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Tracheostomy decannulation readiness: A cross sectional study comparing standardised evaluation for tacheostomy decannulation to flexible endoscopic evaluation of swallowing examination

Tamin S, Shabrina F, Hutauruk SM, Rachmawati EZK, Fardizza F, Koento T, et al.

Med J Malaysia, 2024 Mar;79(2):119-123.

PMID: 38553913

INTRODUCTION: Tracheostomy is a procedure commonly performed in neurocritical and mechanically ventilated patients in the intensive care unit. Dysphagia and impaired airway protection are the main causes for a delay in tracheostomy decannulation in patients with neurological disorders. Endoscopic evaluation is an objective examination of readiness for tracheostomy decannulation with flexible endoscopic evaluation of swallowing (FEES) as the most commonly used method, yet it requires special expertise and is heavily dependent on its operator in assessing the parameters. A relatively new method for assessing decannulation readiness in neurologic disorder, the Standardized Endoscopic Swallowing Evaluation for Tracheostomy Decannulation (SESETD) was introduced in 2013 by Warnecke, et al. This method includes stepwise evaluation of secretion management, spontaneous swallowing and laryngeal sensitivity. This study aims to find conformity between the SESETD and FEES in assessing readiness for tracheostomy decannulation in patients with neurologic disorders.

MATERIALS AND METHODS: This study is a cross-sectional study conducted on 36 neurologic patients at Cipto Mangunkusumo General Hospital which was aimed to find the agreement between two modalities for tracheostomy decannulation readiness, FEES and SESETD based on parameters, standing secretion, spontaneous swallowing and laryngeal sensitivity.

RESULT: A total of 36 subjects were examined and 22 of them underwent successful tracheostomy decannulation. The agreement between FEES and SESETD showed significant results with p-value <0.0001 and Kappa value = 0.47.

CONCLUSION: There was conformity between FEES and SESETD in evaluating tracheostomy decannulation readiness based on three parameters: standing secretion, spontaneous swallowing and laryngeal sensitivity.

Matched MeSH terms: Device Removal/methods

Spontaneous knot formation impeding the removal of a silicone urethral catheter

Mustafa NA, Lope RJ, Cheah FC

Arch. Dis. Child. Fetal Neonatal Ed., 2006 Jul;91(4):F287.

PMID: 16790731

Matched MeSH terms: Device Removal/methods

A simple method for removal of a broken intramedullary nail

Sivananthan KS, Raveendran K, Kumar T, Sivananthan S

Injury, 2000 Jul;31(6):433-4.

PMID: 10831741

The removal of broken implanted intramedullary nails secondary to re-fracture or non-union is challenging. In 12 cases a simple and safe method has been used to remove broken implants.

Matched MeSH terms: Device Removal/methods*

Sonographically guided removal of a double J ureteral stent in an infant

Jutti RC, Subramaniam R, Balsingh D, Qureshi AM

J Clin Ultrasound, 2002 May;30(4):232-5.

PMID: 11981933 DOI: 10.1002/jcu.10062

A 2-month-old male infant with a prenatally diagnosed obstruction of the ureteropelvic junction underwent a dismembered Anderson-Hynes pyeloplasty. A transanastomotic double J ureteral stent was placed between the renal pelvis and the urinary bladder. This report describes the subsequent removal of the double J ureteral stent from the patient's urinary bladder without the aid of a cystoscope: a rigid biopsy forceps was introduced trans-urethrally into the urinary bladder, and the stent was removed with sonographic guidance. Removal of a ureteral stent with sonographic guidance has not been previously reported in infants. This technique may be particularly useful in developing countries, where appropriate-sized cystoscopes and accessories may not be available.

Matched MeSH terms: Device Removal/methods*

Fulltext Schizophrenia and anaesthesia

Constance LSL, Lansing MG, Khor FK, Muniandy RK

BMJ Case Rep, 2017 Nov 23;2017.

PMID: 29170175 DOI: 10.1136/bcr-2017-221659

Administering anaesthesia for elderly patients with chronic schizophrenia has always been a great challenge to anaesthetists. These patients will usually be on multiple antipsychotic drugs for many years and may lead to delayed awakening, cardiovascular instability, arrhythmias and sudden cardiac death during general anaesthesia. This case report is about the perioperative anaesthetic management of an elderly schizophrenic patient undergoing removal of femur implant. This article will explore important drug interactions and available options for a successful anaesthesia.

Matched MeSH terms: Device Removal/methods

Techniques for successful early retrieval of the Micra transcatheter pacing system: A worldwide experience

Afzal MR, Daoud EG, Cunnane R, Mulpuru SK, Koay A, Hussain A, et al.

Heart Rhythm, 2018 06;15(6):841-846.

PMID: 29427820 DOI: 10.1016/j.hrthm.2018.02.008

BACKGROUND: Experience with retrieval of the Micra transcatheter pacing system (TPS) is limited because of its relatively newer technology. Although abandonment of the TPS at end of life is recommended, certain situations such as endovascular infection or device embolization warrant retrieval.

OBJECTIVE: The purpose of this study was to report the worldwide experience with successful retrieval of the Micra TPS.

METHODS: A list of all successful retrievals of the currently available leadless pacemakers (LPs) was obtained from the manufacturer of Micra TPS. Pertinent details of retrieval, such as indication, days postimplantation, equipment used, complications, and postretrieval management, were obtained from the database collected by the manufacturer. Other procedural details were obtained directly from the operators at each participating site.

RESULTS: Data from the manufacturer consisted of 40 successful retrievals of the Micra TPS. Operators for 29 retrievals (73%) provided the consent and procedural details. Of the 29 retrievals, 11 patients underwent retrieval during the initial procedure (immediate retrieval); the other 18 patients underwent retrieval during a separate procedure (delayed retrieval). Median duration before delayed retrieval was 46 days (range 1-95 days). The most common reason for immediate retrieval was elevated pacing threshold after tether removal. The most common reasons for delayed retrieval included elevated pacing threshold at follow-up, endovascular infection, and need for transvenous device. Mean procedure duration was 63.11 ± 56 minutes. All retrievals involved snaring via a Micra TPS delivery catheter or steerable sheath. No serious complications occurred during the reported retrievals.

CONCLUSION: Early retrieval of the Micra TPS is feasible and safe.

Matched MeSH terms: Device Removal/methods*

Fulltext The 50% and 95% effective doses of desflurane for removal of the classic laryngeal mask airway in spontaneously breathing anaesthetised adults

Hui MT, Subash S, Wang CY

Anaesthesia, 2011 Apr;66(4):274-7.

PMID: 21401540 DOI: 10.1111/j.1365-2044.2011.06620.x

The 50% and 95% effective doses of desflurane for removal of the classic laryngeal mask airway after suction of the upper airway, in anaesthetised spontaneously breathing adult patients, are not known. To determine these, we studied 38 healthy patients, aged between 18 and 44 years. The target desflurane concentration in each individual patient was determined by the Dixon up-and-down method. When the predetermined target end-tidal desflurane concentration reached steady state, we kept a constant end-expiratory partial pressure between the alveolus and the brain for 10 min before attempting to remove the classic laryngeal mask airway after suctioning the upper airway. The initial desflurane target concentration was set at 6% and up-down desflurane increments were 0.1%. This continued until there were at least six crossover pairs. From the probit analysis, the 50% effective dose of desflurane was 5.29% (95% CI 5.132-5.379%) and the 95% effective dose was 5.55% (95% CI 5.429-6.394%).

Matched MeSH terms: Device Removal/methods

Stent dislodgement in left anterior descending coronary artery and successful deployment with two parallel wires and a small balloon

Ngow H

Kardiol Pol, 2009 Sep;67(9):1040-2 discussion 1043.

PMID: 19838965

Coronary artery stent dislodgement during angioplasty is a rare complication. Stent dislodgement was more frequent in the past when stents were manually crimped onto the balloon. Newer and improved balloon-mounted stents with better radio-opacity have reduced the incidence of stent dislodgement but do not completely eliminate it. We report a case of balloon-mounted stent dislodgement in the proximal left anterior descending (LAD) coronary artery prior to deployment. This patient however was successfully treated with re-wiring of the artery with two parallel wires and the stent's reposition prior to deployment with the help of a small balloon.

Matched MeSH terms: Device Removal/methods

Retained Endoscope: An Unexpected but Serious Complication of Hemospray®

Yii RSL, Chuah KH, Poh KS, Lau PC, Ng KL, Ho SH, et al.

Dig Dis Sci, 2022 01;67(1):344-347.

PMID: 33491164 DOI: 10.1007/s10620-021-06835-4

Matched MeSH terms: Device Removal/methods*

Retained haemodialysis-catheter guidewire in the head and neck: a multidisciplinary team approach

Xiao Hong C, Abd Wahab S, Azman M

BMJ Case Rep, 2020 Oct 27;13(10).

PMID: 33109696 DOI: 10.1136/bcr-2020-236484

Penetrating foreign body in the head and neck can be catastrophic from injury to the constellation of vascular and neural structures in the neck. Early recognition and prompt surgical intervention is imperative to save lives. Herein, we present an unusual case of iatrogenic foreign body-a coiled guidewire embedded in the deep neck space. The complications, radiological investigation and multidisciplinary surgical management are further discussed.

Matched MeSH terms: Device Removal/methods

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