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      Anaesthetic management of an infant with tracheomalacia scheduled for computed tomography angiography: A challenge

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          Abstract

          Tracheomalacia is characterised by collapse of the tracheal wall with respiration. Computed tomography angiography (CTA) can be utilised for evaluation of airway abnormalities but providing sedation/anaesthesia for CTA in such a case carries the risk of airway catastrophe. We describe the anaesthetic management of an infant who had tracheomalacia with >90% collapse in lower two third of the intrathoracic trachea as diagnosed on videobronchoscpy and was scheduled for CTA.

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          An Update on Diagnosis of Tracheomalacia in Children.

          Congenital tracheomalacia is the most common congenital tracheal abnormality and occurs in approximately 1:2,100 children. Tracheomalacia can be isolated or associated with other airway anomalies such as laryngomalacia, bronchomalacia, and large laryngeal clefts. Also, an abnormal division of the embryonic foregut is frequently associated with congenital tracheomalacia; mostly in the form of proximal esophageal atresia with distal tracheoesophageal fistula. In such cases, the ratio between the cartilage ring and the posterior membranous wall drops from the normal ratio of 4 to 5:1 to 2 to 3:1. The diagnosis can be made upon clinical history and physical examination as well as by pulmonary function testing, computed tomography, dynamic magnetic resonance imaging, and fiberoptic bronchoscopy. Other approaches such as tracheobronchography have been used, but have not been validated for the diagnosis of tracheomalacia; fluoroscopy can be specific for diagnosing tracheomalacia, but lacks a reasonable sensitivity. Tracheomalacia is often self-limited and will resolve or become asymptomatic by the second year of life without intervention. For patients who remain symptomatic, possible treatments include pharmacotherapy, positive pressure application, and surgery.
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            Paediatric tracheomalacia - A review of clinical features and comparison of diagnostic imaging techniques

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              The Management of Cyanotic Spells in Children with Oesophageal Atresia

              Cyanotic spells, also known as blue spells, dying spells, or apparent life-threatening events, refer to a bluish tone visible in the mucosal membranes and skin caused by an oxygen decrease in the peripheral circulation. Although this decrease may be transient and benign, it may also be indicative of a severe underlying problem that requires immediate intervention. Children with oesophageal atresia (OA) are at risk for a number of coexisting conditions that may trigger cyanotic spells. This current article will focus on the management of cyanotic spells both in children with innominate artery compression and those with tracheomalacia.
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                Author and article information

                Journal
                Indian J Anaesth
                Indian J Anaesth
                IJA
                Indian Journal of Anaesthesia
                Wolters Kluwer - Medknow (India )
                0019-5049
                0976-2817
                April 2019
                : 63
                : 4
                : 312-315
                Affiliations
                [1]Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
                Author notes
                Address for correspondence: Dr. Manpreet Kaur, Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India. E-mail: manpreetkaurrajpal@ 123456yahoo.com
                Article
                IJA-63-312
                10.4103/ija.IJA_874_18
                6460980
                96d1d59c-0c16-4dbf-9e88-d01adc0cd6d1
                Copyright: © 2019 Indian Journal of Anaesthesia

                This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

                History
                Categories
                Case Report

                Anesthesiology & Pain management
                airway,bronchomalacia,ct angiography,general anaesthesia,sedation,tracheomalacia

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