Upper Airway Infections

Question 0

What are Some common upper airway infections and adults?

Answer 0

1) Sinusitis
2) laryngitis
3) tonsillitis
4) peritonsillar abscess
5) Acute epiglottitis
6) Pharyngeal abscess
7) retropharyngeal abscess
8) Oral infection
9) Ludwigs angina

Question 1

What are some common upper airway infections in children?

Answer 1

1) Acute epiglottitis (can cause problems with emergence)
2) croup
3) tonsillitis
4) Laryngotracheobronchitis

Question 2

When gathering the history regarding airway infections what are some important questions you should ask

Answer 2

1) out when the onset was and when the original symptoms occurred
2) the progression
3) find out where the Infection is located
4) are there any associated diseases with it

Question 3

What are some questions that you should ask yourself regard the physical examination of airway infections

Answer 3

1) How are the airway and surrounding tissue effected
2) does the tissue move with normal actions
3) can i move the tissue if necessarily
4) how is the current airway patency compared to normal (cross-section at or less than 70%)
5) how much leeway in paytency if edema forms or worsens

Question 4

Airway case 1

In POHA, you are interviewing 34-year-old man with history of alcohol abuse and 60 pack years of tobacco abuse. His neck is stiff And he has limited mouth opening. With light and tongue depressor you see an apparent mass on the right pharyngeal wall obscuring the margin of the soft palate And displacing the uvula.

Answer 4

Planning
Surgical diagnosis: peritonsillar abscess
additional data: CT scan
type of anesthesia:
airway management plan: anode OETT
Induction: short-acting IV anesthetic, short-acting muscle relaxant
Maintenance: Sevo or Des
Emergence: goal is normotensive to keep the surgical field drive
Postop airway management: careful oral suctioning with flexible catheter & patient should be awake and alert

Question 5

Case 2

55-year-old diabetic male presents to the ER with inability to eat, drink, or swallow due to throat pain. On physical exam, he has very poor dentition, his mouth opening is limited to about 1 cm, and his submental compartment is tense

Answer 5

Planning

Surgical ex: Ludwig’s angina
additional data: get CT scan/CBC with diff
type of anesthesia: general airway management plan: awake FFOB NETT sedation induction: IV after intubation complete
Maintenance: Sevo or Des
Postop Airway management: patient will remain intubated 1-3 days, r/t antibiotic efficacy
Emergence: sedation with propofol infusion

Question 6

Case 3

You’re called to the ER to see a 4 yr old boy who began crying and would not lie down for his afternoon nap. His mother brought him in for a temperature of 103°. The patient is sitting on stretcher, Leaning forward, and drooling. He is stridorous and does not want to be examined. The ER physician wants to get a soft tissue lateral neck x-ray, but the pediatric surgeon wants you to transport him immediately to the OR for a tracheostomy

Answer 6

Planning

Surgical DX: acute epiglottitis
additional data: presentation, exam, CBC with diff
type of anesthesia: general
airway management plan: OETT
induction: single breath Sevo
Maintenance: Sevo
Post op airway management: patient will remain intubated 1-2 days, for antibiotic efficacy
emergence: complete sedation, possible NMB

Question 7

Management of a patient with retropharyngeal abscess

Answer 7

Patient presents with sore throat and Difficulty swallowing. On assessment you note that her left posterior Pharyngeal wall proves to be very tender on palpation.

Note: this can produce a partial airway extraction and can limit nasopharyngeal access . Also the infection can limit the efficacy of topical pharyngeal anesthesia. Airway management, you should use OETT With possible use of FFOB, depending on the size of the abscess

Question 8

History of Ludwigs angina

Answer 8

Angina ludovici – cellulitis of the floor ofmouth

Angina (Greek) – strangling

Question 9

Pathophysiology of acute epiglottitis

Answer 9

H flu infection

acute onset and can lead to life-threatening airway emergency

usually seen in children 2-6 years of age

fever, drool, difficulty swallowing
sitting upright, leaning forward,
lateral x-ray will demonstrate an enlarged epiglottis

Question 10

What is this?

insert picture

Answer 10

Kissing tonsils

notice the significant lymphoid tissue enlargement
this will obscure DL view
more of a problem in children
often due to bacterial or viral infections
Major peri-op risk is postop hemorrhage