Cases reported "Anoxia"

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1/29. airway obstruction in a child with asymptomatic tracheobronchomalacia.

    PURPOSE: To report a case of airway obstruction with hypoxia during emergence from anesthesia due to unexpected tracheobronchomalacia in a child. CLINICAL FEATURES: In a previously healthy 22-month-old boy with no symptoms or signs of respiratory disease, general anesthesia was induced by inhalation of increasing concentrations of sevoflurane (up to 5%) in oxygen and a laryngeal mask was inserted. Partial airway obstruction persisted during surgery, but obstruction was relieved by positive-pressure ventilation. During emergence from anesthesia, airway obstruction with hypoxia occurred, necessitating tracheal intubation. Emission of carbon dioxide as well as of sevoflurane was reduced and emergence from anesthesia markedly delayed. Fibreoptic tracheoscopy showed marked collapse of the tracheobronchi during expiration, and a diagnosis of tracheobronchomalacia was made. No respiratory complications occurred postoperatively. CONCLUSION: Asymptomatic tracheomalacia should also be suspected in case of airway obstruction during anesthesia in young children.
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ranking = 1
keywords = airway obstruction, airway, obstruction
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2/29. Persistent hypoxia after diagnosis and treatment of pulmonary thromboembolism.

    Acute respiratory failure in the perioperative period represents a frequent challenge to the anesthesiologist. The differential diagnosis is extensive and includes alterations on the pulmonary parenchyma, pulmonary vessels, airway, and cardiac system. Occasionally, two or more pathophysiological process superimpose. We present a patient who suffered from a left pulmonary embolism that was appropriately diagnosed and treated. However, the hypoxemia persisted and a second pathology was suspected. After careful evaluation and differential diagnosis, we drained a right pleural effusion, which had been present preoperatively, with resolution of the hypoxemia. There is controversy in the literature as to the role of drainage of pleural effusions on improving oxygenation. We present this case as an example of successful management of perioperative respiratory failure by thoracentesis in the presence of a second concurrent pathologic process.
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ranking = 0.041241882501409
keywords = airway
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3/29. Treatment of plastic bronchitis in a Fontan patient with tissue plasminogen activator: a case report and review of the literature.

    Plastic bronchitis is a condition in which large, bronchial casts with rubber-like consistency develop in the tracheobronchial tree and cause airway obstruction. We describe a 4-year-old girl who had Fontan physiology and who developed plastic bronchitis and report for the first time the use of aerosolized tissue plasminogen activator for treatment of this condition. The literature is reviewed with emphasis placed on the occurrence of this disorder in patients with single ventricle physiology.
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ranking = 0.2391288203032
keywords = airway obstruction, airway, obstruction
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4/29. Bilateral vocal cord dysfunction complicating short-term intubation and the utility of heliox.

    Bilateral vocal cord paralysis is an extremely rare complication of short-term endotracheal intubation. Its etiology following intubation is likely due to recurrent laryngeal nerve injury on intubation. The anterior ramus of the recurrent laryngeal nerve is especially susceptible to pressure injury in intubated patients. Heliox is reported as a successful means of decreasing the work of breathing in upper airway obstruction via decreases in airway resistance. Two cases of bilateral vocal cord dysfunction following short-term intubation are reported. The first case of bilateral vocal cord paresis treated with Heliox is described.
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ranking = 0.28037070280461
keywords = airway obstruction, airway, obstruction
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5/29. Presentation of non-Hodgkin's lymphoma as acute hypoxia caused by right ventricular compression.

    IMPLICATIONS: A case is presented of a woman developing acute right ventricular outflow tract obstruction because of mediastinal non-Hodgkin's lymphoma. Systemic blood flow was possible through a patent foramen ovale.
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ranking = 0.0086969437574379
keywords = obstruction
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6/29. Coronary artery obstruction due to membranous ridge of the right sinus valsalva associated with tetralogy of fallot: syncope mimics anoxic spell.

    We report an infant with tetralogy of fallot who had suffered from repetitive attacks of syncope without obvious cyanosis. Careful observation by means of echocardiography and angiography revealed that the attacks resulted from acute coronary artery obstruction due to membranous ridge covering the sinus Valsalva. Surgical resection of the abnormal ridge and repair of tetralogy of fallot successfully improved the patient's symptoms. syncope in children should be extensively investigated to exclude obstruction of the coronary arteries.
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ranking = 0.052181662544627
keywords = obstruction
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7/29. Anoxic-epileptic seizures in Cornelia de lange syndrome: case report of epileptic seizures induced by obstructive apnea.

    We describe epileptic seizures including status epilepticus provoked by recurrent obstructive apnea in a child with Cornelia de lange syndrome. From the age of 10 months, this boy had recurrent respiratory infections with obstructive apnea leading to cyanosis and loss of consciousness. Approximately, 25% of apneas were followed by clonic jerks usually lasting 10 min, but once status epilepticus. He never had unprovoked epileptic seizures. At first he was diagnosed with symptomatic epilepsy and given carbamazepine and phenobarbital, without benefit. Significant improvement occurred after his mother was taught to extract mucus from his upper airways before obstruction occurred. He is no longer on anti-epileptic drugs. With this management, he had only one episode of obstructive apnea followed by an epileptic component. The events in this child were anoxic-epileptic seizures, that is, epileptic seizures triggered by syncopes. Anoxic-epileptic seizures have not previously been described in Cornelia de lange syndrome. This case illustrates that, even when recurrent epileptic seizures occur in patients with known structural cerebral pathology, the diagnosis of symptomatic epilepsy should not be uncritically accepted.
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ranking = 0.049938826258847
keywords = airway, obstruction
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8/29. Sudden hypoxia during anesthesia in a patient with Kartagener's syndrome.

    We report a case of anesthesia in an adolescent with recurrent left pneumothorax, Kartagener's syndrome, and severe learning disability with behavioral difficulties. After induction of anesthesia, he rapidly developed severe desaturation as measured on pulse oximetry. Placement of an intercostal chest drain did not remedy the situation and he was found to have blocked the left main bronchus with viscous secretions. Subsequent suctioning relieved the obstruction. Despite successful postoperative thoracic epidural analgesia and minitracheostomy for bronchial toilet, he developed bronchopneumonia that resolved with antibiotics. We discuss anesthesia for patients with Kartagener's syndrome and for patients with pneumothorax.
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ranking = 0.0086969437574379
keywords = obstruction
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9/29. Hypoxic right ventricular cardiomyopathy. A morphological and pathogenetic study on the myocardial atrophy and fatty infiltration.

    The autopsy report of an asymptomatic, non familial cardiomyopathy with widespread fatty infiltration of the right ventricular wall in two alcoholic subjects, who were also heavy smokers and suffering from a serious laryngeal obstruction, led the Authors to investigate, on the basis of a thorough review of the literature, the possibility that hypoxia, alcoholism and smoke could have caused the development of the cardiac lesion. The presence of myocardial fatty infiltration is explained, under conditions of high-flow hypoxia, by the reduced fatty acid oxidation. The higher tissue levels of fatty acyl-CoA, fatty acyl-carnitine and alpha-glycerophosphate thereby lead to the increased conversion of the FFA into tissue lipids. Under hypoxic conditions there is also an increased polyols synthesis. The reduced conversion of dyacylglycerol into phosphatidic acid causes its tissutal increase and the interaction with fatty acyl-CoA to produce triacylglycerol and CoASH. In alcoholic patients reduced oxidation and increased FFA synthesis is sustained by the altered mitochondrial respiratory control and excess of acetate, with the consequent increase in acetyl-CoA, fatty acyl-CoA and alpha-glycerophosphate concentration. In addition, fatty acid ethyl esters normally absent in the myocardium are formed. The fact that, in hypoxic or alcoholic subjects with cardiomyopathy, an impaired myocardial contractility has been noted as the most relevant haemodynamic factor may be explained by both the reduced energy production following the decrease in aerobic glycolysis and FFA oxidation, and specific genetic changes that lead to both the production of a myosin with lower Ca2 ATPase activity and a reduced protein (and therefore myofibrillar) synthesis. This fact can result in a severe atrophy of the cardiac myocytes. The lower their contractile activity, the more evident the process of atrophy. The lesion principally affects the right ventricle for both metabolic and anatomical reasons. It has been shown how, under normal conditions, the RV metabolism is suited to a relatively reduced O2 supply situation, with a high lactate dehydrogenase and alpha-hydroxybutiratedehydrogenase activity. It is more likely to be affected therefore whenever there is a chronic state of high-flow hypoxia. While alpha-HBDH allows the RV extensive utilization of ketone bodies as an energy source, its notable increase under hypoxic conditions further increases the synthesis of fatty acids and therefore fatty infiltration of the myocardium. The relatively lower capacity for oxygen extraction and lower tissue perfusion of the RV compared with the left ventricle make an adequate oxygen supply in the case of increased O2 demand even more difficult.(ABSTRACT TRUNCATED AT 400 WORDS)
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ranking = 0.0086969437574379
keywords = obstruction
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10/29. Cardiovascular response to acute airway obstruction and hypoxia.

    We wished to evaluate the role of hypoxia in the production of cardiovascular manifestations of acute airway obstruction. We monitored blood pressure, electrocardiogram, and radionuclide ejection fraction in 14 healthy volunteers on exposure to four experimental conditions: expiratory resistive loading while breathing room air (RAL), expiratory resistive loading while hypoxic (HL), hypoxia alone (H), and expiratory resistive loading while voluntarily hyperventilating in a pattern similar to HL trials (VL). Mean respiratory-related oscillation in systolic blood pressure (pulsus paradoxus) increased significantly under each experimental condition compared with those at baseline (2 /- 2.3 mm Hg): for RAL, 21 /- 8.4 mm Hg; for HL, 34 /- 16.3 mm Hg; for H, 10 /- 5.4 mm Hg; for VL 26 /- 13.4 mm Hg. Pulsus paradoxus was significantly greater under conditions of moderate hypoxia (saturation, 80%) than of mild hypoxia (saturation, 90%). Electrocardiographic changes were more marked under HL and H conditions than under RAL and VL conditions. HL induced changes in blood pressure and frontal QRS axis that were qualitatively similar to those seen in naturally occurring asthma. Radionuclide ejection fraction showed no dramatic change with any experimental condition. We conclude that hypoxia magnifies the cardiovascular changes induced by acute expiratory resistive loads and may contribute to the degree of pulsus paradoxus seen in severe asthma.
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ranking = 1.195644101516
keywords = airway obstruction, airway, obstruction
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