Cases reported "Apnea"

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1/47. Factors determining the onset and course of hypoxemia during apnea: an investigation using physiological modelling.

    We used the Nottingham physiology Simulator to examine the onset and course of hypoxemia during apnea after pulmonary denitrogenation. The following factors, as possible determinants of the hypoxemia profile, were varied to examine their effect: functional residual capacity, oxygen consumption, respiratory quotient, hemoglobin concentration, ventilatory minute volume, duration of denitrogenation, pulmonary venous admixture, and state of the airway (closed versus open). Airway obstruction significantly reduced the time to 50% oxyhemoglobin saturation (8 vs 11 min). Provision of 100% oxygen rather than air to the open, apneic patient model greatly prolonged time to 50% oxyhemoglobin saturation (66 vs 11 min). Hemoglobin concentration, venous admixture, and respiratory quotient had small, insignificant effects on the time to desaturation. Reduced functional residual capacity, short duration of denitrogenation, hypoventilation, and increased oxygen consumption significantly shortened the time to 50% oxyhemoglobin saturation during apnea. IMPLICATIONS: Reduction in oxygen levels during cessation of breathing is dangerous and common in anesthetic practice. We used validated, mathematical, physiological models to reveal the impact of physiological factors on the deterioration of oxygen levels. This study could not be performed on patients and reveals important information.
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ranking = 1
keywords = airway, obstruction
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2/47. Breath-holding-like spells in an infant: an unusual presentation of lingual thyroglossal duct cyst.

    The authors report the case of an infant with a lingual thyroglossal duct cyst who presented with breath-holding-like spells, which actually represented life-threatening ball-valve obstruction of the larynx, leading to hypoxemia and transient cerebral dysfunction. When evaluating apparent breath-holding spells in young infants, physicians should include dynamic, episodic upper airway obstruction in the differential diagnosis.
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ranking = 8.4795682049324
keywords = airway obstruction, airway, obstruction
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3/47. "apnea-volume" warning during normal ventilation of the lungs: an unusual leak in the Narkomed 4 anesthesia System.

    We report a case of an unusual breathing circuit leak in the Narkomed 4 anesthesia System due to a loose retaining ring at the junction of the expiratory valve assembly and the Spiromed Respiratory Volume Monitor. In the presence of the leak, the monitor panel displayed the messages "apnea volume" and "minute volume low," yet the low airway pressure alarm was not triggered and other parameters and clinical signs pointed to normal ventilation of the lungs. These conflicting data led to some delay in localizing the leak. After conclusion of the case, we found that occult loosening of this ring without causing leaks large enough to fail the FDA generic or manufacturer-recommended leak checks can occur. We recommend checking the tightness of this ring during routine leak checks and after rotating the expiratory valve assembly during re-positioning of the anesthetic system.
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ranking = 0.82902279722487
keywords = airway
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4/47. Hypersomnia with periodic breathing (an acromegalic Pickwickian).

    The syndromes of Pickwickian, Ondine's curse, and primary alveolar hypoventilation are respiratory disorders manifesting increased sleepiness and irregular respiratory rhythms. These disorders are currently grouped as hypersomnia with periodic breathing (HPB). Polygraphic techniques have lead to a reasonable hypothesis as to the pathophysiology of the multiple variants of HPB. Discernible causes of HPB have been attributed to both central and peripheral factors. Peripheral factors encompass those conditions relating to upper airway obstruction. An acromegalic person suffering the HPB syndrome secondary to laryngeal stenosis is described.
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ranking = 8.3085910021573
keywords = airway obstruction, airway, obstruction
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5/47. Failure of mouth-to-mouth resuscitation in cases of sudden infant death.

    We describe two cases of sudden infant death syndrome (SIDS) and one case of apparent life threatening apnoea where resuscitation was attempted by the mouth-to-mouth route. This was associated with evidence of gastric distension, including reflux of milk into the airway in the first two cases. In the second case the mother used mouth-to-mouth breathing after finding that she could not cover her baby's nose-and-open-mouth with her mouth. In the last case, the mother went on to try the mouth-to-nose route, with a good outcome. Systematic documentation of the route of resuscitation and its outcome in all cases of SIDS and near-miss SIDS may provide valuable insights into the optimal route for infant resuscitation.
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ranking = 0.82902279722487
keywords = airway
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6/47. Unusual features of pulmonary sling.

    patients with an anomalously placed left pulmonary artery ("pulmonary sling") typically have signs and symptoms of respiratory obstruction in the neonatal period. Experience with four previously unreported patients confirmed this. Typical radiographic features include unilateral air trapping (usually on the right side), an abnormal position of the esophagus, and a soft tissue mass interposed between the trachea and esophagus. Less common findings include a normal esophageal position, left-side air trapping, and delayed egress of neonatal pulmonary fluid. Both typical and atypical features were seen; the more unusual aspects are emphasized.
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ranking = 0.17097720277513
keywords = obstruction
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7/47. apnea and the elongated uvula.

    Four cases of respiratory distress and apnea associated with an elongated uvula are presented. In all cases, the uvula was found to intermittently fall onto the epiglottis and vocal cords. In all four patients, resection of the uvula led to resolution of all airway symptoms. It is hypothesized that the uvula, touching the vocal cords, caused intermittent laryngospasm and subsequent symptoms of cough, airway obstruction, and cyanosis. The anatomic reasons for such phenomenon are discussed.
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ranking = 9.1376137993821
keywords = airway obstruction, airway, obstruction
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8/47. Innominate artery compression of the trachea: an unusual cause of apnea in a 12-year-old boy.

    Innominate artery compression of the trachea is a common cause of airway obstruction in infants and young children. The clinical significance of this lesion, even when compression is documented endoscopically or radiographically, is controversial. Obstructive respiratory symptoms occur in only a fraction of such cases, and symptomatic patients are most commonly detected in the first year of life. We present a case of a 12-year-old boy with a chief complaint of progressive stridor and apnea who was diagnosed with symptomatic innominate artery compression of the trachea. We reviewed the literature regarding the pathology, diagnosis, and treatment of this condition.
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ranking = 8.3085910021573
keywords = airway obstruction, airway, obstruction
(Clic here for more details about this article)

9/47. Anaesthetic management in a neonate with congenital complete heart block.

    We present the case of a neonate undergoing surgery on the first day of life for the installation of a permanent pacemaker because of the existence of congenital complete heart block (CCHB) with a basal heart rate of 43 b.min(-1) and minimal elevation after initiating an isoproterenol perfusion. The intervention was under general anaesthesia with laryngeal mask airway (LMA) and spontaneous ventilation. The principal anaesthetic goals were to assure adequate anaesthesia, with haemodynamic and respiratory stability, to maintain the best possible heart rate and to avoid postoperative respiratory depression or apnoea.
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ranking = 0.82902279722487
keywords = airway
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10/47. Clinical experience in using a new type of nasal prong for administration of N-CPAP.

    Nasal continuous positive airway pressure (N-CPAP) has been used in infants with decreased lung compliance for increasing the functional residual capacity (FRC), decreasing the work of breathing and improving the PaO2/PAO2 (arterial-alveolar PO2 ratio) without intubation. However, the currently available nasal prongs for administration of N-CPAP have presented some problems in fixation, and lesions to the nasal septum or nostrils might be induced by aggressive pressure intended to fix them. We would therefore like to report our experience in using a new type of nasal prong for administration of N-CPAP therapy. The nasal prongs we used were provided by Dr. Wung of Columbia University in new york, who first designed them, and have been used safely, effectively and without any complications.
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ranking = 0.82902279722487
keywords = airway
(Clic here for more details about this article)
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