Airway management for oral surgery in a patient with repaired cleft palate
Notice bibliographique
Résumé
Sir, Sharing airway with surgeon is always challenging for anesthesiologist. However, the preexisting airway defect would certainly add more problems to it. Here, we have highlighted such an issue in patient with preexisting palatal defect who was posted for oral surgery. Otherwise healthy female was diagnosed as a case of benign growth of tongue and scheduled for wide local excision of right lateral border of tongue. She had been operated for repair of cleft palate at the age of 18 month and still had a peanut size defect in the midline of soft palate. There was neither an associated upper respiratory tract infection (URTI) nor airway obstruction like symptoms. Surgical procedure required nasal intubation for the case; however, in view of existing soft palate defect, a decisive dilemma emerged regarding the management of airway. Standard monitors were attached. After standard anesthetic induction, nasal intubation was carefully performed through left nostril and trachea was intubated with 7.5 mm flexomettalic tube under fibreoptic bronchoscopy (FOB). A Ryle's tube was also inserted under Glidoscope view without causing injury to soft palate. Rest of the intraoperative course was uneventful and at the completion of surgery, trachea was extubated. The patient was shifted to postoperative recovery unit. In general, nasal intubation is not advocated in patients with previous cleft palate surgery in childhood and even if it is required then it has to done on the opposite side of defect.[12] Since the defect is in midline in our case and nasal intubation was required, we opted for intubation using FOB. The alternate method of intubation is also described in the literature.[2] The anatomy of the nasopharynx as well as oropharynx usually gets altered after the cleft palate repair and increases the difficulty during nasotracheal intubation.[3] It also carries a risk of damage to the repaired palatal defect. Although considered being a gold standard, FOB has its own limitations in such conditions. It requires the expertise to assess the size of the nasopharyngeal ports and passing the scope into the oropharynx without further traumatizing the nasopharyngeal structures. Moreover, in conditions with secretions and bleeding, it becomes difficult to visualize by FOB. In summary, airway management in patients with previous cleft palate surgery will always be a challenge for the anesthesiologist and will influence the method of airway control. Thorough preoperative assessment to rule out persisting palatal defect coupled with judicious implementation of knowledge and skill is needed to avert the unwanted complication.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,001 | 0,002 |
| Bibliométrie | 0,002 | 0,001 |
| Études des sciences et des technologies | 0,004 | 0,001 |
| Communication savante | 0,002 | 0,002 |
| Science ouverte | 0,002 | 0,001 |
| Intégrité de la recherche | 0,007 | 0,004 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,004 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».