Mediastinal tumors - Airway obstruction and management
Cora and Webb Manning Department of Surgery, Baylor College of Medicine, Houston, TX. Seminars in Pediatric Surgery
(Impact Factor: 2.22).
Large mediastinal massess can cause compression of surrounding mediastinal structures. Patients may have symptoms of airway obstruction or cardiovascular compromise. The additive effects of anesthetics, paralysis, and positioning during biopsy can lead to acute airway obstruction and death. In some cases, tissue diagnosis can be achieved and treatment initiated without general anesthesia. When general anesthesia is necessary, specific measures should be taken to avoid disaster or immediately alleviate obstruction should it occur. Some patients at greatest risk will require pretreatment of the mass before tissue diagnosis. This article reviews these issues and provides a useful algorithm for managing patients with mediastinal masses.
Available from: Abeer A Arab
- "EMLA cream has been studied for pain management associated with venipuncture where it had equivalent efficacy to lidocaine infiltration and ethyl chloride spray. EMLA cream significantly decreased the response associated with the painful phases of circumcision also, it offers significant pain reduction and improved patients’ co-operation who underwent surgical management of molluscum contagiosum, split thickness skin grafting and superficial lymph node biopsy. "
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ABSTRACT: Providing sedation for patients with compromised upper airway is challenging. A 19-year-old female patient with huge maxillofacial tumor invading the whole pharynx scheduled for elective tracheostomy under local anesthesia due to compromised airway. The patient had gastrostomy tube for feeding. Venous cannulation was totally refused by the patient after repeated trials for exhausted sclerosed veins. Pre-operative mixture of dexmedetomidine with ketamine was administered through the gastrostomy tube with eutectic mixture of local anesthetics cream application over the planned tracheostomy site. The patient was sedated with eye opening to command. Local infiltration followed by tracheostomy was performed without patient complaints or recall of operative events.
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ABSTRACT: Malignant airway obstruction affects up to 80,000 patients annually, many of whom will present acutely to the emergency department (ED). This clinical entity should be sought in any patient presenting to the ED with increasing shortness of breath, recurrent chest infections, hemoptysis, and an inability to lie flat. Interventions suggested in malignant airway obstruction include: maintenance of spontaneous ventilation by avoiding respiratory depressing sedation, muscle relaxants or narcotics; changes in patient's position; avoidance of general anesthesia and positive pressure ventilation, if possible; placement of endotracheal tube beyond the level of obstruction; radiotherapy; corticosteroids; availability of helium-oxygen mixtures, cardiopulmonary bypass, or extracorporeal membrane oxygenation. If time allows, further diagnostic studies will be of assistance in assessing the best therapy before definitive intervention.
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