Anaesthesia and intensive care
-
Anaesth Intensive Care · Jan 2023
Case ReportsA case of unexpected intraoperative airway obstruction in a patient with an aneurysm of the ascending aorta and aortic arch.
Upper airway compression is one of the clinical manifestations of thoracic aortic aneurysm, which is associated with poor prognosis and high mortality. A 44-year-old patient with ascending aortic and arch aneurysm who was scheduled for Bentall surgery and total arch replacement under cardiopulmonary bypass suffered difficult ventilation after endotracheal intubation. The patient did not exhibit any positional dyspnoea or orthopnoea, did not show any difficulties in the supine position, and had no noteworthy medical history. ⋯ Fibreoptic bronchoscopy revealed complete obstruction of the carina and confirmed the supracarinal position of the tube. Complete airway obstruction may occur even if there are no symptoms before surgery in patients with thoracic aortic aneurysm. Comprehensive preoperative assessment, a well-developed airway management plan, and responses to possible emergencies are essential to reduce unnecessary events or complications.
-
Anaesth Intensive Care · Jan 2023
Case ReportsAcute bilateral parotid swelling upon laryngeal mask airway insertion: A case report.
We describe a case of bilateral parotid swelling developing shortly after laryngeal mask airway insertion. Spontaneous resolution occurred within 12 h postoperatively This unusual phenomenon has been termed 'anaesthesia mumps' or 'acute sialadenosis'. Its exact relationship to anaesthesia remains unknown. ⋯ Its presentation can be confused with acute angioedema, but, unlike the latter, it is benign and not normally associated with airway compromise. Diagnosis is a process of exclusion, but careful airway assessment is an important component of this. Strategies to aid diagnosis and management are described.
-
Anaesth Intensive Care · Jan 2023
What airway management information do anaesthetic charts prompt for? An audit of charts from 132 hospitals across Australia and New Zealand.
Anaesthetists can make safer airway plans if they know which airway techniques worked previously and which ones did not. Anaesthetic charts do not always capture this information, however, and guidelines from the Australian and New Zealand College of Anaesthetists do not specify what details on airway management they should include. To assess how anaesthetic charts support airway documentation, we audited the airway management section of blank charts from 132 hospitals accredited for training by the Australian and New Zealand College of Anaesthetists. ⋯ Data fields describing bag-mask ventilation and supraglottic airway use were also inconsistent. In summary, data fields on Australian and New Zealand anaesthetic charts focus on tracheal intubation with consistent prompts for both operator method and outcome. The inclusion of fields for outcome and difficulty of bag-mask ventilation and supraglottic airway use could help clinicians make better records of airway management.