This study was performed to observe the changes of oxygen saturation after tracheal extubation, which depends on the following tracheal extubation methods of the group 1. 2A. 2B, has done. One hundred twenty-five healthy patients that had been selected out of 1~15 year-old at random were divided as follows; Group 1; extubation performed in being awake (n=49) Group 2; anesthetized extubation (n=76) 2A: extubation done in 5 min after discontinuing N2O (n=38) 2B: extubation under anesthesia (GOE or GOF) (n=38) The grouping, which has at random been assigned to the patients, was done just before the end of operation. Oxygen saturation was measured continuously by pulse-oximeter (Minolta Pulsox TS-7, Japan) and was recorded in the process of operation, immediately after extubation and at 1.2.4.6.8.10.20.30 min after extubation while they were spontaneously breathng room air. In case oxygen saturation were less than 90%, supplementary oxygen was administered to them. The frequency of hypoxemia was higher in Group 2 (19.7%) than in Group 1 (10.2%). In group 2B, 2 patients developed severe hypoxemia and 1 patient developed PVC immediately after extubation. Changes of oxygen saturation were as follows; Oxygen saturation in Group 2B was higher than that in Group 1 at each 2 min and 4 min and was also higher than that in Group 2A at 4 min after extubation. As a result, Group 1 is the safest extubation method because of its low risk of hypoxemia. If anestltized extubation must be needed, Group 2A would be preferable to Group 2B method because the frequency of hypoxemia was higher in Group 2B than in Group 2A.In addition, It is suggested that monitoring oxygen saturation continuously by the patients should be safe.
Airway Extubation* ; Anesthesia ; Anoxia ; Humans ; Oxygen*

Congenital cystic adenomatoid malformation (CCAM) is a rare developmental entity. Symptomatic patients must undergo thoracic surgery for lobectomy. Perioperative anesthetic management is challenging because it involves
thoracotomy in a young patient that may lead to hemodynamic compromise and inadequate ventilation. We present 3 cases of pediatric patients (6 months - 2 years old) with CCAM who underwent lobectomy.

All anesthesiologists, at some stage, have experienced problems after tracheal extubation, the frequency of which probably exceeds those relating to tracheal intubation. Whereas the anesthetic literature is replete with studies that the problems associated with tracheal intubation, it is unusual to find discussion concerning those following extubation. This review attempts to redress this imbalance.
AIRWAY EXTUBATION ; ANESTHESIA ; PULMONARY EDEMA ; ANOXIA

Paradoxical vocal fold movement (PVFM) is an uncommon upper airway disorder defined as paradoxical adduction of the vocal folds during inspiration. The etiology and treatment of PVFM are unclear. The physician should manage this condition because of the possibility of near complete airway obstruction in severe case of PVFM. We report a case of successful airway management in a patient with PVFM by applying continuous positive airway pressure (CPAP). In this case, PVFM was detected after removing an endotracheal tube from a 67-year-old male who underwent excision of a laryngeal mass. The patient recovered without complications in 1 day with support by CPAP.
Aged ; Airway Extubation* ; Airway Management ; Airway Obstruction ; Continuous Positive Airway Pressure* ; Humans ; Male ; Vocal Cords*

BACKGROUND: The timing of tracheal extubation in patients undergoing major intraoperative procedures is controversial. Immediate postoperative tracheal extubation after liver transplantation was not popularized. But in these days, early tracheal extubation has been safely performed in certain cases and routine use of mechanical ventilation is being questioned. We performed preliminary study of our 25 liver transplantation cases to evaluate factors affecting duration and indications of postoperative mechanical ventilation. METHODS: Our 25 cases were divided into two groups by periodic difference - early 13 cases (group 1) and late 12 cases (group 2). We evaluated preoperative UNOS (united network for organ sharing) scale, intraoperative transfusion and vasopressor requirement, postoperative multiple organ complications which would have influence upon tracheal extubation. RESULTS: We found great difference between two groups in duration of mechanical ventilation (Group 1: 94.4+/-7.12 hrs, Group 2: 36.1+/-28.3 hrs) and ICU stay (Group 1: 22.8+/-8.3 days, Group 2: 11.8+/-5.5 days). CONCLUSIONS: We concluded that early tracheal extubation in selected liver transplantation cases was safe and effective because it could shorten duration of ICU stay and reduce postoperative mortality. But more experience and knowledge may be needed to get more ideal guidelines for postoperative mechanical ventilation.
Airway Extubation* ; Humans ; Liver Transplantation* ; Liver* ; Mortality ; Respiration, Artificial

BACKGROUND: Extubation failure and reintubation increase the morbidity and the mortality rate. Several extubation criteria and risk factors for extubation failure have been recommended. However, some patients present with extubation failure even after a planned extubation. The aim of this study was to evaluate the clinical characteristics of patients with extubation failure after a planned extubation. METHODS: Thirty one patients who presented with planned extubation were included. Extubation failure was defined as reintubation within 48 hours after extubation. The clinical, respiratory and hemodynamic parameters between extubation success and failure group were compared. RESULTS: Six patients were included in the failure group. The extubation failure rate was 19.4%. The age, periods of intubation and heart rates were significantly different between the extubation success and failure group. In the success and failure group, the mean age were 60.4+/-15.65 vs. 80.3+/-7.17 year, the intubation periods were 7.12+/-.47 vs. 13.83+/-.4 day and the heart rates were 94.32+/-.77 vs. 110. 67+/-.78 /min, respectively. CONCLUSION: Old age and patients intubated for periods will require a will careful assessment before extubation. Extensive cardiac evaluations before extubation will also be needed.
Airway Extubation* ; Heart Rate ; Hemodynamics ; Humans ; Intubation ; Mortality ; Risk Factors

Chordoma is a slow-growing, locally invasive, lowgrade malignant tumor with a prevalence of one in 100 000, accounting for 1%-4% of all malignant bone tumors. At present, it is considered that chordoma originates from ectopic embryonic chordal tissue and can occur in any part of the spine from the skull base to the sacrum. About 50% of chordoma occurs in the sacrococcygeal region, about 30% in the skull base, and the rest occurs in the active spinal region. Cervical chordoma is rare, but it may be accompanied by difficult airways. The tumors compress the pharynx and throat forward, which can cause upper airway obstruction. If the anesthesia is not properly handled, the patient may die of asphyxia. The core issues of airway management during the perioperative period of cervical chordoma surgery involve three main parts: preoperative airway evaluation, airway management and extubation management. Difficult airway assessment often relies on physical examination indicators, such as inter-incisor gap, thyromental distance, neck circumference, Mallampati test, etc. But the accuracy is insufficient. The application of imaging examination in the observation of different tissues can make up for the inaccurate evaluation of the internal structure of the airway. Because chordoma destroys cervical vertebral body and accessories, cervical stability is impaired. Excessive cervical vertebral extention should be avoided during tracheal intubation to prevent severe compression of the spinal cord. It is better to fix the head by an assistant and perform neutral tracheal intubation. Considering that the patient with a difficult airway that could be predicted before operation, the strategy of tracheal intubation under conscious sedation with topical anesthesia was selected. After sedation and topical anesthesia, the patient was successfully intubated with optical stylet. After operation, the patient returned to ICU with tracheal catheter. On the 4th day after operation, the tracheal tube was pulled out. On the 5th day after operation, the patient was transferred to the orthopaedic ward and discharged on the 7th day after operation. It is of great significance to establish specific strategies for such operations to reduce related complications, speed up post-operative rehabilitation and save medical resources. We reported the anesthetic management of cervical chordoma cured in Peking University Third Hospital.
Airway Extubation ; Cervical Vertebrae ; Chordoma ; Humans ; Intubation, Intratracheal ; Neck

Humans ; Child ; Glucocorticoids/therapeutic use* ; Airway Extubation ; Airway Obstruction/prevention & control* ; Intubation, Intratracheal/adverse effects*

Negative pressure pulmonary edema (NPPE) is a rare complication of acute airway obstruction which develops after endotracheal extubation. The proposed mechanism is generation of very low negative pressure during laryngospasm by inspiratory efforts, which leads to alveolar exudation and hemorrhage. The diagnosis of NPPE is confirmed by clinical findings of tachypnea, pink prothy sputum in the endotracheal tube, hypoxemia on arterial blood gas analysis, and distinctive radiologic findings. NPPE is usually self-limited within 48 hours when diagnosed early and treated appropriately. We report three patients who recovered from NPPE without complications.
Airway Extubation ; Airway Obstruction ; Anoxia ; Blood Gas Analysis ; Hemorrhage ; Humans ; Laryngismus ; Pulmonary Edema ; Sputum ; Tachypnea

Pulmonary edema is a recognized complication of acute airway obstruction, laryngospasm, especially after endotracheal extubation. It usually follows relief of the obstruction and is likely to be of noncardiogenic origin. The mechanism by which an upper airway obstruction causes pulmonary edema is likely due to the combination of the increased reduction of intrapulmonary pressure, increased capillary permeability and hypoxia. We present a case of pulmonary edema that occurred in an adult patient after upper airway obstruction following extubation of the trachea.
Adult ; Airway Extubation* ; Airway Obstruction* ; Anoxia ; Capillary Permeability ; Edema ; Humans ; Laryngismus ; Lung ; Pulmonary Edema* ; Trachea