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Anaesthetic management of Ludwig's angina with comorbidities.

Sujatha MP, Madhusudhana R, Amrutha KS, Nupoor N - Indian J Anaesth (2015)

View Article: PubMed Central - PubMed

Affiliation: Department of Anaesthesiology, Sri Devaraj Urs Medical College, Kolar, Karnataka, India.

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Ludwig's angina is a rapidly progressing necrotising cellulitis affecting the posterior oropharynx, submaxillary and sublingual spaces... Arterial blood gas showed pH of 7.50, PCO2 of 34.5 mm Hg and PO2 of 64 mm Hg and HCO3 of 26.5 mmol/L... The patient was explained about the risk associated and plan for awake fibreoptic intubation... The primary management of the patient involves appropriate antibiotic therapy covering gram-positive, gram-negative and anaerobic infection... Patients not responding to antibiotic therapy or those associated with airway compromise require surgical manipulation... The anaesthetic challenge in our patient was that he had already progressed to a stage where he had symptoms of airway obstruction and was becoming exhausted even with slight movements... Moreover, the patient was not able to lie in the supine position... Airway oedema can be reduced using steroids Fibreoptic intubation following induction and muscle paralysis can cause the collapse of the airway and inability to mask ventilate due to anatomical distortion... Hence, the best option was to go ahead with awake fibreoptic nasotracheal intubation... It also helps in visualisation of the airway, minimising trauma if done carefully... The risk associated with this method include chances of intraoral rupture of the abscess with risk of aspiration and in case of bleeding, airway compromise... We went ahead with nasal fibreoptic intubation in left lateral position supplementing oxygen by facemask kept in front of the face as continuous suction was necessary... Fibreoptic laryngoscope is a very useful aid in such situations... These patients usually have a good recovery following surgery.

No MeSH data available.


Related in: MedlinePlus

Diffuse neck swelling
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Figure 1: Diffuse neck swelling

Mentions: A 35-year-old male patient weighing 80 kg presented with a swelling in the left side of the face and neck since 5 days following dental infection. The patient was admitted to the hospital 2 days before and started on antibiotics by the surgeon (ciprofloxacin, metronidazole), in spite of which swelling was progressive, associated with pain, with inability to swallow saliva. There was no fever, chills or rigors. The patient was diagnosed as hypertensive and diabetic 15 days ago and started on tablet telmisartan 20 mg. He was not treated for diabetes. The patient was a known asthmatic since childhood on salbutamol, ipratropium and budesonide nebulisation and was a smoker since 5 years, smoking 4–5 cigarettes/day. He was not able to lie down supine due to difficulty in breathing and was feeling better in left lateral position. On examination, heart rate was 126 beats/min and blood pressure 150/110 mm of Hg. Airway examination showed mouth opening of one finger breath with trismus and limited neck extension and sternomental and thyromental distance could not be assessed. The swelling was diffuse extending from the left side of the face to the entire anterior aspect of the neck down until the upper end of the sternum and front of the manubrium sternum [Figures 1 and 2]. There were brawny oedema and erythema over this region. Nasal flaring and bilateral rhonchi were present. Investigations revealed increased fasting blood sugar (210 mg/dL) and post-prandial blood sugar (345 mg/dL). Arterial blood gas showed pH of 7.50, PCO2 of 34.5 mm Hg and PO2 of 64 mm Hg and HCO3 of 26.5 mmol/L.


Anaesthetic management of Ludwig's angina with comorbidities.

Sujatha MP, Madhusudhana R, Amrutha KS, Nupoor N - Indian J Anaesth (2015)

Diffuse neck swelling
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4645361&req=5

Figure 1: Diffuse neck swelling
Mentions: A 35-year-old male patient weighing 80 kg presented with a swelling in the left side of the face and neck since 5 days following dental infection. The patient was admitted to the hospital 2 days before and started on antibiotics by the surgeon (ciprofloxacin, metronidazole), in spite of which swelling was progressive, associated with pain, with inability to swallow saliva. There was no fever, chills or rigors. The patient was diagnosed as hypertensive and diabetic 15 days ago and started on tablet telmisartan 20 mg. He was not treated for diabetes. The patient was a known asthmatic since childhood on salbutamol, ipratropium and budesonide nebulisation and was a smoker since 5 years, smoking 4–5 cigarettes/day. He was not able to lie down supine due to difficulty in breathing and was feeling better in left lateral position. On examination, heart rate was 126 beats/min and blood pressure 150/110 mm of Hg. Airway examination showed mouth opening of one finger breath with trismus and limited neck extension and sternomental and thyromental distance could not be assessed. The swelling was diffuse extending from the left side of the face to the entire anterior aspect of the neck down until the upper end of the sternum and front of the manubrium sternum [Figures 1 and 2]. There were brawny oedema and erythema over this region. Nasal flaring and bilateral rhonchi were present. Investigations revealed increased fasting blood sugar (210 mg/dL) and post-prandial blood sugar (345 mg/dL). Arterial blood gas showed pH of 7.50, PCO2 of 34.5 mm Hg and PO2 of 64 mm Hg and HCO3 of 26.5 mmol/L.

View Article: PubMed Central - PubMed

Affiliation: Department of Anaesthesiology, Sri Devaraj Urs Medical College, Kolar, Karnataka, India.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Ludwig's angina is a rapidly progressing necrotising cellulitis affecting the posterior oropharynx, submaxillary and sublingual spaces... Arterial blood gas showed pH of 7.50, PCO2 of 34.5 mm Hg and PO2 of 64 mm Hg and HCO3 of 26.5 mmol/L... The patient was explained about the risk associated and plan for awake fibreoptic intubation... The primary management of the patient involves appropriate antibiotic therapy covering gram-positive, gram-negative and anaerobic infection... Patients not responding to antibiotic therapy or those associated with airway compromise require surgical manipulation... The anaesthetic challenge in our patient was that he had already progressed to a stage where he had symptoms of airway obstruction and was becoming exhausted even with slight movements... Moreover, the patient was not able to lie in the supine position... Airway oedema can be reduced using steroids Fibreoptic intubation following induction and muscle paralysis can cause the collapse of the airway and inability to mask ventilate due to anatomical distortion... Hence, the best option was to go ahead with awake fibreoptic nasotracheal intubation... It also helps in visualisation of the airway, minimising trauma if done carefully... The risk associated with this method include chances of intraoral rupture of the abscess with risk of aspiration and in case of bleeding, airway compromise... We went ahead with nasal fibreoptic intubation in left lateral position supplementing oxygen by facemask kept in front of the face as continuous suction was necessary... Fibreoptic laryngoscope is a very useful aid in such situations... These patients usually have a good recovery following surgery.

No MeSH data available.


Related in: MedlinePlus