Journal of clinical anesthesia
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A 6-year-old girl with laryngeal papillomatosis underwent ablation of the tumors with Nd-YAG laser under microlaryngosurgery. During the surgery, she was managed with subglottic high-frequency jet ventilation using a stainless steel cannula made from a nerve block needle. ⋯ There was no hypoxia or barotrauma to the lungs during the surgery. The postoperative course was uneventful.
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Spinal cord injuries continue to be a devastating medical problem. By impairing voluntary and involuntary nervous system function, virtually every body system function is affected. However, pulmonary function alteration and respiratory complications continue to be the major causes of morbidity and mortality in patients with spinal cord injuries. The current understanding of respiratory problems faced by patients with loss of innervation from cervical spinal cord injuries are reviewed.
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Clinical Trial
Combined local-propofol anesthesia with noninvasive positive pressure ventilation in a vasectomy patient with sleep apnea syndrome.
A vasectomy patient with sleep apnea syndrome, who requested general anesthesia and day surgery, was given sole propofol infusion with airway maintenance by noninvasive positive-pressure ventilation. Surgery was performed with additional local anesthesia. Because this patient was treated successfully, this anesthetic technique may also be applicable to other normal patients.
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Clinical Trial
Perioperative use of the Thrombelastograph in patients with inherited bleeding disorders.
There are few reports of the use of Thrombelastgraph (TEG) in patients with isolated or inherited bleeding disorders. Three surgical patients are presented with von Willebrand's disease, factor XII deficiency, and hemophilia A with dysfibrinogenemia in which the abnormalities detected by the TEG were similar to the expected coagulation abnormalities based on preoperative laboratory studies. This initial report suggests that this potential application of the TEG be further investigated.
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Cervicofacial necrotizing fasciitis is a necrotizing soft tissue infection of face and neck spreading at the level of fascia. It has been described as a putrid ulcer, phagedaena, and hospital gangrene. It has a high mortality rate, and presents a challenge to anesthesiologists who must secure an airway to deliver anesthesia safely. ⋯ The tracheas of these patients should remain intubated after initial debridement. Tracheostomy should be performed early. Antibiotic therapy, nutritional support, early debridement, and hyperbaric oxygen therapy all help to decrease mortality in these patients.