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Subglottic stenosis and acute airway obstruction.

Hariharan U - J Anaesthesiol Clin Pharmacol (2014)

View Article: PubMed Central - PubMed

Affiliation: Ex-Senior Resident, Department of Anesthesia and Intensive care Dr. Ram Manohar Lohia Hospital & Post Graduate Institute of Medical Education and Research, New Delhi, India.

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Sir, A 22-year-old female patient presented to the Emergency Department (ED) with acute breathlessness, stridor, agitation and altered sensorium... On applying pulse oximeter, her oxygen saturation (SpO2) was 74% on room air, which only marginally improved with supplemental O2... A definitive tracheostomy was planned after securing airway with an emergency endotracheal intubation... A difficult airway cart was readied and an ear, nose & throat (ENT) surgeon was called to be standby for an emergency tracheostomy during endotracheal intubation in ED... Direct laryngoscopy revealed a modified Cormack and Lehane grade 3... A 4mm un-cuffed endotracheal (ETT) portex tube was successfully negotiated through the vocal cords, beyond the obstruction after repeated unsuccessful attempts to intubate with 5 and 4.5 millimeter (mm) ETT... On direct laryngoscopy, a miniscule rim of the proximal part of the disconnected ETT was visible just below the glottic opening... After oropharyngeal suctioning, adjusting head and neck position and proper external laryngeal manipulation, the tube was successfully retrieved using a pediatric magill's forceps... No obvious abnormal post-contrast enhancement was seen [Figures 3 and 4]... Her post-tracheostomy course was uneventful in the ward, where her tracheostomy tube size was sequentially reduced and was finally decannulated... Postpartum patients who were on prolonged endotracheal intubation are more likely to develop subglottic stenosis... A high index of suspicion is warranted with the onset of respiratory symptoms following a history of intubation, regardless of the duration of intubation... This case highlights the fact that subglottic stenosis can present as acute airway obstruction.

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Related in: MedlinePlus

Video laryngoscopy view taken by ear, nose and throat surgeon on first presentation of hoarseness postpartum
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Figure 1: Video laryngoscopy view taken by ear, nose and throat surgeon on first presentation of hoarseness postpartum

Mentions: On detailed evaluation of her past history, she had pregnancy-induced hypertension and generalized edema during the last trimester of her pregnancy (3 months back). She developed postpartum jaundice and sepsis due to retained products of conception after normal vaginal delivery. She underwent management in the intensive care unit of a peripheral hospital for her condition for 15 days, with intubation and ventilatory support, the records of which were not available. Two months later, she developed progressive hoarseness of voice and paroxysmal stridor, for which she consulted a local ENT surgeon. Video laryngoscopy findings performed then revealed: “Less movement of left Vocal cord on phonation. Normal morphology of larynx with narrowing of trachea just below the vocal cords, and was negotiable with a 5 mm bronchoscope only. Mucosa was inflamed and edematous. No growth was present. Rest of trachea, carina, bronchi and bronchioles were normal” [Figures 1 and 2].


Subglottic stenosis and acute airway obstruction.

Hariharan U - J Anaesthesiol Clin Pharmacol (2014)

Video laryngoscopy view taken by ear, nose and throat surgeon on first presentation of hoarseness postpartum
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3927282&req=5

Figure 1: Video laryngoscopy view taken by ear, nose and throat surgeon on first presentation of hoarseness postpartum
Mentions: On detailed evaluation of her past history, she had pregnancy-induced hypertension and generalized edema during the last trimester of her pregnancy (3 months back). She developed postpartum jaundice and sepsis due to retained products of conception after normal vaginal delivery. She underwent management in the intensive care unit of a peripheral hospital for her condition for 15 days, with intubation and ventilatory support, the records of which were not available. Two months later, she developed progressive hoarseness of voice and paroxysmal stridor, for which she consulted a local ENT surgeon. Video laryngoscopy findings performed then revealed: “Less movement of left Vocal cord on phonation. Normal morphology of larynx with narrowing of trachea just below the vocal cords, and was negotiable with a 5 mm bronchoscope only. Mucosa was inflamed and edematous. No growth was present. Rest of trachea, carina, bronchi and bronchioles were normal” [Figures 1 and 2].

View Article: PubMed Central - PubMed

Affiliation: Ex-Senior Resident, Department of Anesthesia and Intensive care Dr. Ram Manohar Lohia Hospital & Post Graduate Institute of Medical Education and Research, New Delhi, India.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Sir, A 22-year-old female patient presented to the Emergency Department (ED) with acute breathlessness, stridor, agitation and altered sensorium... On applying pulse oximeter, her oxygen saturation (SpO2) was 74% on room air, which only marginally improved with supplemental O2... A definitive tracheostomy was planned after securing airway with an emergency endotracheal intubation... A difficult airway cart was readied and an ear, nose & throat (ENT) surgeon was called to be standby for an emergency tracheostomy during endotracheal intubation in ED... Direct laryngoscopy revealed a modified Cormack and Lehane grade 3... A 4mm un-cuffed endotracheal (ETT) portex tube was successfully negotiated through the vocal cords, beyond the obstruction after repeated unsuccessful attempts to intubate with 5 and 4.5 millimeter (mm) ETT... On direct laryngoscopy, a miniscule rim of the proximal part of the disconnected ETT was visible just below the glottic opening... After oropharyngeal suctioning, adjusting head and neck position and proper external laryngeal manipulation, the tube was successfully retrieved using a pediatric magill's forceps... No obvious abnormal post-contrast enhancement was seen [Figures 3 and 4]... Her post-tracheostomy course was uneventful in the ward, where her tracheostomy tube size was sequentially reduced and was finally decannulated... Postpartum patients who were on prolonged endotracheal intubation are more likely to develop subglottic stenosis... A high index of suspicion is warranted with the onset of respiratory symptoms following a history of intubation, regardless of the duration of intubation... This case highlights the fact that subglottic stenosis can present as acute airway obstruction.

No MeSH data available.


Related in: MedlinePlus