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8 results

  • Chapter 8 - Airway Issues

  • Edited by David R. Gambling, University of California, San Diego, M. Joanne Douglas, University of British Columbia, Vancouver, Grace Lim, University of Pittsburgh
  • Book:
    Obstetric Anesthesia and Uncommon Disorders
    Published online:
    26 January 2024
    Print publication:
    01 February 2024, pp 97-109

  • Summary

    Pathological airway issues frequently masquerade as more severe forms of the physiological respiratory and airway symptoms that many pregnant patients describe. Disorders of the airway are often exacerbated by pregnancy; persistent or worsening dyspnea must be investigated. Gold standard investigations that involve radiation exposure should be used appropriately for diagnosis and surveillance. Goitre is endemic in many countries and often worsens in pregnancy, which places the patient at risk for tracheomalacia. Idiopathic subglottic stenosis is a disease of women in the child-bearing years, and while easily treated, needs to be first diagnosed. Anterior mediastinal masses are unfortunately frequently missed as the presenting symptoms are ascribed to pregnancy changes. Airway changes in pregnancy lead to sleep-disordered breathing and are worsened by preeclampsia. The airway worsens in labor and can transform an awkward airway into a difficult one. Current airway management guidelines should be followed, with specificity for the pregnant patient, ensuring equivalent airway equipment and airway expertise are available for women with known airway issues. Finally, the pregnant patient with a known structural airway issues must be managed in a centre with access to airway experts, surgeons, and cardiopulmonary bypass or ECMO to ensure outcomes are good for both mother and baby.

  • Angioedema with haloperidol - case report

  • A. Costa, S. Jesus, J. Alcafache
  • Journal:
    European Psychiatry / Volume 64 / Issue S1 / April 2021
    Published online by Cambridge University Press:
    13 August 2021, pp. S480-S481
    • Article
      • You have access
      • Open access
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  • Introduction

    Haloperidol is a high-potency first generation antipsychotic and one of the most frequently used antipsychotic medications. It is a potent central antagonist of type 2 dopamine receptors, with low alpha 1 adrenergic activity and has no antihistamine or anti-cholinergic activity. It is a widely used drug with proven efficacy. Angioedema is a very rare side effect, occurring in <1% of cases.

    Objectives

    Case report and reflection on its etiology

    Methods

    A Pubmed search was performed with the MeSH terms “haloperidol” and “Anaphylactic reactions”. Relevant articles obtained from the respective bibliographic references were also consulted.

    Results

    The following case describes the development of angioedema in a patient with an acute confusional syndrome on the second haloperidol IM administration for symptomatic control of agitation. Angioedema has been reported as an adverse effect of various antipsychotics such as clozapine, risperidone, ziprazidone and chlorpromazine, however, resulting from haloperidol administration is rare.

    Conclusions

    In long-term formulations sensitization testing is especially important but a single prior administration is not sufficient, a second controlled administration is essential to avoid this kind of fatal reactions.

  • A clozapine-induced hypersensitivity reaction

  • L. Curtis, B. Hallahan, F. Byrne
  • Journal:
    Irish Journal of Psychological Medicine / Volume 37 / Issue 2 / June 2020
    Published online by Cambridge University Press:
    17 October 2017, pp. 122-125
    Print publication:
    June 2020

  • A 57-year-old female patient with a diagnosis of schizo-affective disorder since 1986 was commenced on clozapine due to persistent positive and negative psychotic symptoms in September 2014. After commencement of clozapine she was delusion free and demonstrated an improvement in negative symptoms. Three months after commencement of clozapine she developed a hypersensitivity reaction. Her symptoms continued to deteriorate despite being prescribed an anti-histamine. Clozapine was discontinued 6 days after the appearance of a generalised pruritic rash, as it was believed to be the probable cause. There was complete resolution of symptoms 1 week after discontinuation of clozapine. Clozapine was replaced with olanzapine and amisulpride. There has been no similar cutaneous or allergic reactions for the past 30 months.

  • Chapter 15 - Anesthesia for neck dissection and laryngectomy

  • from Section 3 - Anesthesia for head and neck surgery
  • Edited by Basem Abdelmalak, John Doyle
  • Book:
    Anesthesia for Otolaryngologic Surgery
    Published online:
    05 November 2012
    Print publication:
    18 October 2012, pp 143-150

  • Summary

    This chapter provides a brief overview of otolaryngologic emergencies. Complete or partial airway obstruction is common in ENT practice and anesthesiologists are familiar with a variety of measures, such as tracheal intubation, to deal with this event. Intubation is often needed in cases of angioedema; this will usually be performed under topical anesthesia with the patient awake or lightly sedated. Airway-related bleeding may occur spontaneously, as with a bleeding tumor, as a consequence of anticoagulation (e.g. for atrial fibrillation), or following surgery (e.g. after UVPP surgery). Posterior epistaxis may be particularly severe, may be accompanied by hematemesis or melena, and may require general anesthesia and intubation as part of the treatment. Airway-related infections such as epiglottitis, retropharyngeal abscess and Ludwig's angina constitute an emergency airway. One approach commonly taken in such cases is awake intubation, especially in conjunction with a fiberscope.

  • Unilateral tongue angioedema caused by angiotensin-converting enzyme inhibitor

  • Y S Ee, A J Sow, B S Goh
  • Journal:
    The Journal of Laryngology & Otology / Volume 124 / Issue 12 / December 2010
    Published online by Cambridge University Press:
    08 June 2010, pp. 1337-1339
    Print publication:
    December 2010
  • Objective:

    We report a case of an elderly man receiving treatment with perindopril, who presented with angioedema of the left side of the tongue, floor of the mouth and upper neck. This affected his speech and swallowing, and occurred one day after a burr hole and evacuation procedure undertaken to treat a subdural haematoma. The patient was kept under close observation and treated with intravenous hydrocortisone. The angioedema resolved completely in two days. This is the third reported case of unilateral tongue angioedema occurring secondary to angiotensin-converting enzyme inhibitor use.

    Method:

    Case report and literature review concerning angiotensin-converting enzyme inhibitor induced angioedema.

    Conclusion:

    Unilateral angioedema of the tongue is a rare adverse reaction to angiotensin-converting enzyme inhibitors. Early recognition may prevent unnecessary surgical intervention and complications.

  • Angioedema of the airway: an unusual case

  • A J Roper, A Farragher, J J Homer, M Helbert
  • Journal:
    The Journal of Laryngology & Otology / Volume 121 / Issue 8 / August 2007
    Published online by Cambridge University Press:
    31 May 2007, E11
    Print publication:
    August 2007

  • We report a case of angioedema caused by angiotensin-converting enzyme inhibitor and topical lignocaine spray, administered during nasendoscopy.

    Angioedema induced by angiotensin-converting enzyme inhibitors is a rare but well known entity. Allergy to topical lignocaine has been acknowledged as a rare phenomenon when used for dental surgery and for skin anaesthesia, but it has not previously been reported after topical administration prior to nasendoscopy. In the reported case, our patient was unfortunate enough to be allergic to both lisinopril and lignocaine. The result was life-threatening airway obstruction, and the continued use of lignocaine spray sustained the laryngeal oedema. We advise that patients are asked about any and every allergy – specifically, any previous problems with dental procedures – before administration of local anaesthetic spray to the upper aerodigestive tract.