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King JP, Natarajan NK. Right place, no trace: A case report of postintubation bronchospasm. J Perioper Pract 2024; 34:164-167. [PMID: 37615417 DOI: 10.1177/17504589231180735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
Evidence suggests obesity correlates with airway hyperreactivity, which can result in severe bronchospasm. This report presents a 31-year-old female with a high body mass index who presented for a laparoscopic hysterectomy and bilateral salpingo-oophorectomy. She had no past medical or atopic history. After induction of anaesthesia and intubation, O2 saturation fell with no CO2 trace, breathing sounds or chest rise. Despite confirming endotracheal tube position by video laryngoscopy, the CO2 trace remained flat and mechanical ventilation was difficult with high airway pressures. Blood pressure was stable with no mucocutaneous signs of anaphylaxis. Administration of 100% O2, bronchodilators and steroids improved ventilation and oxygenation with a return of a CO2 trace. The operation was postponed. Prior to her subsequent surgery, the patient was premedicated with inhaled steroids and long-acting beta agonist with an uneventful induction and intubation. Giving a rising obese population, this case report aims to educate anaesthetists and anaesthetic practitioners as to the presentation, risk factors, mechanisms and management of uncommon, life-threatening postintubation bronchospasm.
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Affiliation(s)
- James P King
- Queen Elizabeth the Queen Mother Hospital, Margate, UK
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2
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Kaushik A, Singh DP, Sahu M, Kumar A, Pratibha, Pandey P, Patel MK, Chanda D, Sundaresan V, Mani DN, Shukla AK. Protective effect of Achyranthes aspera against compound 48/80, histamine and ovalbumin-induced allergic disorders in murine model. Mol Biol Rep 2024; 51:202. [PMID: 38270668 DOI: 10.1007/s11033-023-09137-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 12/08/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND Achyranthes aspera L. (family Amaranthaceae) is a plant species valued in Ayurveda for the treatment of respiratory ailments. Scientific validation of its antiallergic potential was aimed. METHODS AND RESULTS Three extracts of A. aspera [aqueous (AaAq), hydroalcoholic (AaHA), ethanolic (AaEt)] were evaluated for their potency against C48/80-induced anaphylaxis in mice at 200 mg/kg BW oral dose. The effective dose of the most potent extract was determined through its effect on C48/80-induced anaphylaxis, and was further analyzed through its effect on mast cell degranulation, histamine-induced bronchospasm and ovalbumin (OVA)-induced asthma in a murine model. Among the three extracts, AaAq was found to be most potent at 200 mg/kg BW. AaAq 400 (400 mg/kg BW) was found to be the most effective dose in terms of inhibition of mortality and histamine level. AaAq 400 prevented the peritoneal and mesenteric mast cells from undergoing morphological changes due to degranulation induced by C48/80. Further, AaAq 400 delayed pre-convulsive time in histamine-induced bronchospasm. In the OVA-induced asthma model, AaAq 400 inhibited the level of inflammatory cell count in blood, bronchoalveolar lavage fluid and peritoneal fluid of mice. The Th2 cytokines (IL-4, IL-5, IL-13), TGF-β and OVA-specific IgE were also reduced as evaluated by ELISA. Also, significant reduction in IL-5 (an eosinophilia indicator) transcript abundance and lung inflammatory score was observed. AaAq was safe up to 4000 mg/kg BW. CONCLUSIONS Thus AaAq 400 possesses significant antiallergic potential and acts via attenuation of C48/80-induced anaphylaxis and inhibition of mast cell degranulation. It reduces pre-convulsive dyspnea in histamine-induced bronchospasm and Th2 cytokines in asthmatic mice.
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Affiliation(s)
- Amit Kaushik
- CSIR-Central Institute of Medicinal and Aromatic Plants, P.O. CIMAP, Lucknow, 226015, Uttar Pradesh, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002, Uttar Pradesh, India
| | - Dewasya P Singh
- CSIR-Central Institute of Medicinal and Aromatic Plants, P.O. CIMAP, Lucknow, 226015, Uttar Pradesh, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002, Uttar Pradesh, India
| | - Mridula Sahu
- CSIR-Central Institute of Medicinal and Aromatic Plants, P.O. CIMAP, Lucknow, 226015, Uttar Pradesh, India
| | - Ashish Kumar
- CSIR-Central Institute of Medicinal and Aromatic Plants, P.O. CIMAP, Lucknow, 226015, Uttar Pradesh, India
| | - Pratibha
- CSIR-Central Institute of Medicinal and Aromatic Plants, P.O. CIMAP, Lucknow, 226015, Uttar Pradesh, India
| | - Pallavi Pandey
- CSIR-Central Institute of Medicinal and Aromatic Plants, P.O. CIMAP, Lucknow, 226015, Uttar Pradesh, India
| | - Manish K Patel
- CSIR-Central Institute of Medicinal and Aromatic Plants, P.O. CIMAP, Lucknow, 226015, Uttar Pradesh, India
| | - Debabrata Chanda
- CSIR-Central Institute of Medicinal and Aromatic Plants, P.O. CIMAP, Lucknow, 226015, Uttar Pradesh, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002, Uttar Pradesh, India
| | - Velusamy Sundaresan
- CSIR-Central Institute of Medicinal and Aromatic Plants, Research Centre, Allalasandra, GKVK Post, Bengaluru, 560065, Karnataka, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002, Uttar Pradesh, India
| | - Daya N Mani
- CSIR-Central Institute of Medicinal and Aromatic Plants, P.O. CIMAP, Lucknow, 226015, Uttar Pradesh, India.
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002, Uttar Pradesh, India.
| | - Ashutosh K Shukla
- CSIR-Central Institute of Medicinal and Aromatic Plants, P.O. CIMAP, Lucknow, 226015, Uttar Pradesh, India.
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002, Uttar Pradesh, India.
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Marques-Mejias MA, Tomás-Pérez M, Hernández-Martin I, Loli-Ausejo D, Quirce S. Recurrent Bronchospasm in Children Treated in the Emergency Department. J Investig Allergol Clin Immunol 2023; 33:49-51. [PMID: 35361571 DOI: 10.18176/jiaci.0810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Affiliation(s)
- M A Marques-Mejias
- Pediatric Allergy Group, Department of Women and Children´s Health, School of Life Course Sciences, King´s College London, London, UK.,Children´s Allergy Service, Evelina London Children´s Hospital, Guy´s and St Thomas´ NHS Foundation Trust, London, UK
| | - M Tomás-Pérez
- Department of Allergy, La Paz University Hospital, Madrid, Spain.,Hospital La Paz Institute for Health Research (IDIPAZ), Madrid, Spain
| | | | - D Loli-Ausejo
- Department of Allergy, La Paz University Hospital, Madrid, Spain
| | - S Quirce
- Department of Allergy, La Paz University Hospital, Madrid, Spain.,Hospital La Paz Institute for Health Research (IDIPAZ), Madrid, Spain.,CIBER de Enfermedades Respiratorias CIBERES, Madrid, Spain
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Goyal VD, Pahare A, Misra G. Allergic bronchopulmonary aspergillosis in association with rheumatic heart disease: report of three cases. Indian J Thorac Cardiovasc Surg 2022; 38:663-665. [PMID: 36258820 PMCID: PMC9569282 DOI: 10.1007/s12055-022-01392-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 06/09/2022] [Accepted: 06/27/2022] [Indexed: 10/16/2022] Open
Abstract
Allergic bronchopulmonary aspergillosis is usually seen in patients with asthma or cystic fibrosis. Its association with rheumatic heart disease has not been adequately reported in literature. We report our experience of three cases who were diagnosed cases of rheumatic heart disease. Their symptomatology and clinical findings required further evaluation and investigations, which were suggestive of allergic bronchopulmonary aspergillosis. The patients were treated with steroids and/or antifungals before proceeding with the valve replacement.
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Affiliation(s)
- Vikas Deep Goyal
- Department of Surgery, Shri Ram Murti Samarak Institute of Medical Sciences, Bareilly, U.P 243202 India
| | - Akhilesh Pahare
- Department of Anesthesia, Shri Ram Murti Samarak Institute of Medical Sciences, Bareilly, U.P 243202 India
| | - Gaurav Misra
- Department of Anesthesia, Shri Ram Murti Samarak Institute of Medical Sciences, Bareilly, U.P 243202 India
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Wang K, Gartman CH, Zhou EY, Horak J, Augoustides JG, Gebhardt BR, Jain A, Coleman SR, Fernando RJ. Severe Bronchospasm During Separation from Cardiopulmonary Bypass: Diagnosis, Etiology, and Treatment. J Cardiothorac Vasc Anesth 2022; 36:3964-3972. [PMID: 35909041 DOI: 10.1053/j.jvca.2022.06.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 06/20/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Kelvin Wang
- Cardiovascular and Thoracic Division, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Charles H Gartman
- Cardiovascular and Thoracic Division, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Elizabeth Yaxi Zhou
- Cardiovascular and Thoracic Division, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jiri Horak
- Cardiovascular and Thoracic Division, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - John G Augoustides
- Cardiovascular and Thoracic Division, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Brian R Gebhardt
- Department of Anesthesiology and Perioperative Medicine, University of Massachusetts Medical Center, Worcester, MA, USA
| | - Ankit Jain
- Department of Anesthesiology and Perioperative Medicine, Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Scott R Coleman
- Department of Anesthesiology, Cardiothoracic Section, Medical Center Boulevard, Wake Forest School of Medicine, Winston Salem, NC 27157-1009, USA
| | - Rohesh J Fernando
- Department of Anesthesiology, Cardiothoracic Section, Medical Center Boulevard, Wake Forest School of Medicine, Winston Salem, NC 27157-1009, USA.
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La Via L, Sanfilippo F, Cuttone G, Dezio V, Falcone M, Brancati S, Crimi C, Astuto M. Use of ketamine in patients with refractory severe asthma exacerbations: systematic review of prospective studies. Eur J Clin Pharmacol 2022; 78:1613-1622. [PMID: 36008492 PMCID: PMC9482594 DOI: 10.1007/s00228-022-03374-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 08/17/2022] [Indexed: 12/16/2022]
Abstract
PURPOSE Asthma is a heterogeneous disease with a wide range of symptoms. Severe asthma exacerbations (SAEs) are characterized by worsening symptoms and bronchospasm requiring emergency department visits. In addition to conventional strategies for SAEs (inhaled β-agonists, anticholinergics, and systemic corticosteroids), another pharmacological option is represented by ketamine. We performed a systematic review to explore the role of ketamine in refractory SAEs. METHODS We performed a systematic search on PubMed and EMBASE up to August 12th, 2021. We selected prospective studies only, and outcomes of interest were oxygenation/respiratory parameters, clinical status, need for invasive ventilation and effects on weaning. RESULTS We included a total of seven studies, five being randomized controlled trials (RCTs, population range 44-92 patients). The two small prospective studies (n = 10 and n = 11) did not have a control group. Four studies focused on adults, and three enrolled a pediatric population. We found a large heterogeneity regarding sample size, age and gender distribution, inclusion criteria (different severity scores, if any) and ketamine dosing (bolus and/or continuous infusion). Of the five RCTs, three compared ketamine to placebo, while one used fentanyl and the other aminophylline. The outcomes evaluated by the included studies were highly variable. Despite paucity of data and large heterogeneity, an overview of the included studies suggests absence of clear benefit produced by ketamine in patients with refractory SAE, and some signals towards side effects. CONCLUSION Our systematic review does not support the use of ketamine in refractory SAE. A limited number of prospective studies with large heterogeneity was found. Well-designed multicenter RCTs are desirable.
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Affiliation(s)
- Luigi La Via
- Department of Anesthesiology and Intensive Care, AOU "Policlinico - San Marco", 95123, Catania, Italy. .,School of Specialization in Anesthesia and Intensive Care, University of Catania, Catania, Italy.
| | - Filippo Sanfilippo
- Department of Anesthesiology and Intensive Care, AOU "Policlinico - San Marco", 95123, Catania, Italy
| | - Giuseppe Cuttone
- School of Specialization in Anesthesia and Intensive Care, University of Catania, Catania, Italy
| | - Veronica Dezio
- Department of Anesthesiology and Intensive Care, AOU "Policlinico - San Marco", 95123, Catania, Italy.,School of Specialization in Anesthesia and Intensive Care, University of Catania, Catania, Italy
| | - Monica Falcone
- School of Specialization in Anesthesia and Intensive Care, University "Magna Graecia", Catanzaro, Italy
| | - Serena Brancati
- Clinical Pharmacology Unit/Regional Pharmacovigilance Centre, University Hospital of Catania, Catania, Italy
| | - Claudia Crimi
- Department of Pneumology, AOU "Policlinico - San Marco", Catania, Italy
| | - Marinella Astuto
- Department of Anesthesiology and Intensive Care, AOU "Policlinico - San Marco", 95123, Catania, Italy
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Bayable SD, Melesse DY, Lema GF, Ahmed SA. Perioperative management of patients with asthma during elective surgery: A systematic review. Ann Med Surg (Lond) 2021; 70:102874. [PMID: 34603720 PMCID: PMC8473668 DOI: 10.1016/j.amsu.2021.102874] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/16/2021] [Accepted: 09/17/2021] [Indexed: 01/22/2023] Open
Abstract
Asthma is one of the commonest respiratory illnesses among elderly patients undergoing surgery. Detailed preoperative assessment, pharmacotherapy and safe anaesthetic measures throughout perioperative period are the keys to decrease complications. Resistance to expiratory airflow results in positive alveolar pressures at the end of expiration, which causes air-trapping and hyperinflation of the lungs and thorax, increased work of breathing, and alteration of respiratory muscle function. This systematic review was conducted according to the Preferred Reporting Items for systematic review and metanalysis (PRISMA) statement. Search engines like PubMed through HINARI, Cochrane database and Google Scholars were used to find evidences. Low-dose IV ketamine, midazolam, IV lidocaine or combined with salbutamol are recommended to be used as premedication before induction. Propofol, ketamine, halothane, isoflurane and sevoflurane are best induction agents and maintenance for asthmatic surgical patients respectively. Among the muscle relaxants, vecuronium is safe for use in asthmatics. In addition, Succinylcholine and pancronium which releases low levels of histamine has been used safely in asthmatics with little morbidity. Asthma is one of the commonest respiratory illnesses among patients undergoing surgery. This systematic review was conducted according to PRISMA protocol. Propofol, ketamine, halothane, isoflurane and sevoflurane are best pharmacologic agents for asthmatic surgical patients. Vecuronium is safe for use in asthmatic surgical patients.
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Affiliation(s)
- Samuel Debas Bayable
- Department of Anesthesia, College of Medicine and Health Sciences, Debre Berhan University, Debre Berhan, Ethiopia
| | - Debas Yaregal Melesse
- Department of Anesthesia, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Girmay Fitiwi Lema
- Department of Anesthesia, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Seid Adem Ahmed
- Department of Anesthesia, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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8
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Tejada S, Campogiani L, Solé-Lleonart C, Gómez A, Gallego M, Vendrell M, Soriano JB, Rello J. Inhaled antibiotics for treatment of adults with non-cystic fibrosis bronchiectasis: A systematic review and meta-analysis. Eur J Intern Med 2021; 90:77-88. [PMID: 33947626 DOI: 10.1016/j.ejim.2021.04.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 02/26/2021] [Accepted: 04/12/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Inhaled antibiotics (IA) in non-cystic fibrosis bronchiectasis (NCFB) are recommended by some clinical practice guidelines for prevention or treatment of NCFB exacerbations. METHODS We performed a systematic review and meta-analysis to evaluate the efficacy and safety of IA use for treatment of adults with NCFB and Pseudomonas aeruginosa chronic bronchial infection. The search was performed in the Cochrane Library, PubMed, and Web of Science databases from 2000 to 2019. Studies of IA for treatment of stable or exacerbated NCFB adults (≥18 years) with P. aeruginosa infection were considered eligible. PROSPERO Registration number: CRD42019136154. RESULTS Twelve trials (2476 participants) were included. IA therapy increased P. aeruginosa eradication from sputum in patients with exacerbations (OR: 3.19, 95%CI: 1.70-5.99) with similar effects on stable patients (OR: 7.22, 95%CI: 2.81-18.59), and a trend to reduced emergence of new respiratory pathogens (OR: 0.58, 95%CI: 0.28-1.18). IA achieved significant reduced exacerbation rates (RR: 0.90; 95%CI: 0.82-0.98) in stable patients, with a number needed to treat (NNT) of 59, but no significant changes in FEV1, mortality, hospitalizations or quality of life were identified. In stable patients, IA use increased antimicrobial resistance (RR: 2.10, 95%CI: 1.35-3.27) at the end of therapy, with a number needed to treat of 6. CONCLUSIONS IA therapy achieved a statistically significant eradication of P. aeruginosa from sputum, with a 10% reduction of exacerbations in stable patients. This effect has to be balanced with significant increases in antimicrobial resistance. Our meta-analysis failed to show a significant benefit in terms of patient-centered outcomes.
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Affiliation(s)
- Sofia Tejada
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Clinical Research/Epidemiology in Pneumonia & Sepsis (CRIPS), Vall d'Hebron Institute of Research (VHIR), Barcelona, Spain.
| | - Laura Campogiani
- Clinical Infectious Diseases, Department of System Medicine, Tor Vergata University, Rome, Italy
| | | | - Aroa Gómez
- Department of Donor & Transplant Coordination, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Miguel Gallego
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Respiratory Department, Parc Taulí University Hospital, Barcelona, Spain
| | - Monserrat Vendrell
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Clinical Research/Epidemiology in Pneumonia & Sepsis (CRIPS), Vall d'Hebron Institute of Research (VHIR), Barcelona, Spain; Respiratory Department, Dr. Josep Trueta University Hospital, Girona, Spain; Insitut d'Investigació Biomèdica de Girona (IDIBGI), Universitat de Girona, Girona, Spain
| | - Joan B Soriano
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Hospital Universitario La Princesa, Universidad Autónoma de Madrid, Madrid, Spain
| | - Jordi Rello
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Clinical Research/Epidemiology in Pneumonia & Sepsis (CRIPS), Vall d'Hebron Institute of Research (VHIR), Barcelona, Spain; Clinical Research in the ICU, Anesthesia Department, CHU Nimes, Universite de Nimes-Montpellier, France
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Ts M, Belitova M, Popov TM. Higher doses of fentanyl during bronchoscopy in infants significantly reduces perioperative complication rates. Int J Pediatr Otorhinolaryngol 2020; 138:110374. [PMID: 33152965 DOI: 10.1016/j.ijporl.2020.110374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 09/04/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The specific aim of this study was to assess the effect of higher fentanyl doses on reducing perioperative complication rates among infants undergoing rigid bronchoscopy. METHODS Sixty children who underwent rigid bronchoscopy for foreign body removal were enlisted in our 2-year prospective cohort study at the Department of ENT and Head & Neck Surgery, Medical University - Sofia. Infants were randomly distributed into two groups according to fentanyl dose (group 1 - 1-2 μg/kg vs group 2 - 6-7 μg/kg). Hemodynamic parameters and perioperative complications were recorded. RESULTS The mean age of the whole study group was 1.94 years. Five minutes prior to anesthesia both groups presented with similar parameter levels and no statistically significant difference was found. In contrast, at 5th and 10th minutes after intubation the heart rate, systolic and diastolic blood pressure levels were recorded at significantly higher levels in group 1 compared to group 2 (p = .000). Same results were obtained five minutes after extubation. Additionally, after performing the Pearson chi-Square test we found that bronchospasm and laryngospasm were significantly more frequent among patients from group 1 infused with lower dosage of fentanyl in comparison to the infants that were administered with a higher dose of this medication (p = .020). Phi and Cramer's V tests both display moderate strength of this association (V = 0.302). CONCLUSION In the current study we propose refinement of current anesthetic protocols by using higher doses of fentanyl during rigid bronchoscopy in infants. This significantly reduces perioperative complication rates and improves intraoperative hemodynamics without presenting any newly formed risks.
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Affiliation(s)
- Marinov Ts
- Department of Anesthesiology and Intensive Care, Medical University-Sofia, Sofia, Bulgaria
| | - M Belitova
- Department of Anesthesiology and Intensive Care, Medical University-Sofia, Sofia, Bulgaria
| | - T M Popov
- Department of ENT and Head and Neck Surgery, Medical University-Sofia, Sofia, Bulgaria.
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Abstract
INTRODUCTION The use of cannabis, cocaine or heroin can be responsible for many respiratory complications including asthma. OBJECTIVES The aim of this systematic literature review of data was to expose the relations between cannabis, cocaine or heroin use and asthma. RESULTS Cannabis, cocaine or heroin use by inhalation may be responsible for respiratory symptoms (cough, wheezing), asthma onset, acute asthma exacerbations (which may require intubation and invasive ventilation) or deaths related to asthma. Lower adherence to asthma treatment is also observed. Cannabis induces a rapid bronchodilator effect. In contrast, its chronic use may induce a decrease in specific airway conductance. Studies on forced expiratory volume in one second (FEV1) reduction or decline are discordant. CONCLUSION Cannabis, cocaine or heroin use must be considered in cases of acute respiratory symptoms or asthma exacerbation in young persons and practitioners must help illicit substance users to stop their consumption.
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Affiliation(s)
- M Underner
- Consultation de tabacologie, unité de recherche clinique, centre hospitalier Henri-Laborit, université de Poitiers, 370, avenue Jacques-Cœur, CS 10587, 86021 Poitiers cedex, France.
| | - G Peiffer
- Service de pneumologie, CHR Metz-Thionville, 57038 Metz, France
| | - J Perriot
- Dispensaire Émile-Roux, CLAT 63, centre de tabacologie, 63100 Clermont-Ferrand, France
| | - N Jaafari
- Consultation de tabacologie, unité de recherche clinique, centre hospitalier Henri-Laborit, université de Poitiers, 370, avenue Jacques-Cœur, CS 10587, 86021 Poitiers cedex, France
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11
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Abstract
Background Lung ultrasonography has been increasingly recognized has a valuable diagnostic tool. In adult patients with asthma/chronic obstructive pulmonary disease and wheezing, LUS usually presents as an A/nude profile (normal profile, with sliding and A-lines, and without any abnormal findings) or at most reveals a decrease/absence of lung sliding. Therefore, until now simple point-of-care ultrasonography appeared to be unable to assess the severity of airflow limitation. Case presentation We report the case of a woman presenting to the emergency department with an asthma exacerbation. Bedside ultrasound showed the usual A/normal profile, but also an associated vertical pleural displacement, probably secondary to hyperinflation and accessory muscle recruitment. We evaluated the described movement with M-mode and established a comparison index between end-inspiration and end-expiration, using the skin as reference. This index showed improvement and complete normalization during treatment. Conclusions Pleural vertical displacement appears to be a sonographic alteration associated to bronchospasm and accessory muscle recruitment. It is easily identifiable and measurable on LUS, thus possibly representing a new method to evaluate bronchospasm and monitoring treatment response. Further research is needed to confirm or refute this finding.
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12
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Roy S, Meena M, Dhoot NB, Kant R. Hypomagnesaemia induced hypocalcemia mimicking as acute exacerbation of COPD-Rare cause of a common presentation: A case report. J Family Med Prim Care 2020; 9:2541-2543. [PMID: 32754541 PMCID: PMC7380821 DOI: 10.4103/jfmpc.jfmpc_314_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 03/19/2020] [Accepted: 03/30/2020] [Indexed: 11/25/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a common respiratory condition characterized by limitation in airflow. Most of the exacerbations are due to respiratory infections, some are due to environmental pollution. Hypocalcaemia( of any etiology ) is one of the rare causes of acute exacerbation. Here we are reporting a case of severe hypocalcaemia induced bronchospasm, presenting as acute exacerbation in a diagnosed case of COPD. 61 years old female patient, home maker by occupation and from a rural background and low socio-economic status with past history of chronic exposure to household wood smoke has presented to us with acute exacerbation of COPD. Her reports showed significant hypocalcaemia, hypomagnesaemia and low parathyroid hormone Her symptoms were controlled adequately only after correcting the hypocalcemia in addition to the standard COPD management.
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Affiliation(s)
- Shankar Roy
- Junior Resident, Department of General Medicine, AIIMS, Rishikesh, Uttarakhand, India
| | - Mahendra Meena
- Junior Resident, Department of General Medicine, AIIMS, Rishikesh, Uttarakhand, India
| | - Nisha B Dhoot
- Senior Resident, Department of General Medicine, AIIMS, Rishikesh, Uttarakhand, India
| | - Ravi Kant
- Additional Professor, Department of General Medicine, AIIMS, Rishikesh, Uttarakhand, India
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Underner M, Perriot J, Peiffer G, Jaafari N. [Electronic cigarette use and asthma in adolescents]. Rev Mal Respir 2019; 37:91-92. [PMID: 31864880 DOI: 10.1016/j.rmr.2019.11.644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 11/07/2019] [Indexed: 02/05/2023]
Affiliation(s)
- M Underner
- Unité de recherche clinique, centre hospitalier Henri-Laborit, université de Poitiers, 370, avenue Jacques-Cœur, CS 10587, 86021 Poitiers, France.
| | - J Perriot
- Centre de tabacologie, Dispensaire Émile-Roux, 63100 Clermont-Ferrand, France
| | - G Peiffer
- Service de pneumologie, CHR de Metz-Thionville, 57038 Metz, France
| | - N Jaafari
- Unité de recherche clinique, centre hospitalier Henri-Laborit, université de Poitiers, 370, avenue Jacques-Cœur, CS 10587, 86021 Poitiers, France
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Aggarwal P. Risk of bronchospasm and coronary arteriospasm with sugammadex use: a post marketing analysis. Ther Adv Drug Saf 2019; 10:2042098619869077. [PMID: 31452867 PMCID: PMC6700844 DOI: 10.1177/2042098619869077] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 07/20/2019] [Indexed: 12/15/2022] Open
Abstract
Introduction: Sugammadex is used for the reversal of neuromuscular blockade caused by rocuronium bromide and vecuronium bromide. As part of the post licensing phase of drug development, adverse events related to the use of sugammadex are still being uncovered and being reported. The potential association between sugammadex and adverse events bronchospasm and coronary arteriospasm using a retrospective pharmacovigilance signal analysis was carried out. Methods: Food and Drug Administration’s Adverse Event Reporting System database was used to run disproportionality analyses to investigate the potential association of sugammadex with bronchospasm or coronary arteriospasm. In this analysis we report the adverse event signal using frequentist methods of Relative reporting ratio (RRR), proportional reporting ratio (PRR), reporting odds ratio (ROR) and the Bayesian based Information Component metric. Results: A statistically significant disproportionality signal is found between sugammadex and bronchospasm (n = 44; chi-squared = 2993.87; PRR = 71.95 [95% CI: 54.00–95.85]) and sugammadex and coronary arteriospasm (n = 6; chi-squared = 209.39; PRR = 43.82 [95% CI: 19.73–97.33]) as per Evans criteria. Both statistically significant disproportionality signals persisted when stratified by gender. Based upon dynamic cumulative PRR graph, the PRR value has steadily increased and the 95% CI narrowed since December 2012. Conclusion: The results of the pharmacovigilance analysis highlight a statistically significant disproportionality signal between sugammadex usage and bronchospasm and coronary arteriospasm adverse events. Physicians need to be aware of these adverse events when using sugammadex. The results of the pharmacovigilance signal analysis highlight a statistically significant disproportionality signal between sugammadex usage and bronchospasm and coronary arteriospasm adverse events. Physicians need to be aware of these adverse events when using sugammadex.
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Affiliation(s)
- Pushkar Aggarwal
- University of Cincinnati College of Medicine, 2545 Dennis Street Apt 7105, Cincinnati, Ohio, USA
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Abstract
Patients with respiratory failure due to obstructive lung disease present a challenge to the emergency physician. These patients have physiologic abnormalities that prevent adequate gas exchange and lung mechanics which render them at increased risk of cardiopulmonary decompensation when managed with invasive mechanical ventilation. This article addresses key principles when managing these challenging patients: patient-ventilator synchrony, air trapping and auto-positive end-expiratory pressure, and airway pressures. This article provides a practical workflow for the emergency physician responsible for managing these patients.
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Abstract
INTRODUCTION Cocaine use can be responsible for many respiratory complications including asthma. OBJECTIVES Systematic literature review of data on asthma in cocaine users. DOCUMENTARY SOURCES PubMed/Medline search, on the period 1980-2017 with the following keywords: "asthma*" or "bronchospasm" and "cocaine" or "freebase*" or "crack", limits "title/abstract"; the selected languages were English or French. Among 108 articles, 43 abstracts underwent dual reading to select 22 studies. RESULTS In four case reports of asthma associated with cocaine use including 11 patients (mean age: 28.3 years [22-33 years]; sex-ratio: 2.5 [males: 71.5%]), cocaine was sniffed [snorted] (9%), smoked (36.5%) or both sniffed and smoked (54.5%). A medical history of childhood asthma was observed in 45.4% of the cases. Acute respiratory failure, requiring intubation and mechanical ventilation, was observed in 45.4% of the cases. Outcome was rapidly favorable in 82%; 9/11, progressively favorable in one patient, and fatal in another patient. Other studies included 6 cross-sectional studies, 4 case-control studies and 8 longitudinal studies (7 retrospective studies and one prospective study). The mean age was 36.6 years (women: 44.7%). Twenty percent of the subjects used cocaine exclusively, and 80% used cocaine combined with other addictive drugs (cocaine and heroin: 62%). The prevalence of cocaine users was higher in asthmatic subjects and the prevalence of asthma was higher in cocaine users. Cocaine use can be responsible for asthma onset and acute asthma exacerbation. In the case of asthma exacerbation, cocaine users were more likely to be admitted in intensive care units and to require intubation and invasive ventilation. Asthma exacerbations may be fatal in spite of resuscitation measures. Asthma treatment observance was lower in cocaine users. CONCLUSION Cocaine use may be responsible for asthma onset, acute asthma exacerbations (which may require intubation and invasive ventilation) or death related to asthma. Cocaine use must be systematically considered in the case of asthma exacerbation and practitioners must help cocaine users to stop their consumption.
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Affiliation(s)
- M Underner
- Service de pneumologie, unité de tabacologie, centre hospitalier Henri Laborit, CHU La Milétrie, rue de la Milétrie, Pavillon René Beauchant, BP 577, avenue Jacques Cœur, 86021 Poitiers, France; Addictologie, dispensaire Emile Roux, 63100 Clermont-Ferrand, France; Pneumologie, centre hospitalier de Metz, Metz, France; Unité de recherche clinique, centre hospitalier Henri Laborit, 86021 Poitiers, France.
| | - J Perriot
- Service de pneumologie, unité de tabacologie, centre hospitalier Henri Laborit, CHU La Milétrie, rue de la Milétrie, Pavillon René Beauchant, BP 577, avenue Jacques Cœur, 86021 Poitiers, France; Addictologie, dispensaire Emile Roux, 63100 Clermont-Ferrand, France; Pneumologie, centre hospitalier de Metz, Metz, France; Unité de recherche clinique, centre hospitalier Henri Laborit, 86021 Poitiers, France
| | - G Peiffer
- Service de pneumologie, unité de tabacologie, centre hospitalier Henri Laborit, CHU La Milétrie, rue de la Milétrie, Pavillon René Beauchant, BP 577, avenue Jacques Cœur, 86021 Poitiers, France; Addictologie, dispensaire Emile Roux, 63100 Clermont-Ferrand, France; Pneumologie, centre hospitalier de Metz, Metz, France; Unité de recherche clinique, centre hospitalier Henri Laborit, 86021 Poitiers, France
| | - N Jaafari
- Service de pneumologie, unité de tabacologie, centre hospitalier Henri Laborit, CHU La Milétrie, rue de la Milétrie, Pavillon René Beauchant, BP 577, avenue Jacques Cœur, 86021 Poitiers, France; Addictologie, dispensaire Emile Roux, 63100 Clermont-Ferrand, France; Pneumologie, centre hospitalier de Metz, Metz, France; Unité de recherche clinique, centre hospitalier Henri Laborit, 86021 Poitiers, France
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Nafiu OO, Owusu-Bediako K, Chimbira WT. Unequal Rates of Serious Perioperative Respiratory Adverse Events Between Black and White Children. J Natl Med Assoc 2019; 111:481-489. [PMID: 31003832 DOI: 10.1016/j.jnma.2019.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Revised: 09/22/2018] [Accepted: 03/26/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Recent data among pediatric otolaryngology patients showed unexplained higher rates of serious perioperative respiratory adverse events (PRAE) in black children compared to their white peers. We evaluated whether preoperative respiratory comorbidity (PRC) burden contributes to racial disparity in serious PRAE in children undergoing non-otolaryngologic procedures. METHODS Rates of serious PRAE (laryngospasm and/or bronchospasm) were compared across racial groups in a retrospective cohort of black and white children (N = 18538; black 10%) who underwent various elective, non-otolaryngologic procedures between 2007 and 2014 at a US tertiary Children's hospital. Self-reported race was the primary exposure while age, gender, recent upper respiratory tract infection, use of endotracheal intubation, PRC burden and an interaction term between PRC and race were covariates. RESULTS Serious PRAE occurred in 9.6% of black children and 6.6% of white children. Although there was no significant difference in age between the groups, being black (odds ratio (OR) 1.70; 95% confidence interval (CI) 1.11-2.62) was independently associated with serious PRAE. Similarly, baseline PRC was independently linked (p < 0.001) with serious PRAE. Notably, there was no significant (p = 0.454) interactions between race and PRC and serious PRAE in our subjects. CONCLUSION Race and PRC are important considerations in the risk of serious PRAE and black children are especially at risk compared to their white peers. Children, with PRC (particularly those with SDB and asthma) are also at risk suggesting that due consideration should be given to these factors in the perioperative care of children undergoing elective surgical procedures. Mechanisms underlying these associations deserve further evaluation.
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Affiliation(s)
- Olubukola O Nafiu
- Department of Anesthesiology, Section of Pediatric Anesthesiology, University of Michigan, Ann Arbor, MI, USA.
| | - Kwaku Owusu-Bediako
- Department of Anesthesiology, Section of Pediatric Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Wilson T Chimbira
- Department of Anesthesiology, Section of Pediatric Anesthesiology, University of Michigan, Ann Arbor, MI, USA
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Nghe MC, Godier A, Shaffii A, Leblanc I, Picard H, Blanc R, Lumbroso-Le Rouic L, Devys JM. Prospective analysis of serious cardiorespiratory events in children during ophthalmic artery chemotherapy for retinoblastoma under a deep standardized anesthesia. Paediatr Anaesth 2018; 28:120-126. [PMID: 29205669 DOI: 10.1111/pan.13294] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/31/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVE Serious adverse cardiorespiratory events complicate super selective ophthalmic artery chemotherapy for retinoblastoma in anesthetized children. Their mechanism remains unclear but may be attributed to an autonomic nervous reflex induced by the catheter close to the ophthalmic artery. Inadequate depth of anesthesia during catheter stimulation might be an aggravating factor. Thus, we tested whether deep general anesthesia reduced the incidence of serious cardiorespiratory events. METHODS Children were prospectively included in this observational study. Standardized deep general anesthesia with sevoflurane, rocuronium, and sufentanil was administered. Sevoflurane MAC was kept between 1.5 and 1.7 and additional sufentanil administered. Serious cardiorespiratory event criteria were predefined and included arterial hypotension, bradycardia, and severe decrease in lung compliance. They were recorded and the factors influencing their occurrence were investigated. RESULTS One hundred fifteen procedures were performed on 32 children. The median MAC of sevoflurane was 1.5 and median BIS value was 44. Serious cardiorespiratory events occurred in 20% of procedures and were mainly severe decrease in lung compliance (83% of events). All of them required active treatment. One procedure was aborted due to cardiorespiratory compromise and required an epinephrine infusion. All severe decreases in lung compliance occurred within 2 minutes after catheter insertion in the ophthalmic artery. No recorded demographic and endovascular characteristics were associated with serious cardiorespiratory events. CONCLUSION Serious cardiorespiratory events occur commonly during super selective ophthalmic artery chemotherapy. Standardized deep anesthesia with analgesia did not appear to be protective. No predictive factors were identified, but these events systematically arose within 2 minutes after ophthalmic artery catheter insertion. Anesthetists and neuroradiologists should be prepared to manage these serious complications and parents should be informed of the risks.
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Affiliation(s)
- Marie-Claire Nghe
- Department of Anesthesiology and Intensive Care, Foundation Adolphe de Rothschild, Paris, France
| | - Anne Godier
- Department of Anesthesiology and Intensive Care, Foundation Adolphe de Rothschild, Paris, France.,INSERM UMR-S1140, Paris Descartes University, Paris, France
| | - Anoushée Shaffii
- Department of Anesthesiology and Intensive Care, Foundation Adolphe de Rothschild, Paris, France
| | - Isabelle Leblanc
- Department of Anesthesiology and Intensive Care, Foundation Adolphe de Rothschild, Paris, France
| | - Hervé Picard
- Clinical Research Unit, Foundation Adolphe de Rothschild, Paris, France
| | - Raphaël Blanc
- Department of Interventional Neuroradiology, Foundation Adolphe de Rothschild, Paris, France
| | | | - Jean-Michel Devys
- Department of Anesthesiology and Intensive Care, Foundation Adolphe de Rothschild, Paris, France
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Lee DW, Kim ES, Do WS, Lee HB, Kim EJ, Kim CH. The effect of tulobuterol patches on the respiratory system after endotracheal intubation. J Dent Anesth Pain Med 2017; 17:265-270. [PMID: 29349348 PMCID: PMC5766091 DOI: 10.17245/jdapm.2017.17.4.265] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 12/01/2017] [Accepted: 12/03/2017] [Indexed: 11/15/2022] Open
Abstract
Background Endotracheal intubation during anesthesia induction may increase airway resistance (Raw) and decrease dynamic lung compliance (Cdyn). We hypothesized that prophylactic treatment with a transdermal β2-agonist tulobuterol patch (TP) would help to reduce the risk of bronchospasm after placement of the endotracheal tube. Methods Eighty-two American Society of Anesthesiologists (ASA) category I or II adult patients showing obstructive patterns were divided randomly into a control and a TP group (n = 41 each). The night before surgery, a 2-mg TP was applied to patients in the TP group. Standard monitors were recorded, and target controlled infusion (TCI) with propofol and remifentanil was used for anesthesia induction and maintenance. Simultaneously, end-tidal carbon dioxide, Raw, and Cdyn were determined at 5, 10, and 15 min intervals after endotracheal intubation. Results There was no significant difference in demographic data between the two groups. The TP group was associated with a lower Raw and a higher Cdyn, as compared to the control group. Raw was significantly lower at 10 min (P < 0.05) and 15 min (P < 0.01), and Cdyn was significantly higher at 5 min (P < 0.05) and 15 min (P < 0.01) in the TP group. A trend towards a lower Raw was observed showing a statistically significant difference 5 min after endotracheal intubation (P < 0.01) in each group. Conclusions Prophylactic treatment with TP showed a bronchodilatory effect through suppressing an increase in Raw and a decrease in Cdyn after anesthesia induction without severe adverse effects.
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Affiliation(s)
- Do-Won Lee
- Department of Anesthesia and Pain Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Eun-Soo Kim
- Department of Anesthesia and Pain Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Wang-Seok Do
- Department of Anesthesia and Pain Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Han-Bit Lee
- Department of Anesthesia and Pain Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Eun-Jung Kim
- Department of Dental Anesthesia and Pain Medicine, Pusan National University Dental Hospital, Dental Research Institute, Yangsan, Republic of Korea
| | - Cheul-Hong Kim
- Department of Dental Anesthesia and Pain Medicine, Pusan National University Dental Hospital, Dental Research Institute, Yangsan, Republic of Korea
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Seevaunnamtum SP, Mohd Ariff Ghazali NA, Nazaruddin WM, Besari AM, Fariza NHN, Omar SC, Ali S, Rhendra Hardy MZ, Mat Hassan ME, Abdullah NMN. Case report: Unusual cause of difficulty in intubation and ventilation with asthmatic-like presentation of Endobronchial Tuberculosis. Respir Med Case Rep 2017; 22:292-294. [PMID: 29159029 PMCID: PMC5676088 DOI: 10.1016/j.rmcr.2017.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 10/27/2017] [Indexed: 12/02/2022] Open
Abstract
Endobronchial Tuberculosis is hazardous in causing circumferential narrowing of tracheobronchial tree despite the eradication of tubercle bacilli in the initial insult from Pulmonary Tuberculosis. They may present as treatment resistant bronchial asthma and pose challenge to airway management in the acute setting. We present a 25 year-old lady who was newly diagnosed bronchial asthma with a past history of Pulmonary Tuberculosis that had completed treatment. She presented with sudden onset of difficulty breathing associated with noisy breathing for 3 days and hoarseness of voice for 6 months. Due to resistant bronchospasm, attempts were made to secure the airway which led to unanticipated difficult intubation and ventilation. Subsequent investigations confirmed the diagnosis of Endobronchial Tuberculosis and patient was managed successfully with anti TB medication, corticosteroids and multiple sessions of tracheal dilatation for tracheal stenosis. This case highlights the unusual cause of difficulty in intubation and ventilation due to Endobronchial Tuberculosis, which required medical and surgical intervention to improve the condition.
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Affiliation(s)
- S Praveena Seevaunnamtum
- Department of Anaesthesiology & Intensive Care, School of Medical Science, Health Campus, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Nazhan Afeef Mohd Ariff Ghazali
- Department of Anaesthesiology & Intensive Care, School of Medical Science, Health Campus, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Wan Mohd Nazaruddin
- Department of Anaesthesiology & Intensive Care, School of Medical Science, Health Campus, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Alwi Muhd Besari
- Department of Internal Medicine, School of Medical Science, Health Campus, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - N H Nik Fariza
- Department of Otorhinolaryngology-Head & Neck Surgery, School of Medical Science, Health Campus, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Sanihah Che Omar
- Department of Anaesthesiology & Intensive Care, School of Medical Science, Health Campus, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Saedah Ali
- Department of Anaesthesiology & Intensive Care, School of Medical Science, Health Campus, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - M Z Rhendra Hardy
- Department of Anaesthesiology & Intensive Care, School of Medical Science, Health Campus, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Mohd Erham Mat Hassan
- Department of Anaesthesiology & Intensive Care, School of Medical Science, Health Campus, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - N M Nik Abdullah
- Department of Anaesthesiology & Intensive Care, School of Medical Science, Health Campus, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
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Kou K, Omae T, Wakabayashi S, Sakuraba S. A case in which a capnometer was useful for diagnosing laryngospasm following administration of sugammadex. JA Clin Rep 2017; 3:41. [PMID: 29457085 PMCID: PMC5804625 DOI: 10.1186/s40981-017-0111-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 08/07/2017] [Indexed: 11/10/2022] Open
Abstract
Background Sugammadex has been reported to cause upper-airway obstruction, such as laryngospasm or bronchospasm. These two conditions are treated using different approaches, but the differential diagnosis is difficult. Case presentation We describe a case in which general anesthesia was administered via endotracheal intubation, in combination with brachial-plexus block, for arthroscopic surgical treatment of a rotator-cuff tear caused by recurrent shoulder dislocation. The total dose of rocuronium administered was 90 mg, and the last dose of 10 mg was given 15 min before the end of the surgery. Sugammadex was intravenously administered at 100 mg to reverse the effect of rocuronium after the operation ended. After extubation in this case, we placed a mask firmly around the patient's mouth, and thus, there was no air leakage around the mask. We detected upper-airway obstruction that was presumably attributable to administration of sugammadex. The end-tidal carbon dioxide (EtCO2) concentration was undetectable on a capnometer. Although 100% oxygen was administered at 10 L/min via a facemask, oxygen saturation (SpO2) decreased to approximately 70%. With suspected onset of laryngospasm, continuous positive airway pressure with 100% oxygen at 10 L/min was started at 30 cm H2O. The patient's airway obstruction resolved after a short time. Conclusion The use of a capnometer facilitated the diagnosis of laryngospasm and allowed us to administer appropriate treatment after administration of sugammadex.
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Affiliation(s)
- Keito Kou
- Department of Anesthesiology and Pain Clinic, Juntendo University Shizuoka hospital, 1129 Izunokuni, Shizuoka, Japan
| | - Takeshi Omae
- Department of Anesthesiology and Pain Clinic, Juntendo University Shizuoka hospital, 1129 Izunokuni, Shizuoka, Japan
| | - Saiko Wakabayashi
- Department of Anesthesiology and Pain Clinic, Juntendo University Shizuoka hospital, 1129 Izunokuni, Shizuoka, Japan
| | - Sonoko Sakuraba
- Department of Anesthesiology and Pain Clinic, Juntendo University Shizuoka hospital, 1129 Izunokuni, Shizuoka, Japan
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Abstract
Anaphylaxis is an acute, systemic reaction mediated by immunoglobulin E hypersensitivity. Release of bioactive factors causes vasodilation and bronchiole constriction that can lead to hypotensive shock and asphyxiation. Differential diagnosis includes acute asthma, localized angioedema, syncope, and anxiety/panic attacks. Diagnostic tests lack specificity. Clinical diagnosis is based on demonstration of specific airway or cardiovascular compromise within proximity of allergen exposure. Treatment includes epinephrine, antihistamines, fluid resuscitation, and airway management. Prevention focuses on awareness/avoidance of triggers, implementation of personalized action plans, as well as immune modulation by desensitization in a closely controlled setting where available.
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Affiliation(s)
- Lorenzo Hernandez
- Department of Family Medicine, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224, USA
| | - Sarah Papalia
- Department of Family Medicine, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224, USA
| | - George G A Pujalte
- Department of Family Medicine, Mayo Clinic College of Medicine, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224, USA.
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Messan F, Tito A, Gouthon P, Nouatin KB, Nigan IB, Blagbo AS, Lounana J, Medelli J. Comparison of Catecholamine Values Before and After Exercise-Induced Bronchospasm in Professional Cyclists. Tanaffos 2017; 16:136-43. [PMID: 29308078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND The concentration of circulating catecholamine increases during exercise in healthy athletes, but the variation has not been studied much in athletes who develop exercise-induced bronchospasm. This study measured changes in circulating catecholamine levels using the induced maximal effort test in the laboratory in professional cyclists sensitive to bronchospasm. MATERIALS AND METHODS This experimental study included 86 professional cyclists. They underwent two pulmonary function tests (to determine forced expiratory volume in one second [FEV1]) and two blood samples (to measure adrenaline and noradrenaline levels) were drawn before and after the stress test. Two subsets emerged: subjects whose FEV1 decreased by at least 10% from the resting value and non-sensitive subjects whose FEV1 do not meet this criterion. RESULTS A total of 51 cyclists (59%) were classified into the sensitive group. Resting catecholamine levels showed no significant difference (p > 0.05) between the two groups. In contrast, at the end of the exercise test, the adrenaline (581.9 ± 321.0 pg/mL versus 1783.5 ± 1001.0 pg/mL) and noradrenaline (4994.0 ± 2373.0 pg/mL versus 3205.0 ± 7714.4 pg/mL) levels were both lower in the sensitive group than those in the resting group (p < 0.0001). CONCLUSION The frequency of the occurrence of bronchospasm observed in the studied cyclists was one of the highest among professional sports environments and the circulating catecholamine level was low in cyclists susceptible to bronchospasm. A training protocol adapted to their respiratory physiological profile may be indicated.
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Rosenbrier Ribeiro L, Ian Storer R. A semi-quantitative translational pharmacology analysis to understand the relationship between in vitro ENT1 inhibition and the clinical incidence of dyspnoea and bronchospasm. Toxicol Appl Pharmacol 2016; 317:41-50. [PMID: 28041785 DOI: 10.1016/j.taap.2016.12.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 12/22/2016] [Accepted: 12/27/2016] [Indexed: 01/17/2023]
Abstract
Adenosine contributes to the pathophysiology of respiratory disease, and adenosine challenge leads to bronchospasm and dyspnoea in patients. The equilibrative nucleoside transporter 1 (ENT1) terminates the action of adenosine by removal from the extracellular environment. Therefore, it is proposed that inhibition of ENT1 in respiratory disease patients leads to increased adenosine concentrations, triggering bronchospasm and dyspnoea. This study aims to assess the translation of in vitro ENT1 inhibition to the clinical incidence of bronchospasm and dyspnoea in respiratory disease, cardiovascular disease and healthy volunteer populations. Four marketed drugs with ENT1 activity were assessed; dipyridamole, ticagrelor, draflazine, cilostazol. For each patient population, the relationship between in vitro ENT1 [3H]-NBTI binding affinity (Ki) and [3H]-adenosine uptake (IC50) to the incidence of: (1) bronchospasm/severe dyspnoea; (2) tolerated dyspnoea and; (3) no adverse effects, was evaluated. A high degree of ENT1 inhibition (≥13.3x Ki, ≥4x IC50) associated with increased incidence of bronchospasm/severe dyspnoea for patients with respiratory disease only, whereas a lower degree of ENT1 inhibition (≥0.1x Ki, ≥0.05x IC50) associated with a tolerable level of dyspnoea in both respiratory and cardiovascular disease patients. ENT1 inhibition had no effect in healthy volunteers. Furthermore, physicochemical properties correlative with ENT1 binding were assessed using a set of 1625 diverse molecules. Binding to ENT1 was relatively promiscuous (22% compounds Ki<1μM) especially for neutral or basic molecules, and greater incidence tracked with higher lipophilicity (clogP >5). This study rationalises inclusion of an assessment of ENT1 activity during early safety profiling for programs targeting respiratory disorders.
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Affiliation(s)
- Lyn Rosenbrier Ribeiro
- Discovery Safety, Drug Safety and Metabolism, AstraZeneca, Cambridge Science Park, Cambridge, United Kingdom.
| | - R Ian Storer
- Discovery Safety, Drug Safety and Metabolism, AstraZeneca, Cambridge Science Park, Cambridge, United Kingdom
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Baker JG, Wilcox RG. β-Blockers, heart disease and COPD: current controversies and uncertainties. Thorax 2016; 72:271-276. [PMID: 27927840 DOI: 10.1136/thoraxjnl-2016-208412] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 10/14/2016] [Accepted: 10/21/2016] [Indexed: 11/03/2022]
Abstract
Treating people with cardiovascular disease and COPD causes significant clinician anxiety. β-Blockers save lives in people with heart disease, specifically postinfarction and heart failure. COPD and heart disease frequently coexist and people with both disorders have particularly high cardiovascular mortality. There are concerns about giving β-blockers to people with concomitant COPD that include reduced basal lung function, diminished effectiveness of emergency β-agonist treatments, reduced benefit of long-acting β-agonist treatment and difficulty in discriminating between asthma and COPD. β-Blockers appear to reduce lung function in both the general population and those with COPD because they are poorly selective for cardiac β1-adrenoceptors over respiratory β2-adrenoceptors, and studies have shown that higher β-agonist doses are required to overcome the β-blockade. COPD and cardiovascular disease share similar environmental risks and both disease states have high adrenergic and inflammatory activation. β-Blockers may therefore be particularly helpful in reducing cardiovascular events in this high-risk group. They may reduce the background inflammatory state, and inhibit the tachycardia and hypertension associated with both the endogenous adrenaline and high-dose β-agonist treatment associated with acute exacerbations of COPD. Some studies have suggested no increased and, at times, reduced mortality in patients with COPD taking β-blockers for heart disease. However, these are all observational studies and there are no randomised controlled trials. Potential ways to improve this dilemma include the development of highly β1-selective β-blockers or the use of non-β-blocking heart rate reducing agents, such as ivabridine, if these are proven to be beneficial in randomised controlled trials.
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Affiliation(s)
- Jillian G Baker
- Respiratory Medicine, Cell Signalling, School of Life Sciences, University of Nottingham, Nottingham, UK
| | - Robert G Wilcox
- Department of Clinical Neurosciences, Queen's Medical Centre, University of Nottingham, Nottingham, UK
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Abstract
INTRODUCTION Providers at all levels should have some understanding of the pathophysiology and be able to manage such a patient in the operating room. In addition, any anesthetists providing pediatric care should be able to identify and understand the importance of other comorbid conditions in these patients. This simulation on posttonsillectomy and adenoidectomy hemorrhage in the pediatric patient presents a challenging case usually encountered in some form by most anesthesia residents during training. This simulation's objective is to challenge and further reinforce the knowledge of anesthesiology resident physicians who have completed 1 year of clinical anesthesia and at least 1 month of pediatric anesthesia. METHODS The simulation can be delivered in a single session of 1 hour or less. Materials in this simulation include a case template designed to provide facilitators with a general overview, a checklist of critical actions each learner should perform during the scenario, a brief summary to be provided to the learner to reinforce knowledge gained through the activity, and an evaluation form to assess the learner's view of the activity's educational value. RESULTS Learner comments were almost unanimously positive. All learners who returned surveys answered the questions "This simulation enhanced my understanding of how to manage critically ill patients in the perioperative period" and "The content was current and relevant to my practice" with either agree or strongly agree. DISCUSSION The module offers various points to practice troubleshooting skills in the management of difficult IV line placement as well as difficult airway management. In reality, this case could be modified in multiple ways, including management of a more severe hemorrhage with a much more hypovolemic patient.
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Affiliation(s)
- Cody C. Breinholt
- Fourth-year Resident, Department of Anesthesiology, University of Iowa Carver College of Medicine
| | - Clark J. Obr
- Clinical Associate Professor of Anesthesiology, University of Iowa Carver College of Medicine
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Tassoudis V, Ieropoulos H, Karanikolas M, Vretzakis G, Bouzia A, Mantoudis E, Petsiti A. Bronchospasm in obese patients undergoing elective laparoscopic surgery under general anesthesia. Springerplus 2016; 5:435. [PMID: 27104123 PMCID: PMC4828359 DOI: 10.1186/s40064-016-2054-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Accepted: 03/24/2016] [Indexed: 11/25/2022]
Abstract
Background Existing data suggest that obesity correlates with airway hyper-reactivity. However, the incidence of bronchospasm during bariatric surgery in obese patients has not been well studied. Methods
This was a prospective observational study comparing 50 obese versus 50 non obese patients undergoing elective laparoscopic surgery over a 2 year period. Bronchospasm was detected clinically by auscultation and was confirmed by measuring peak airway pressure during mechanical ventilation. Blood gases were measured at predetermined time intervals intraoperatively. Categorical variables were analyzed using Fisher’s exact test, while numerical variables within and between groups were compared using repeated measures general linear model. Results The incidence of bronchospasm was significantly higher in obese compared to non obese patients (P = 0.027). Peak airway pressures and blood gases differed significantly when comparing non obese patients versus obese patients without bronchospasm versus obese patients with bronchospasm. Hypoventilation resulting in gradual increase of arterial PaCO2 was noted in all groups during surgery. Conclusion The incidence of bronchospasm is higher in obese patients compared to non obese patients undergoing elective laparoscopic surgery. Airway pressures and blood gas values in obese patients are somewhere between values in non obese patients and values in patients with bronchospasm, thereby implying that obesity is associated with a state where bronchial smooth muscles are not fully relaxed. Consideration of increased airway reactivity in obese patients undergoing laparoscopic surgery is important for improved patient care and uneventful anesthetic course.
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Affiliation(s)
| | - Hronis Ieropoulos
- Department of Anesthesiology, University of Larissa, Larissa, Greece
| | - Menelaos Karanikolas
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO USA
| | - George Vretzakis
- Department of Anesthesiology, University of Larissa, Larissa, Greece
| | - Aik Bouzia
- Intensive Care Unit, University Hospital of Larissa, Larissa, Greece
| | - Elias Mantoudis
- Department of Anesthesiology, University of Larissa, Larissa, Greece
| | - Argyro Petsiti
- Department of Anesthesiology, University of Larissa, Larissa, Greece
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Abstract
Therapy for asthma has undergone substantial changes in the past three decades, prompted by a better understanding of the role of inflammation in reversible airway disease. Improved therapies and a workable algorithm of therapy guidelines have provided an improved quality of life for the patient with asthma. This article outlines the most recent revisions of the stepwise guidelines provided by the National Heart, Lung, and Blood Institute.
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Affiliation(s)
- John A Fornadley
- Department of Surgery, Penn State University, 500 University Drive, Hershey, PA 17036, USA.
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29
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Sharifi M, Krishanswami S, McPheeters ML. A systematic review of validated methods to capture acute bronchospasm using administrative or claims data. Vaccine 2013; 31 Suppl 10:K12-20. [PMID: 24331069 DOI: 10.1016/j.vaccine.2013.06.091] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Revised: 06/08/2013] [Accepted: 06/21/2013] [Indexed: 11/23/2022]
Abstract
PURPOSE To identify and assess billing, procedural, or diagnosis code, or pharmacy claim-based algorithms used to identify acute bronchospasm in administrative and claims databases. METHODS We searched the MEDLINE database from 1991 to September 2012 using controlled vocabulary and key terms related to bronchospasm, wheeze and acute asthma. We also searched the reference lists of included studies. Two investigators independently assessed the full text of studies against pre-determined inclusion criteria. Two reviewers independently extracted data regarding participant and algorithm characteristics. RESULTS Our searches identified 677 citations of which 38 met our inclusion criteria. In these 38 studies, the most commonly used ICD-9 code was 493.x. Only 3 studies reported any validation methods for the identification of bronchospasm, wheeze or acute asthma in administrative and claims databases; all were among pediatric populations and only 2 offered any validation statistics. Some of the outcome definitions utilized were heterogeneous and included other disease based diagnoses, such as bronchiolitis and pneumonia, which are typically of an infectious etiology. One study offered the validation of algorithms utilizing Emergency Department triage chief complaint codes to diagnose acute asthma exacerbations with ICD-9 786.07 (wheezing) revealing the highest sensitivity (56%), specificity (97%), PPV (93.5%) and NPV (76%). CONCLUSIONS There is a paucity of studies reporting rigorous methods to validate algorithms for the identification of bronchospasm in administrative data. The scant validated data available are limited in their generalizability to broad-based populations.
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Rosen S. Cardiac tamponade presenting as refractory asthma. Glob Adv Health Med 2013; 2:18-21. [PMID: 24278840 PMCID: PMC3833587 DOI: 10.7453/gahmj.2013.2.1.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Asthma has numerous etiologies, and successful treatment requires a proper diagnosis. Changes in weather and exposure to dust can make treatment of asthma difficult. This case exemplifies a diagnostic dilemma associated with bronchospasm; bronchospasm can have an occult cardiac etiology. Diagnosis can be particularly challenging in rural sub-Saharan Africa during the Harmattan, when winds are blowing sands from the Sahara into nearby villages, especially when radiographs are not available. This case is that of a 40-year-old female Ghanaian woman with a lifelong history of asthma. Although she has often had exacerbations of bronchospasm during the dusty Harmattan season, her bronchospasm was now refractory to usual treatments. X-rays were not available at the clinic in the rural city of Tamale, Ghana, and bedside ultrasound was utilized. She was found to have cardiac tamponade with secondary “cardiac asthma.” After 750 cc of fluid was aspirated during a bedside pericardiocentesis, her bronchospasm immediately resolved. The cardiac effusion was due to previously unknown renal failure from hyper-tension. The patient was referred for dialysis and 1 year later was well without any recurrence of significant cardiac effusions. Healthcare providers should be wary of atypical non-pulmonary etiologies of bronchospasm, especially in cases where there is an inadequate response to usual treatment. Bedside ultrasound has great utility for the diagnosis of cardiac tamponade.
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Affiliation(s)
- Sasha Rosen
- University of Michigan School of Public Health, Ann Arbor, Michigan, United States
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31
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Abstract
Respiratory anesthetic emergencies are the most common complications encountered during the administration of anesthesia in both the adult and pediatric populations. Regardless of the depth of anesthesia, a thorough review of the patients' health history, including the past medical history, edication list, prior anesthesia history, and complex physical examination, is critical in the promotion of safety in the oral and maxillofacial surgery office. The effective management of respiratory anesthetic emergencies includes both strong didactic and clinical skills.
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Chaudhuri S, Gopalkrishna M, Paul C, Kundu R. Can bilateral bronchospasm be a sign of unilateral phrenic nerve palsy after supraclavicular brachial plexus block? J Anaesthesiol Clin Pharmacol 2012; 28:249-51. [PMID: 22557755 PMCID: PMC3339737 DOI: 10.4103/0970-9185.94912] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Ultrasound-guided peripheral nerve blocks facilitate ambulatory anesthesia for upper limb surgeries. Unilateral phrenic nerve blockade is a common complication after interscalene brachial plexus block, rather than the supraclavicular block. We report a case of severe respiratory distress and bilateral bronchospasm following ultrasound-guided supraclavicular brachial plexus block. Patient did not have clinical features of pneumothorax or drug allergy and was managed with oxygen therapy and salbutamol nebulization. Chest X-ray revealed elevated right hemidiaphragm confirming unilateral phrenic nerve paresis.
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Affiliation(s)
- Souvik Chaudhuri
- Department of Anaesthesiology, Kasturba Medical College, Manipal, Karnataka, India
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Abstract
Exercise induced asthma (EIA) is a transient increase in airway resistance after intensive exercise and can be measured as a decline in forced expiratory volume in one second (FEV1). The condition is due to increased training load and inhalation of cold and dry air. Several studies have shown that eucapnic voluntary hyperpnea challenge test (EVH test) is a very sensitive and specific diagnostic method. EVH test develops EIA by hyperventilation of dry gas and the test achieves the same airway obstruction as training in cold and dry air. The test is better than the previously used methacholine challenge test.
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Kim HJ, Kim SY, Oh MJ, Kim JM. Anaphylaxis induced by hydroxyethyl starch during general anesthesia -A case report-. Korean J Anesthesiol 2012; 63:260-2. [PMID: 23060984 PMCID: PMC3460156 DOI: 10.4097/kjae.2012.63.3.260] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2011] [Revised: 07/22/2011] [Accepted: 08/02/2011] [Indexed: 11/10/2022] Open
Abstract
Hydroxyethyl starch (HES) solutions are synthetic non-protein colloid solutions used to treat hypovolemia. However, their use is not free from the risk of allergic reactions. A 42-year-old male was scheduled to undergo aortic-iliac-femoral bypass surgery for the treatment of arteriosclerosis obliterans. He had no history of allergy. Two hours after the start of surgery, and within minutes after HES administration, facial erythema, hypotension and bronchospasm developed. HES infusion was discontinued under the estimation of anaphylaxis. The patient received phenylephrine, ephedrine, diphenhydramine and hydrocortisone with hydration. After restoration of vital signs, surgery was performed without complications.
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Affiliation(s)
- Hyun Jee Kim
- Department of Anesthesiology and Pain Medicine, School of Medicine, Keimyung University, Daegu, Korea
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Panahi Y, Tavana S, Sahebkar A, Masoudi H, Madanchi N. Impact of Adjunctive Therapy with Chlorellav ulgaris Extract on Antioxidant Status, Pulmonary Function, and Clinical Symptoms of Patients with Obstructive Pulmonary Diseases. Sci Pharm 2012; 80:719-30. [PMID: 23008817 PMCID: PMC3447618 DOI: 10.3797/scipharm.1202-06] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2012] [Accepted: 06/18/2012] [Indexed: 11/22/2022] Open
Abstract
This present trial investigated the efficacy of supplementation with Chlorella vulgaris, a bioactive microalga rich in macro- and micronutrients, in the improvement of biochemical and clinical symptoms in patients with obstructive pulmonary disorders. Ninety-seven patients with chronic obstructive pulmonary disease (COPD) or asthma who were under conventional treatment regimens were randomly assigned to C. vulgaris extract (CVE) (n=48; 2700 mg/day) or no adjunctive therapy (n=49) for eight weeks. Serum levels of antioxidants along with spirometric parameters and clinical symptoms were evaluated pre- and post-trial. The magnitude of increases in the concentrations of glutathione, vitamin E, and vitamin C, and activities of glutathione peroxidase, catalase, and superoxide dismutase enzymes were all significantly greater in the CVE vs. control group (p<0.05). In spite of increases, none of the assessed spirometric parameters (FVC, FEV1, FEV1/FVC, and FEF25–75%) did significantly differ by the end of the trial in the study groups, apart from a significant elevation of FEV1 in the control group (p=0.03). The frequency of coughing, shortness of breath, wheezing, and sputum brought up were all significantly reduced in both CVE and control groups (p<0.05). The rate of improvement for sputum brought up and wheezing were significantly greater in the CVE group compared to the control group (p<0.05). Although CVE was found to ameliorate serum antioxidant status, its supplementation was not associated with any bronchodilatory activity. The results of the present trial do not support any clinical efficacy for CVE in patients with obstructive pulmonary disorders.
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Affiliation(s)
- Yunes Panahi
- Chemical Injuries Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
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36
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Jeong YS, Kang YJ. Lethal pulmonary thromboembolism misdiagnosed as pneumonia: A case report. Korean J Anesthesiol 2009; 56:211-216. [PMID: 30625725 DOI: 10.4097/kjae.2009.56.2.211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Although pulmonary thromboembolism (PTE) is not rare, unfortunately for anesthesiologists, the signs and symptoms of PTE are unreliable and nonspecific. PTE is a potentially lethal condition without an accurate diagnosis and prompt treatment. We report a case of PTE misdiagnosed as simple pneumonia. A 60-year-old female, not receiving prophylactic anticoagulant therapy, underwent elective surgery for a left proximal tibial fracture. During induction of general anesthesia, a temporary bronchospasm occurred and subsided quickly. Because vital signs were stable and patient monitoring was normal, we did not identify a serious hypercarbic condition. After surgery, a massive hemoptysis occurred and the patient expired due to cardiopulmonary collapse. According to autopsy, the cause of death was a PTE originating in deep vein thrombosis.
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Affiliation(s)
- Yoo Sung Jeong
- Department of Anesthesiology and Pain Medicine, Hanil General Hospital, Seoul, Korea.
| | - Yang Ja Kang
- Department of Anesthesiology and Pain Medicine, Hanil General Hospital, Seoul, Korea.
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Soni KK, Khare ML, Saxena R. Spasmolytic activity of a herbal drug isolated from Tephrosia purpurea in guinea pigs. Anc Sci Life 2004; 23:59-65. [PMID: 22557142 PMCID: PMC3330980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2003] [Accepted: 02/12/2004] [Indexed: 11/03/2022] Open
Abstract
We investigated the spasmolytic activity of herbal drugs isolated from Tephrosia purpurea on guinea pigs for the treatment of asthma in India. For this investigation, the herbal drug was extracted with 70% ethanol in soxhlet apparatus. After purification and isolution, the drug was used in experimental animals to observe prophylactic activity. For anaphylactic activity, horse serum 0.5 ml along with triple antigen (0.5 ml) was induced in guinea pigs. To observe prophylactic activity, male guinea pigs weighing about 250-450 gms were killed by cervical dislocation and the trachea was isolated. Each trachea was cut in to six segments. Each segment consists of three cartilage rings. Each end of tracheal muscles was attached to the bronchospasm transducers for isometric recording of the tension charges on a polygraph. The results of experiments clearly showed the spasmolytic activity of the drug. The preliminary phytochemical investigation, however shows the presence of glycoside saponins.
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Affiliation(s)
- Kapil K. Soni
- Pest Control and Ayurvedic Drug Research Laboratory, S.S.L. Jain P.G. College, Vidisha (M.P.) 464 221, India
| | - M. L. Khare
- Pest Control and Ayurvedic Drug Research Laboratory, S.S.L. Jain P.G. College, Vidisha (M.P.) 464 221, India
| | - R.C. Saxena
- Pest Control and Ayurvedic Drug Research Laboratory, S.S.L. Jain P.G. College, Vidisha (M.P.) 464 221, India
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Hirabayashi Y, Fukuda H, Saitoh K, Shimizu R. Bronchospasm induced with ergometrine during high spinal anesthesia. J Anesth 1995; 9:198-199. [PMID: 28921295 DOI: 10.1007/bf02479858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/1994] [Accepted: 12/26/1994] [Indexed: 11/29/2022]
Affiliation(s)
- Yoshihiro Hirabayashi
- Department of Anesthesiology, Jichi Medical School, 3311-1 Yakushiji, Minamikawachi-machi, Kawachi-gun, 329-04, Tochigi, Japan
| | - Hirokazu Fukuda
- Department of Anesthesiology, Jichi Medical School, 3311-1 Yakushiji, Minamikawachi-machi, Kawachi-gun, 329-04, Tochigi, Japan
| | - Kazuhiko Saitoh
- Department of Anesthesiology, Jichi Medical School, 3311-1 Yakushiji, Minamikawachi-machi, Kawachi-gun, 329-04, Tochigi, Japan
| | - Reiju Shimizu
- Department of Anesthesiology, Jichi Medical School, 3311-1 Yakushiji, Minamikawachi-machi, Kawachi-gun, 329-04, Tochigi, Japan
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