are randomly assigned into one of two groups depending on whether intubation is performed using a tracheal tube lubricated with water (n?=?150) or without any pretreatment (n?=?150). The primary outcome is the incidence of sore throat at 0, 2, 4, and 24 h after surgery, which is analyzed with a noninferiority test. The secondary outcomes are the incidence and severity of postoperative hoarseness, oropharyngeal injuries, and respiratory infections.Because we hypothesized that lubricating tracheal tubes using water has no advantage in reducing airway injuries associated with intubation, we will compare the incidence of sore throat, which is the most common complaint after intubation, in a noninferiority manner. This is the first randomized controlled trial to investigate the possibly beneficial or harmful effects of lubricating tracheal tubes using water before intubation. We expect that this trial will provide useful evidence to formulate a protocol for preparing tracheal tubes before intubation.This trial is registered at ClinicalTrials.gov on 1 July 2015 ( NCT02492646 ).
| S-EPMC5124294 | biostudies-literature
Project description:Neuromuscular blocking agents play a significant role in improving the success rate for urgent intubation, although there is limited evidence about the effect on subsequent outcomes, such as the incidence of tracheostomy. In this retrospective cohort study, we aimed to examine the association between avoidance of neuromuscular blocking agents for urgent tracheal intubation and incidence of tracheostomy among patients in the intensive care unit (ICU). The setting of this study was an eight-bed ICU at a tertiary-care hospital in Okayama, Japan. We included patients who underwent urgent tracheal intubation at the emergency department or the ICU and were admitted to the ICU between April 2013 and November 2017. We extracted data on methods and medications of intubation, predictors for difficult intubation, Cormack-Lehane grade, patient demographics, primary diagnoses, reintubation. We estimated odds ratios and their 95% confidence intervals for elective tracheostomy during the ICU stay using logistic regression models. Of 411 patients, 46 patients underwent intubation without neuromuscular blocking agents and 61 patients underwent tracheostomy. After adjusting for potential confounders, patients who avoided neuromuscular blocking agents had more than double the odds of tracheostomy (odds ratio 2.59, 95% confidence interval 1.06-6.34, p value?=?0.04). When stratifying the subjects by risk status for tracheostomy, the association was more pronounced in high-risk group, while we observed less significant association in the low-risk group. Avoidance of neuromuscular blocking agents for urgent intubation increases the risk of tracheostomy among emergency patients, especially those who have a higher risk for tracheostomy.
| S-EPMC7222110 | biostudies-literature
Project description: Not available
| S-EPMC8640235 | biostudies-literature