Insufflation-exsufflation devices in post-operative respiratory failure: Case report

  • Ángel Becerra-Bolaños Anesthesiology and Resuscitation Service, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas, Gran Canaria, Spain
  • Nazario Ojeda-Betancor Anesthesiology and Resuscitation Service, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas, Gran Canaria, Spain
  • Lucia Valencia Anesthesiology and Resuscitation Service, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas, Gran Canaria, Spain
  • Aurelio Rodríguez-Pérez Anesthesiology and Resuscitation Service, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas, Gran Canaria, Spain
Keywords: Respiratory insufficiency, Respiratory therapy, Noninvasive ventilation, Neuromuscular diseases, Postoperative complications

Abstract

Introduction: Patients suffering from a neuromuscular disease have a greater likelihood of postoperative respiratory failure. Sometimes, this complication does not respond to noninvasive mechanical ventilation.

Case report: Perioperative management of a patient with Werdnig-Hoffmann disease who underwent bilateral coronoidectomy due to trismus. The postoperative period was hampered by the patient's poor respiratory mechanics, inducing the appearance of atelectasis. Despite the application of preventive non-invasive mechanical ventilation, the patient suffered respiratory failure and required endotracheal intubation. Finally, the respiratory weaning was achieved after the application of insufflation-exsufflation devices associated with non-invasive mechanical ventilation.

Conclusion: The application of insufflations-exsufflation devices in the immediate postoperative period of patients with neuromuscular diseases promotes the proper respiratory evolution of a patient considered impossible to extubate.

References

1. Ferrer M, Torres A. Noninvasive ventilation for acute respiratory failure. Curr Opin Crit Care. 2015;21:1-6.

2. Khirani S, Bersanini C, Aubertin G, Bachy M, Vialle R, Fauroux B. Non-invasive positive pressure ventilation to facilitate the post-operative respiratory outcome of spine surgery in neuromuscular children. Eur Spine J. 2014;23 Suppl. 4:S406-11.

3. Bach JR, Goncalves MR, Hamdani I, Winck JC. Extubation for patients with neuromuscular weakness: a new management paradigm. Chest. 2010;137:1033-9.

4. Bach JR, Salstein K, Sinquee D, Weaver B, Komaroff E. Long-term survival in Werdnig-Hoffmann disease. Am J Phys Med Rehabil. 2007;86:339-45.

5. Wang CH, Lunn MR. Spinal muscular atrophy: advances in research and consensus on care of patients. Curr Treat Options Neurol. 2008;10:420-8.

6. Graham RJ, Athiraman U, Laubach AE, Sethna NF. Anesthesia and perioperative medical management of children with spinal muscular atrophy. Paediatr Anaesth. 2009;19:1054-63.

7. Guasch Arévalo E, Campo G, Suárez Cobián A, Gilsanz Rodríguez F. Cambio intraoperatorio de plan anestésico en una paciente con enfermedad de Werdnig Hoffman tipo II. Rev Esp Anestesiol Reanim. 2005;52:61-2.

8. Habib AS, Helsley SE, Millar S, Deballi P, Muir HA. Anesthesia for cesarean section in a patient with spinal muscular atrophy. J Clin Anesth. 2004;16:217-9.

9. Watts JC. Total intravenous anesthesia without muscle relaxant for eye surgery in a patient with Kugelberg-Welander Syndrome. Anaesthesia. 2003;58:96.

10. Liu XF, Wang DX, Ma D. Using general anesthesia plus muscle relaxant in a patient with spinal muscular atrophy type IV: a case report. Case Rep Anesthesiol. 2011;2011:1-3.

11. Stewart PA, Philips S, De Boer HD. Sugammadex reversal of rocuronium-induced neuromuscular blockade in two types of neuromuscular disorders: myotonic dystrophy and spinal muscular atrophy. Rev Esp Anestesiol Reanim. 2013;60:226-9.

12. Jaber S, De Jong A, Castagnoli A, Futier E, Chanques G. Non-invasive ventilation after surgery. Ann Fr Anesth Reanim. 2014;33:487-91.

13. MacDuff A, Grant IS. Critical care management of neuromuscular disease, including long-term ventilation. Curr Opin Crit Care. 2003;9:106-12.

14. Forget P, Lois F, Pendeville P. Postoperative use of nasal intermittent positive pressure in a patient with spinal muscular atrophy type II. Acta Anaesthesiol Belg. 2008;59:99-101.

15. Miske LJ, Hickey EM, Kolb SM, Weiner DJ, Panitch HB. Use of the mechanical in-exsufflator in pediatric patients with neuromuscular disease and impaired cough. Chest. 2004;125:1406-12.

16. Mirambeaux Villalona R, Mayoralas Alises S, Díaz Lobato S. Resolution of obstructive atelectasis with non-invasive mechanical ventilation. Arch Bronconeumol. 2014;50:452-3.

17. Marchant WA, Fox R. Postoperative use of a cough-assist device in avoiding prolonged intubation. Br J Anaesth. 2002;89:644-7.
How to Cite
1.
Becerra-Bolaños Ángel, Ojeda-Betancor N, Valencia L, Rodríguez-Pérez A. Insufflation-exsufflation devices in post-operative respiratory failure: Case report. Colomb. J. Anesthesiol. [Internet]. 2017Apr.1 [cited 2021May12];45(Supplement):40 -44. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/454

Downloads

Download data is not yet available.
Published
2017-04-01
How to Cite
1.
Becerra-Bolaños Ángel, Ojeda-Betancor N, Valencia L, Rodríguez-Pérez A. Insufflation-exsufflation devices in post-operative respiratory failure: Case report. Colomb. J. Anesthesiol. [Internet]. 2017Apr.1 [cited 2021May12];45(Supplement):40 -44. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/454
Section
Case Report / Case Series

More on this topic