Cases reported "Respiratory Insufficiency"

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11/26. Complications of metallic stents in the pediatric airway.

    OBJECTIVE: Our aim was to present our experience with complications caused by placement of metallic stents in the pediatric airway. DESIGN AND SETTING: We conducted a retrospective study of the medical records of patients with complications resulting from metallic stent placement, managed by the senior authors between 1993 and 2002. RESULTS: Nine children had complications associated with the placement of metallic airway stents. Of these, 8 children required stent removal. granulation tissue and tracheal stenosis were seen in all 7 children with long standing stent placement. There was 1 stent death in this series. CONCLUSIONS: Metallic airway stents can cause significant complications in the pediatric airway. These complications may supersede the airway compromise that necessitated their initial placement. As such, metallic stent placement should be approached with caution. The likelihood and severity of complications increase with time, as do the difficulties encountered upon removal. The proportion of patients in whom metallic stents may be placed "permanently" without complications is not known. Therefore we recommend that metallic airway stents be considered a temporizing measure of limited duration.
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ranking = 1
keywords = tracheal stenosis, stenosis
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12/26. Narcotic administration and stenosing lesions of the upper airway--a potentially lethal combination.

    Two cases are reported where significant narrowing of the upper airway in association with narcotic administration resulted in respiratory compromise and death. Case 1: A 29-year-old woman with upper airway narrowing due to tonsillar enlargement from an Epstein-Barr infection was admitted to hospital, administered morphine and left in a room on her own with the door closed. She was found dead several hours later. At autopsy there was significant narrowing of the upper airway due to tonsillomegaly with a blood morphine level of 0.16 mg/L. Case 2: A 48-year-old woman with severe narrowing of her glottic inlet from recurrent squamous cell carcinoma and an intravenous drug taking history was found dead at her home. At autopsy there was evidence of recent and remote intravenous drug administration with marked narrowing of the glottis due to a recurrent tumor with a blood morphine level of 0.48 mg/L. In both cases, death was due to the effects of severe upper airway narrowing in combination with the respiratory depressant actions of morphine. Additional exacerbating factors may have included muscle weakness, drowsiness and reduced clearance of airway secretions from the effects of morphine. Narcotic administration in individuals with compromised upper airways should be undertaken extremely circumspectly and hospital protocols should ensure constant surveillance if this has been undertaken. Individuals who self administer narcotics should also be made aware of the dangers if there is coincidental upper airway narrowing. Toxicological evaluation in fatal cases of upper airway narrowing/stenosis may be extremely useful in revealing compounding factors such as opiate administration.
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ranking = 0.0017934585398965
keywords = stenosis
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13/26. Ventilatory management of severe tracheal stenosis.

    We present here a 4 year old child with severe tracheal stenosis and respiratory failure. The patient was not responding to conventional ventilation settings and had significant hypercarbia. The difficulty in mechanical ventilation was handled successfully with specific ventilatory strategy: use of low respiratory rate, long inspiratory time and normal inspiratory time: expiratory time ratio. Thereafter the child was managed surgically and the stenosis was corrected. The child was discharged after a Montgomery T-tube placement.
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ranking = 5.0017934585399
keywords = tracheal stenosis, stenosis
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14/26. Irreversible respiratory failure in an achondroplastic child: the importance of an early cervicomedullary decompression, and a review of the literature.

    The authors report the case of a girl with achondroplasia suffering from a progressively worsening hypotonic quadriparesis. CT scan showed slight dilatation of ventricular and subarachnoid spaces, with well-defined evidence of cortical sulci and gyri. This aspect was compatible with the diagnosis of macrocrania and megalencephaly (CP being 51 cm). The foramen magnum was narrowed, the transverse diameter measuring 15 mm and the 50th percentile being, for age, 26 mm. Somatosensory evoked potentials (SEPs) revealed bilaterally prolonged interpeak latencies Erb-N13, slowing of central conduction time N13-N20 from right median nerve stimulation, and block from left median nerve. The suspicion of cervicomedullary compression was confirmed by MRI, showing a very marked stenosis with compression exerted by the odontoid process. Further, a stenotic cervical canal and optic nerves verticalization were manifest. The patient underwent neurosurgical decompression by suboccipital craniectomy and cervical-C1 laminectomy. In spite of treatment, both neurologic and respiratory problems (rapid, shallow and almost abdominal breathing) were unchanged. The girl died 4 1/2 months later. The authors emphasize the important role of SEPs in detection of cervicomedullary compression in achondroplastic children and also stress the necessity of an early surgical treatment as the only condition for possible clinical improvement and/or full recovery.
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ranking = 0.0017934585398965
keywords = stenosis
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15/26. alfentanil for urgent caesarean section in a patient with severe mitral stenosis and pulmonary hypertension.

    We present the case of a parturient with severe mitral stenosis and pulmonary hypertension who received general anaesthesia using alfentanil for urgent Caesarean section. alfentanil promoted haemodynamic stability and allowed immediate postoperative extubation. Epidural morphine provided postoperative analgesia. This combination permitted early ambulation and prevention of thromboembolism. A disadvantage of this technique, neonatal respiratory depression, was promptly reversed with a single dose of naloxone. The anaesthetic management of mitral stenosis in pregnancy is discussed and the neonatal pharmacokinetics of maternally administered alfentanil are presented.
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ranking = 0.010760751239379
keywords = stenosis
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16/26. Obese hypoventilation syndrome of early childhood requiring ventilatory support.

    In December 1986 a 30-month-old female child with morbid obesity and respiratory failure was admitted to the Izaak Walton Killam Hospital for Children in Halifax. The etiology of the obesity was found to be dietary in origin after ruling out genetic, neurological and metabolic causes. This patient exhibited somnolence and cyanosis in association with hypercapnia and right ventricular overload. Her respiratory failure in the presence of a normal upper airway required ventilatory support, first with nasal endotracheal intubation, and then, tracheotomy. Weight reduction normalized her capillary blood gases and her somnolence disappeared. Subglottic stenosis hampered removal of the tracheotomy tube until 9 months after admission. The pathogenesis and management of obese hypoventilation syndrome are reviewed by the authors.
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ranking = 0.0017934585398965
keywords = stenosis
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17/26. Serious sequelae of delayed diagnosis of endobronchial tuberculosis.

    We report three cases of pulmonary tuberculosis in whom the diagnosis of the endobronchial component was missed initially. Despite proper chemotherapy, one patient had bronchostenosis leading to acute respiratory failure and death, the second developed collapse of the left lung, while failure of endotracheal intubation for general anaesthesia was the immediate problem faced by the third patient.
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ranking = 0.0017934585398965
keywords = stenosis
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18/26. Bony inlet stenosis as a cause of nasal airway obstruction.

    Two cases of congenital bony stenosis of the nasal piriform aperture (anterior nares) are presented. Both patients experienced episodes of respiratory distress and clinical symptoms similar to those seen in patients with posterior choanal atresia. The underlying anatomic abnormalities in congenital bony inlet stenosis are quite different from those in choanal atresia and require different surgical approaches for correction. Computed tomography demonstrates in detail the underlying anatomic abnormality and allows differentiation of bony inlet stenosis from choanal atresia.
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ranking = 0.012554209779276
keywords = stenosis
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19/26. postoperative complications of dystrophia myotonica.

    A 44-year-old man with known mitral stenosis presented for minor surgery. Anaesthesia was induced with fentanyl, droperidol and etomidate and maintained with nitrous oxide, oxygen and vecuronium. Surgery and anaesthesia were uneventful but the postoperative course was stormy, with respiratory arrest, haemophilus pneumonia, refractory cardiac dysrhythmias and gastrointestinal atony. A diagnosis of dystrophia myotonica was made after 3 weeks in the intensive care unit, and he spent 6 weeks in hospital. A high index of suspicion for this disease must be maintained and intensive care facilities and monitoring should be available for all procedures.
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ranking = 0.0017934585398965
keywords = stenosis
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20/26. Management of airway complications of burns in children.

    Children who have been exposed to smoke in a confined space or who have soot or burns, however minimal, on the face should be admitted to hospital. Respiratory distress may be delayed, but if it is progressive the patient should be curarised, intubated, and mechanically ventilated. Unless ventilation continues for 48 hours, followed by 24 hours' spontaneous respiration against a positive airway pressure, stridor and pulmonary oedema may recur. An endotracheal tube small enough to allow a leak between it and the oedematous mucosa must be passed to prevent laryngeal damage and subsequent subglottic stenosis. High humidity of inspired gases keeps secretions fluid and the endotracheal tube patent. A high oxygen concentration compensates for deficient oxygen uptake and transport caused by pulmonary lesions and the presence of poisonous compounds interfering with oxygen transport. dexamethasone to minimise cerebral oedema and antibiotics to reduce the incidence of chest infections should be given.
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ranking = 0.0017934585398965
keywords = stenosis
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