Anaesthesia and intensive care
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Anaesth Intensive Care · Oct 1994
Alterations in endotracheal tube position during general anaesthesia.
The effect of head and neck movement and Trendelenburg tilt on endotracheal tube position, relative to the carina, was studied in fifty adult patients requiring intubation for elective surgery. On average, inward movement, that is shortening of the distance between the endotracheal tube tip and the carina, resulted from neck flexion (mean = -5.5 mm), whereas outward movement occurred with neck extension (mean = 6.3 mm). Neck rotation, to right and left, and Trendelenburg tilt did not show any trend towards inward nor outward movement (mean = 0.3 mm/1.7 mm/-0.6 mm, respectively). Whilst these mean positional changes for flexion and extension confirm the findings of earlier investigations, our range of maximum inward and outward displacement for flexion (23 mm in/19 mm out), extension (21 mm in/33 mm out), rotation to right (19 mm in/17 mm out), to left (22 mm in/19 mm out) and Trendelenburg tilt (22 mm in/16 mm out) indicate that for any given postural change in any one patient, the direction and magnitude of endotracheal tube displacement is not readily predictable.
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Anaesth Intensive Care · Oct 1994
Anaesthesia for three-stage thoracoscopic oesophagectomy: an initial experience.
We report our experience in the anaesthetic management of five patients undergoing three-stage thoracoscopic oesophagectomy. One patient required conversion to open thoracotomy because of extensive pleural adhesions. The other four patients, aged between 68 and 78, were all chronic smokers with mid-oesophageal squamous cell carcinoma. ⋯ Postoperative pulmonary complications were not decreased in our patients despite the avoidance of thoracotomy. The thoracoscopic technique might contribute to pulmonary complications because of prolonged thoracoscopic dissection and unintentional pulmonary injuries. The concept of minimally invasive surgery needs further evaluation when the technique is applied in extensive procedures such as oesophagectomy.
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Anaesth Intensive Care · Oct 1994
External abdominal aortic compression: a study of a resuscitation manoeuvre for postpartum haemorrhage.
External aortic compression is an emergency manoeuvre proposed to reduce postpartum haemorrhage and permit time for resuscitation and control of bleeding. To assess this technique, a prospective study was performed on twenty normal non-bleeding parturients. The abdominal aorta was compressed by firm pressure with a closed fist just above the umbilicus. ⋯ Discomfort with the manoeuvre was significantly increased (P < 0.05) in the group of subjects that had successful aortic occlusion. It is recommended that external aortic compression be considered in severe life-threatening postpartum haemorrhage, particularly during stabilisation or transport of the patient. This simple manoeuvre may be used as an adjunct to other measures and could prove of benefit, especially in locations or situations where advanced medical assistance is geographically or temporally removed.