An investigation of the surgical physiology of adult laryngotracheal stenosis

• Main Author: Nouraei, Seyed Ahmad Reza
• Published: University of Bath 2012
• Subjects: 617.533
• Online Access: http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.616576

Abnormal narrowing of the larynx, trachea, or bronchi, -Laryngotracheal Stenosis- increases airflow resistance and manifests as exertional dyspnoea, stridor, and effort intolerance. This clinical presentation is very similar to those of lower airway diseases. It is common therefore for this rare condition to be misdiagnosed and incorrectly managed. I addressed this potentially fatal diagnostic shortcoming by developing a simple physiological index, derived from routine spirometry data of approximately 10,000 patients, that can reliably diagnosis laryngotracheal stenosis. Undertaking shared-airway anaesthesia presents unique challenges since many standard anaesthetic techniques cannot be used and the reduced safety margin in a critically-narrowed airway makes anaesthesia hazardous. I studied the physiology of intravenous anaesthesia induction with positive-pressure ventilation, and showed underlying physiological differences between spontaneous and positive-pressure ventilation in airway stenosis which favours intravenous induction and positive-pressure ventilation, and which contrasts with traditional anaesthesia teaching in this area.