Recently, balanced sedation has commonly been used during procedural sedation. Dexmedetomidine is known for its relative safety to cause “conscious sedation” with little respiratory depression but has some limitations such as frequent awakening and hemodynamic instability during surgery. To facilitate sedation, a small dose of midazolam can be co-administered rather than escalating the dose of dexmedetomidine, especially in elderly patient. Despite the respiratory safety profile of dexmedetomidine, the overall safety of co-administration has not been clarified. We describe the first case of fatal pulmonary aspiration that developed in an elderly patient during balanced sedation with spinal anesthesia for elective femur fracture surgery.
Aged ; Anesthesia, Spinal ; Conscious Sedation ; Dexmedetomidine ; Femur ; Hemodynamics ; Humans ; Midazolam ; Respiratory Aspiration of Gastric Contents ; Respiratory Insufficiency

Pulmonary aspiration of gastric contents is one of the most frightening complications during anesthesia. Although pulmonary aspiration of gastric contents in general surgical patients is not common and resulting long-term morbidity and mortality are rare, severe hypoxemia and other sequelae of pulmonary aspiration continue to be reported. We report a case of massive aspiration of gastric contents during induction of general anesthesia, resulting in cardiac arrest due to severe pulmonary hypertension and myocardial infarction. Sustained cardiac arrest and shock that did not respond the conventional resuscitation was successfully treated using milrinone. The patient was discharged without complications in 20 days.
Anesthesia ; Anesthesia, General ; Anoxia ; Heart Arrest ; Humans ; Hypertension, Pulmonary ; Milrinone* ; Mortality ; Myocardial Infarction ; Respiratory Aspiration of Gastric Contents ; Resuscitation ; Shock ; Shock, Cardiogenic*

OBJECTIVE: To assess cough reflex sensitivity using the simplified cough test (SCT) and to evaluate the usefulness of SCT to screen for silent aspiration. METHODS: The healthy control group was divided into two subgroups: the young (n=29, 33.44+/-9.99 years) and the elderly (n=30, 63.66+/-4.37 years). The dysphagic elderly group (n=101, 72.95+/-9.19 years) consisted of patients with dysphagia, who suffered from a disease involving central nervous system (ischemic stroke 47, intracerebral hemorrhage 27, traumatic brain injury 11, encephalitis 5, hypoxic brain damage 3, and Parkinson disease 8). The SCT was performed using the mist of a 1% citric acid from a portable nebulizer. The time from the start of the inhalation to the first cough was measured as the cough latency. All the dysphagic patients underwent the videofluoroscopic swallowing study. RESULTS: The cough latency was more significantly prolonged in the healthy elderly group than in the healthy young group (p<0.001), and in the dysphagic elderly group than in the healthy elderly group (p<0.001). The sensitivity and specificity of SCT were 73.8% and 72.5% for detecting aspiration in the dysphagic patients, and 87.1% and 66.7% for detecting silent aspiration in the aspirated patients. CONCLUSION: Cough latency measured with the SCT reflects the impairment of cough reflex in healthy elderly and dysphasic subjects. The results of this study show that the SCT test can be a valuable method of screening aspiration with or without cough in dysphasic patients.
Aged ; Brain Injuries ; Central Nervous System ; Cerebral Hemorrhage ; Citric Acid ; Cough* ; Deglutition ; Deglutition Disorders ; Diagnosis ; Encephalitis ; Humans ; Hypoxia, Brain ; Inhalation ; Mass Screening* ; Nebulizers and Vaporizers ; Parkinson Disease ; Reflex* ; Respiratory Aspiration of Gastric Contents ; Sensitivity and Specificity ; Stroke

Activated charcoal is an inert substance and it is used in standard therapy in patients with acute intoxication. Charcoal has some side effects such as pulmonary aspiration, gastrointestinal complications, and electrolyte abnormalities. Although aspiration of charcoal is a rare complication, it can cause fatal sequelae. We report a 69-year old man who developed acute respiratory failure associated with charcoal aspiration after management of glyphosate poisoning. The patient was drowsy and suffered severe vomiting during transport to our hospital. On arrival, acute respiratory failure was observed due to charcoal aspiration, but the clinical state was improved with repeated bronchoscopy with a bronchoalveolar lavage (BAL). We presumed that the aspirated charcoal was an important factor in evoking a lung injury. Early bronchoscopy with a BAL might be an effective method for eliminating charcoal from the lung, especially in the case of a large amount of aspiration, and be helpful in decreasing respiratory failure due to charcoal aspiration.
Bronchoalveolar Lavage ; Bronchoscopy ; Charcoal ; Glycine ; Humans ; Lung ; Lung Injury ; Respiratory Aspiration ; Respiratory Insufficiency ; Vomiting

This case demonstrates the rare occurrence of a radiolucent temporary resin bridge aspiration in adults while they are in a conscious and awaken state and the resultant formation of inflammatory polyps. Although no unique findings were noted in a chest x-ray, careful history taking accompanied by physical examinations can lead to clinical suspicion of foreign body aspiration in an earlier stage. Moreover, flexible bronchoscopy is a tool useful not only for the evaluation process but also for managing the aspirated foreign material.
Adult ; Bronchoscopy ; Dentures ; Foreign Bodies ; Humans ; Physical Examination ; Polyps ; Resins, Synthetic ; Respiratory Aspiration ; Thorax

A 6-year-old male patient underwent general anesthesia for laparoscopic appendectomy. During induction of intubation, metallic intubation stylet was broken. Broken piece was confirmed by bronchoscopy and chest radiography and was rapidly removed using a surgical forceps. The patient was discharged on the fifth postoperative day without any adverse effects.
Anesthesia, General ; Appendectomy ; Bronchoscopy ; Child ; Foreign Bodies ; Humans ; Intubation* ; Male ; Radiography ; Respiratory Aspiration ; Surgical Instruments ; Thorax

Hemoptysis requires proper treatment to prevent blood aspiration and asphyxiation. If the patient loses consciousness or is anesthetized, the bleeding inside the trachea may continuously flow into the distal part, which may be fatal. Fatal damage resulting from hemoptysis is mainly caused by asphyxiation, and it is important to find the exact location of the bleeding in order to prevent it from spreading to both lungs. However, endotracheal intubation may increase the bleeding by stimulating the bleeding lesion in the respiratory track, and can make airway management more difficult. We report a successful case of airway management using the cuff and Murphy eye of the endotracheal tube in a patient with tracheal bleeding.
Airway Management* ; Consciousness ; Hemoptysis ; Hemorrhage* ; Humans ; Intubation, Intratracheal ; Lung ; Respiratory Aspiration ; Trachea*

BACKGROUND: There are few studies of how to diagnose small cell lung cancer in cytological tests through morphometric analysis. We tried to measure and analyze characteristics of small cell carcinoma in lung by image analysis. METHODS: We studied three types of cytologic specimens from 89 patients who were diagnosed with small cell lung cancer by immunohistochemistry. We measured area, perimeter, maximal length and maximal width of cells from small cell carcinoma using image analysis. RESULTS: In lung aspirates, the nuclear mean area, perimeter, maximal length and maximal width of small cell lung cancer were 218.69 microm2, 55 microm, 18.48 microm and 14.65 microm. In bronchial washings, nuclear measurements were 194.66 microm2, 50.07 microm, 16.27 microm and 14.1 microm. In pleural fluid, values were 177.85 microm2, 48.09 microm, 15.7 microm and 13.37 microm. CONCLUSIONS: Nuclear size of small cell lung carcinoma is variable and depends on the cytology method. Nuclei are spindle-shaped and larger in small cell carcinoma from lung aspirates than in bronchial washings or pleural fluid. The cytoplasms of the cells in bronchial washings and pleural fluid were swollen. Therefore, one should consider morphologic changes when trying to diagnose small cell lung cancer through cytological tests.
Bronchoalveolar Lavage ; Carcinoma, Small Cell ; Cytoplasm ; Humans ; Immunohistochemistry ; Lung ; Respiratory Aspiration ; Small Cell Lung Carcinoma

BACKGROUND AND OBJECTIVES: We evaluated the role of temporary injection laryngoplasty in patients with unilateral vocal fold paralysis (UVFP) after cardiothoracic surgeries. SUBJECTS AND METHOD: Taking the introduction of injection laryngoplasty as a milestone, we divided patients into those who underwent cardiothoracic surgery with UVFP during the years 2001-2004, before the introduction of injection laryngoplasty as pre-injection group (n=83) and those who underwent after the introduction during the years 2000-2007 as post-injection group (n=103). Of the post injection group, patients who received injection laryngoplasty postoperatively before being discharged were defined as injection group (n=37). Patients were also divided into non-esophageal surgery group and esophageal surgery group. Clinical outcomes including the length of hospital stay and oral feeding initiation time were compared between the pre-injection group and the injection group within the same operation group. The degrees of aspiration were classified into 4 grades. RESULTS: In the non-esophageal surgery group, the injection group with aspiration grade III had shorter hospital stay and oral feeding initiation time after extubation compared to the pre-injection group with grade III aspiration (p=0.042). However, in the esophageal surgery group, there was no statistical difference between the pre-injection and injection groups. CONCLUSION: Temporary injection laryngoplasty can reduce the hospital stay and enhance oral feeding initiation in patients with aspiration due to UVFP after non-esophageal cardiothoracic surgeries.
Humans ; Laryngoplasty ; Length of Stay ; Paralysis ; Respiratory Aspiration ; Thoracic Surgery ; Vocal Cords

OBJECTIVE: To investigate the clinical features and outcome of neonatal acute respiratory distress syndrome (ARDS) in southwest Hubei, China. METHODS: According to the Montreux definition of neonatal ARDS, a retrospective clinical epidemiological investigation was performed on the medical data of neonates with ARDS who were admitted to Department of Neonatology/Pediatrics in 17 level 2 or level 3 hospitals in southwest Hubei from January to December, 2017. RESULTS: A total of 7 150 neonates were admitted to the 17 hospitals in southwest Hubei during 2017 and 66 (0.92%) were diagnosed with ARDS. Among the 66 neonates with ARDS, 23 (35%) had mild ARDS, 28 (42%) had moderate ARDS, and 15 (23%) had severe ARDS. The main primary diseases for neonatal ARDS were perinatal asphyxia in 23 neonates (35%), pneumonia in 18 neonates (27%), sepsis in 12 neonates (18%), and meconium aspiration syndrome in 10 neonates (15%). Among the 66 neonates with ARDS, 10 neonates (15%) were born to the mothers with an age of ≥35 years, 30 neonates (45%) suffered from intrauterine distress, 32 neonates (49%) had a 1-minute Apgar score of 0 to 7 points, 24 neonates (36%) had abnormal fetal heart monitoring results, and 21 neonates (32%) experienced meconium staining of amniotic fluid. Intraventricular hemorrhage was the most common comorbidity (12 neonates), followed by neonatal shock (9 neonates) and patent ductus arteriosus (8 neonates). All 66 neonates with ARDS were treated with mechanical ventilation in addition to the treatment for primary diseases. Among the 66 neonates with ARDS, 10 died, with a mortality rate of 15% (10/66), and 56 neonates were improved or cured, with a survival rate of 85% (56/66). CONCLUSIONS Neonatal ARDS in southwest Hubei is mostly mild or moderate. Perinatal asphyxia and infection may be the main causes of neonatal ARDS in this area. Intraventricular hemorrhage is the most common comorbidity. Neonates with ARDS tend to have a high survival rate after multimodality treatment.
China ; Female ; Humans ; Infant, Newborn ; Meconium Aspiration Syndrome ; Pregnancy ; Respiratory Distress Syndrome, Newborn ; Retrospective Studies