Anaesthetic management of a patient with myasthenia gravis and tracheal stenosis

Froelich, Jennifer; Eagle, Chris

doi:10.1007/bf03015964

Cited by 10 publications

(2 citation statements)

References 7 publications

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“…Awake intubation with the airway topicalized with local anesthetics and the patient breathing spontaneously is another option if bronchoscopy is not to be done first. 28 Of the 28 case reports reviewed, nine proceeded with intravenous induction which included a depolarizing muscle relaxant, 29-34 a non-depolarizing agent,Ss,36or a muscle relaxant not identified s7 with no adverse events reported. Dodge s~ had a CPB on standby with both femoral artery and vein cannulated in case of complete obstruction during induction.…”

Section: Inductionmentioning

confidence: 99%

Tracheal resection and reconstruction

Pinsonneault

Fortier

Donati

1999

Can J Anesth/J Can Anesth

114

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Tracheal resection and reconstructionPurpose: To review the literature on tracheal and carinal resection and reconstruction, and to report the general approach to these patients, as well as the general guidelines for the safe administration of anesthesia. The airway management is extensively reviewed. Source: Articles obtained from a Medline search (1960 to October 1997; keywords: tracheal surgery, carinal surgery, airway management). Textbook literature including the bibliographies were also consulted. Principal Findings: Benign or malignant tracheal and carinal pathology causing obstruction can be managed in several ways but resection and reconstruction are the treatment of choice for most patients with tracheal stenosis or tumour. Surgery of the trachea is a special endeavour where the airway is shared by the surgeon and the anesthesiologist. The principal anesthetic consideration is ventilation and oxygenation in the face of an open airway. Ventilation can be managed in different ways, including manual oxygen jet ventilation, high frequency jet ventilation, distal tracheal intubation, spontaneous ventilation, and cardiopulmonary bypass. Conclusion: The management of anesthesia for tracheal surgery presents many challenges to the anesthesiologist. Knowledge of the various techniques for airway management is crucial. Meticulous planning and communication between the anesthesia and surgical teams are mandatory for the safe and successful outcome of surgery for patients undergoing this procedure.Objectif: Passer en revue la documentation concernant la r&ection trach~ale et car~nale ainsi que leur reconstruction, et indiquer la conduite ~ tenir dans ce cas avec les patients, aussi bien que les directives g~n&ales pour I'administration s&uritaire de I'anesth&ie. La gestion des voies respiratoires a fait I'objet d'un examen pouss& Sources : Des articles provenant d'une recherche dans Medline (1960 ~ octobre 1997; mots-cl&: chirurgie de la trach&, chirurgie de la car~ne, gestion des voies respiratoires). Des monographies incluant les bibliographies ont aussi ~t~ consult&s. Constatations principales : La pathologie trach~ale et car~nale b~nigne ou maligne causant de I'obstruction peut &re trait~e de diff&entes mani&es, mais la r&ection et la reconstruction sont le traitement de choix pour la plupart des patients atteints de st~nose trachfiale ou de tumeur. C'est une intervention sp&iale off I'acc~s aux voies respiratoires est partag~ par le chirurgien et I'anesth&iologiste. La consideration anesth&ique principale est la ventilation et I'oxyg~nation en pr&ence de voies a&iennes ouvertes. La ventilation jet manuelle avec de I'oxyg~ne, la ventilation jet ~ haute fr~quence, rintubation trach~ale distale, la ventilation spontan& et la circulation extracorporelle sont des variantes possibles de la ventilation dans cecas. Conclusion 9 La gestion de I'anesth&ie Iors d'intervention ~. la trach& repr&ente de nombreux d~fis pour ranesth&iologiste. La connaissance des diverses techniques de gestion des voies respiratoires est pr...

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Section: Inductionmentioning

confidence: 99%

Tracheal resection and reconstruction

Pinsonneault

Fortier

Donati

1999

Can J Anesth/J Can Anesth

114

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“…An unusual cause of tracheal stenosis Lakshmi Vas MD , * Savita Sanzgiri MDDNB ,* Bharati Patil MD ,* Vikram Sanghvi MS † UCCESS of tracheal reconstruction [1][2][3][4][5][6][7][8][9][10] depends on careful planning. We anesthetized a patient twice for severe tracheal stenosis.…”

Section: Brief Reportmentioning

confidence: 99%

An unusual cause of trachael stenosis

Vas

Sanzgiri

Patil

et al. 2000

Can J Anesth/J Can Anesth

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Purpose: To report a large chronic tracheal foreign body, causing tracheal stenosis in an 11-yr-old girl. Clinical Features: The history was suggestive of obstructive airways disease with secondary bronchiectasis. Physical findings were crepitations and rhonchi all over the chest. Blood gases were normal. Chest X-ray showed bronchiectasis and a ventilation perfusion scan identified a tracheo-esophageal fistula. During anesthesia to confirm this, intubation and ventilation were difficult because of tracheal stenosis. The hypoventilation resulted in severe hypercarbia and acidosis. A subsequent CT scan showed a stenosis of 2 mm diameter and 1 cm length in the middle third of trachea, bronchiectasis, and an air filled pocket between the trachea and esophagus. PFT showed a severe obstruction. Antitubercular treatment which was started on the presumptive diagnosis of tuberculous stenosis and tracheoesophageal fistula caused a delay with deterioration of patient from intermittent dyspnea to orthopnea with severe hypecarbia and acidosis. The anesthetic management of the tracheal reconstruction was difficult due to her moribund condition even after medical treatment, the short length of the trachea above the obstruction, its severity and lack of resources for alternative techniques. A large foreign body was found lying obliquely in the trachea dividing it into an anterior narrow airway mimicking a stenosed trachea , and a wider posterior blind passage. Conclusion:The anesthetic consequences were peculiar to the unexpected etiology of the stenosis and poor general condition of the patient. Minor details like the tracheal tube bevel and ventilatory pattern became vitally important.Objectif : Rapporter le cas d'un important corps étranger trachéal causant une sténose de la trachée chez une fillette de 11 ans.Éléments cliniques : L'histoire évoquait une maladie obstructive chronique et des bronchectasies associées. L'examen physique a révélé des crépitations et des ronchus diffus au thorax. Les gaz du sang étaient normaux. Les radiographies pulmonaires ont montré des bronchectasies et la scintigraphie de ventilation et de perfusion a identifié une fistule trachéo-oesophagienne. Pendant l'anesthésie, réalisée pour confirmer la présence d'une fistule, l'intubation et la ventilation ont été difficiles à cause de la sténose trachéale. L'hypoventilation a provoqué une hypercapnie et une acidose sévères. La tomographie subséquente a montré une sténose de 2 mm de diamètre sur 1 cm de long au tiers moyen de la trachée, une bronchectasie et une poche d'air entre la trachée et l'oesophage. Les épreuves fonctionnelles respiratoires (EFR) ont montré une obstruction importante. Le traitement antituberculeux, fondé sur l'hypothèse retenue de sténose tuberculeuse et de fistule trachéo-oesophagienne, a causé un délai pendant lequel l'état de la patiente s'est détérioré, la dyspnée intermittente devenant une orthopnée accompagnée d'hypercapnie et d'acidose sévères. L'anesthésie pratiquée pour la reconstruction de la trachée a été difficile ...

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Neuromuscular Blocking Agents and Neuromuscular Diseases

Plaud¹,

Donati²

2000

On the Study and Practice of Intravenous Anaesthesia

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Anaesthetic management of a patient with myasthenia gravis and tracheal stenosis

Cited by 10 publications

References 7 publications

Tracheal resection and reconstruction

Tracheal resection and reconstruction

An unusual cause of trachael stenosis

Neuromuscular Blocking Agents and Neuromuscular Diseases

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