ABSTRACT
Coronavirus disease 2019 (COVID-19), besides its well-known deleterious effects on the respiratory system, is also reported to affect the central nervous system (CNS), presenting with neurological manifestations, that are commoner among older patients with associated co-morbidities and in the critically ill with COVID pneumonia. Infective, cerebrovascular, and hypoxic-toxic-metabolic etiology have been implicated. Reported outcomes have been poor with persistent neurological deficits among the majority who have survived. We report a young lady who presented with neurological manifestations alongside moderately severe COVID-19 pneumonia. Diagnosed early and managed as severe encephalopathy after excluding infective and cerebrovascular aetiology. Responded well to conservative measures and made a complete recovery. Early recognition of neurological manifestations of COVID-19 disease followed by the institution of appropriate therapies improved the outcomes.
ABSTRACT
Studies suggest that flexible fibreoptic bronchoscopy, when performed through a laryngeal mask airway (FFB-LMA), have fewer rates of complications and better efficacy. In comparison to rigid bronchoscopy, FFB is safer for the operator, as it prevents direct exposure to respiratory tract infections such as Covid-19. Airway maintenance with LMA is uncommon when performing FFB in Sri Lanka. This study aimed to report the efficacy and peri-procedural complications of FFB performed through LMA at a tertiary care children's hospital in Sri Lanka. Data were retrieved retrospectively from anaesthetic charts and bed head tickets of all the patients who underwent FFBs performed through LMA at the Sirimavo Bandaranayake Specialized Children's Hospital, Peradeniya. Collected data included age, gender, indication, duration of the procedure, bronchoscopy findings, and complications, if any. Of the total of 176 patients, the majority were infants and between 1-5 years (33.52% each). The most common indication was recurrent/persistent respiratory tract infections (57.9%) followed by foreign body aspirations (21.6%). Clinically significant abnormalities were detected in 87% of the cases. The success rate of extraction of positively identified foreign bodies was 100%. Perioperative complications were observed in 4.5% of the patients. Risk factor analysis, based on multivariate logistic regression, identified the duration of the procedure as a risk factor for complications (OR = 15.57, p = 0.0011). FFB performed through LMA has good efficacy and low complication profile in the studied patient sample.