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difficult airway due to cervical haemorrhage caused by spontaneous rupture of a parathyroid adenoma: A case report

World Journal of Clinical Cases 2023年第5期11卷 1217-1223页

作者： Yong-Zheng Han Yang Zhou Ying Peng Jin Zeng Yu-Qing Zhao Xiao-Ru Gao Hong Zeng Xiang-Yang Guo Zheng-Qian Li Department of Anesthesiology Peking University Third HospitalBeijing 100191China Beijing Center Quality Control and Improvement on Clinical AnesthesiaBeijing 100191China Department of General Surgery Peking University Third HospitalBeijing 100191China Department of Otorhinolaryngology Head and Neck Surgery Peking University Third HospitalBeijing 100191China Department of Radiology Peking University Third HospitalBeijing 100191China Department of Anesthesiology Haidian Maternal and Child Health Care HospitalBeijing 100191China

BACKGROUND Cervical haemorrhage due to spontaneous rupture of a parathyroid adenoma is a rare complication that may cause life-threatening acute airway *** SUMMARY A 64-year-old woman was admitted to the hospital 1 day after the onset of right neck enlargement, local tenderness, head-turning difficulty, pharyngeal pain, and mild dyspnoea. Repeat routine blood testing showed a rapid decrease in the haemoglobin concentration, indicating active bleeding. Enhanced computed tomography images showed neck haemorrhage and a ruptured right parathyroid adenoma. The plan was to perform emergency neck exploration, haemorrhage removal, and right inferior parathyroidectomy under general anaesthesia. The patient was administered 50 mg of intravenous propofol, and the glottis was successfully visualised on video laryngoscopy. However, after the administration of a muscle relaxant, the glottis was no longer visible and the patient had a difficult airway that prevented mask ventilation and endotracheal intubation. Fortunately, an experienced anaesthesiologist successfully intubated the patient under video laryngoscopy after an emergency laryngeal mask placement. Postoperative pathology showed a parathyroid adenoma with marked bleeding and cystic changes. The patient recovered well without *** airway management is very important in patients with cervical haemorrhage. After the administration of muscle relaxants, the loss of oropharyngeal support can cause acute airway ***, muscle relaxants should be administered with caution. Anaesthesiologists should pay careful attention to airway management and have alternative airway devices and tracheotomy equipment available.

关键词： Cervical haemorrhage Parathyroid adenoma Muscle relaxants difficult airway Case report

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Unexpected difficult airway due to severe upper tracheal distortion:A case report

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World Journal of Clinical Cases 2022年第26期10卷 9348-9353页

作者： Jian-Wei Zhou Chuan-Guang Wang Gang Chen You-Fa Zhou Jia-Feng Ding Jia-Wei Zhang Department of Anesthesia The Fifth Affiliated Hospital of Wenzhou Medical UniversityLishui Municipal Central HospitalLishui 323000Zhejiang ProvinceChina Department of Anesthesia Sir Run Run Shaw HospitalHangzhou 310016Zhejiang ProvinceChina Department of Urology The Fifth Affiliated Hospital of Wenzhou Medical UniversityLishui Municipal Central HospitalLishui 323000Zhejiang ProvinceChina

BACKGROUND difficult airway is a significant cause of anesthesia-associated death and ***,physical examinations of thyromental distance,mouth opening,Mafampaii classification,*** with X-ray,computed tomography(CT),and other imaging technologies are mainly used to evaluate difficult ***,in many special cases,i.e.,emergency surgery,imaging examinations cannot be completed *** patients’airway can only be evaluated through general physical examination,which inevitably increases the likelihood of an unexpected difficult airway during *** SUMMARY We report a rare case of difficult intubation because of severe upper trachea distortion after *** holmium laser lithotripsy was performed under transurethral ureteroscopy because the patient had anuria for 4 d and a creatinine level of 890μmol/*** to the urgency of the condition,chest radiography or chest CT was not examined before surgery and the anesthesiologist did not evaluate the airway adequately,resulting in an unexpected difficult *** The incidence of tracheal malformation and tracheal stenosis is extremely low,but the risk of hypoxia and even death due to difficult airways is extremely high for such *** is recommended to complete preoperative imaging examinations of the *** life-threatening emergency patients,a pre-anesthesia reassessment should be performed and surgeons should be prepared to prevent and manage the difficult airway.

关键词： Tracheal distortion difficult airway Management Imaging examination Emergency

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Expert consensus on difficult airway assessment

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Hepatobiliary Surgery and Nutrition 2023年第4期12卷 545-566页

作者： Ming Xia Wuhua Ma Mingzhang Zuo Xiaoming Deng Fushan Xue Denise Battaglini Vivek Aggarwal Giustino Varrassi Vladimir Cerny Ida Di Giacinto Rita Cataldo Daqing Ma Toru Yamamoto Martina Rekatsina Alessandro De Cassai Andrea Carsetti Marvin G.Chang Edwin Seet Daniel P.Davis Michael G.Irwin Yuguang Huang Hong Jiang Department of Anesthesiology Shanghai Ninth People’s HospitalShanghai Jiao Tong University School of MedicineShanghaiChina Department of Anesthesiology The First Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhouChina Department of Anaesthesiology Beijing HospitalNational Center of GerontologyInstitute of Geriatric MedicineChinese Academy of Medical ScienceBeijingChina Department of Anesthesiology Plastic Surgery HospitalCAMS and PUMCBeijingChina Department of Anesthesiology Beijing Friendship HospitalCapital Medical UniversityBeijingChina Anesthesia and Intensive Care San Martino Policlinico HospitalIRCCS for Oncology and NeuroscienceGenoaItaly Department of Conservative Dentistry&Endodontics Jamia Millia IslamiaNew DelhiIndia Paolo Procacci Foundation RomaItaly Department of Anaesthesiology and Intensive Care Medicine University Hospital Hradec KraloveHradec KraloveCzech Republic Unit of Anesthesia and Intensive Care Mazzoni HospitalAscoli PicenoItaly Unit of Anaesthesia Intensive Care and Pain ManagementDepartment of MedicineUniversitàCampus Bio-Medico of RomeRomaItaly Division of Anaesthetics Pain Medicine&Intensive CareDepartment of Surgery&CancerFaculty of MedicineImperial College Londonand Chelsea and Westminster HospitalLondonUK Division of Dental Anesthesiology Graduate School of Medicine and Dental SciencesNiigata UniversityNiigataJapan Department of Anaesthesiology National and Kapodistrian University of AthensAthensGreece Institute of Anesthesia and Intensive Care Unit University Hospital of PaduaPaduaItaly Department of Biomedical Sciences and Public Health UniversitàPolitecnica delle MarcheAnconaItaly Anesthesia and Intensive Care Unit Azienda Ospedaliero Universitaria delle MarcheAnconaItaly Department of Anesthesia Critical Careand Pain MedicineMassachusetts General HospitalBostonMAUSA Lee Kong Chian School of Medicine Nanyang Technological UniversitySingaporeSingapore Department of Anaesthesia Yong Loo Lin School of Medic

Background:Identifying a potentially difficult airway is crucial both in anaesthesia in the operating room(OR)and non-operation room *** are no guidelines or expert consensus focused on the assessment of the difficult airway before,so this expert consensus is developed to provide guidance for airway assessment,making this process more standardized and accurate to reduce airway-related complications and improve ***:Seven members from the airway Management Group of the Chinese Society of Anaesthesiology(CSA)met to discuss the first draft and then this was sent to 15 international experts for review,comment,and *** Grading of Recommendations,Assessment,Development and Evaluation(GRADE)is used to determine the level of evidence and grade the strength of *** recommendations were revised through a three-round Delphi survey from ***:This expert consensus provides a comprehensive approach to airway assessment based on the medical history,physical examination,comprehensive scores,imaging,and new developments including transnasal endoscopy,virtual laryngoscopy,and 3D *** addition,this consensus also reviews some new technologies currently under development such as prediction from facial images and voice information with the aim of proposing new research directions for the assessment of difficult ***:This consensus applies to anesthesiologists,critical care,and emergency physicians refining the preoperative airway assessment and preparing an appropriate intubation strategy for patients with a potentially difficult airway.

关键词： Expert consensus difficult airway airway management

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airway ultrasound for patients anticipated to have a difficult airway:Perspective for personalized medicine

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World Journal of Clinical Cases 2023年第9期11卷 1951-1962页

作者： Harumasa Nakazawa Kohji Uzawa Joho Tokumine Alan Kawarai Lefor Akira Motoyasu Tomoko Yorozu Department of Anesthesiology Kyorin University School of MedicineMitaka 181-8611TokyoJapan Department of Surgery Jichi Medical UniversityShimotsuke 329-0498TochigiJapan

airway ultrasound allows for precise airway evaluation,particularly for assessing the difficult airway and the potential for front of neck *** studies have shown that identification of the cricothyroid membrane by airway ultrasound is more accurate than digital ***,no reports to date have provided clinical evidence that ultrasound identification of the cricothyroid membrane increases the success rate of *** is a narrative review which describes patients with difficult airways for whom airway ultrasound may have been useful for clinical decision *** role of airway ultrasound for the evaluation of difficult airways is summarized and an approach to the use of ultrasound for airway management is *** goal of this review is to present practical applications of airway ultrasound for patients predicted to have a difficult airway and who undergo cricothyroidotomy.

关键词： airway ultrasound difficult airway Point-of-care ultrasound Cricothyroidotomy Intubation Mask ventilation

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difficult airway for Patients Undergoing Spine Surgeries

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Chinese Medical Journal 2016年第6期129卷 749-750页

作者： Lu-Lu Ma Xue-Rong Yu Bo Zhu Yu-Guang Huang Jian-Xiong Shen Jian-Guo Zhang Department of Anesthesiology Peking Union Medical College Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing 100730 China Department of Orthopedics Peking Union Medical College Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing 100730 China

INTRODUCTION The “cannot intubate, cannot ventilate” situation although rare is a nightmare for anesthesiologists. difficult airway is defined as difficult facemask or supraglottic airway （SGA） ventilation, difficult SGA placement, laryngoscopy, tracheal intubation, or failed intubation. We presented three cases of difficult airway and their airway management.

关键词： Ankylosing Spondylitis difficult airway Klippel-Feil Syndrome

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Anesthesia management in a pediatric patient with complicatedly difficult airway:A case report

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World Journal of Clinical Cases 2023年第11期11卷 2482-2488页

作者： Jia-Xiang Chen Xiao-Li Shi Chang-Sheng Liang Xing-Gang Ma Liang Xu Department of Anesthesiology Shenzhen Children's HospitalShenzhen 518038Guangdong ProvinceChina Department of Anesthesiology Shenzhen Pediatrics Institute of Shantou University Medical CollegeShenzhen 518038Guangdong ProvinceChina

BACKGROUND Reports on perioperative anesthesia management in pediatric patients with difficult airways are *** addition to relatively more difficulties in the technique of endotracheal intubation,the time for manipulation is restricted compared to *** the airways safely and avoiding the occurrence of hypoxemia in these patients are of *** SUMMARY A 9-year-old boy with spastic cerebral palsy,severe malnutrition,thoracic scoliosis,thoracic and airway malformation,laryngomalacia,pneumonia,and epilepsy faced the risk of anesthesia during palliative *** a thorough preoperative evaluation,a detailed scheme for anesthesia and a series of intu-bation tools were prepared by a team of *** fiberoptic intubation is the widely accepted strategy for patients with anticipated difficult *** the age and medical condition of the patient,we kept him sedated with spontaneous breathing during endotracheal *** endotracheal intubation was completed on the second attempt after the failure of the first ***,the surgery was successful without postoperative *** Dealing with difficult airways in the pediatric population,proper sedation allows time to intubate without interrupting spontaneous *** appropriate endotracheal intubation method based on the patient’s unique characteristics is the key factor in successful management of these rare cases.

关键词： Pediatric anesthesia difficult airway Spastic cerebral palsy Awake fiberoptic intubation Case report

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Induction of Anesthesia with Dexmedetomidine and Sevoflurane for a Pediatric difficult airway

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Chinese Medical Journal 2017年第16期130卷 1997-1998页

作者： Ling-Xin Wei Xiao-Ming Deng Jing-Hu Sui Lei Wang Department of Anesthesiology Plastic Surgery Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing 100144 China

difficult airway is a challenge frequently faced by anesthesiologists. For children recovering from burns with severe scarring contracture in the neck and chest wall, the best strategy is to maintain spontaneous breathing during the induction of anesthesia and to insert a laryngeal mask airway to secure the airway as early as possible.

关键词： Children Dexmedetomidine difficult airway

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A case of radiation-induced difficult airway in a patient with nasopharyngeal carcinoma

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The Chinese-German Journal of Clinical Oncology 2012年第11期11卷 676-677页

作者： Deke Li Shiying Wang Kun Chen Department of Anesthesiology The Fifth Hospital of Wuhan Wuhan 430050 China Department of Anesthesiology Tongji Hospital Tongji Medical College Huazhong University of Science andTechnology Wuhan 430030 China

In this report, we describe radiation-induced difficult airway management in a patient with nasopharyngeal carcinoma. The patient was presented to receive laparoscopic cholecystectomy for gallbladder stone. He had been diagnosed to have nasopharyngeal cancer about 2 years ago. In operation, after sleeping, the patient was manual controlled ventilation. However, we subsequently found that his neck campaign was limited and mask ventilation was obstructed. We immediately performed oropharyngeal airway, then mask ventilation improved. Fully surface anesthesia with tetracaine atomizing to the root of tongue, larynx wall and piriform recess, the patient was endotracheal intubated with fiberoptic bronchoscope. After intubation, the patient inhaled 2.5% sevoflurane, then esmeron (50 mg) and remifentanyl (0.1 μg/kg every minute) were administrated by intravenous. After the treatment, the patient's life indexes were normal and steady. In conclusion, patients with nasopharyngeal carcinoma (NPC) after radiation therapy should be based on comprehensive evaluation of upper airway and obstructive condition before operation, then perform safe and effective tracheal intubation methods under spontaneous breathing.

关键词： difficult airway nasopharyngeal carcinoma tracheal intubation

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Comparison of five video-assisted intubation devices by novice and expert laryngoscopists for use in the aeromedical evacuation environment

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Military Medical Research 2017年第2期4卷 61-69页

作者： Matthew C.Wallace SSgt Tyler Britton Robbie Meek Sharon Walsh-Hart Col Todd E.Carter Steven J.Lisco University of Cincinnati Medical Center Department of Anesthesiology

Background: The critically ill or injured patient undergoing military medical evacuation may require emergent intubation. Intubation may be life-saving, but it carries *** novice or infrequent laryngoscopist has a distinct disadvantage because experience is critical for the rapid and safe establishment of a secured airway. This challenge is compounded by the austere environment of the back of an aircraft under blackout conditions. This study determined which of five different video-assisted intubation devices(VAIDs) was best suited for in-flight use by U.S. Air Force Critical Care Air Transport Teams by comparing time to successful intubation between novice and expert laryngoscopists under three conditions, Normal airway Lights on(NAL), difficult airway Lights on(DAL) and difficult airway Blackout(DAB), using manikins on a standard military transport stanchion and the floor with a minimal amount of setup time and extraneous light ***: A convenience sample size of 40 participants(24 novices and 16 experts) attempted intubation with each of the 5 different video laryngoscopic devices on high-fidelity airway manikins. Time to tracheal intubation and number of optimization maneuvers used were recorded. Kruskal-Wallis testing determined significant differences between the VAIDs in time to intubation for each particular scenario. Devices with significant differences underwent pair-wise comparison testing using rank-sum analysis to further clarify the difference. Device assembly times, startup times and the amount of light emitted were recorded. Perceived ease of use was surveyed. Results: Novices were fastest with the Pentax AWS in all difficult airway scenarios. Experts recorded the shortest median times consistently using 3 of the 5 devices. The AWS was superior overall in 4 of the 6 scenarios tested. Experts and novices subjectively judged the Glide Scope Ranger as easiest to use. The light emitted by all the devices was less than the USAF-issued hea

关键词： simulation difficult airway novice expert military video laryngoscopy light emission

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Anesthesia management for cesarean section in a pregnant woman with odontogenic infection:A case report

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World Journal of Clinical Cases 2022年第14期10卷 4563-4568页

作者： Yan-Li Ren Yu-Shan Ma Department of Anesthesiology West China Second University HospitalSichuan UniversityChengdu 610000Sichuan ProvinceChina

BACKGROUND In recent years,people have paid more attention to oral health with the development of *** to the various physiological changes during pregnancy,such as changing hormone levels and immune functions,oral diseases have a high incidence during pregnancy,and the prevention and treatment of oral diseases have also received the attention of both dentists and ***,the anesthetic management of pregnant patients with oral disease,especially severe maxillofacial infections,and patients who need surgical treatment or have obstetric emergencies and need to terminate their pregnancy is not *** SUMMARY This article describes a parturient patient with a severe masseteric space infection who had an emergency cesarean *** This case report aims to discuss the important anesthetic considerations for these patients.

关键词： Anesthesia Cesarean section difficult airway Maxillofacial infections Case report

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