Archive for the ‘Airway Obstruction’ Category


We reviewed the laser record in our case for possible causes of the fire. No differences in pulse frequency or total energy delivered were found by 10-second or 2-minute treatment intervals. We found a maximum of five pulses delivered per any 10-second interval, and only three pulses were delivered at the time of the fire. Thus, we concluded the most likely cause of the fire was the increased FIo2. When complications occur, quick, decisive action is imperative. Our case illustrates that rapid removal of the burning materials can minimize trauma and morbidity. It should also be noted that the potential exists for larger disaster when vigorously burning materials are directly connected to anesthesia equipment and volatile gases. (more…)

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  • Long-term Survival after Endobronchial Fire during Treatment of Severe Malignant Airway Obstruction: DiscussionLaser phototherapy has been shown to be effective with acceptable risks in the management of malignant and benign obstructing airway lesions. The concomitant use of radiation therapy after LPT for malignant lesions improves the quality of life and survival, which may exceed one year. At initial treatment, our patient had a Karnofsky score of 10 percent, indicating an extremely poor prognosis with a high likelihood of early mortality. As a result of the endobronchial fire, there was initial worsening of the airway obstruction and her hospital stay was lengthened by a few days. Combined LPT and radiation therapy enabled her to survive nearly 23 months with improvement of her Karnofsky score and no long-term morbidity due to the fire. (more…)

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  • Both arterial oxygen saturation (SaOg) (Biox II ear oximeter) and mixed venous oxygen saturation (SvOa) were monitored. Her hemodynamic status became unstable and she required Flog 0.5 to maintain Sa02 above 90 percent and Sv02 above 60 percent Table 1, item 2 gives the laser settings and bronchoscopic findings. During LPT directed to the left main bronchus, the Teflon-coated laser fiber (TCF) tip was maintained 1 cm distal to the bronchoscope and 1 cm from the treatment site. After 201 pulses, the TCF was damaged and failed to function properly. Another TCF was not available. Since insufficient improvement in left main bronchus patency had been achieved, LPT was continued using an 0.6 mm quartz monofilament fiber without Teflon sheath (NTCF) (designed for intravascular procedures and lacking an air-feeding jacket). After 38 pulses were delivered uneventfully over 5-10 minutes, she became hypotensive and the Sa02 dropped below 90 percent. She was stablized over 15 minutes. Administration of enflurane was stopped and the FIo2 increased to 1.0. (more…)

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  • Long-term Survival after Endobronchial Fire during Treatment of Severe Malignant Airway ObstructionLaser phototherapy (LPT) utilizing the neodymium-yttrium-aluminum-garnet (Nd:YAG) laser has been shown to be an effective tool in the therapy of malignant endobronchial obstruction12 especially when combined with radiation therapy. While LPT is generally safe, there are potential complications which can increase morbidity and mortality. We present a case of endobronchial fire during LPT and report long-term follow-up after successful outcome with no residual damage resulting from the occurrence.
    Case Report
    A 65-year-old woman with squamous cell carcinoma (left upper lobe resection in June, 1985) was admitted to another hospital in November, 1985 with dyspnea and chest pain. Physical examination revealed pulse rate of 88/min; respirations, 24/min; blood pressure, 164/94 mm Hg; inspiratory and expiratory rhonchi and diffuse wheezes. The chest x-ray film showed elevation of the left hemi-diaphragm with well expanded left lower lobe. Arterial blood gas determinations showed: pH, 7.37; Po2, 49; Pco2, 46 (room air). Over nine days of therapy with bronchodilators and antibiotics, she developed stridor with Pco2 increasing to 55. She was transferred to our hospital. (more…)

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