RESUMEN
We report a case of an 8-year-old boy with laryngeal edema and vocal cord paralysis due to lithium battery ingestion. He had ingested a lithium battery of a television remote controller, and was admitted to our hospital. He was suffering from wheezing and retractive respiration with crying. The foreign body was removed under general anesthesia about two hours after the ingestion. It was a 3 volt lithium battery of 20 millimeters in diameter. Endoscopy showed chemical burn of the postcricoid area and severe edema of the laryngeal arytenoids. Twelve days later we confirmed healing of edema and extubated the tracheal tube, but endoscopy showed bilateral vocal fold paralysis. He had no difficulty in breathing and eating but the vocal cord paralysis remained. Lithium batteries ingestion may cause severe airway injury in a short period because of their large size and high voltage. Immediate removal and careful management are required.
Asunto(s)
Suministros de Energía Eléctrica/efectos adversos , Cuerpos Extraños/complicaciones , Edema Laríngeo/etiología , Litio/efectos adversos , Parálisis de los Pliegues Vocales/etiología , Anestesia General , Niño , Cuerpos Extraños/cirugía , Humanos , Edema Laríngeo/patología , Masculino , Factores de Tiempo , Parálisis de los Pliegues Vocales/patologíaRESUMEN
BACKGROUND: Applying cricoid pressure is a simple and effective means of preventing aspiration of gastric juice and content. This procedure prevents a possible reflux by compressing the esophagus between the cricoid cartilage and the cervical vertebral bodies. Recent studies recommend a pressure of 30-40 N. The present study was undertaken to determine whether with education and practice, anesthesia assisitants could be taught a recommended cricoid pressure and retain this skill. METHODS: Thirty-four participants (seventeen doctors, seventeen nurses) were asked to apply pressure to the blinded model to simulate application of maneuver on three occations: before instruction, after practice and 1 month after the practice. Cricoid force was measured using a life-size model on a calibrated scale. RESULTS: Only four doctors and five nurses actually applied cricoid pressure effectively. After training, 13 doctors and 12 nurses applied cricoid pressure correctly. But they could not retain skill for 1 month. CONCLUSIONS: This model represents an easy and practical means of training the application of the optimal level cricoid pressure but the training should be continued.