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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.

AUTOMATICALLY GENERATED EXCERPT
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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.

No MeSH data available.


Computed tomography scan of the neck as in Figure 3
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Figure 4: Computed tomography scan of the neck as in Figure 3

Mentions: The patient was further investigated after been sent to the ward, with cervical X-rays (antero-posterior and lateral), indirect laryngoscopy (IDL) and computed tomography (CT) scan. On IDL, the glottic chink was inadequate and left vocal cord was immobile. On fiber-optic laryngoscopy, bilateral arytenoids were boggy and edematous. On X-ray neck, pre-vertebral soft-tissue shadow appeared increased in thickness, mildly compressing the trachea. On contrast-enhanced CT of the neck, thickening of soft-tissue was noted in glottic and subglottic region, leading to narrowing of lumen. No obvious abnormal post-contrast enhancement was seen [Figures 3 and 4].


Subglottic stenosis and acute airway obstruction.

Hariharan U - J Anaesthesiol Clin Pharmacol (2014)

Computed tomography scan of the neck as in Figure 3
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 4: Computed tomography scan of the neck as in Figure 3
Mentions: The patient was further investigated after been sent to the ward, with cervical X-rays (antero-posterior and lateral), indirect laryngoscopy (IDL) and computed tomography (CT) scan. On IDL, the glottic chink was inadequate and left vocal cord was immobile. On fiber-optic laryngoscopy, bilateral arytenoids were boggy and edematous. On X-ray neck, pre-vertebral soft-tissue shadow appeared increased in thickness, mildly compressing the trachea. On contrast-enhanced CT of the neck, thickening of soft-tissue was noted in glottic and subglottic region, leading to narrowing of lumen. No obvious abnormal post-contrast enhancement was seen [Figures 3 and 4].

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.