Chronic hypoventilation due to injury to the brain stem respiratory center or high cervical cord (above the C3 level) can result in dependence to prolonged mechanical ventilation with tracheostomy, frequent nosocomial pneumonia, and prolonged hospitalization. Diaphragm pacing through electrical stimulation of the phrenic nerve is an established treatment for central hypoventilation syndrome. We performed chronic phrenic nerve stimulation for diaphragm pacing with the spinal cord stimulator for pain control in a quadriplegic patient with central apnea due to complete spinal cord injury at the level of C2 from cervical epidural hematoma. After diaphragmatic pacing, the patient who was completely dependent on the mechanical ventilator could ambulate up to three hours every day without aid of mechanical ventilation during the 12 months of follow-up. Diaphragm pacing through unilateral phrenic nerve stimulation with spinal cord stimulator was feasible in an apneic patient with complete quadriplegia who was completely dependent on mechanical ventilation. Diaphragm pacing with the spinal cord stimulator is feasible and effective for the treatment of the central hypoventilation syndrome.
Apnea ; Brain Stem ; Diaphragm* ; Electric Stimulation ; Follow-Up Studies ; Hematoma ; Hospitalization ; Humans ; Hypoventilation ; Phrenic Nerve* ; Pneumonia ; Quadriplegia ; Respiration, Artificial ; Respiratory Center ; Sleep Apnea, Central ; Spinal Cord ; Spinal Cord Injuries ; Tracheostomy ; Ventilators, Mechanical ; Wounds and Injuries

OBJECTIVES: To share our experience in managing a rare involvement of phrenic nerve injury in laryngeal trauma

METHODS:
Design: Case Report
Setting: Tertiary Referral Centre
Patient: One

RESULTS: A 23 year old male sustained blunt laryngeal trauma associated with phrenic nerve injury leading to silent traumatic diaphragmatic paralysis. He underwent tracheotomy and surgical repair of Schaeffer class IV laryngeal injuries, and conservative therapy for the diaphragmatic paralysis, which eventually resolved.

CONCLUSION: Patients with laryngeal trauma may have concomitant phrenic nerve injury causing diaphragmaic paralysis. The diagnosis should be considered particularly if the patient has respiratory problems despite securing the airway by tracheotomy. A high index of suspicion is required in diagnosing such an association. Patients should be closely monitored even though most will recover as some may present with later morbidities. A search of PubMed and OvidSP using the terms "larynx" "laryngeal trauma and "phrenic nerve" did not yield any report of phrenic nerve injury in associaion with laryngeal trauma. To our knowledge, this is may be the first reported case of phrenic nerve injury in association with blunt laryngeal trauma.

Human ; Male ; Young Adult ; Laryngeal Nerve Injuries ; Medication Therapy Management ; Larynx-injuries ; Phrenic Nerve-injuries ; Wounds And Injuries ; Respiratory Paralysis ; General Surgery ; Tracheostomy

Atrial Fibrillation ; therapy ; Catheter Ablation ; adverse effects ; Humans ; Male ; Middle Aged ; Phrenic Nerve ; injuries ; Trauma, Nervous System ; etiology

BACKGROUND: Diaphragm is innervated by phrenic nerve and lower intercostal nerves. For patients with avulsion injury of brachial plexus, an in situ graft of phrenic nerve is frequently used to neurotize a branch of the brachial plexus. We studied short-term and mid-term changes of diaphragmatic level and movement in patients with dissection of phrenic nerve for neurotization. MATERIAL AND METHOD: Thirteen patients with division of either-side phrenic nerve for neurotization of musculocutaneous nerve were included in this study. With endoscopic surgical procedure, the intrathoracic phrenic nerve was entirely dissected and divided just above the diaphragm. The dissected phrenic nerve was taken out through thoracic inlet and neck wound and then anastomosed to the musculocutaneous nerve through a subcutaneous tunnel. With chest films and fluoroscopy, levels and movements of diaphragm were measured before and after operation. RESULT: There was no specific technical difficulty or even minor postoperative complications following endoscopic division of phrenic nerve. After division of phrenic nerve, diaphragm was soon elevated about 1.7 intercostal spaces compared with the preoperative level, but it did not show paradoxical motion in fluoroscopy. More than 1.5 months later, diaphragm returned downward close to the preoperative level (average level difference was 0.9 intercostal spaces; p=NS). Movement of diaphragm was not significantly decreased compared with the preoperative one. CONCLUSION: After division of phrenic nerve, the affected diaphragm did not show a significant decrease in movement, and the elevated diaphragm returned downward with time. However, the decreased lung volumes in the last spirometry suggest the decreased inspiratory force following partial paralysis of diaphragm.
Bays ; Brachial Plexus ; Diaphragm ; Diaphragmatic Eventration ; Endoscopy ; Fluoroscopy ; Humans ; Intercostal Nerves ; Lung ; Musculocutaneous Nerve ; Neck ; Nerve Transfer ; Paralysis ; Phrenic Nerve* ; Postoperative Complications ; Spirometry ; Thorax ; Transplants ; Wounds and Injuries

BACKGROUND: In this study, the role and the surgical outcome of the modified Blalock-Taussig shunt in the treatment of the infants with cyanotic complex congenital heart diseases were investigated. MATERIAL AND METHOD: Over the last 12 years, 105 modified BT shunts were performed in 100 infants. Postoperative course, shunt patency rate, complications, mortality and its risk factors were reviewed restrospectively. RESULT: The mean age at operation was 43.0 36.6 days. Sex ratio was 60:40(M:F). The postoperative oxygen saturations were lowest after mean duration of 11 hours after the shunt procedure. The operative mortality was 8%(8) with 3 late deaths. Causes of operative death included failure of maintenance of minimum oxygenation during the procedure(2), immediate postoperative shunt occlusion(2), respiratory failure(2), low cardiac output due to heart failure and pericardial effusion(2) and sepsis(2). Late deaths resulted from acute cardiac arrest during the follow up cardiac catheterization, hypoxic myocardial failure, and arrhythmia. Year of surgery, shunt size, age at operation, and complexity of the anomalies were not the risk factors for mortality. Six month shunt patency rate was 97% and overall patency rate was 96%. Postoperative complications comprised of shunt occlusion(6), phrenic nerve palsy(3), and wound infection(2). CONCLUSION: We demonstrated that modified Blalock-Taussig shunt was a useful tool to palliate the infants with complex cyanotic heart disease in whom early complete repair was not feasible with acceptable mortality and patency rate. An adequate postoperative management and a meticulous surgical technique may be key factors for the better results.
Arrhythmias, Cardiac ; Blalock-Taussig Procedure* ; Cardiac Catheterization ; Cardiac Catheters ; Cardiac Output, Low ; Follow-Up Studies ; Heart Arrest ; Heart Diseases ; Heart Failure ; Humans ; Infant ; Mortality ; Oxygen ; Phrenic Nerve ; Postoperative Complications ; Risk Factors ; Sex Ratio ; Wounds and Injuries

The brachial plexus block by interscalene approach is useful for any procedure on upper extremity, including the shoulder. Complications such as phrenic nerve block, Horner's syndrome, permanent neurologic damage, high epidural block, total spinal anesthesia, pneumothorax and cardiac arrest etc. were reported. We experienced a case of 56-year old male patient with ankylosing spondylitis who developed cervical spinal cord injury following the turning of head for brachial plexus block by interscalene approach. The patient developed quadriplegia and finally died after 28 days.
Anesthesia, Spinal ; Brachial Plexus* ; Head ; Heart Arrest ; Horner Syndrome ; Humans ; Male ; Middle Aged ; Phrenic Nerve ; Pneumothorax ; Quadriplegia ; Shoulder ; Spinal Cord Injuries* ; Spinal Cord* ; Spondylitis, Ankylosing ; Upper Extremity