In this report, we describe radiation-induced difficult airway management in a patient with nasopharyngeal carcinoma. The patient was presented to receive laparoscopic cholecystectomy for gallbladder stone. He had bee...In this report, we describe radiation-induced difficult airway management in a patient with nasopharyngeal carcinoma. The patient was presented to receive laparoscopic cholecystectomy for gallbladder stone. He had been diagnosed to have nasopharyngeal cancer about 2 years ago. In operation, after sleeping, the patient was manual controlled ventilation. However, we subsequently found that his neck campaign was limited and mask ventilation was obstructed. We immediately performed oropharyngeal airway, then mask ventilation improved. Fully surface anesthesia with tetracaine atomizing to the root of tongue, larynx wall and piriform recess, the patient was endotracheal intubated with fiberoptic bronchoscope. After intubation, the patient inhaled 2.5% sevoflurane, then esmeron (50 mg) and remifentanyl (0.1 μg/kg every minute) were administrated by intravenous. After the treatment, the patient's life indexes were normal and steady. In conclusion, patients with nasopharyngeal carcinoma (NPC) after radiation therapy should be based on comprehensive evaluation of upper airway and obstructive condition before operation, then perform safe and effective tracheal intubation methods under spontaneous breathing.展开更多
Objective: To explore the palliative methods to patients with central airway obstruction due to advanced malignancies. Methods: Twenty-seven patients with carcinous airway obstruction and respiratory distress were eme...Objective: To explore the palliative methods to patients with central airway obstruction due to advanced malignancies. Methods: Twenty-seven patients with carcinous airway obstruction and respiratory distress were emergency remedied, including 12 cases with atelectasis and 23 with pulmonary infection. Soft cryoablated probe of CO2 and/or reticulate endobronchial stent with filmed titanium alloy were placed to the neoplasm following by bronchofibroscope. Results: Totally there were 21 patients achieved completely remission, including airway obstruction, respiratory distress and pulmonary infection remission, and 3 cases got partial remission. Meanwhile there were 3 cases died, in which one was happened during the period of endobronchial stent making, another one with heavy airway obstruction died due to asphyxia 24 h after the operation of bronchofibroscope examination, and the last one with knob invaded died because of hemoptysis and asthema secondarily 36 h after stent placed. Conclusion: The emergency remedy using soft cryoablated probe of CO2 and/or reticulate endobronchial stent with filmed titanium alloy placed to the neoplasm following by bronchofibroscope to patients with malignant central airway obstruction was a effective salvage method and could prolong patients’ lifespan for more subsequent therapeutic opportunities.展开更多
Objective： To investigate the diagnos- tic and therapeutic effect ofbronchofiberscopy in the manage- ment of severe thoracic trauma. Methods： A retrospective study was conducted on 207 consecutive patients with sev...Objective： To investigate the diagnos- tic and therapeutic effect ofbronchofiberscopy in the manage- ment of severe thoracic trauma. Methods： A retrospective study was conducted on 207 consecutive patients with severe thoracic trauma enrolled in our hospital between January 2008 and June 2012. During the period, 488 bronchofiberscopies and lavages were done. The bronchofiberscope was inserted through tracheal inci- sion （282）, nasal cavity （149） and oral cavity （57）. Intensive SaO2 monitoring as well as blood gas analysis were per- formed pre-, intra- and postoperatively. Simultaneously oxy- gen therapy or ventilatory support was given. Sputum cul- ture was done intraoperatively. Results： Diagnosis in 207 cases was confirmed by bronchofiberscopy. The result of sputum culture was posi- tive in 78 cases. Lavage was performed on 156 cases. SaO2 significantly increased after bronchofiberscopies as well as lavages and PaO2 obviously improved 2 h after surgery （both P〈0.05）. Heart rate and respiratory rate decreased. There was no bronchofiberscopy-related death. Conclusion： Bronchofiberscopy plays an important role in the diagnosis and treatment of severe thoracic trauma, which can not only timely diagnose bronchial injury and collect deep tracheal sputum for bacterial culture but also effectively remove foreign body, secretion, blood and spu- tum crust in the airway, manage obstructive atelectasis and pneumonia, and signifcantly improve respiratory fimction and treatment outcome.展开更多
文摘In this report, we describe radiation-induced difficult airway management in a patient with nasopharyngeal carcinoma. The patient was presented to receive laparoscopic cholecystectomy for gallbladder stone. He had been diagnosed to have nasopharyngeal cancer about 2 years ago. In operation, after sleeping, the patient was manual controlled ventilation. However, we subsequently found that his neck campaign was limited and mask ventilation was obstructed. We immediately performed oropharyngeal airway, then mask ventilation improved. Fully surface anesthesia with tetracaine atomizing to the root of tongue, larynx wall and piriform recess, the patient was endotracheal intubated with fiberoptic bronchoscope. After intubation, the patient inhaled 2.5% sevoflurane, then esmeron (50 mg) and remifentanyl (0.1 μg/kg every minute) were administrated by intravenous. After the treatment, the patient's life indexes were normal and steady. In conclusion, patients with nasopharyngeal carcinoma (NPC) after radiation therapy should be based on comprehensive evaluation of upper airway and obstructive condition before operation, then perform safe and effective tracheal intubation methods under spontaneous breathing.
文摘Objective: To explore the palliative methods to patients with central airway obstruction due to advanced malignancies. Methods: Twenty-seven patients with carcinous airway obstruction and respiratory distress were emergency remedied, including 12 cases with atelectasis and 23 with pulmonary infection. Soft cryoablated probe of CO2 and/or reticulate endobronchial stent with filmed titanium alloy were placed to the neoplasm following by bronchofibroscope. Results: Totally there were 21 patients achieved completely remission, including airway obstruction, respiratory distress and pulmonary infection remission, and 3 cases got partial remission. Meanwhile there were 3 cases died, in which one was happened during the period of endobronchial stent making, another one with heavy airway obstruction died due to asphyxia 24 h after the operation of bronchofibroscope examination, and the last one with knob invaded died because of hemoptysis and asthema secondarily 36 h after stent placed. Conclusion: The emergency remedy using soft cryoablated probe of CO2 and/or reticulate endobronchial stent with filmed titanium alloy placed to the neoplasm following by bronchofibroscope to patients with malignant central airway obstruction was a effective salvage method and could prolong patients’ lifespan for more subsequent therapeutic opportunities.
文摘Objective： To investigate the diagnos- tic and therapeutic effect ofbronchofiberscopy in the manage- ment of severe thoracic trauma. Methods： A retrospective study was conducted on 207 consecutive patients with severe thoracic trauma enrolled in our hospital between January 2008 and June 2012. During the period, 488 bronchofiberscopies and lavages were done. The bronchofiberscope was inserted through tracheal inci- sion （282）, nasal cavity （149） and oral cavity （57）. Intensive SaO2 monitoring as well as blood gas analysis were per- formed pre-, intra- and postoperatively. Simultaneously oxy- gen therapy or ventilatory support was given. Sputum cul- ture was done intraoperatively. Results： Diagnosis in 207 cases was confirmed by bronchofiberscopy. The result of sputum culture was posi- tive in 78 cases. Lavage was performed on 156 cases. SaO2 significantly increased after bronchofiberscopies as well as lavages and PaO2 obviously improved 2 h after surgery （both P〈0.05）. Heart rate and respiratory rate decreased. There was no bronchofiberscopy-related death. Conclusion： Bronchofiberscopy plays an important role in the diagnosis and treatment of severe thoracic trauma, which can not only timely diagnose bronchial injury and collect deep tracheal sputum for bacterial culture but also effectively remove foreign body, secretion, blood and spu- tum crust in the airway, manage obstructive atelectasis and pneumonia, and signifcantly improve respiratory fimction and treatment outcome.
