scholarly journals The Contentious Management of Anaplastic Thyroid Carcinoma with Acute Airway Obstruction during COVID-19 Pandemic

2021 ◽  
pp. 1-11
Author(s):  
Ahmad Izani Mohd Safian ◽  
Kamaruddin Ibrahim ◽  
Seoparjoo Azmel Mohd Isa ◽  
Norhafiza Mat Lazim ◽  
Irfan Mohamad
Keyword(s):  
Thyroid Carcinoma ◽  
Airway Obstruction ◽  
Fatal Outcome ◽  
Upper Airway ◽  
Anaplastic Thyroid Carcinoma ◽  
Upper Airway Obstruction ◽  
Acute Airway Obstruction ◽  
Assessment And Treatment ◽  
Patient Will ◽  
Unknown Status

There are many important concerns and issues raised in managing acute airway obstruction cases with regards to the current COVID-19 pandemic. As a further matter, a patient with a huge thyroid mass in anaplastic thyroid carcinoma (ATC) presenting with impending airway obstruction poses treatment challenges, as immediate active intervention is necessary despite the risk of spreading of COVID-19 viruses. The unknown status of COVID-19 of the patient will add additional concerns during active assessment and treatment as patients with this undifferentiated thyroid carcinoma commonly deteriorate fast. This carcinoma may also invade the trachea and result in upper airway obstruction leading to a fatal outcome. Therefore, an appropriate treatment strategy is essential. This report highlights a case of an ATC patient who presented with diffuse cemented-hard anterior neck, whereby the whole management of ATC with acute airway obstruction during this COVID-19 pandemic is purely contentious and challenging. The issue of providing artificial ventilation either via intubation or tracheostomy is made more complicated as the patient presents with an acute upper airway obstruction whilst the COVID-19 status is unknown. While endotracheal intubation approach was not easy, the trachea was also difficult to be identified externally due to the huge ‘cemented-hard’ mass plastered over the compressed trachea. Due to the advanced disease, surgical intervention was not an option.

scholarly journals Extensive Neck Haematoma as an Extremely Rare Presentation of Thyroid Carcinoma: A Case Report

2020 ◽  
Vol 4 (3) ◽  
pp. 226
Author(s):  
Lo Ren Hui ◽  
Fairuz Mohd Ibrahim ◽  
Khairudin Abdullah ◽  
Nasriah Ahmad ◽  
Fazilah Hassan ◽  
...  
Keyword(s):  
Case Report ◽  
Thyroid Carcinoma ◽  
Airway Obstruction ◽  
Upper Airway ◽  
Health Sciences ◽  
Neck Mass ◽  
Anaplastic Thyroid Carcinoma ◽  
Upper Airway Obstruction ◽  
Rare Presentation ◽  
Fast Growing

Anaplastic thyroid carcinoma (ATC) is uncommon but deadly. It is typically presented with fast growing neck mass, hoarseness or dysphagia. We report an extremely rare presentation of ATC in an elderly lady, with expanding ecchymosis involving laryngopharynx, neck and upper chest region, which causing upper airway obstruction. The rarity of presentation and the management dilemma were discussed.International Journal of Human and Health Sciences Vol. 04 No. 03 July’20 Page : 226-228

scholarly journals Concurrent Negative-Pressure Pulmonary Edema (NPPE) and Takotsubo Syndrome (TTS) after Upper Airway Obstruction

2019 ◽  
Vol 2019 ◽  
pp. 1-4
Author(s):  
Evan Harmon ◽  
Sebastian Estrada ◽  
Ryan J. Koene ◽  
Sula Mazimba ◽  
Younghoon Kwon
Keyword(s):  
Airway Obstruction ◽  
Pulmonary Edema ◽  
Negative Pressure ◽  
Upper Airway ◽  
Upper Airway Obstruction ◽  
Takotsubo Syndrome ◽  
Negative Pressure Pulmonary Edema ◽  
Acute Airway Obstruction ◽  
Increased Risk ◽  
Life Threatening

Upper airway obstruction is a potentially life-threatening emergency often encountered in the acute care, perioperative, and critical care settings. One important complication of acute obstruction is negative-pressure pulmonary edema (NPPE). We describe two cases of acute upper airway obstruction, both of which resulted in flash pulmonary edema complicated by acute hypoxic respiratory failure. Though NPPE was suspected, these patients were also found to have Takotsubo syndrome (TTS). Neither patient had prior cardiac disease, and both subsequently had a negative ischemic workup. Because TTS is a condition triggered by hyperadrenergic states, the acute airway obstruction alone or in combination with NPPE was the likely explanation for TTS in each case. These cases highlight the importance of also considering cardiogenic causes of pulmonary edema in the setting of upper airway obstruction, which we suspect generates a profound catecholamine surge and places patients at increased risk of TTS development.

Corticosteroids in Airway Management

1983 ◽  
Vol 91 (6) ◽  
pp. 593-596 ◽  
Author(s):  
Donald B Hawkins ◽  
Dennis M Crockett ◽  
Tony K Shum
Keyword(s):  
Airway Management ◽  
Airway Obstruction ◽  
Intramuscular Injection ◽  
Upper Airway ◽  
Suppressive Effect ◽  
Upper Airway Obstruction ◽  
Blood Levels ◽  
High Concentration ◽  
Acute Airway Obstruction ◽  
Inflamed Tissue

Adrenal corticosteroids exert a strong suppressive influence on the basic inflammatory response that leads to tissue swelling. The corticosteroid effect is nonspecific. In upper airway obstruction caused by edema from infection, allergy, or trauma, corticosteroids will exert some degree of suppressive effect. The steroid effect is local and directly proportional to the concentration of steroids in the inflamed tissue. In upper airway obstruction steroids should be delivered to the inflamed tissue in high concentration with the least delay. Dexamethasone and methylprednisolone produce high blood levels within 15 to 30 minutes of intramuscular injection. Recommended initial doses for acute airway obstruction are dexamethasone, 1.0 to 1.5 mg/kg, or methylprednisolone, 5 to 7 mg/kg. The risk of harm from steroid therapy of 24 hours or less is negligible.

Failure to control the airway in a patient with Hunter's syndrome

1998 ◽  
Vol 112 (4) ◽  
pp. 380-382 ◽  
Author(s):  
Luis Gaitini ◽  
Milo Fradis ◽  
Sonia Vaida ◽  
Geoffrey Collins ◽  
Millian Croitoru ◽  
...  
Keyword(s):  
Airway Obstruction ◽  
General Anaesthesia ◽  
Simple Procedure ◽  
Fatal Outcome ◽  
Upper Airway ◽  
Upper Airway Obstruction ◽  
Storage Diseases ◽  
Hunter's Syndrome

AbstractHunter's syndrome is due to recessively inherited mucopolysaccharide storage diseases. The anaesthetic complications in this syndrome are related to the organs involved in the disease, but pertain especially to upper airway obstruction problems. We report a patient with Hunter's syndrome who, while under general anaesthesia for a simple procedure (the introduction of bilateral grommets), suffered a fatal outcome.

scholarly journals Functional Upper Airway Obstruction

1998 ◽  
Vol 26 (2) ◽  
pp. 216-218 ◽  
Author(s):  
A. Norton ◽  
G. Roberton
Keyword(s):  
Airway Obstruction ◽  
Surgical Intervention ◽  
Correct Diagnosis ◽  
Upper Airway ◽  
Upper Airway Obstruction ◽  
Functional Disorders ◽  
Vocal Cords ◽  
Functional Dysphonia ◽  
Acute Airway Obstruction ◽  
Appropriate Therapy

Functional disorders of the vocal cords can present with acute, dramatic upper airway obstruction, with features mimicking asthma or functional dysphonia. We report the case of an eighteen-year-old female with acute airway obstruction initially misdiagnosed as asthma. Laryngoscopy, bronchoscopy and psychiatric assessment confirmed a diagnosis of functional disorder of the vocal cords. Although a diagnosis of exclusion, it must be borne in mind in order to reduce unnecessary medical therapy and surgical intervention. It is only with the correct diagnosis that patients can receive appropriate therapy.

The use of mini-tracheostomy and high frequency jet ventilation in the management of acute airway obstruction

1986 ◽  
Vol 100 (10) ◽  
pp. 1199-1202 ◽  
Author(s):  
S. J. Squires ◽  
M. C. Frampton
Keyword(s):  
Airway Obstruction ◽  
High Frequency ◽  
Upper Airway ◽  
Upper Airway Obstruction ◽  
Operating Theatre ◽  
Optimal Conditions ◽  
Jet Ventilation ◽  
High Frequency Jet Ventilation ◽  
Acute Airway Obstruction

AbstractA case is described in which upper airway obstruction was successfully treated using cri-cothyroidotomy in association with high frequency jet ventilation. This procedure allowed time for the patient to be transferred to the operating theatre for formal tracheostomy under optimal conditions. It is suggested that the Portex ‘Mini-trach’ kit, though primarily designed for tracheobronchial toilet, can be used to provide a satisfactory and safe airway during the resuscitation of an obstructed patient, particularly if jet ventilation is available.

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