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The Veterinary Clinics of North... Jan 2021In addition to presenting with respiratory signs, many dogs with brachycephalic airway obstructive syndrome show digestive tract signs related to the same conformational... (Review)
Review
In addition to presenting with respiratory signs, many dogs with brachycephalic airway obstructive syndrome show digestive tract signs related to the same conformational abnormalities. A detailed diagnostic investigation is usually required, including clinicopathologic analyses, thoracic radiographs, fluoroscopic studies, abdominal ultrasound examinations and both upper airway and gastrointestinal tract endoscopy. In most cases, medical therapies are successful in managing clinical signs, but surgery can occasionally be required to resolve hiatal hernia or pyloric stenosis. In determining prognosis, the features of each individual case should be considered, with the overall prognosis depending on the severity and extent of all the identified lesions.
Topics: Airway Obstruction; Animals; Craniosynostoses; Dog Diseases; Dogs; Gastritis; Pedigree
PubMed: 33187623
DOI: 10.1016/j.cvsm.2020.09.006 -
The New England Journal of Medicine Nov 2019
Review
Topics: Acute Disease; Airway Obstruction; Algorithms; Croup; Humans; Intubation, Intratracheal; Laryngeal Diseases; Physical Examination; Respiratory System; Supraglottitis; Vocal Cord Paralysis
PubMed: 31722154
DOI: 10.1056/NEJMra1811697 -
The Veterinary Quarterly Dec 2022Brachycephalic obstructive airway syndrome (BOAS) is a chronic, lifelong, debilitating, primarily obstructive airway disease which adversely affects the quality of life... (Review)
Review
Brachycephalic obstructive airway syndrome (BOAS) is a chronic, lifelong, debilitating, primarily obstructive airway disease which adversely affects the quality of life of many popular dog breeds. Respiratory restriction in bulldog breeds, pugs and Boston terriers frequently co-exist with pathologies of the gastrointestinal tract. In addition, many brachycephalic dogs that appear clinically normal are, in fact suffering from chronic hypoxia and its systemic consequences. Concurrent gastroesophageal reflux-associated conditions, sleep disorders and systemic hypertension further impact the welfare of affected dogs. Acceptance of BOAS and associated clinical signs as being 'normal for the breed' is common amongst owners. While surgical correction of the upper airway is the mainstay of treatment, the provision of subsequent, frequently lifelong medical management is equally important for the maintenance of an acceptable quality of life, at least for some affected patients. Here we review the current knowledge concerning brachycephaly, combine it with shared clinical experience in the management of this debilitating condition, and discuss ethical considerations and the responsibility of veterinarians to contribute public education and to support appropriate breed standards for animals under our care.
Topics: Dogs; Animals; Quality of Life; Dog Diseases; Craniosynostoses; Airway Obstruction
PubMed: 36342210
DOI: 10.1080/01652176.2022.2145621 -
Resuscitation Nov 2020To summarise in a systematic review the effectiveness of interventions to treat foreign body airway obstructions (FBAO). (Review)
Review
OBJECTIVE
To summarise in a systematic review the effectiveness of interventions to treat foreign body airway obstructions (FBAO).
METHODS
We searched MEDLINE, EMBASE, and the Cochrane library from inception on 30th September 2019 for studies that described the effectiveness of interventions to treat FBAO in adults and children. We included randomised controlled trials, observational studies and case series (≥5 cases) that described evidence of benefit. For evidence of harm/complications, we included case reports. Two reviewers independently assessed study eligibility, extracted study data, and assessed risk of bias. Data are summarised in a narrative synthesis. The GRADE system is used to assess evidence certainty.
RESULTS
We included 69 publications, comprising three cross-sectional studies (557 patients); eight case series (755 patients), and 59 were case reports (64 patients). One paper was included as a case series and cross-sectional study. For all interventions and associated outcomes, evidence certainty was very low. Early removal of FBAO by bystanders was associated with improved neurological survival (odds ratio 6.0, 95% confidence interval 1.5 to 23.4). Identified evidence showed that key interventions (back blows, abdominal thrusts, chest thrusts/compressions, Magill forceps, manual removal of obstructions from the mouth, suction-based airway clearance devices) are effective in relieving FBAO. We identified reports of harm in relation to back blows, abdominal thrusts, chest thrusts/compressions, and blind finger sweeps.
CONCLUSIONS
Key interventions successfully relieve FBAO, but may be associated with important harms. Guidelines for FBAO management should balance the benefits and harms of interventions.
Topics: Adult; Airway Obstruction; Bias; Child; Cross-Sectional Studies; Foreign Bodies; Humans
PubMed: 32949674
DOI: 10.1016/j.resuscitation.2020.09.007 -
TheScientificWorldJournal 2021OSA pediatric subjects suffer from episodes of upper airway obstruction that can be partial or complete, with atypical sleep patterns and blood-gas level alteration. If... (Review)
Review
OSA pediatric subjects suffer from episodes of upper airway obstruction that can be partial or complete, with atypical sleep patterns and blood-gas level alteration. If poor treated and/or diagnosed, it can cause cardiovascular disease, learning difficulties, behavioural issues, and retardation of growth. In the literature, there are conflicting evidence about OSA assessment and treatment in pediatric age, so the aim of this paper is to highlight the multidisciplinary approach in the management of sleep disorders, stressing the role of the pediatric dentist in both diagnosing and treating the OSAS in children, according to the current evidence of the treatment options effectiveness of the syndrome itself. . Scientific evidence shows that OSAS management requires a multidisciplinary approach in order to make an early diagnosis and a correct treatment plan. The orthodontic treatment approach includes orthopedic maxillary expansion and mandibular advancement using intraoral appliances. Hence, the orthodontist and the pediatric dentist play an important role not only in early diagnosis but also in the treatment of pediatric OSAS.
Topics: Airway Obstruction; Cardiovascular Diseases; Child; Dentists; Early Diagnosis; Growth Disorders; Humans; Mandibular Advancement; Orthodontics, Corrective; Orthodontists; Sleep Apnea, Obstructive
PubMed: 33981185
DOI: 10.1155/2021/5591251 -
Seminars in Fetal & Neonatal Medicine Oct 2023Safe and effective management of the neonatal airway requires knowledge, teamwork, preparation and experience. At baseline, the neonatal airway can present significant... (Review)
Review
Safe and effective management of the neonatal airway requires knowledge, teamwork, preparation and experience. At baseline, the neonatal airway can present significant challenges to experienced neonatologists and paediatric anaesthesiologists, and increased difficulty can be due to anatomical abnormalities, physiological instability or increased situational stress. Neonatal airway obstruction is under recognised, and should be considered an emergency until the diagnosis and physiological implications are understood. When multiple types of difficulties are present or there are multiple levels of anatomical obstruction, the challenge increases exponentially. In these situations, preparation, multi-disciplinary teamwork and a consistent hospital-wide approach will help to reduce errors and morbidity.
Topics: Humans; Infant, Newborn; Airway Obstruction; Neonatology
PubMed: 38030433
DOI: 10.1016/j.siny.2023.101483 -
Anaesthesia Jan 2022Haematoma after thyroid surgery can lead to airway obstruction and death. We therefore developed guidelines to improve the safety of peri-operative care of patients...
Management of haematoma after thyroid surgery: systematic review and multidisciplinary consensus guidelines from the Difficult Airway Society, the British Association of Endocrine and Thyroid Surgeons and the British Association of Otorhinolaryngology, Head and Neck Surgery.
Haematoma after thyroid surgery can lead to airway obstruction and death. We therefore developed guidelines to improve the safety of peri-operative care of patients undergoing thyroid surgery. We conducted a systematic review to inform recommendations, with expert consensus used in the absence of high-quality evidence, and a Delphi study was used to ratify recommendations. We highlight the importance of multidisciplinary team management and make recommendations in key areas including: monitoring; recognition; post-thyroid surgery emergency box; management of suspected haematoma following thyroid surgery; cognitive aids; post-haematoma evacuation care; day-case thyroid surgery; training; consent and pre-operative communication; postoperative communication; and institutional policies. The guidelines support a multidisciplinary approach to the management of suspected haematoma following thyroid surgery through oxygenation and evaluation; haematoma evacuation; and tracheal intubation. They have been produced with materials to support implementation. While these guidelines are specific to thyroid surgery, the principles may apply to other forms of neck surgery. These guidelines and recommendations provided are the first in this area and it is hoped they will support multidisciplinary team working, improving care and outcomes for patients having thyroid surgery.
Topics: Airway Obstruction; Cognition; Elective Surgical Procedures; Hematoma; Humans; Hyperbaric Oxygenation; Intubation, Intratracheal; Thyroid Gland
PubMed: 34545943
DOI: 10.1111/anae.15585 -
Journal of Veterinary Emergency and... 2023To characterize the clinical features of noncardiogenic pulmonary edema (NCPE), etiology, and outcome in dogs and cats. The study also aimed to evaluate associations...
OBJECTIVE
To characterize the clinical features of noncardiogenic pulmonary edema (NCPE), etiology, and outcome in dogs and cats. The study also aimed to evaluate associations with mortality.
DESIGN
Retrospective study.
SETTING
University teaching hospital.
ANIMALS
Thirty dogs and 1 cat, all client owned.
INTERVENTIONS
None.
MEASUREMENTS AND MAIN RESULTS
Data collected included animal characteristics, clinical history, evaluation of oxygenation, radiographic features, treatments, and outcomes. Causes of NCPE included upper airway obstruction, electrocution, drowning, neurogenic etiology, and unknown. The etiology was known in 21 of 31 cases (68%), while the etiology of the remaining 10 cases (32%) was classified as unknown. The most common cause for NCPE was upper airway obstruction, found in 14 of 31 cases (45%). The majority of thoracic radiographs showed a mixed interstitial-to-alveolar pulmonary pattern with a diffuse distribution (52%). Oxygen therapy was administered to 27 dogs (90%). Furosemide was administered to 12 dogs (40%). The median duration of hospitalization was 48 hours (range: 1-192). Twenty-three animals (74%) survived to discharge. Six dogs were mechanically ventilated, with only 2 of them (33%) surviving to discharge. The requirement for mechanical ventilation was the only parameter associated with mortality (P = 0.03).
CONCLUSIONS
NCPE is a heterogenous disease process that is most common in dogs. There are a variety of causes, but upper airway obstruction appears to be the most common. The overall prognosis is good in animals that do not require mechanical ventilation.
Topics: Cats; Dogs; Animals; Pulmonary Edema; Retrospective Studies; Cat Diseases; Dog Diseases; Airway Obstruction
PubMed: 37087613
DOI: 10.1111/vec.13290 -
Pediatric Pulmonology May 2023Pulmonary artery sling is a rare childhood vascular tracheobronchial compression syndrome that is frequently associated with tracheal stenosis. Consequently, neonates or... (Review)
Review
Pulmonary artery sling is a rare childhood vascular tracheobronchial compression syndrome that is frequently associated with tracheal stenosis. Consequently, neonates or infants may present with critical airway obstruction if there is long segment airway narrowing and complete rings. Rapid diagnosis of this cardiac vascular malformation and evaluation of the extent and severity of airway involvement is essential to plan surgery, typically a slide tracheoplasty to relieve critical airway obstruction. Long term outcome can be excellent following surgical repair of the stenosed airway and reimplantation of the left pulmonary artery. In this review we focus on the embryology, diagnostic workup, airway investigations and management for this rare but challenging congenital condition.
Topics: Infant; Infant, Newborn; Humans; Child; Pulmonary Artery; Treatment Outcome; Retrospective Studies; Heart Defects, Congenital; Vascular Malformations; Airway Obstruction; Trachea
PubMed: 36790334
DOI: 10.1002/ppul.26345 -
The Veterinary Clinics of North... Mar 2022This article discusses updates in brachycephalic and other upper respiratory surgery of dogs and cats, including schemata for classifying brachycephalic dogs in terms of... (Review)
Review
This article discusses updates in brachycephalic and other upper respiratory surgery of dogs and cats, including schemata for classifying brachycephalic dogs in terms of severity of disease and indications for monitoring and treatment, new characterizations of the primary and secondary components of brachycephalic obstructive airway syndrome (BOAS), and updates to traditional brachycephalic airway surgical procedures as well as novel surgeries to treat BOAS, including laser-assisted turbinectomy, the cardiopulmonary effects of brachycephaly on some feline breeds, epiglottic entrapment and retroversion, and upper airway syndrome in Norwich terriers.
Topics: Airway Obstruction; Animals; Cat Diseases; Cats; Craniosynostoses; Dog Diseases; Dogs; Laryngeal Diseases
PubMed: 35082092
DOI: 10.1016/j.cvsm.2021.12.002