Indian journal of anaesthesia
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Negative pressure pulmonary oedema (NPPO) is a life threatening condition, manifested due to upper airway obstruction in a spontaneously breathing patient. Upper airway obstruction caused by classic laryngeal mask airway (cLMA) and ProSeal laryngeal mask airway (PLMA) has been reported, and NPPO has also been reported following the use of cLMA. Search of literature did not confirm NPPO following the use of PLMA. ⋯ Multiple attempts were made to get patent airway without success. PLMA was replaced with endotracheal tube following which pink frothy secretion appeared in breathing circuit. Patient was managed successfully with ICU care.
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Postoperative diaphragmatic hernia following transhiatal oesophagectomy is a rare but potentially life threatening complication. We describe a case of a 65 year old patient who developed diaphragmatic hernia following oesophagectomy and presented with cardio pulmonary compromise. During surgery, haemodynamic instability continued despite fluid resuscitation and noradrenaline infusion. ⋯ This can be explained by tension colothorax causing collapse of the underlying lung and cardiac tamponade. It is a surgical emergency requiring urgent decompression for resuscitation. The etiology, clinical presentation, pathophysiology and preventive measures are discussed.
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Ineffective face mask seal is the most common cause for suboptimal pre-oxygenation. Room air entrainment can be more with vital capacity (VC) breaths when the mask is not a tight fit. ⋯ TV breathing for 5 min provides better pre-oxygenation in patients with ineffective mask seal with fresh gas flow of 10 L/min delivered through a circle system.