Respiratory Obstruction from Uvular Edema in a Pediatric Patient

Haselby, Kenneth A.; McNiece, William L.

doi:10.1213/00000539-198312000-00015

Cited by 30 publications

(13 citation statements)

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“…Reintubation following a planned extubation is a rare event: Its incidence varies between 6.7 and 27/10 000 cases but in a series of 137 children who had been difficult to intubate it occurred in up to 5% of the cases . As expected, the main causes are of respiratory origin: upper airway obstruction, laryngospasm, respiratory failure, or aspiration.…”

Section: Failure Of Extubationmentioning

confidence: 83%

Tracheal extubation in children: Planning, technique, and complications

Veyckemans

2020

Pediatric Anesthesia

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Although poorly described in textbooks and rarely a topic of lecture, tracheal extubation is a critical phase of anesthetic care. It should therefore be carefully planned taking into account simple physiology‐based principles to maintain the upper airway patent and avoid lung de‐recruitment, but also the pharmacology of all anesthetic agents used. Although the management of most of its complications can be learned in a clinical simulation environment, the basic techniques can so far only be taught at the bedside, in the operating room. In this paper, the process of extubation is described in successive steps: preparation, return to adequate spontaneous ventilation, awake versus deep extubation, timing according to the child's breathing cycle, extubation in the operating room or in the Postanesthesia Care unit, child's management immediately after extubation, diagnosis and treatment of the early complications, and finally, how to prepare for a difficult reintubation.

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Section: Failure Of Extubationmentioning

confidence: 83%

Tracheal extubation in children: Planning, technique, and complications

Veyckemans

2020

Pediatric Anesthesia

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“…Patients suffering uvular trauma or necrosis following general anaesthesia complain of a range of symptoms. These vary from sore throat, coughing, gagging, odynophagia or a foreign body sensation in the throat at the more benign end of the spectrum, to a fear of suffocation leading to anxiety and disturbed sleep, or life-threatening airway obstruction [2] secondary to swelling and localised oedema. Airway obstruction in such cases is more likely to occur on movement from supine to sitting positions.…”

Section: Discussionmentioning

confidence: 99%

“…In cases in which a sore throat is severe or persistent, suspicions of a more serious complication may be raised. Whilst rare, localised pathological changes to the uvula may complicate general anaesthesia and result in potentially life-threatening consequences [2]. Uvular trauma and oedema may result in postoperative airway compromise or complete uvular necrosis.…”

Section: Introductionmentioning

confidence: 99%

“…Uvular necrosis has been reported as a complication of bronchoscopy [3], endoscopy, endoscopic retrograde cholangiopancreatography, endotracheal intubation [4], anaesthesia using a laryngeal mask airway (LMA) [5] and secondary to aggressive suctioning techniques [6]. It has been reported in both adults and children [2,5]. During general anaesthesia, the use of LMAs, direct laryngoscopy, endotracheal intubation and oropharyngeal suctioning all predispose to uvular trauma.…”

Section: Introductionmentioning

confidence: 99%

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Uvular necrosis in an adolescent following general anaesthesia in the prone position

Smith

Lobo

2015

Anaesthesia Cases

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Uvular necrosis is a rare but potentially life-threatening complication of general anaesthesia involving endotracheal intubation. The proposed mechanism is mechanical disruption of uvular blood supply resulting in ischaemia and subsequent necrosis. This is typically a consequence of impingement of the uvula against a midline tracheal tube and the hard palate. Vigorous suctioning, multiple pharyngeal tubes and patient positioning have also been implicated. We present the case of a 13-yr-old girl who suffered uvular necrosis following a procedure performed in the prone position. The patient was reassured and managed conservatively. As in previous cases, after two weeks she made a full recovery following separation of the necrosed portion of her uvula. In the paediatric population, due to the relatively smaller oropharyngeal space, particular vigilance should be maintained during airway instrumentation, patient positioning, and placement of pharyngeal tubes in order to minimise the risk of uvular trauma.

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“…Indeed, Haselby et al showed that such mechanisms could be a reason for sudden stridor, airway obstruction and cyanosis. 17 Laryngospasm in childhood could be associated with general anesthesia, gastroesophageal reflux disease, and foreign body aspiration. 18 This condition is much more common among children than in adults, especially those younger than 12 months.…”

Section: Discussionmentioning

confidence: 99%