Pulmonary function in horses with recurrent airway obstruction after aerosol and parenteral administration of beclomethasone dipropionate and dexamethasone, respectively
Bonnie R. RushElizabeth S. RaubWilliam S. RhoadsM. Julia B.F. FlaminioCharles J. MatsonJoyce E. HakalaJerry R. Gillespie
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Abstract Objective To determine changes in clinical signs of disease and response to pulmonary function testing in horses with recurrent airway obstruction (heaves) after aerosol and parenteral administration of beclomethasone dipropionate and dexamethasone, respectively. Animals 6 horses with inducible and reversible heaves. Procedure Episodes of heaves were induced by exposure (challenge) to moldy hay and straw for 7 days. Horses were assigned to treatment groups (aerosolized beclomethasone dipropionate, parenterally administered dexamethasone, aerosolized propellant [control]), and respiratory frequency and subjective assessment of respiratory effort were determined twice daily. Maximal change in pleural pressure (ΔPpl max ), pulmonary resistance (R L ), and dynamic compliance (C dyn ) was determined on days 0, 7, 10, 14, and 21. Results The R L and ΔPpl max were increased, and C dyn was decreased in all horses in response to natural challenge. Beclomethasone reduced R L on day 10, reduced ΔPpl max on days 14 and 21 and increased C dyn on day 14. Dexamethasone reduced R L and ΔPpl max on days 10, 14, and 21 and increased C dyn on days 10 and 14. Respiratory effort (subjective assessment) improved after 2 and 3 days of beclomethasone and dexamethasone administration but rebounded to pretreatment values 1 and 3 days after discontinuation of drugs. Conclusions Pulmonary function testing responses and clinical signs of airway obstruction were improved by administration of beclomethasone. The magnitude of response to aerosolized beclomethasone generally was less marked than the response to parenterally administered dexamethasone. Higher or more frequent dosing of aerosolized beclomethasone may be necessary to achieve the anti-inflammatory response to parenterally administered dexamethasone. ( Am J Vet Res 1998;59:1039–1043)Keywords:
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Airway management is critical during near-fatal obstruction of the upper airway in epiglottitis; however, this is challenging because of the sitting posture and agitated mental status of the patient. Moreover, there is currently no established protocol for safe airway management in patients with epiglottitis. Here, we describe the use of a conventional tracheal tube as a nasolaryngeal airway to maintain airway patency at the site of airway narrowing in the supine position, which enabled alleviation of imminent airway obstruction in a patient with epiglottitis. For definitive airway establishment, tracheostomy was then safely performed in the supine position.
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Pierre Robin sequence (PRS), also called Robin sequence, is a congenital anomaly characterized by a triad of micrognathia, glossoptosis, and upper airway obstruction. Infants with PRS can present with varying degrees of respiratory difficulty secondary to upper airway obstruction. There has been no consensus for the treatment of upper airway obstruction in infants with PRS, but recent studies recommend attempting non-surgical interventions before surgical treatment. In this case report, we present 3 cases of infants diagnosed with PRS who showed persistent respiratory difficulties after birth. Before considering surgical intervention, insertion of a nasopharyngeal airway was attempted in these infants. Following this procedure, symptoms of upper airway obstruction were relieved, and all infants were discharged without surgical interventions; the nasopharyngeal airway was removed 1 to 2 months later. To date, no infant has shown signs of upper airway obstruction. Nasopharyngeal airway insertion is a highly effective and less invasive treatment option for infants with PRS. However, it is not widely known and used in Korea. Nasopharyngeal airway insertion can be preferentially considered before surgical intervention for upper airway obstruction in such infants. Keywords: Pierre Robin syndrome; Upper airway obstruction; Nasopharyngeal airway
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Topicalisation of the airway by various techniques has routinely been recommended for awake fibre-optic bronchoscopy in cases of difficult airway. However, topicalisation by itself can cause airway obstruction by decreasing the tone of the laryngeal muscles and causing a dynamic air inflow obstruction. Two cases of difficult airway are illustrated where anaesthetising upper airway with nebulisation with 4% lignocaine (Xylocaine™) or 2% lignocaine (Xylocaine™) jelly resulted in stridor and upper airway obstruction. This is the first reported case of airway obstruction after lignocaine (Xylocaine™) jelly. We would like to highlight that topicalisation of airway, once thought as a relatively safe technique, can cause airway collapse if not detected and anticipated at the earliest. Pre-operative spirometry and airway ultrasonography can be useful in detecting the patients at risk of developing airway obstruction. Using a nasopharyngeal airway during topicalisation can serve as a valuable device in preventing total airway obstruction in susceptible patients.
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Abstract We developed a technique to determine the site of upper airway obstruction in patients with idiopathic obstructive sleep apnea (OSA). This technique is based on the analysis of inspiratory airflow pressures at various levels of the pharyngeal airway during sleep. Pharyngeal pressure was measured by a moveable Millar catheter pressure transducer. The catheter's position in the airway was localized radiographically. Ten patients with OSA were tested: five patients were found to have upper airway obstruction at the level of the soft palate, and five had upper airway obstruction at the base of the tongue. We concluded that measuring airway pressures at multiple sites along the airway is useful in localizing the site of obstruction in patients with OSA, and may have important implications in terms of the patient's response to surgical treatment.
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The aim of the study was to evaluate noninvasive continuous positive airway pressure as first-line treatment for upper airway obstruction in neonates with Pierre Robin sequence. Forty-four neonates were enrolled and classified in 4 groups: ventilator-dependent patients (severe upper airway obstruction group), patients with clinical upper airway obstruction, an abnormal (moderate upper airway obstruction group) or normal polygraphy (mild upper airway obstruction group), and those with no clinical upper airway obstruction (no upper airway obstruction group). Five neonates in the severe upper airway obstruction group (n = 9) were successfully managed by noninvasive continuous positive airway pressure and 4 required a tracheotomy. The moderate upper airway obstruction group (n = 4) was successfully managed by noninvasive continuous positive airway pressure and the other patients by prone positioning. Continuous positive airway pressure represents an effective treatment of upper airway obstruction in Pierre Robin sequence and may be recommended in selected patients.Therapeutic, IV.
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In a series of 12 cases with initially abnormal brain scans, repeat scan after dexamethasone therapy showed changes in 10 but none in 2. Two of the 10 reverted to nearly normal; 6 showed marked improvement although the lesions were still visible, and 1 showed slight improvement. One patient was on dexamethasone at the time the study was started and her scan showed dramatic, increased uptake after the drug was discontinued. Generally, clinical improvement correlated with improvement in the scan. Our clinical observations suggest that dexamethasone can cause changes in the 99mTc brain scan.
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