King Vision video laryngoscope for severe post burn contracture neck: an encouraging experience / Videolaringoscópio King Vision para contratura grave do pescoço após queimadura: uma experiência encorajadora

Abstract Background and objectives Managing the airway of post burn contracture of the neck has always been challenging to anesthesiologists as it limits the alignment of oro-pharyngo-laryngeal axes because of functional and anatomical deformities that occur as a result of long standing contractures. Here the role of the King Vision video laryngoscope which is the latest in the series of video laryngoscope has been evaluated for such patients. Case report A 35 year old male patient with post burn contracture of neck was scheduled for release of the contracture. As the patient had had fixed flexion deformity of the neck we did not attempt the conventional laryngoscopy. Instead we opted for King Vision video laryngoscope. Conclusion We therefore conclude that King Vision videolaryngoscope can be used for difficult airway situations like post burn contracture of neck.

Resumo Justificativa e objetivos O manejo de vias aéreas em contratura de pescoço após queimadura sempre foi um desafio para os anestesiologistas, pois a contratura limita o alinhamento do eixo orofaringolaríngeo devido às deformidades funcionais e anatômicas que ocorrem como resultado de contraturas de longa duração. Relato de caso Paciente do sexo masculino, 35 anos de idade, com contratura do pescoço após queimadura foi programado para liberação da contratura. Como estava com deformidade fixa em flexão no pescoço, não tentamos a laringoscopia convencional e optamos por usar o videolaringoscópio King Vision. Conclusão O videolaringoscópio King Vision pode ser usado em situações de via aérea difícil como a contratura de pescoço após queimadura.

Surgical outcome of pancreaticoduodenectomy in pancreatic and periampullary neoplasms

Objective: To report the results in the surgical treatment of pancreatic and periampullary neoplasms with emphasis on surgical technique, short-term postoperative outcome and the lessons learnt

Study Design: Case series

Place and Duration of Study: This study was carried out at Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, from October 2014 to May 2016

Methodology: Patients undergoing surgical treatment of pancreatic and periampullary neoplasms were selected. Patients' characteristics including demographics, surgical technique, and 30-day morbidity and mortality were recorded. International Study Group of Pancreatic Fistula [ISGPF] classification was used to define postoperative pancreatic fistula and Clavien-Dindo classification to grade complications

Results: A total number of 65 patients underwent the trial of dissection; 50 had pancreaticoduodenectomy and 15 patients underwent palliative bypass and were excluded from analysis. Sixty-four percent were males and 36% were females. The most common tumor was periampullary [n=29, 58%] followed by pancreatic head [14, 28%] and duodenal tumors [n=07, 14%]. Mean age was 52.92 +/- 13.27 years; mean operating time was 470 +/- 358.28 minutes and median blood loss was 400 [287-500] ml. Pancreaticogastrostomy [PG] was the preferred reconstruction technique in 37 [74%] verses pancreaticojejunostomy [PJ] in 13 [26%] patients. Four [08%] patients needed portal vein reconstruction and two [04%] replaced right hepatic artery resection and reconstruction due to tumor involvement. There were seven Grade A, and one Grade B and C pancreatic fistulae each. Three patients [06%] needed endoscopic therapy for gastrointestinal hemorrhage from pancreatic stump. There was one death in postoperative period

Conclusion: Pancreaticoduodenectomy is a safe procedure with excellent postoperative outcome, if carried out in a specialized hepato-pancreato-biliary unit. A PG reconstruction can be a safer alternative to PJ

Laringoscópio óptico Airtraq® para intubação traqueal em paciente com grande lipoma na nuca: relato de caso / Airtraq® optical laryngoscope for tracheal intubation in a patient with giant lipoma at the nape: a case report / Laringoscopio óptico Airtraq® para la intubación traqueal en un paciente con lipoma enorme en la nuca: relato de caso

JUSTIFICATIVA E OBJETIVOS: Lipoma é uma doença de crescimento progressivo que pode surgir em qualquer parte do corpo. O seu aparecimento na parte de trás do pescoço, especialmente quando é grande o bastante para causar restrição do pescoço, principalmente da extensão, é um desafio para os anestesiologistas sempre que precisam manejar as vias aéreas. Aqui, o papel do Airtraq® foi avaliado no movimento restrito do pescoço. RELATO DE CASO: Relatamos o caso de uma paciente selecionada para remoção cirúrgica eletiva de um lipoma enorme na nuca, medindo 14 x 12 cm, que apresentou dificuldade para assegurar a permeabilidade das vias aéreas por meio de laringoscopia convencional. Para resolver o problema, usamos com sucesso um dispositivo recentemente desenvolvido, o Airtraq®, que é um laringoscópio óptico para assegurar a via aérea. CONCLUSÃO: O Airtraq® pode ser usado para intubação eletiva em pacientes com movimentos restritos do pescoço.

BACKGROUND AND OBJECTIVES: Lipoma is a progressively increasing disease which may appear anywhere in the body. Its appearance at the back of the neck, especially when it is large enough to cause restriction of neck extension, poses challenges to anesthesiologists in airway management whenever needed. This paper evaluates the role of Airtraq® in restricted neck movement. CASE REPORT: Case with a huge lipoma of 14 x 12 cm at the nape, and its surgical removal during an elective operation theatre posed difficulty in securing the airway by conventional laryngoscopy. To overcome the problem we successfully used a newly developed device, the Airtraq®, which is an optical laryngoscope for securing the airway. CONCLUSION: Airtraq® can be used for elective intubation in patients with restricted neck movements.

JUSTIFICATIVA Y OBJETIVOS: El Lipoma es una enfermedad de crecimiento progresivo que puede surgir en cualquier parte del cuerpo. Su aparecimiento en la parte de atrás del cuello, especialmente cuando es bastante grande para causar su restricción, principalmente en la extensión, es un reto para los anestesistas que necesitan siempre manejar las vías aéreas. Aquí el papel del Airtraq® se avaluó en el movimiento restringido del cuello. RELATO DE CASO: Caso de una paciente seleccionada para la retirada quirúrgica electiva de un lipoma enorme en la nuca, que medía 14 x 12 cm, y que tuvo una dificultad para asegurar la permeabilidad de las vías aéreas por medio de una laringoscopia convencional. Para resolver el problema, ha utilizado exitosamente un dispositivo recientemente desarrollado, el Airtraq®, que es un laringoscopio óptico para asegurar la vía aérea. CONCLUSIONES: El Airtraq® puede ser usado para la intubación electiva en pacientes con movimientos restringidos del cuello.