Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Randomized Controlled Trial
Laryngeal injuries and intubating conditions with or without muscular relaxation: an equivalence study.
The need for muscular relaxation to improve intubating conditions and to reduce the incidence of laryngeal morbidity is still controversial. The aim of this study was to determine the incidence of symptomatic laryngeal injuries (SLI) and of acceptable intubating conditions (including both good and excellent conditions), both with and without cisatracurium during induction of anesthesia, along with moderate doses of remifentanil and propofol. ⋯ Following induction of anesthesia with propofol and moderate-dose remifentanil, cisatracurium did not confer a higher rate of good-to-excellent conditions for tracheal intubation, nor did muscle relaxation with cisatracurium decrease the rate of SLI after tracheal intubation.
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Case Reports
Case report: unilateral negative pressure pulmonary edema - a complication of endobronchial intubation.
We describe an unusual presentation of a case of fulminant unilateral pulmonary edema caused by unrecognized right endobronchial intubation that occurred during patient movement at the end of surgery. We review factors which may predispose to this complication. ⋯ A high degree of airway anatomic variation, common tracheal tube insertion practices, unreliability of tube position detection methods, and the effects of patient positioning may all contribute to endotracheal tube malposition, including partial endobronchial intubation. Several modifications in airway management may help to prevent such complications of tracheal tube malposition.
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The automated recognition of critical clinical events by physiological monitors is a challenging task exacerbated by a lack of standardized and clinically relevant threshold criteria. The objective of this investigation was to develop consensus for such criteria regarding the identification of three ventilatory events: disconnection or significant leak in the anesthesia circuit, decreased lung compliance or increased resistance, and anesthetic overdose from inhaled anesthetics. ⋯ This investigation has provided a set of consensus-based criteria for developing rules for the identification of three critical ventilatory events and has presented insight into the decision heuristics used by clinicians.