Epiglotite na era pós-vacinal ao Haemophilus influenzae tipo B / Epiglottitis in the post Haemophilus influenzae type B vaccine era

A epiglotite, conhecida recentemente como supraglotite, é uma infecção grave da epiglote e estruturas supraglóticas, com consequente obstrução da via aérea superior e risco iminente de morte. Trata-se de emergência médica, e a via aérea do paciente deve ser garantida o mais breve possível. Com o desenvolvimento e introdução da vacinação contra o Haemophilus influenzae tipo B (Hib), houve queda expressiva de sua incidência e mortalidade na faixa etária pediátrica, principalmente em crianças menores de cinco anos, porém, tal redução não foi tão significativa em adultos. A doença passou a ser mais comum em crianças acima de cinco anos e na faixa etária adulta, e agentes como Streptococcus e Staphylococcus tornaram-se os principais responsáveis. Embora rara, ela ainda não foi eliminada, fazendo-se necessário o seu rápido reconhecimento e tratamento, a fim de evitar mortalidade. (AU)

Epiglottitis, recently known as supraglottitis, is a severe infection of the epiglottis and supraglottic structures, leading to upper airway obstruction and imminent risk of death. It is considered a medical emergency and the patient's airway must be cleared as soon as possible. With the development and introduction of the vaccination against Haemophilus influenzae type B (Hib), there has been a significant decline in its incidence and mortality in the pediatric age range, especially in children younger than five years old, yet not so much in adults. The disease has become more common in children older than five years old and in adults, with Streptococcus and Staphylococcus being the main responsible pathogens. Although it is a rare condition, it has not yet been eradicated, making its fast recognition and treatment necessary to decrease the chance of mortality. (AU)

Failed ventilation with LMA Proseal [registered sign] in a patient with sleep apnea syndrome

Patients with sleep apnea syndrome [SAS] have excessive adipose tissue in oropharynx which can obstruct the airway. A high prevalence of difficult intubation has been reported in these patients and an association between the severity of SAS and difficult intubation has been suggested. LMA Proseal[registered sign] [LMA Company, USA] has been launched as a better alternative to LMA classic, as it provides good airway seal due to its modified cuff. The improved seal of LMA Proseal[registered sign] [PLMA[registered sign]] has an advantage in obese patients where higher airway pressures are required for positive pressure ventilation. We found that LMA Classic[registered sign] provided better airway management than PLMA[registered sign] in one of our obese patients with SAS

CT Findings of Supraglottitis in Adults

PURPOSE: To determine the CT findings and to evaluate the role of CT scanning in adult supraglottitis. MATERIALS AND METHODS: The CT findings of five male patients aged between 29 and 69 (mean, 53) years with adult supraglottitis were reviewed and evaluated. Particular attention was focussed on swelling of epiglottis and laryngeal structures, abscess formation and extension of the inflammatory process to adjacent neck spaces. In addition, the findings of CT were compared with those of plain radiography. RESULTS: In all patients, CT revealed swelling of the epiglottis and aryepiglottic folds, while in four, swelling of the paralaryngeal space was noted. Abscesses in the epiglottis were seen in four patients, and in three of these, small abscesses in the preepiglottic, parapharyngeal, or peritonsillar space or palatine tonsil, were also noted. One patient had an emphysematous epiglottitis, and in three, inflammation extended to adjacent regions of the neck, namely the parapharyngeal, retropharyngeal, submandibular, or peritonsillar space. Plain radiographs gave only restricted information regarding abscess formation and the extension of inflammation to adjacent neck space. CONCLUSION: CT is useful for assessing the extent of adult supraglottitis and for evaluating ensuing complications. It may also be useful for differentiating this condition from other supraglottic diseases, for the planning of treatment, and for evaluating the results of therapy.