Cases reported "Apnea"

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11/47. Upper airway oedema following autologous blood transfusion from a wound drainage system.

    We report a case of a 70-yr-old white woman who underwent a revision of a total hip arthroplasty under general anaesthesia. The intraoperative course was stable without any complications and the estimated blood loss was 2500 ml. The patient received an autologous transfusion of blood from a wound drainage system in the recovery room. The transfusion was followed immediately by marked respiratory distress and upper airway oedema. She required emergency tracheal intubation and mechanical pulmonary ventilation. A coagulopathy also developed which was treated and resolved within 12 hr of the capillary leak phenomenon. The trachea was extubated on the first postoperative day and she had an uneventful course until discharge from the hospital two days later. We discuss the possible, aetiology of such a reaction to autologous blood including complement and platelet activation. It is suggested that reinfusion of nonwashed shed blood from a wound drainage system may present a hazard even though the fluid was autologous in origin.
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ranking = 1
keywords = airway
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12/47. Anesthetic management of the complications of previously undiagnosed ingested foreign body in a pediatric patient.

    A case of a previously undiagnosed ingested foreign body, subsequent acquired tracheoesophageal fistula and airway obstruction in a pediatric patient is described. We suggest that the capability to provide cardiopulmonary bypass was a key factor in this patient's survival.
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ranking = 2.0044300422063
keywords = airway obstruction, airway, obstruction
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13/47. A thyroglossal duct cyst causing apnea and cyanosis in a neonate.

    This is a case of a 3-week-old male who presented to the emergency department with intermittent apnea and cyanosis. While in the emergency department, he had respiratory compromise with stress and required intubation. Further evaluation confirmed the diagnosis of a thyroglossal duct cyst. Congenital lesions causing extrinsic airway compression should be considered in all neonates with apnea, cyanosis, and respiratory compromise. knowledge of pediatric airway anatomy and physiology is important in all cases where obstructive apnea is suspected.
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ranking = 0.4
keywords = airway
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14/47. Target-controlled infusion of propofol for a patient with myotonic dystrophy.

    We present a patient with myotonic dystrophy (MD) who was anesthetized with propofol using a target-controlled technique for electrophysiologic examination and cardiac catheter ablation. The patient became apneic unexpectedly at the same time when he fell asleep, with effect-site propofol concentration of 1.6 microg ml(-1). We had to insert a laryngeal mask airway (LMA), and mechanical ventilation was performed. The patient opened his eyes on verbal command at an effect-site concentration of 1.2 microg ml(-1) after the procedure. This concentration (1.2 microg ml(-1)) was slightly lower than our institutional average for adult male patients (1.5 /- 0.2 microg ml(-1)). However, the time from the end of anesthesia to the patient's awakening was about 10 min. We considered that emergence from anesthesia was not delayed in this case. Careful titration of propofol by target-controlled infusion (TCI) enabled to evaluate the patient's sensitivity to propofol. We conclude that TCI of propofol was a useful anesthetic technique in the MD patient. Respiratory depression might occur in MD patients at low propofol concentrations. Precise control and titration over target propofol concentration is important in anesthetic management for MD patients.
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ranking = 0.2
keywords = airway
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15/47. Endoscopic findings in sleep apnea syndrome.

    Sleep apnea syndrome is a constellation of symptoms resulting from recurrent episodes of apnea during sleep. Often the upper airway becomes obstructed during slumber in this disorder. Symptoms relate to sleep deprivation and include morning headaches, daytime somnolence, personality changes with deteriorating intellectual capacity, nocturnal enuresis, and sexual dysfunction. diagnosis is assisted by polysomnographic recordings. Therapy is directed at the cause of obstruction when one can be found, weight loss in massively obese patients, tracheostomy in the symptomatic patient. Four patients with documented sleep apnea syndrome are discussed. One patient, a thin adolescent female underwent adenoidectomy without improvement. Two massively obese adult males required tracheostomy with marked amelioration of symptoms. One additional adult male was found to have sleep apnea due to severe, acquired micrognathia; he was significantly improved by tracheostomy. All three adult patients were found by endoscopic visualization to have marked pharyngeal soft tissue collapse with inspiration during apneic episodes. Possible causes of pharyngeal collapse are discussed.
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ranking = 0.24124788928543
keywords = airway, obstruction
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16/47. Characterization of prolonged apneic episodes associated with respiratory syncytial virus infection.

    We used high-speed polygraphic recordings to document in detail the sequence of events during prolonged apneic spells in two infants with respiratory syncytial viral (RSV) infection. Also, we elicited upper airway reflexes by stimulating the airway with saline during sleep. Spontaneous prolonged apneic spells were recorded in both infants, and these consisted of two distinctly different apnea types. A number of similarities between apnea of prematurity, upper airway reflex apnea and the apneas in these two infants with RSV infection suggests the possibility that these various kinds of apnea may have related causal mechanisms.
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ranking = 0.6
keywords = airway
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17/47. Apnoeic episodes induced by smothering: two cases identified by covert video surveillance.

    Recurrent cyanotic episodes associated on some occasions with loss of consciousness due to cerebral hypoxia were investigated by long term tape recordings of breathing activity, oxygen saturation, air flow, electrocardiographic activity, and in some cases electroencephalographic activity. In 51 infants and children the mechanisms for the cyanotic episodes were identified (prolonged expiratory apnoea in 45, sleep related airway obstruction in three, seizure induced apnoea in one, behaviour induced apnoea in one). In one child apnoea was suspected as being caused by suffocation (smothering) by the mother. This was confirmed after enlisting the help of the police, who undertook covert video surveillance during cyanotic episodes. Each cyanotic episode was associated with a pattern of disturbance on the multichannel tape recordings which may be pathognomonic of this type of apnoea. A second infant with cyanotic episodes in whom smothering was suspected was referred for similar investigation after the availability of video recordings became established. Maternal smothering was again supported by specific patterns on multichannel tape recordings and confirmed by video surveillance. diagnosis by video surveillance produces unequivocal evidence in these cases and avoids the need for medical and nursing staff to confront the mother with a possibly incorrect suspicion or in a court of law.
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ranking = 2.0044300422063
keywords = airway obstruction, airway, obstruction
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18/47. airway obstruction by vascular anomalies. Importance of telescopic bronchoscopy.

    This review of 28 cases of airway obstruction by vascular anomalies in the past 6 years emphasizes the importance of these anomalies as causes of obstruction, stridor, and apnea in infants as well as the important contribution of telescopic bronchoscopy to the recognition of these lesions, especially compression of the trachea by the innominate artery. There were 20 patients with compression by the innominate artery; four were surgically corrected. Seven vascular ring anomalies were all corrected by operation as was an enlarged left atrium and malformed mitral valve in one patient. Vascular anomalies caused 26% of the obstructive airway lesions in a series of infants who had bronchoscopy for obstruction, stridor, or apnea. Failure to diagnose and treat these entities may result in progressive respiratory embarrassment and even death. barium esophagogram and aortic arch arteriogram, the traditional modalities for diagnosing vascular rings, may fail to identify tracheal compression by enlarged cardiac chambers or the more common "anomalous" innominate artery. Telescopic bronchoscopy will identify tracheal compression by the innominate artery; furthermore, it will identify the area of compression by the vascular ring. observation of the compressed area during corrective surgery ensures that the operative manipulations are appropriate and successful in relieving the obstruction. This observation can be facilitated by televised monitoring and videotaping.
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ranking = 2.4931652672043
keywords = airway obstruction, airway, obstruction
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19/47. Nasal continuous positive airway pressure in the treatment of whooping cough.

    A 3-week-old baby, suffering from whooping cough with severe attacks of apnoea and hypoxia, was treated by nasal CPAP with a positive airway pressure of about 5 cm H2O. The respiration improved rapidly and the transcutaneous oxygen tension increased to a normal level. The treatment was carried on for 7 days and discontinued gradually in the course of 3 days. The child was also treated with pertussis immunoglobulin and erythromycin. The CPAP system employed is easily and rapidly applied and allows normal nursing of the child during the treatment and manual lung physiotherapy in upright position. The treatment probably proved lifesaving.
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ranking = 1
keywords = airway
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20/47. Observations made on severe apneic spells in two infants at risk for sudden death.

    We have studied the sequence of events during prolonged apneic spells in two infants who, by virtue of multiple risk factors or ultimate death, were at risk for sudden death. Using techniques to quantitate airflow and pharyngeal airway pressures, we have reported many descriptive aspects of the apnea in these infants. Specifically, we have noted that severe apneic spells in these infants were accompanied by a wide spectrum of lengths and types of shorter apneas. In the case of infant A, the most severe spells occurred in clusters. Physiologic phenomena usually considered normal (sighs, swallows, etc.) often occurred in association with the apneic spells. In addition, we found that: 1) mixed apnea was the clinically significant form of apnea; 2) in mixed apnea, the site of obstruction was in the pharynx; 3) obstruction often occurred at the beginning of the spells; and 4) this obstruction occurred progressively over a series of breaths prior to the spell and resolved in a similar fashion. theophylline, in one infant, decreased the incidence of apnea.
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ranking = 0.32374366785628
keywords = airway, obstruction
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