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European Journal of Translational... Oct 2023Choking (or foreign body airway obstruction) is a widespread phenomenon with serious consequences of morbidity and mortality. Choking (often also called suffocation) can...
Choking (or foreign body airway obstruction) is a widespread phenomenon with serious consequences of morbidity and mortality. Choking (often also called suffocation) can be caused by food or inedible objects and leads to various degrees of asphyxiation or lack of oxygen in the blood stream. The incidence is very high in both young children and adults, especially seniors. However, since not all choking episodes end up in the emergency room or become fatalities, they often escape statistics. Although episodes of choking from non-edible bodies are infrequent, they affect mostly young children. Three of the most common risks for choking in general are neurological disorders, dysphagia and dental issues (few or no teeth, unstable or unsuitable prosthesis or orthodontic appliances). The purpose of this study was to evaluate the risk factors of choking and ways to reduce/avoid this event. We reported data on a series of 138 patients admitted to the emergency department following a choking event, at a hospital in Rome, Italy. The age group of the analyzed population ranged from 1 to 88 years, with the most represented age group of these between 40 and 59, with a similar distribution between males and females. The types of foods on which people choked reflected the seasonal, traditional and local foods: 67% of patients reported choking on fish bones followed by meat bones (9%) and artichokes (3%). Three relevant non-food choking elements reported were: orthodontic items, toothpicks and pins (one occurrence each). We also reported on two clinical cases of patients choking on meat and a chicken bone. In conclusion, choking awareness and prevention are essential for implementing potential life-saving precautions. Prevention is the first tool to reduce the occurrence of this event, therefore it is necessary to analyze the risk factors and educate the population to eliminate them. Proper chewing and oral manipulation are paramount functions in preventing choking, along with meal-time supervision if little children and elderly. Then, it behooves the healthcare professionals to disseminate knowledge.
PubMed: 37905785
DOI: 10.4081/ejtm.2023.11471 -
Journal of Acute Medicine Dec 2022Dentures dislodged into throat on bilevel positive airway pressure (BiPAP) ventilation can be overlooked and potentially compromise airway patency. An 81-year-old man...
Dentures dislodged into throat on bilevel positive airway pressure (BiPAP) ventilation can be overlooked and potentially compromise airway patency. An 81-year-old man with a history of chronic obstructive pulmonary disease (COPD) presented with increased shortness of breath and productive cough for 1 week. Inhaled bronchodilators, parenteral steroids, and BiPAP ventilation were administered for acute exacerbation of COPD complicated with acute hypercapnic respiratory failure. Fifty minutes after receiving BiPAP ventilation, his respiratory condition improved; however, he started to complain of neck pain. The patient remained intolerant to the device 3 hours later, despite receiving assurance that the discomfort might be caused by air pressure through mask ventilation. His throat did not exhibit any abnormality during visual examination. Neck radiographs were subsequently obtained and demonstrated a denture impacted in the hypopharynx. His neck pain resolved after the removal of the dislodged maxillary denture. Denture dislodgement can occur in mask ventilation and compromise airway patency if stuck in the hypopharynx or respiratory tract. Such adverse events may be overlooked on the coexistence of respiratory and pulmonary diseases. A precisely pharyngolaryngeal inspection and complete imaging studies must be performed to facilitate early identification and further retrieval intervention.
PubMed: 36761857
DOI: 10.6705/j.jacme.202212_12(4).0004 -
Anesthesia and Pain Medicine Jan 2023Supraglottic airways (SGA) are increasingly used in pediatric anesthesia.Among SGA, I-gelTM is a commonly used device in pediatric patients. The BlockbusterTM laryngeal...
BACKGROUND
Supraglottic airways (SGA) are increasingly used in pediatric anesthesia.Among SGA, I-gelTM is a commonly used device in pediatric patients. The BlockbusterTM laryngeal mask airway (LMA) is latest addition in pediatric airway armamentarium. This studywas conducted to compare the clinical performance of I-gelTM and BlockbusterTM LMA in pediatric patients.
METHODS
A total of 140 children aged 1-5 years, who were undergoing elective surgery,were randomized into two groups either I-gelTM (Group I) or BlockbusterTM LMA (Group B). Airway was secured with appropriate-sized LMA according to group allocation under generalanesthesia. The primary objective of study was oropharyngeal leak pressures (OPLP), andsecondary objectives were number of attempts of device insertion, success rate, ease ofLMA insertion, hemodynamic parameters, and postoperative pharyngolaryngeal morbidities.
RESULTS
The mean OPLP was significantly higher for I-gelTM compared to BlockbusterTM LMA(27.97 ± 1.65 vs. 26.04 ± 2.12; P < 0.001). The devices were successfully inserted on thefirst attempt in 97.14% and 90% of the Group I and Group B respectively. The insertion time,ease of insertion, hemodynamic parameters and postoperative complications were comparable between groups.
CONCLUSIONS
The I-gelTM was more efficacious device in term of OPLP than BlockbusterTMLMA for positive pressure ventilation in pediatric patients undergoing short surgical procedures under general anesthesia.
PubMed: 36746902
DOI: 10.17085/apm.22209 -
Journal of Infection and Chemotherapy :... Feb 2023Herpes zoster caused by reactivation of latent varicella-zoster virus (VZV) usually develop in later adulthood. In the pediatric population, herpes zoster is unusual,...
Herpes zoster caused by reactivation of latent varicella-zoster virus (VZV) usually develop in later adulthood. In the pediatric population, herpes zoster is unusual, and involvement of pharyngolaryngeal lesion and cranial nerves is rare. Here, we report a 14-year-old boy who was diagnosed with laryngeal herpes zoster (LHZ), and developed subsequent cranial nerve symptoms suspected of vagus neuropathy. This case provides additional evidence that children can develop LHZ and subsequent cranial nerve symptoms. LHZ should be considered if a pediatric patient with a history of varicella, has unilateral throat pain, with or without cranial nerve symptoms.
Topics: Male; Child; Humans; Adult; Adolescent; Herpesvirus 3, Human; Herpes Zoster; Pharyngitis
PubMed: 36208857
DOI: 10.1016/j.jiac.2022.10.001 -
Dysphagia Jun 2023Dysphagia is sometimes accompanied by pain. Because orofacial structures subserve mastication and swallowing, orofacial pain might impair both functions. Tongue biting...
Dysphagia is sometimes accompanied by pain. Because orofacial structures subserve mastication and swallowing, orofacial pain might impair both functions. Tongue biting can occur not only accidentally while eating but also in some pathological conditions. However, it remains unclear whether noxious mechanical stimulation of the tongue affects swallowing. To explore this question, we evaluated the effects of lingual pinch stimulation on the initiation of swallowing evoked by distilled water (DW) infusion with a flow rate of 5.0 µL/s for 20 s into the pharyngolaryngeal region in anesthetized rats. The swallowing reflex was identified by electromyographic (EMG) bursts in the suprahyoid muscles which include the anterior belly of the digastric muscle, mylohyoid and geniohyoid muscles, and laryngeal elevation by visual inspection. The number of DW-evoked swallows during pinch stimulation was significantly smaller than that in a control condition or during pressure stimulation. The onset latency of the first swallow during pinch stimulation was significantly longer than that in the control condition. DW-evoked swallowing was almost abolished following bilateral transection of the superior laryngeal nerve (SLN) compared with the control condition, suggesting that the SLN plays a crucial role in the initiation of DW-evoked swallowing. Finally, electrophysiological data indicated that some SLN-responsive neurons in the nucleus tractus solitarii (nTS) exhibited delayed latency from a single SLN stimulation during lingual pinch stimulation. These results suggest that noxious mechanical stimulation of the tongue inhibits the initiation of swallowing and modulates neuronal activity in the nTS.
Topics: Rats; Animals; Deglutition; Rats, Sprague-Dawley; Water; Deglutition Disorders; Tongue; Electric Stimulation; Reflex; Electromyography
PubMed: 36127446
DOI: 10.1007/s00455-022-10522-5 -
Medical Science Monitor : International... Aug 2022BACKGROUND The Baska mask is a supraglottic airway device that has a continuous non-inflatable flexible cuff that mimics an airway, reducing the risk of overinflation... (Randomized Controlled Trial)
Randomized Controlled Trial
Safety and Efficacy of the Baska Mask Versus Endotracheal Intubation in 64 Women Undergoing Elective Laparoscopic Gynecological Surgery Under General Anesthesia: A Prospective Single-Center Study.
BACKGROUND The Baska mask is a supraglottic airway device that has a continuous non-inflatable flexible cuff that mimics an airway, reducing the risk of overinflation and aspiration of gastric contents. This prospective study from a single center aimed to compare the safety and efficacy of the Baska mask vs endotracheal intubation (ET) in 64 women undergoing elective laparoscopic gynecological surgery in Trendelenburg position under general anesthesia. MATERIAL AND METHODS This was a prospective randomized study conducted on 64 adult female patients, 32 in each group, undergoing gynecologic surgery under general anesthesia. The study population was divided into 2 groups: the Baska group and the ET group. The respiratory and haemodynamic variables, the degree of gastric distension, and postoperative pharyngolaryngeal symptoms were compared between groups. RESULTS After 2 patients dropped out of the study, data from 62 patients were analyzed. The Baska group showed significantly shorter device insertion time (28.4±10.7 vs 46.6±19.8, P=0.001), a significantly lower oropharyngeal leak pressure at all studied time points, and a higher leak fraction at 1 min after the completion of pneumoperitoneum (5.6% vs 2.1%, P=0.031) compared to the ET group. Respiratory and haemodynamic variables, the gastric antrum size, and postoperative pharyngolaryngeal symptoms showed no significant difference. CONCLUSIONS This study supports the findings from previous studies in patients undergoing general surgery. The Baska mask was as effective as ET in ventilation during general anesthesia in women undergoing elective laparoscopic gynecological surgery. Respiratory and hemodynamic responses were similar to ET, and no complications were associated with the Baska mask in this study.
Topics: Adult; Anesthesia, General; Female; Gynecologic Surgical Procedures; Humans; Intubation, Intratracheal; Laparoscopy; Laryngeal Masks; Prospective Studies
PubMed: 35927929
DOI: 10.12659/MSM.937630 -
Respiratory Medicine May 2022Pulmonary hypertension (PH), as a consequence of lung disease or hypoxia, has been classified as Group 3 PH by the World Symposium on Pulmonary Hypertension. The most... (Review)
Review
Pulmonary hypertension (PH), as a consequence of lung disease or hypoxia, has been classified as Group 3 PH by the World Symposium on Pulmonary Hypertension. The most common lung diseases associated with Group 3 PH are chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD). PH in ILD (PH-ILD) is associated with reduced exercise capacity, greater supplemental oxygen needs, decreased quality of life, and earlier death compared to ILD alone. Several agents have been evaluated in clinical trials for the treatment of Group 3 PH, but only one treatment has been recently approved by the FDA as conclusively demonstrating efficacy for the treatment of pulmonary hypertension in this group. In the INCREASE study, treprostinil inhalation solution (Tyvaso) demonstrated significant clinical benefit for patients with PH-ILD. The inhaled route of administration may be associated with cough, throat irritation, pharyngolaryngeal pain and risk of bronchospasm and are important considerations upon initiation of therapy. Here we provide a practical review of inhaled prostacyclin therapy and suggestions for healthcare professionals to optimize the management and outcomes for the treatment of WHO Group 3, PH-ILD patients. Recommendations include up-to-date practical considerations pertaining to the entire care team and encompass patient education and communication, monitoring, titration methods and mitigation of side effects.
Topics: Epoprostenol; Humans; Hypertension, Pulmonary; Lung Diseases, Interstitial; Prostaglandins I; Quality of Life; World Health Organization
PubMed: 35334313
DOI: 10.1016/j.rmed.2022.106806 -
Journal of Perianesthesia Nursing :... Jun 2021In general anesthesia, the laryngeal mask airway (LMA) is a frequently used effective option. The effect of nitrous oxide on intracuff pressure of the LMA and... (Randomized Controlled Trial)
Randomized Controlled Trial
PURPOSE
In general anesthesia, the laryngeal mask airway (LMA) is a frequently used effective option. The effect of nitrous oxide on intracuff pressure of the LMA and postoperative sore throat is well known; however, there are no studies related to the second-generation LMA Protector. The purpose of this study was to determine the differences in intracuff pressure and postoperative sore throat, depending on the use of nitrous oxide during general anesthesia using the LMA Protector.
DESIGN
This randomized double-blind prospective study was conducted among 88 patients aged 20 to 70 years.
METHODS
The cuff pressure started with a baseline of 40 cm HO and was measured using a digital cuff pressure manometer for 30 minutes. Postoperative sore throat, dysphonia, dysphagia, and numeric rating scale scores were also recorded.
FINDINGS
Over time, the intracuff pressure of the nitrous oxide group increased significantly compared with that of the air group. Furthermore, postoperative sore throat and pharyngolaryngeal complications were not significantly different between the two groups.
CONCLUSIONS
Intracuff pressure of the LMA Protector increased during anesthesia using nitrous oxide. When the anesthesia time was less than 2 hours, however, there was no difference in postoperative sore throat.
Topics: Anesthesia, General; Humans; Laryngeal Masks; Nitrous Oxide; Pharyngitis; Postoperative Complications; Prospective Studies
PubMed: 33648860
DOI: 10.1016/j.jopan.2020.10.001 -
The Cochrane Database of Systematic... May 2020Several agents are used to clear secretions from the airways of people with cystic fibrosis. Mannitol increases mucociliary clearance, but its exact mechanism of action... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Several agents are used to clear secretions from the airways of people with cystic fibrosis. Mannitol increases mucociliary clearance, but its exact mechanism of action is unknown. The dry powder formulation of mannitol may be more convenient and easier to use compared with established agents which require delivery via a nebuliser. Phase III trials of inhaled dry powder mannitol for the treatment of cystic fibrosis have been completed and it is now available in Australia and some countries in Europe. This is an update of a previous review.
OBJECTIVES
To assess whether inhaled dry powder mannitol is well tolerated, whether it improves the quality of life and respiratory function in people with cystic fibrosis and which adverse events are associated with the treatment.
SEARCH METHODS
We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register which comprises references identified from comprehensive electronic databases, handsearching relevant journals and abstracts from conferences. Date of last search: 12 December 2019.
SELECTION CRITERIA
All randomised controlled studies comparing mannitol with placebo, active inhaled comparators (for example, hypertonic saline or dornase alfa) or with no treatment.
DATA COLLECTION AND ANALYSIS
Authors independently assessed studies for inclusion, carried out data extraction and assessed the risk of bias in included studies. The quality of the evidence was assessed using GRADE.
MAIN RESULTS
Six studies (reported in 36 unique publications) were included with a total of 784 participants. Duration of treatment in the included studies ranged from 12 days to six months, with open-label treatment for an additional six months in two of the studies. Five studies compared mannitol with control (a very low dose of mannitol or non-respirable mannitol) and the final study compared mannitol to dornase alfa alone and to mannitol plus dornase alfa. Two large studies had a similar parallel design and provided data for 600 participants, which could be pooled where data for a particular outcome and time point were available. The remaining studies had much smaller sample sizes (ranging from 22 to 95) and data could not be pooled due to differences in design, interventions and population. Pooled evidence from the two large parallel studies was judged to be of low to moderate quality and from the smaller studies was judged to be of low to very low quality. In all studies, there was an initial test to see if participants tolerated mannitol, with only those who could tolerate the drug being randomised; therefore, the study results are not applicable to the cystic fibrosis population as a whole. While the published papers did not provide all the data required for our analysis, additional unpublished data were provided by the drug's manufacturer and the author of one of the studies. Pooling the large parallel studies comparing mannitol to control, up to and including six months, lung function (forced expiratory volume at one second) measured in both mL and % predicted was significantly improved in the mannitol group compared to the control group (moderate-quality evidence). Beneficial results were observed in these studies in adults and in both concomitant dornase alfa users and non-users in these studies. In the smaller studies, statistically significant improvements in lung function were also observed in the mannitol groups compared to the non-respirable mannitol groups; however, we judged this evidence to be of low to very low quality. For the comparisons of mannitol and control, we found no consistent differences in health-related quality of life in any of the domains except for burden of treatment, which was less for mannitol up to four months in the two pooled studies of a similar design; this difference was not maintained at six months. It should be noted that the tool used to measure health-related quality of life was not designed to assess mucolytics and pooling of the age-appropriate tools (as done in some of the included studies) may not be valid so results were judged to be low to very low quality and should be interpreted with caution. Cough, haemoptysis, bronchospasm, pharyngolaryngeal pain and post-tussive vomiting were the most commonly reported side effects in both treatment groups. Where rates of adverse events could be compared, statistically no significant differences were found between mannitol and control groups; although some of these events may have clinical relevance for people with CF. For the comparisons of mannitol to dornase alfa alone and to mannitol plus dornase alfa, very low-quality evidence from a 12-week cross-over study of 28 participants showed no statistically significant differences in the recorded domains of health-related quality of life or measures of lung function. Cough was the most common side effect in the mannitol alone arm but there was no occurrence of cough in the dornase alfa alone arm and the most commonly reported reason of withdrawal from the mannitol plus dornase alfa arm was pulmonary exacerbations. In terms of secondary outcomes of the review (pulmonary exacerbations, hospitalisations, symptoms, sputum microbiology), evidence provided by the included studies was more limited. For all comparisons, no consistent statistically significant and clinically meaningful differences were observed between mannitol and control treatments (including dornase alfa).
AUTHORS' CONCLUSIONS
There is moderate-quality evidence to show that treatment with mannitol over a six-month period is associated with an improvement in some measures of lung function in people with cystic fibrosis compared to control. There is low to very low-quality evidence suggesting no difference in quality of life for participants taking mannitol compared to control. This review provides very low-quality evidence suggesting no difference in lung function or quality of life comparing mannitol to dornase alfa alone and to mannitol plus dornase alfa. The clinical implications from this review suggest that mannitol could be considered as a treatment in cystic fibrosis; but further research is required in order to establish who may benefit most and whether this benefit is sustained in the longer term. Furthermore, studies comparing its efficacy against other (established) mucolytic therapies need to be undertaken before it can be considered for mainstream practice.
Topics: Administration, Inhalation; Adult; Child; Cystic Fibrosis; Deoxyribonuclease I; Forced Expiratory Volume; Humans; Mannitol; Mucociliary Clearance; Powders; Randomized Controlled Trials as Topic; Recombinant Proteins; Respiratory Function Tests; Vital Capacity
PubMed: 32358807
DOI: 10.1002/14651858.CD008649.pub4 -
Clinical Otolaryngology : Official... May 2020Pharyngolaryngeal and oesophagogastric cancers present with swallowing symptoms and as such, their clinical evaluation traverses boundaries between different...
OBJECTIVES
Pharyngolaryngeal and oesophagogastric cancers present with swallowing symptoms and as such, their clinical evaluation traverses boundaries between different specialties. We studied the incidence and significance of interspecialty cancer referrals (ICRs), that is, pharyngolaryngeal cancers first evaluated by gastroenterology and oesophagogastric cancers first evaluated by otolaryngology.
DESIGN
A subset analysis of our Integrated Aerodigestive Partnership's audit dataset, of all ICR patients, and an equal number of controls matched for age, sex and cancer subsite.
MAIN OUTCOME MEASURES
Information about patient age and presenting symptoms was recorded. The relationship between symptoms and ICR risk was examined with binary logistic regression. Referral-to-diagnosis latency was compared between ICR and control patients with unpaired Student's t test. Cox regression was used to identify independent predictors of overall survival.
RESULTS
Of 1130 patients with pharyngolaryngeal and oesophagogastric cancers between 2008 and 2018, 60 diagnoses (5.3%) were preceded by an ICR. Referral-to-diagnosis latency increased from 43 ± 50 days for control patients to 115 ± 140 days for ICR patients (P < .0001). Dysphagia significantly increased the risk of an ICR (odds ratio 3.34; 95% CI 1.30-8.56), and presence of classic gastroesophageal reflux symptoms (heartburn or regurgitation; OR 0.25; 95% CI 0.08-0.83) and "distal" symptoms (nausea/vomiting, abdominal pain or dyspepsia; OR 0.23; 95% CI 0.08-068) significantly reduced the risk. Eleven pharyngolaryngeal cancers (of 26; 42%) were missed by gastroenterology, and eight (of 34; 24%) oesophageal cancers were missed by otolaryngology. An ICR was an independent adverse prognostic risk factor on multivariable analysis (hazard ratio 1.76; 95% CI 1.11-2.73; P < .02; log-rank test). Two systemic root causes were poor visualisation of pharynx and larynx by per-oral oesophago-gastro-duodenoscopy (OGD) for pharyngolaryngeal cancers, and poor sensitivity (62.5%) of barium swallow when it was used to 'evaluate' oesophageal mucosa.
CONCLUSIONS
An interspecialty cancer referral occurs in a significant proportion of patients with foregut cancers. It almost triples the time to cancer diagnosis and is associated with a high incidence of missed cancers and diminished patient survival. It is a complex phenomenon, and its reduction requires an integrated approach between primary and secondary care, and within secondary care, to optimise referral pathways and ensure appropriate and expeditious specialist evaluation.
Topics: Aged; Aged, 80 and over; Case-Control Studies; Delayed Diagnosis; Esophageal Neoplasms; Female; Gastroenterology; Humans; Male; Middle Aged; Otolaryngology; Otorhinolaryngologic Neoplasms; Referral and Consultation; Risk Factors; Survival Rate
PubMed: 31984641
DOI: 10.1111/coa.13510