Upper airway diseases and airway management: a synopsis☆
Section snippets
Stridor
Stridor, or noisy inspiration from turbulent gas flow in the upper airway, often is seen in airway obstruction, and always commands attention. Wherever possible, attempts should be made to immediately establish the cause of the stridor (eg, foreign body, vocal cord edema, tracheal compression by tumor, functional laryngeal dyskinesia, and so forth) [1].
The first issue of clinical concern in the setting is whether or not intubation is immediately necessary. If intubation can be delayed, a number
Diabetes and the airway
The link between diabetes mellitus and difficult laryngoscopy has been described only in recent years [2]. Approximately one third of long-term type diabetics (juvenile onset) present with laryngoscopic difficulties [3], [4]. This is a result, at least in part, of diabetic “stiff joint syndrome,” [5], [6] characterized by short stature, joint rigidity, and tight, waxy skin. The fourth and fifth proximal pharyngeal joints most commonly are involved. Patients with diabetic stiff joint syndrome
Airway polyps
Polyps may be found throughout the airway. Nasal polyps and polyps elsewhere in the airway can lead to partial or complete airway obstruction [45], [46]. Vocal cord granulomas and polyps may occur as a result of traumatic intubation, cord irritation from ETT movement or lubricant chemicals, or other causes. The problem occurs more frequently in women. Pedunculated granulomas or polyps detected after the investigation of hoarseness are usually removed surgically, as they can sometimes lead to
Mediastinal masses: some practical points
- 1.
Patient evaluation should center on the following clinical questions:
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Is there SVC obstruction?
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Is there tracheal compression?
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Is the PA involved?
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Is the heart involved?
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- 2.
These questions must be investigated with the following tools:
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Clinical presentation (signs, symptoms, and clinical findings). Note that the clinical presentation is the most important determinant of severity.
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Chest radiogaph
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CT scan of chest
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Flow-volume loops (ideally, both sitting and supine)
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Signs and symptoms indicating airway
Tonsillitis and other tonsillar disorders [65,66]
Tonsillectomy surgery may be required in adults and children either because tonsillar hypertrophy is causing partial airway obstruction or because of the nuisance of repeated tonsillar infections. Less commonly, tonsillar malignancy may require radical craniofacial surgery, whereas occult hypertrophic tonsillar masses in completely asymptomatic individuals rarely may lead to fatal airway obstruction with the routine induction of general anaesthesia.
Airway considerations for general anaesthesia
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Cited by (8)
Asthma: Guidelines for differential diagnosis
2014, Medicine (Spain)Repeated episodes of respiratory failure due to bilateral vocal cord paralysis
2013, Journal of Emergency MedicineCitation Excerpt :The diagnosis of upper airway obstruction in the ED may be difficult, especially because functional causes are usually far more likely than anatomical causes. In any case, upper airway obstruction is a medical emergency that requires rapid evaluation of the patient (4). Inspiratory stridor indicates lesions at or above glottis and always commands attention.
Respiratory anesthetic emergencies in oral and maxillofacial surgery
2013, Oral and Maxillofacial Surgery Clinics of North AmericaCitation Excerpt :Respiratory anesthetic emergencies are the most common complications encountered during the administration of anesthesia in both the adult and pediatric populations.1–26
The relationship between night time snoring and Cormack and Lehane grading
2010, Acta Anaesthesiologica TaiwanicaCitation Excerpt :Also, it was demonstrated that body mass index, age, macroglossia growing beard, lack of teeth, history of snoring, increased Mallampati grade, and lower thyromental distance are potential difficult mask ventilation risk factors.10 In another study it was shown that a history of upper airway compromise during sleep (snoring, obstructive apneas) should be sought for detection of difficult intubation and also, snoring could be a cause for mild partial airway obstruction.11 The findings of this study demonstrated a relationship between the presence of snoring and increased number of Cormack and Lehane grading score.
Assessment and therapy of selected endocrine disorders
2004, Anesthesiology Clinics of North AmericaPressure Oscillation in Biomedical Diagnostics and Therapy
2022, Pressure Oscillation in Biomedical Diagnostics and Therapy
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This article is modified from an earlier review published in Anesthesiology Clinics of North America. DJ Doyle, R Arellano. Medical Conditions With Airway Implications. The Difficult Airway II. WB Saunders; September 1995.