# Acute and chronic airway obstruction in children

Publication date: Available online 31 October 2015 Source:Anaesthesia & Intensive Care Medicine Author(s): Gary M. Doherty Airway obstruction is more common in children than in adults. This is because of subtle anatomical differences in the childhood airway and an increased propensity to infection. Effects of obstruction manifest more quickly in children because of a smaller airway diameter, reduced physiological reserve and easily fatigued respiratory muscles. The anaesthetist may encounter airway obstruction in children both outside and within the operating theatre. Problems can be either anticipated or unexpected. The anaesthetist must be able to recognize risk factors for airway obstruction such as a history of respiratory symptoms, including sleep-disordered breathing, and high-risk groups, such as ex-preterm infants. An understanding of the pathophysiology of airway obstruction can help in the recognition, diagnosis and appropriate management of airway obstruction. The pathophysiology of airway obstruction is intimately linked with the anatomy and mechanics of the upper airway and the tracheobronchial tree. The pathophysiology of airway obstruction is reviewed and this knowledge applied to problems occurring inside and outside the operating theatre, including both anticipated and unexpected problems.
Source: Anaesthesia and intensive care medicine - Category: Anesthesiology Source Type: research

AbstractPurpose of ReviewThe measurement and assessment of pain outcomes is critical to the design, analysis, and interpretation of a pain clinical trial. Results from clinical research impact a number of stakeholders, but it can be argued that patients are the most affected. The purpose of this review is to summarize the most important pain outcomes to patients and discuss methodological considerations in collecting these data in a clinical trial.Recent FindingsWe found that there are a number of outcomes that are important to patients. The outcomes that consistently appear in the literature include reductions in pain int...
Source: Current Anesthesiology Reports - Category: Anesthesiology Source Type: research
The phrase “sacred masculine” can evoke images of patriarchal religiosity.  But it has a different meaning for today’s guest. For Miguel Dean, the sacred masculine is an ideal, embodied by a man who accepts all of his emotions, understands the connectedness of humanity, and is devoted to helping others. Join us as Miguel explains how the sacred masculine is increasingly being recognized as a new model of masculinity to replace the old ideas of what it meant to be a man. This new man embraces all of his humanity and recognizes that part of this is the courage to feel, express and honor the full spect...
Source: World of Psychology - Category: Psychiatry & Psychology Authors: Tags: Ethics & Morality General Inspiration & Hope Interview LifeHelper Men's Issues Podcast Relationships Self-Help Spirituality The Psych Central Show Source Type: blogs
A 40-year-old man was treated with tonsillectomy and underwent early surgical exploration because of bleeding. Postoperative bleeding complications were treated with bronchoscopy. In addition to obesity, normal thyroid function, type 2 diabetes mellitus, and current tobacco abuse with severe obstructive sleep apnea syndrome, biochemistry revealed severe hypercholesterolemia (total cholesterol 572 mg/dL) and hypertriglyceridemia (1,220 mg/dL). During the postoperative period, low doses of propofol (up to 2 mg/kg/h for 10 hours), along with remifentanil (up to 0.0016 mg/kg/h for 20 hours), midazolam, and tramadol, were neede...
Source: Journal of Cardiothoracic and Vascular Anesthesia - Category: Anesthesiology Authors: Tags: Letter to the Editor Source Type: research
CONCLUSION: Rebound pain assessment should always be considered in clinical practice, as it is not a rare side effect of peripheral nerve blocks. There are still many challenging questions to be answered about rebound pain, so large prospective studies are needed to address the issue. For prevention, the use of peripheral nerve block techniques that avoid nerve damage and adequate perioperative analgesia associated with patient education on the early administration of analgesics, even during the period of analgesia provided by peripheral nerve block, is recommended. A better understanding of the "rebound pain" ph...
Source: Revista Brasileira de Anestesiologia - Category: Anesthesiology Tags: Rev Bras Anestesiol Source Type: research
A 72-year-old, 94-kg, 173-cm man with hypertension, diabetes mellitus, obstructive sleep apnea, and a family history of coronary artery disease presented to the authors ’ preoperative evaluation clinic before an elective carpal tunnel release. An electrocardiogram obtained in the clinic showed previously undocumented atrial flutter. The hand surgery was postponed; the patient was referred to the electrophysiology service for further evaluation. He subsequently un derwent a radiofrequency ablation, but then developed recurrent paroxysmal atrial fibrillation after the procedure.
Source: Journal of Cardiothoracic and Vascular Anesthesia - Category: Anesthesiology Authors: Tags: Diagnostic Dilemma Source Type: research
Purpose of review Ambulatory surgery is the standard for the majority of pediatric surgery in 2019 and adenotonsillectomy is the second most common ambulatory surgery in children so it is an apt paradigm. Preparing and managing these children as ambulatory patients requires a thorough understanding of the current literature. Recent findings The criteria for undertaking pediatric adenotonsillectomy on an ambulatory basis, fasting after clear fluids, postoperative nausea and vomiting (PONV), perioperative pain management and discharge criteria comprise the themes addressed in this review. Summary Three criteria deter...
Source: Current Opinion in Anaesthesiology - Category: Anesthesiology Tags: AMBULATORY ANESTHESIA: Edited by Claude Meistelman Source Type: research
Purpose of review Although both cost and patient preference tend to favor the office-based setting, one must consider the hidden costs in managing complications and readmissions. The purpose of this review is to provide an update on safety outcomes of office-based procedures, as well as to identify common patient-specific factors that influence the decision for office-based surgery or impact patient outcomes. Recent findings Office-based anesthesia (OBA) success rates from the latest publications of orthopedic, plastic, endovascular, and otolaryngologic continue to improve. A common thread among these studies is the a...
Source: Current Opinion in Anaesthesiology - Category: Anesthesiology Tags: AMBULATORY ANESTHESIA: Edited by Claude Meistelman Source Type: research
This article presents a super obese patient (BMI 57 kg/m2) with drug-refractory epilepsy and obstructive sleep apnea who underwent left anterior temporal lobectomy through awake craniotomy to preserve language and memory, using warmed humidified high flow nasal cannula (HFNC) oxygen therapy. Awake craniotomy was facilitated by the use of HFNC, which proved essential to prevent airway collapse by creating continuous positive airway pressure through high flow and facilitated intraoperative neurologic language and memory testing while maintaining adequate oxygenation. PMID: 31686115 [PubMed - as supplied by publisher]
Source: Der Anaesthesist - Category: Anesthesiology Authors: Tags: Anaesthesist Source Type: research
AbstractPerioperative complications related to obstructive sleep apnea still occur despite the use of partial pressure end-tidal CO2$$\left( {{{\text{P}}_{{\text{ETC}}{{\text{O}}_2}}}} \right)$$ and pulse oximetry. Airway obstruction can complicate propofol sedation and a novel monitor combining mandibular movement analysis with capnography may facilitate its detection. Patients scheduled for sleep endoscopy were recruited and monitored with standard monitoring,$${{\text{P}}_{{\text{ETC}}{{\text{O}}_2}}},$$ and Jaw Activity (JAWAC) mandibular movement sensors. A post hoc analysis investigated airway obstruction prediction ...
Source: Journal of Clinical Monitoring and Computing - Category: Information Technology Source Type: research
Abstract Obstructive Sleep Apnea is characterized by interrupted breathing that leads to cardiovascular sequelae including chronic hypertension that can persist into waking hours. Chronic intermittent hypoxia, which models the hypoxemia associated with sleep apnea, is sufficient to cause a sustained increase in blood pressure that involves the central nervous system. The median preoptic nucleus (MnPO) is an integrative forebrain region that contributes to blood pressure regulation and neurogenic hypertension. The MnPO projects to the paraventricular nucleus (PVN), a pre-autonomic region. We hypothesized that pathw...
Source: American Journal of Physiology. Heart and Circulatory Physiology - Category: Physiology Authors: Tags: Am J Physiol Heart Circ Physiol Source Type: research