Delayed diagnosis of arytenoid cartilage dislocation after tracheal intubation in the intensive care unit:A case report

BACKGROUND Arytenoid cartilage dislocation is a rare and often overlooked complication of tracheal intubation or blunt laryngeal trauma.The most common symptom is persistent hoarseness.Although cases of arytenoid dislocation due to tracheal intubation are reported more frequently in otolaryngology,reports on its occurrence in the intensive care unit(ICU)are lacking.We report a case of delayed diagnosis of arytenoid cartilage dislocation after tracheal intubation in the ICU.CASE SUMMARY A 20-year-old woman was referred to the ICU following a fall from a height.Her voice was normal;laryngeal computed tomography showed unremarkable findings on admission.However,due to deterioration of the patient’s condition,tracheal intubation,and emergency exploratory laparotomy followed by laparoscopic surgery two d later under general anesthesia were performed.After extubation,the patient was sedated and could not communicate effectively.On the 10th day after extubation,the patient complained of hoarseness and coughing with liquids,which was attributed to laryngeal edema and is common after tracheal intubation.Therefore,specific treatment was not administered.However,the patient’s symptoms did not improve.Five d later,an electronic laryngoscope examination revealed dislocation of the left arytenoid cartilage.The patient underwent arytenoid closed reduction under general anesthesia by an experienced otolaryngologist.Reported symptoms improved subsequently.The sixmonth follow up revealed that the hoarseness had resolved within four weeks of the reduction procedure.CONCLUSION Symptoms of arytenoid cartilage dislocation are difficult to identify in the ICU leading to missed or delayed diagnosis among patients.

Risk Analysis of Risk Factors for Pressure Injury Related to Tracheal Intubation in ICU Patients

Objective:This article mainly analyzes the risk factors of pressure injury related to tracheal intubation in ICU patients.Methods:This time,the investigation and research were mainly conducted on 110 patients with tracheal intubation received in the ICU of our hospital from June 2020 to June 2021,and the risk factors for related pressure injuries were analyzed.Results:According to statistics,the incidence rate of patients with tracheal intubation-related pressure injury was 23.63%,of which the lip had the highest incidence;the indwelling time of the tracheal tube,the wetness score,the movement force score,and the frictional shear score in the Braden score of the tracheal intubation These are all risk factors for pressure injury related to tracheal intubation(P<0.05).Conclusion:ICU patients have a higher incidence of related pressure injuries during tracheal intubation,so it is necessary to strengthen the care of risk factors and take reasonable and effective measures to prevent them.

Application of early enteral nutrition nursing based on enhanced recovery after surgery theory in patients with digestive surgery

BACKGROUND Postoperative nursing can improve the restlessness and gastrointestinal function of patients with tracheal intubation under general anesthesia in digestive surgery.Wide application of various nursing methods and routine nursing in periop-erative nursing of patients with general anesthesia in digestive surgery.AIM To investigate the impact of early postoperative enteral nutrition nursing based on the enhanced recovery after surgery(ERAS)theory on postoperative agitation and gastrointestinal recovery in patients undergoing general anesthesia that experienced tracheal intubation.METHODS The data of 126 patients with digestive surgery from May 2019 to February 2022 were retrospectively analyzed.According to different nursing methods,they were divided into control group and observation group,with 63 cases in observation group and 63 cases in control group.The patients in the control group had standard perioperative nursing care,whereas those in the observation group got enteral nourishment as soon as possible after surgery in accordance with ERAS theory.Both the rate and quality of gastrointestinal function recovery were compared between the two groups after treatment ended.Postoperative anes-thesia-related adverse events were tallied,patients'nutritional statuses were monitored,and the Riker sedation and agitation score(SAS)was used to measure the incidence of agitation.RESULTS When compared to the control group,the awake duration,spontaneous breathing recovery time,extubation time and postoperative eye-opening time were all considerably shorter(P<0.05).There was no significant difference in the recovery time of orientation force between the two groups(P>0.05);however,the observation group had a lower SAS score than the control group(P<0.05).The recovery time for normal intestinal sounds,the time it took to have the first postoperative exhaust,the time it took to have the first postoperative defecation,and the time it took to have the first postoperative half-fluid feeding were all faster in the observation group than in the control group(P<0.05);Fasting blood glucose was lower in the observation group compared to the control group(P<0.05),while the albumin and hemoglobin levels were higher on the first and third postoperative days;however,there was no statistically significant difference in the incidence of anesthesia-related adverse reactions between the two groups(P>0.05).CONCLUSION The extremely early postoperative enteral nutrition nursing based on ERAS theory can reduce the degree of agitation,improve the quality of recovery,promote the recovery of gastrointestinal function,and improve the nutritional status of patients in the recovery period after tracheal intubation under general anesthesia.

Clinical Observation of Double Tube Laryngeal Mask in Fast-Track Anesthesia for Limb Orthopedic Surgery in Children with Cerebral Palsy

Objective: To compare and analyze the effect and safety of double tube laryngeal mask and endotracheal intubation general anesthesia in fast track anesthesia for limb orthopaedic surgery in children with cerebral palsy. Methods: 78 children with cerebral palsy undergoing limb orthopedic surgery were randomly divided into laryngeal mask group and intubation group, with 39 cases in each group. The perioperative hemodynamic indexes, anesthesia effect related indexes, anesthesia related complications or adverse reaction rates of the two groups were observed and compared between the two groups. Results: When the two groups of children entered the room, there was no significant difference in MAP and HR (P > 0.05);MAP and HR of children in the intubation group were higher than those in the laryngeal mask anesthesia group (P Conclusion: Laryngeal mask is used to establish the airway of intravenous general anesthesia in limb orthopaedic surgery of children with cerebral palsy, which is conducive to the stability of children’s circulatory and respiratory system, to reduce the impact of narcotic drugs on children, to reduce the incidence of postoperative anesthesia related complications, and to improve the anesthetic effect. It meets the requirements of fast track anesthesia, and can be widely used in clinical practice.

Study on the Safety of Different Pressure Artificial Pneumothorax on Endoscopic Radical Esophagectomy

Objective: To study the effect of different pressure artificial pneumothorax on total endoscopic radical esophagectomy during and after an operation. Methods: From 2019 to 2021, 64 patients with esophageal cancer underwent video-assisted thoracoscopic surgery in the same surgical treatment group. The pressure of CO2 artificial pneumothorax was randomly divided into Group A (pressure 6 mmHg), Group B (pressure 8 mmHg), and Group C (pressure 10 mmHg). Heart rate (HR), mean arterial pressure (MAP), end-expiratory CO2 partial pressure (PETCO2), arterial blood pH and PaCO2, operation time, intraoperative blood loss, and anesthesia resuscitation time were recorded at different time points. Observe the changes in inflammatory indexes, coagulation function, and the incidence of complications in the three groups, and statistically analyze and compare the differences among the three groups of patients. Results: Sixty-four patients with esophageal cancer were included in this clinical study. There were no significant differences in gender, age, lung function, BMI, and coagulation function among the three groups (P > 0.05). There were significant differences in PETCO2, arterial pH, and PaCO2 in T2, T3, and T4 among the three groups (P < 0.05). The arterial blood gas index at T5 in Group A was significantly different from that in Group C (P < 0.05). The time of thoracic operation in Group A was significantly longer than that in the other two groups (P < 0.05), and the time of tracheal intubation and extubation was earlier in Group A (P < 0.05). The incidence of subcutaneous emphysema, thoracic tube time, and prothrombin time in Group A was significantly different from those in Group B and C (P < 0.05). There were no significant differences in hospitalization days, pulmonary infection, and other complications (P > 0.05). Conclusion: The artificial pneumothorax with 6 mmHg pressure and 8 L/min flow rate can satisfy the operation, and its safety and postoperative recovery are also better.