Anaesthetic care for noma (cancrum oris) the disease, the airway and how to provide anaesthetic care without a clinical safety infrastructure

Publication date: Available online 15 February 2020Source: Trends in Anaesthesia and Critical CareAuthor(s): Ulrich Braun, Karl Günther Wiese, Hans-Albert Merten, Arnd TimmermannAbstractNoma (Cancrum oris) is an infectious acute disease that is prevalent in Africa, Asia and the American continent. This condition develops as a consequence of deficient nutrition. It is acquired by children between the ages of 1 and 7, and the children who contract it can die from sepsis within 2 weeks. The estimated mortality rate is in the range of 85%. The survivors have disfigurements of the face, massive scarring, open access to the oral and nasal cavities and trismus, which is the inability to open the mouth partially or completely. Noma, the neglected disease is observed among the poorest of the poor.The authors took part in a team effort to treat the sequelae of Noma in the year 2000 in Sokoto, Nigeria. There was no recovery room, intensive care unit, blood chemical laboratory, radiologic or advanced anaesthetic technology in the Noma Hospital in Sokoto as criteria of a clinical safety infrastructure. Flexible optical nasal intubation (FOI) was successful in all 65 Noma patients, where it was attempted. The nasal, cricothyroidotomy and tracheostomy routes in this disease are free, the oral access is obstructed. Supraglottic airways and oral tracheal intubation per conventional or video laryngoscopy are contraindicated.
Source: Trends in Anaesthesia and Critical Care - Category: Anesthesiology Source Type: research

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‚ÄčI'll admit it. I hate the cricothyrotomy. It's not because I haven't done one for a decade or because it is a complicated procedure. Or because I dread the thought of leaving a permanent cosmetic defect on someone's neck. Or because it is a procedure performed as a last resort under extreme time pressure on a hypoxic patient who will almost assuredly die if you fail.It has something to do with the word failed, as in failed airway. That surgical airway is there because the physician could not gain effective control of the patient's airway using all of the other airway tools at his disposal. We all understand that failure...
Source: M2E Too! Mellick's Multimedia EduBlog - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
AbstractFailure to manage bleeding in the airway is an important cause of airway-related death. The purpose of this narrative review is to identify techniques and strategies that can be employed when severe bleeding in the upper airway may render traditional airway management (e.g., facemask ventilation, intubation via direct/video laryngoscopy, flexible  bronchoscopy) impossible because of impeded vision. An extensive literature search was conducted of bibliographic databases, guidelines, and textbooks using search terms related to airway management and bleeding. We identified techniques that establish a definitive a...
Source: Canadian Journal of Anesthesia - Category: Anesthesiology Source Type: research
Abstract Failure to manage bleeding in the airway is an important cause of airway-related death. The purpose of this narrative review is to identify techniques and strategies that can be employed when severe bleeding in the upper airway may render traditional airway management (e.g., facemask ventilation, intubation via direct/video laryngoscopy, flexible bronchoscopy) impossible because of impeded vision. An extensive literature search was conducted of bibliographic databases, guidelines, and textbooks using search terms related to airway management and bleeding. We identified techniques that establish a def...
Source: Canadian Journal of Anaesthesia - Category: Anesthesiology Authors: Tags: Can J Anaesth Source Type: research
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Source: Journal of Neurosurgical Anesthesiology - Category: Anesthesiology Tags: Clinical Investigations Source Type: research
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Source: European Journal of Anaesthesiology - Category: Anesthesiology Tags: Airway management Source Type: research
AbstractPurposeThe purpose of this retrospective study was to evaluate perioperative risk factors concerning difficult airway management, primary tracheostomy, and need for intensive care unit (ICU) admission in severe odontogenic space infections.MethodsPerioperative risk factors were retrospectively analyzed in 499 cases. Fisher ’s exact test and analysis of variance were performed to analyze associations between categorical and continuous variables. Univariate regression analysis was used for estimating predictors for ICU admission. A risk model for ICU admission was performed using multivariate regression analysi...
Source: Oral and Maxillofacial Surgery - Category: ENT & OMF Source Type: research
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Source: Brazilian Journal of Otorhinolaryngology - Category: ENT & OMF Source Type: research
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Source: A&A Case Reports - Category: Anesthesiology Tags: Case Reports Source Type: research
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Source: European Annals of Otorhinolaryngology, Head and Neck Diseases - Category: ENT & OMF Source Type: research
ConclusionsWe present a novel and well tolerated technique for delayed in-office application of MMC in tracheostomy-dependent patients with laryngeal stenosis. This approach can facilitate the study of the ideal timing of topical MMC use in airway stenosis.
Source: American Journal of Otolaryngology - Category: Endocrinology Source Type: research
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