جستجوی مقالات مرتبط با کلیدواژه "tracheal stenosis" در نشریات گروه "پزشکی"

One of the most dangerous complications after endotracheal intubation or tracheostomy is tracheal stenosis.

This study aimed to determine the personal and clinical characteristics of tracheal stenosis following intubation or tracheostomy in intensive care unit patients.

This is a nested case-control study. Thirty-five patients who suffered from tracheal stenosis from March 2016 to March 2021 and had been intubated and tracheostomized in intensive care units (ICU) were selected for the case group. The control group included 105 patients intubated and tracheostomized in ICU during the same period without tracheal stenosis. A demographic and clinical characteristics questionnaire was used to collect data from the patients' medical records.

The mean length of intubation (P < 0.001), endotracheal and tracheostomy tube cuff pressure (P < 0.001), chronic obstructive pulmonary disease (COPD) (P = 0.043), intubation history (P = 0.045), and airway management (P < 0.001) showed significant differences between the case and control groups. The logistic regression model revealed that COPD (OR = 8.519, P = 0.037), intubation history (OR = 3.939, P = 0.013), length of intubation (OR = 1.118, P = 0.003), age (OR = 0.960, P = 0.030), and endotracheal and tracheostomy tube cuff pressure (OR = 1.988, P < 0.001) were associated with tracheal stenosis. The time interval between intubation/tracheostomy ranged from approximately 28 to 938 days.

Given the impact of certain care practices during hospitalization on the occurrence of tracheal stenosis, such as the mean length of intubation, endotracheal and tracheostomy tube cuff pressure, and airway management, it is recommended that standardized training on these interventions be prioritized for staff in intensive care departments. Additionally, attention must be given to specific patient characteristics, such as age, COPD, and history of intubation.

 Tracheotomy is a common procedure, which can induce late and serious complications, such as tracheoarterial fistulae and tracheal stenosis. The tracheal narrowing may occur due to the wrong technique at the time of tracheotomy. In this case report, we aimed to present a rare post-tracheotomy tracheal narrowing during total laryngectomy.

 The patient was a 62-year-old man with a history of smoking and 6-month hoarseness. At the time of the first surgery, direct laryngoscopy had revealed a large exophytic ulcerative mass of epiglottis and pre-epiglottic space with an extra-laryngeal extension. During laryngectomy and after the removal of the larynx, an abnormal coronal thick membrane was found in the caudal part of the specimen with significant tracheal narrowing.

 There are different types of incisions that can be made for tracheotomy tube insertion, such as horizontal, vertical, T-shaped, and H-shaped incisions, as well as resection of a small section of the tracheal ring to create a window. Each type has its own advantages and disadvantages.

 Although it seems that the tracheal narrowing was due to the inverted portion of the tracheal flap during the previous tracheotomy, which was an accidental finding, however, it necessitates a proper evaluation of the tracheal incision types for tracheotomy.

The incidence of tracheal stenosis is progressively increasing. A risk factor for developing this clinical condition is a history of prolonged endotracheal intubation. A transnasal humidified rapid insufflation ventilatory exchange, known as THRIVE, has gained importance in tracheal resection surgeries.

Herein, we describe the anesthetic management of two obstetric patients, a 19-year-old and 29-year-old patients, with a history of prolonged endotracheal intubation and a diagnosis of tracheal stenosis. The patients required the resection of the tracheal segment and end-to-end anastomosis. The anesthetic management focused on THRIVE using a high-flow nasal cannula.

This system proved to be a safe anesthetic technique for pregnant women and the fetus. Furthermore, it allowed surgeons to better visualize the surgical field without the risk of accidental injury to the endotracheal tube.

Rigid bronchoscopy is often used to diagnose and treat the location of resection of the tracheal stenosis. It is a selective procedure for the dilatation of tracheal stenosis, especially when accompanied by respiratory distress.

We introduced patients who were diagnosed with tracheal stenosis and candidate for rigid bronchoscopy dilatation by the upper airway nerve blocks.

This prospective observational study was conducted on 17 patients who underwent dilatation with rigid bronchoscopy in tracheal stenosis at Hospitals affiliated with Babol University of Medical Sciences from 2002 to 2017. The patients were given three nerve blocks, 6 bilateral superior laryngeal nerve block, bilateral glossopharyngeal nerve block, and recurrent laryngeal nerve block (transtracheal) before awake rigid bronchoscopy using 2% lidocaine. We evaluated the demographic data, the cause of tracheal stenosis, the quality of the airway nerve block (Intubation score), patients’ satisfaction from bronchoscopy and thoracic surgeons’ satisfaction. Complications of nerve blocks were recorded.

From 2002 to 2017, 17 patients (14 were male and 3 were) female with tracheal stenosis who were candidates for dilatation with bronchoscopy and accepted the upper nerve block were included. The quality of the block was acceptable in 16 (94%) patients. 15 patients received fentanyl, and only two patients did not need to intravenous sedation. The mean age of patients was 29.59 ± 11.59. The average satisfaction of the surgeon was 8.82 ± 1.13 and the satisfaction of patients with anesthesia was 8.89 ± 1.16. There was one serious complication (laryngospasm) in one patient.

The upper airway nerve block method is a suitable anesthesia technique for patients with tracheal stenosis who are candidates for the tracheal dilatation with rigid bronoscopy, especially when the patient has respiratory distress and has not been evaluated before surgery.