ORL; journal for oto-rhino-laryngology and its related specialties
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ORL J. Otorhinolaryngol. Relat. Spec. · Jan 2009
Case ReportsCase report: respiratory inductance plethysmography as a monitor of ventilation during laser ablation and balloon dilatation of subglottic tracheal stenosis.
We describe a 61-year-old female who underwent KTP laser ablation and CRE balloon dilatation of symptomatic idiopathic subglottic stenosis (50% obstruction). The procedure was conducted, using our standard approach for such cases, under total intravenous general anesthesia with subglottic high-frequency jet ventilation (HFJV) via Lindholm laryngoscope. The patient was enrolled in an ongoing investigational protocol in which respiratory inductance plethysmography (RIP; Ambulatory Monitoring Inc., Ardsley, N. ⋯ After successful tracheal dilation under intermittent apnea, subsequent jet ventilation produced only modest RIP amplitude changes. RIP may be an important safety monitor during jet ventilation for patients with obstructive tracheal lesions to lessen the risk of both barotrauma and hypoventilation. RIP remains under active study by our group for this purpose.
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ORL J. Otorhinolaryngol. Relat. Spec. · Jan 2009
Laryngeal mask airway in laryngoscopies: a safer alternative for the difficult airway.
This study was undertaken to highlight the method, usefulness and postoperative morbidity of using a laryngeal mask airway (LMA) to ventilate patients with difficult airways undergoing laryngeal procedures. ⋯ Insertion of an LMA and maintenance of airway and ventilation were performed with ease in all patients. The airway lesions were easy to visualize, there was minimal vocal cord trauma, and it served as a wide conduit for therapeutic bronchoscopes and laryngoscopes. Therefore, we recommend preoperative identification of difficult airways and consideration of elective LMA use with a flexible endoscope during laryngeal and upper tracheal procedures.
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ORL J. Otorhinolaryngol. Relat. Spec. · Jan 2008
Comparative StudyPartial neuromuscular blockage levels with mivacurium during mastoidectomy allows intraoperative facial nerve monitoring.
Facial nerve monitoring during otologic surgery is helpful for facial nerve preservation, but its usage is closely related to anesthetic procedures. ⋯ We conclude that partial neuromuscular blockade with mivacurium permits intraoperative facial nerve monitoring.
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Surgical treatment of hyperthyroidism requires an understanding of the pathophysiology of thyrotoxicosis and of differentiating hyperthyroidism from non-hyperthyroid causes of thyrotoxicosis. The surgeon must determine or confirm the etiology of the patient's hyperthyroidism for surgical planning and ensure that surgery is indicated. Furthermore, preoperative preparation with appropriate medication is essential for minimizing intraoperative and postoperative complications. This chapter outlines the differential diagnosis of thyrotoxicosis, preoperative evaluation and preparation for surgery.
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ORL J. Otorhinolaryngol. Relat. Spec. · Jan 2007
ReviewPediatric obstructive sleep apnea: current management.
Obstructive sleep apnea syndrome (OSAS) is a condition frequently encountered in children, and belongs to a spectrum of diseases called sleep-disordered breathing. Its pathophysiology is related to decreased ventilation despite respiratory effort, leading to episodes of hypopnea and apnea. Left untreated, this condition could have a significant impact on both physical and mental health. ⋯ This is why in clinical practice history and physical examination remain among the most useful diagnostic tools. Management of OSAS traditionally includes tonsillectomy and/or adenoidectomy to which most of the cases respond. However, other risk factors and coexisting conditions should be carefully investigated and treated prior to considering surgical treatment.