{"title":"Peri-operative and anaesthetic considerations for gender-affirming vocal surgery","authors":"A. Lim, J. Myatt, D. Inglis, C. Al Yaghchi","doi":"10.1002/anr3.12336","DOIUrl":"https://doi.org/10.1002/anr3.12336","url":null,"abstract":"<div>\u0000 \u0000 <p>The number of people identifying as transgender and/or gender diverse has increased significantly in recent years. As there are no pharmacologic options for raising vocal pitch and voice therapy may have limited benefit, vocal feminisation surgery is important for this group of patients. It is important for clinicians to be aware of the procedures which may be carried out and the implications for subsequent airway management. In this article, we present the case of a 46-year-old transgender woman who underwent gender-affirming vocal surgery. We will discuss the modified Wendler glottoplasty surgical technique, anaesthetic management and postoperative recovery. We also discuss future peri-operative implications, including airway management for those undergoing general anaesthesia for subsequent operations.</p>\u0000 </div>","PeriodicalId":72186,"journal":{"name":"Anaesthesia reports","volume":"12 2","pages":""},"PeriodicalIF":0.8,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142692111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Anaesthesia reportsPub Date : 2024-11-18eCollection Date: 2024-07-01DOI: 10.1002/anr3.12333
V Mazandi, L Grosinger, C Ward, R Daly Guris
{"title":"The impact of neck flexion on ventilation and glottic visualisation in a child with Treacher Collins syndrome.","authors":"V Mazandi, L Grosinger, C Ward, R Daly Guris","doi":"10.1002/anr3.12333","DOIUrl":"10.1002/anr3.12333","url":null,"abstract":"<p><p>We report the airway management of an 11-year-old boy with Treacher Collins syndrome. In three instances under general anaesthesia, ventilation via either anaesthesia facemask or supraglottic airway device proved virtually impossible except when the neck was flexed, which runs counter to what is typically observed during routine anaesthetic care. In this report, the impact of neck flexion on the patient's airway is demonstrated with images obtained on videolaryngoscopy and flexible endoscopy. It is prudent to manage airways using validated techniques and established algorithms. Nonetheless, airway management can benefit from atypical measures.</p>","PeriodicalId":72186,"journal":{"name":"Anaesthesia reports","volume":"12 2","pages":"e12333"},"PeriodicalIF":0.8,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11573459/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142670074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"High spinal anaesthesia during local anaesthetic skin infiltration at the cervical facet joint","authors":"J. C. H. Goh, Y. M. Gn, D. J. A. Tan, Z. W. Lim","doi":"10.1002/anr3.12334","DOIUrl":"https://doi.org/10.1002/anr3.12334","url":null,"abstract":"<div>\u0000 \u0000 <p>Facet joint injections are generally safe to perform with a low incidence of adverse events. There are few published reports of neurological complications occurring following procedures at the facet joint or cervical epidural space. However, complications from local anaesthetic infiltration to the skin and surrounding tissue have not been reported. We report a case of transient tetraplegia after local anaesthetic infiltration to the skin in preparation for cervical facet joint injection. We discuss potential reasons for this complication and suggest practice modifications which could reduce the risk.</p>\u0000 </div>","PeriodicalId":72186,"journal":{"name":"Anaesthesia reports","volume":"12 2","pages":""},"PeriodicalIF":0.8,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142665846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The impact of neck flexion on ventilation and glottic visualisation in a child with Treacher Collins syndrome","authors":"V. Mazandi, L. Grosinger, C. Ward, R. Daly Guris","doi":"10.1002/anr3.12333","DOIUrl":"https://doi.org/10.1002/anr3.12333","url":null,"abstract":"<p>We report the airway management of an 11-year-old boy with Treacher Collins syndrome. In three instances under general anaesthesia, ventilation via either anaesthesia facemask or supraglottic airway device proved virtually impossible except when the neck was flexed, which runs counter to what is typically observed during routine anaesthetic care. In this report, the impact of neck flexion on the patient's airway is demonstrated with images obtained on videolaryngoscopy and flexible endoscopy. It is prudent to manage airways using validated techniques and established algorithms. Nonetheless, airway management can benefit from atypical measures.</p>","PeriodicalId":72186,"journal":{"name":"Anaesthesia reports","volume":"12 2","pages":""},"PeriodicalIF":0.8,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/anr3.12333","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142665845","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Cardiac arrest during alveolar recruitment manoeuvre under general anaesthesia for laparoscopic surgery","authors":"M. C. Larsen, U. K. Soni","doi":"10.1002/anr3.12332","DOIUrl":"https://doi.org/10.1002/anr3.12332","url":null,"abstract":"<p>A 67-year-old woman with no history of cardiovascular disease, undergoing an elective laparoscopic cholecystectomy, experienced severe bradycardia and cardiac arrest immediately following an alveolar recruitment manoeuvre under general anaesthesia. Prompt cardiopulmonary resuscitation restored cardiac output within 2–3 min. Postoperatively, she remained stable and was discharged following 24 h of monitoring. The cardiac arrest was likely triggered by vagal nerve stimulation and activation of intrinsic cardiac reflexes by the alveolar recruitment manoeuvre. The event emphasises a rare, but significant, risk of the routine management of pulmonary atelectasis.</p>","PeriodicalId":72186,"journal":{"name":"Anaesthesia reports","volume":"12 2","pages":""},"PeriodicalIF":0.8,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/anr3.12332","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142574096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
H. Elsharkawy, K. Lebak, A. Crofton, S. E. Pope, P. A. Traxler, S. A. Baraka, L. E. Tollinche
{"title":"Retrodural space: a cadaveric evaluation","authors":"H. Elsharkawy, K. Lebak, A. Crofton, S. E. Pope, P. A. Traxler, S. A. Baraka, L. E. Tollinche","doi":"10.1002/anr3.12323","DOIUrl":"https://doi.org/10.1002/anr3.12323","url":null,"abstract":"<p>The retrodural space is an interfascial tissue plane located between the ligamentum flavum and the interspinous ligament [<span>1-3</span>]. The ligamentum flavum forms a barrier between the retrodural and epidural spaces; however, theoretically normal gaps can allow the spread of medications into the epidural space [<span>4</span>]. Therefore, this space can be a potential location for injecting local anaesthetics, leading to their spread into the dorsal rami, neural foramen and epidural space.</p><p>We investigated this technique in one unembalmed cadaver to determine the distribution of local anaesthetic and dye after injection into the lumbar retrodural space. Anterior–posterior fluoroscopic and ultrasound imaging (a curved array transducer in the transverse window between the L3 and L4 vertebrae) were used to guide the injection. An 18-gauge Tuohy needle was advanced in-plane from lateral to medial (left paramedian approach) (Fig. 1a). Once the needle tip was identified superficial to the ligamentum flavum with ultrasound and increased tactile resistance was noted, 6 ml of lidocaine 1% mixed with 0.5 ml methylene blue and 3.5 ml of iodinated contrast agent was injected (Fig. 1b).</p><p>We observed staining in the tissue plane deep (anterior) to the erector spinae muscles from T12 to L5 (Fig. 2a). The intact facet joints showed dye spread around the capsule (Fig. 2b). The lumbar dorsal root ganglion, the dura and the spinal nerves showed no staining (Fig. 2c).</p><p>This is the first cadaveric study of intentional injection into the retrodural space. This technique may prove useful for posterior truncal wall coverage as it allows the dorsal rami to be blocked.</p><p>The authors state that every effort was made to follow all local and international ethical guidelines and laws pertaining to the use of human cadaveric donors in anatomical research.</p>","PeriodicalId":72186,"journal":{"name":"Anaesthesia reports","volume":"12 2","pages":""},"PeriodicalIF":0.8,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/anr3.12323","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142447836","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
L. R. Kidd, P. Wegrzynek, C. Newell, E. Wainwright
{"title":"An exploration of the cognitive and affective processes for anaesthetists when performing an emergency front of neck airway*","authors":"L. R. Kidd, P. Wegrzynek, C. Newell, E. Wainwright","doi":"10.1002/anr3.12331","DOIUrl":"10.1002/anr3.12331","url":null,"abstract":"<div>\u0000 \u0000 <p>Emergency front of neck airway (eFONA) is a potentially lifesaving but very high-stress procedure. We explored the cognitive and affective processes involved via semi-structured interviews with 17 UK anaesthetists who had attempted eFONA within the previous two years. Thematic analyses generated two meta-themes: ‘Making the decision is the hardest part; the doing is easier’ and ‘What helps make the decision?’. We found concerns around scrutiny, lack of a flat hierarchy, unfamiliarity with the situation and the lack of a model for transitioning to eFONA. Culture change, using a shared mental model, priming and emotional disengagement, assisted with eFONA decision-making. Conclusions and implications for practice are presented.</p>\u0000 </div>","PeriodicalId":72186,"journal":{"name":"Anaesthesia reports","volume":"12 2","pages":""},"PeriodicalIF":0.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142395666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Facial fire with use of high-flow nasal oxygen during laser surgery","authors":"S. Shankla, N. De Zoysa, J. Bird, M. Girgis","doi":"10.1002/anr3.12329","DOIUrl":"10.1002/anr3.12329","url":null,"abstract":"<div>\u0000 \u0000 <p>Use of high-flow nasal oxygen to enable apnoeic oxygenation during tubeless airway surgery is well-established. The use of an ignition source in this oxygen-rich environment increases the risk of surgical fire. We present a case of facial fire secondary to the use of carbon dioxide laser and high-flow nasal oxygen during a surgical procedure for subglottic stenosis. The incident occurred when the laser was being tested near the patient, resulting in superficial burns to the patient's face and neck. The airway was unaffected and the burns were managed conservatively. This case highlights important safety consideration for the use of an ignition source in the presence of high-flow nasal oxygen and the role of human factors and in-built risk mitigation features.</p>\u0000 </div>","PeriodicalId":72186,"journal":{"name":"Anaesthesia reports","volume":"12 2","pages":""},"PeriodicalIF":0.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142395675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"A novel application of the Hyperflex™ tracheostomy tube for lung isolation in a patient with airway stoma after laryngectomy","authors":"P. Maurya, N. Gupta, E. Dhamija, V. Kumar","doi":"10.1002/anr3.12328","DOIUrl":"10.1002/anr3.12328","url":null,"abstract":"<div>\u0000 \u0000 <p>In patients who have undergone laryngectomy followed by permanent tracheostomy, managing the airway for one-lung ventilation during lung surgery may present a challenge for anaesthetists. This case report discusses a 45-year-old man with a permanent tracheostomy after a laryngectomy performed for laryngeal carcinoma 5 years ago. He was scheduled to undergo excision of a right bronchial mass for which one-lung ventilation was required. An adjustable Flange Hyperflex™ Tracheostomy tube (Bivona® Silicone Tracheostomy tube, Smiths Medical ASD, Inc., Gary, Indiana, USA) was used for this purpose and the tube was guided into the left main bronchus with a bronchoscope. Appropriate lung isolation was achieved using this technique, and there were no airway-related complications during or after the surgery. This case report shows that a Hyperflex™ tracheostomy tube can be successfully utilised in challenging airway scenarios in patients with a tracheostomy, where other options may not be feasible.</p>\u0000 </div>","PeriodicalId":72186,"journal":{"name":"Anaesthesia reports","volume":"12 2","pages":""},"PeriodicalIF":0.8,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142382588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The use of surgical sealant to repair intubation-related tracheal injury","authors":"C. Cox, A. Crerar-Gilbert, B. Madden","doi":"10.1002/anr3.12327","DOIUrl":"10.1002/anr3.12327","url":null,"abstract":"<div>\u0000 \u0000 <p>This case study describes the management of a tracheal injury following emergency intubation in a 56-year-old man. After collapsing from heavy alcohol ingestion, intubation was performed using a bougie, leading to a punctate tracheal wound. Initial conservative treatment with antibiotics was followed by bronchoscopy, revealing a tracheal laceration. Rigid bronchoscopy was then performed, and the wound was closed using BioGlue® surgical sealant. The patient made a full recovery, with follow-up bronchoscopy confirming complete healing. This case highlights the effectiveness of BioGlue® as a minimally invasive alternative for tracheal wound closure, reducing the need for more complex interventions.</p>\u0000 </div>","PeriodicalId":72186,"journal":{"name":"Anaesthesia reports","volume":"12 2","pages":""},"PeriodicalIF":0.8,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142382590","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}