Ann Oto Rhinol Laryn
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Ann Oto Rhinol Laryn · Apr 1996
Comparative StudyPostoperative care following single-stage laryngotracheoplasty.
Single-stage laryngotracheoplasty (SSLTP) provides a method of correcting mild-to-moderate laryngotracheal stenosis while avoiding the risks of prolonged laryngeal stenting. Pediatric patients are orally intubated for 5 to 7 days postoperatively to ensure an adequate airway while edema resolves and healing begins. During this period, continuous neuromuscular blockade has been advocated in infants and young children to avoid endotracheal tube trauma to the fresh graft and potentially life-threatening accidental decannulation. ⋯ As a group, these patients had less postoperative pulmonary atelectasis prior to extubation (p < .05) and were extubated sooner than patients receiving continuous neuromuscular blockade (p<.05) without compromising the surgical success of the procedure. Intermittent paralysis permitted for more accurate assessment of pain control and protected against accidental drug accumulation. Although self-extubation did not occur, diligent nursing care with adequate sedation and analgesia is necessary to avoid the risk of accidental extubation.
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Ann Oto Rhinol Laryn · Apr 1996
Case ReportsTotal tracheobronchial thrombosis due to extracorporeal membrane oxygenation.
Extracorporeal membrane oxygenation (ECMO) is widely used for neonatal respiratory failure that is potentially reversible but unresponsive to conventional management. Because of the anticoagulation necessary for maintaining the extracorporeal circuit, hemorrhagic complications occur in up to one third of patients. ⋯ The airway was successfully managed with repeated bronchoscopic pulmonary toilet. Our experience and review of the literature provide a summary of ECMO-related complications likely to present to the otolaryngologist, and management strategies are discussed.
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Laryngomalacia is a well-recognized cause of airway obstruction and inspiratory stridor in infants. As children grow and become more active, laryngomalacia may manifest in different, unexpected ways. Otherwise healthy athletes may generate enough inspiratory force to draw the aryepiglottic folds into the endolarynx, causing a subtotal glottic obstruction. ⋯ We have had experience with 2 EIL patients in the last 12 months who have undergone carbon dioxide laser microlaryngoscopy. Both patients benefited significantly from surgery. We conclude that EIL is underdiagnosed but responds well to treatment.
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The accumulation of extrapulmonary air is a well-known complication of airway endoscopic procedures. However, pulmonic disease alone can predispose toward pneumomediastinum and pneumothorax, without iatrogenic manipulation. In this case, a portable chest radiograph diagnosed the cause of the sudden accumulation of extrapulmonary air after rigid bronchoscopy as alveolar rupture, rather than iatrogenic airway perforation. The pathophysiology of pneumothorax and pneumomediastinum and the interpretation of chest radiographs in these situations is reviewed.
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Ann Oto Rhinol Laryn · Sep 1995
Case ReportsJet stylets as an aid for replacement of tracheostomy tubes.
Difficulty in tracheostomy tube replacement can be life-threatening in a patient who is dependent on the tracheostomy for ventilation. The use of jet styles for tracheostomy tube replacement in these patients facilitates the tube exchange and allows for jet ventilation if any difficulty is encountered during the tube replacement. We describe two cases in which jet stylets proved to be helpful during tracheostomy tube replacement and discuss considerations that are important for the safe use of these devices.