Extubation and the Risks of Coughing and Laryngospasm in the Era of Coronavirus Disease-19 (COVID-19)

Laryngospasm following orthognathic surgery: an unusual case report

This study discusses laryngospasm following orthognathic surgery and requiring emergency intubation, followed by systemic complications due to a hypoxic event. A 34-year-old male patient underwent orthognathic surgery due to facial asymmetry. When emerging from general anesthesia, blood pressure elevated suddenly, and severe agitation occurred. After extubation, desaturation occurred immediately, resulting in cyanosis and loss of consciousness. An emergency cricothyroidotomy was performed, and oral intubation was required to maintain the airway. The patient was sent to the intensive care unit on a ventilator. On postoperative day 2, the red blood cell count and hemoglobin level decreased significantly. Electrocardiogram showed abnormalities, although vital signs were stable and no bleeding was observed. Laryngospasm often occurs under general anesthesia, resulting in sustained closure of the vocal cords and obstruction of the airway. This condition can be life-threatening, and awareness of the various precipitating factors is important. Orthognathic surgery is a risk factor for laryngospasm because its surgical site affects the airway, and it involves discharge of blood via intraoral wounds. It is important to understand systemic changes occurring after a hypoxic event, and consultation with specialists from various departments should be actively pursued.

A Complex Case of Laryngospasm Secondary to COVID-19 Infection in a 40-Year-Old Male

COVID-19 is a novel viral infection with a wide variety of clinical manifestations ranging from asymptomatic cases to severe respiratory illness. Laryngospasm is a spontaneous sustained closure of the laryngeal muscles leading to acute airway obstruction. We report a case of a 40-year-old male with a history of nephrolithiasis who underwent laparoscopic pyeloplasty and developed laryngospasm as a consequence of contracting COVID-19. The case was further complicated by the development of pneumothorax and pleural effusion during the postoperative period. The patient was managed with supplemental oxygen, antibiotics, antiviral therapy, and close monitoring. He recovered without any additional complications. This case highlights the potential initial clinical manifestation and the importance of early diagnosis and treatment of COVID-19 infection in surgical patients.

The management of patients with coronavirus disease 2019 in intensive care unit (ICU) in low income countries: A review article

BACKGROUND

The novel coronavirus, severe acute respiratory syndrome-CoV-2 (SARS-CoV2)- causing coronavirus disease 19 (COVID-19), outbreak as a world health problem and was declared as a pandemic disease by the world health organization (WHO) in March 2020. Many serious findings have been observed among victims with sever acute respiratory syndrome-CoV-2.

METHODS

This review was conducted according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) protocol. Search engines like PubMed and PMC through HINARI, Cochrane database, Google Scholar were used to get information about the current evidences on management of coronavirus disease 2019 (COVID-19) in intensive care unit (ICU).

DISCUSSION

Mortality with COVID 19 is associated with geriatric population, the presence comorbidities like hypertension, diabetes mellitus, cardiovascular disease, chronic lung disease, and cancer, acute respiratory failure, higher d-dimer and C-reactive protein concentrations, lower lymphocyte counts, and secondary infections.

CONCLUSION

The international recommendations on nutrition in the ICU should be followed. Some specific issues about the nutrition of the COVID-19 patients in the ICU should be emphasized. Universal infection prevention precautions (hand hygiene and use of personal protection equipment (PPE)) are invaluable during nursing of COVID 19 patients at ICU.

Smooth Extubation and Smooth Emergence Techniques: A Narrative Review

There is a paucity of literature on extubation technique and a lack of consensus regarding the definition of smooth extubation. This narrative review paper defines an ideal extubation, otherwise known as a “smooth extubation,” reviews perioperative criteria for extubation and risks and adverse events related to extubation, and explores various perioperative techniques that can be used to achieve a smooth extubation while caring for an uncomplicated patient without significant risk factors for extubation failure. In light of the evolving practice during the SARS CoV2 (COVID-19) pandemic to minimize aerosol generation and infection transmission, smooth extubation is particularly important.