Posttraumatic Retropharyngeal Pseudomeningocele—A Case Report

A retropharyngeal pseudomeningocele after cervical vertebral fracture dislocation is an extremely rare complication and often associated with hydrocephalus. It usually presents with respiratory difficulty and dysphagia, sometimes as an incidental finding in radiological study. We reported a case of 45-year-old female patient who had posttraumatic lower cervical prevertebral retropharyngeal pseudomeningocele, found as an incidental finding in a routine radiological workup. Patient underwent ACDF but expired 2 weeks postoperatively due to respiratory failure. Although the prognosis of retropharyngeal pseudomeningocele depends upon the severity of initial trauma, early recognition and management can prevent enlargement of cyst and development of respiratory difficulty and dysphagia.

Ludwig’s angina: analysis of clinical features and their management strategy: a study of 30 patients

<p><strong>Background:</strong> Ludwig’s Angina is rapidly progressing infection of submandibular space that can cause severe airway compromise and death. The present study was done to evaluate the clinical features and management strategies in Ludwig’s angina.</p><p><strong>Methods:</strong> Thirty patients presenting with clinical diagnosis of Ludwig’s Angina were recruited in the study. All patients were given systemic antibiotics. Tooth extraction and surgical drainage was done wherever required. Patient records were reviewed for age, sex, duration of symptoms, clinical presentation, etiology, culture/sensitivity reports, requirement of surgical drainage or tracheostomy, hospital stay and complications.</p><p><strong>Results:</strong> The most common age group was third decade of life. Caries tooth was most common etiology followed by gingivitis. Difficulty in swallowing and pain in neck were the most common symptoms. Diabetes was the most common associated co-morbidity followed by chronic renal failure. Surgical treatment was required in twenty-one cases. Eight cases were treated medically while one patient expired during medical treatment. Necrotizing fasciitis was the most common complication. For most patients the hospital stay was between 1-2 weeks.</p><p><strong>Conclusion:</strong> We advocate that surgical management should be done at earliest in presence of respiratory difficulty as medical treatment alone can prove to be dangerous. It can be managed conservatively in younger patients without any associated co-morbidity or respiratory difficulty. However no single factor can predict the behaviour of this disease and it is advisable to be ready for immediate airway management.</p>

Anaesthesia for Caesarean section: Regional anaesthesia

Regional anaesthesia is the technique of choice for CS, provided no contra-indications exist. The relationship between increased use of regional techniques and decreased maternal mortality is well recognized, with evidence suggesting it to be 16 times safer than GA. The use of three commonly practised techniques; epidural top-up, spinal, and combined spinal–epidural anaesthesia are described in detail in this chapter. Pain during CS surgery is the most common complaint and litigation made against obstetric anaesthetists. The importance and conduct of thorough block assessment prior to commencement of surgery and its documentation is emphasized with a ‘top tips’ list. Management of a failed block is described for all three techniques, together with strategies to treat common intra-operative complications e.g. hypotension and respiratory difficulty.

Upper Airway Obstruction among the Paediatric Population in the University of Port Harcourt Teaching Hospital: The Place of Tracheostomy in the Management

Background: The paediatric age group has very peculiar anatomic and physiologic airways therefore, obstruction which commonly occurs in this population, can pose serious challenges in this age group. Aim: To study the pattern and aetiology of acute upper airway obstruction in the paediatric age group in University of Port Harcourt teaching hospital and to determine the place of tracheostomy in the management. Patients and Methods: It is a descriptive hospital based study of all paediatric patients; aged 0-15 years with upper airway obstruction that presented to the ear, nose and throat department and the children emergency ward of university of Port Harcourt teaching hospital within the period of January 2014 to December 2019. Data on demographics, clinical presentations, causes and management were obtained using a Proforma. The diagnosis of upper airway obstruction is made in a child with any degree of respiratory difficulty with or without associated stridor or stertor arising from lesions above the thoracic inlet. Children with respiratory difficulty other than that from an upper airway obstruction were excluded from the study. Data obtained were analyzed with the IBM statistical package for social sciences SPSS version 20. Results were presented in simple descriptive forms with tables. Results: One hundred and sixty paediatric patients with upper air way obstruction with age ranging from 0-15 years were studied. The prevalence of upper airway obstruction was 1.87%. There were more males than females; male to female ratio was 1.2:1. Age group 4-7 years were the most affected, 43.75%. Foreign body aspiration was the commonest cause. Majority of the patients had tracheostomy done, 48.75%. Mortality was n=1(0.625%). Conclusion: Upper air way obstruction among the paediatric age group is still common with foreign body aspiration as a very important cause in our setting. The very young are the most affected and tracheostomy appears to still be the main option of securing airway in these cases in our environment.

The ReSVinet Score for Bronchiolitis: A Scale for All Seasons

The ReSVinet Scale is a clinical score for the assessment of respiratory difficulty in infancy. Our aim was to provide an update on the characteristics that make this tool different to any other. We descriptively compared the characteristics of the ReSVinet Scale with other options that can be found in the current literature or mobile apps stores. The ReSVinet Scale has been devised for its use regardless of the age of the child, entity causing respiratory symptoms, and setting. To this date, it is the only pediatric respiratory scale for acute respiratory distress that provides a parental version, and it is also the first one to have undergone validation in primary care. The tool can be found either in paper format or can be downloaded via App stores for devices running on Android or iOS systems. It has also been adopted recently as the assessment instrument for several clinical trials and for an IMI2 initiative (RESCEU project). All the aforementioned characteristics of the ReSVinet Scale should help toward its dissemination, as currently no other clinical tool for the assessment of respiratory difficulty can offer those advantages.