British journal of anaesthesia
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Chronic pain is common after thoracotomy with reported prevalence rates of 20-60%. The pain may be caused by damage to the intercostal nerves during surgery. Some studies have suggested that young age at the time of surgery reduces the risk of developing chronic pain. So far, no studies have examined if children and adolescents develop chronic pain after thoracotomy. ⋯ The risk of developing chronic pain after thoracotomy seems to be lower if surgery is performed at a young age. Pain after thoracotomy is likely to be of neuropathic origin.
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Case Reports
Pentax-AWS videolaryngoscope for awake nasal intubation in patients with unstable necks.
In patients with unstable necks and at risk of pulmonary aspiration, awake fibreoptic intubation is often appropriate. However, stabilization of the neck can make fibreoptic intubation more difficult. I report the use of awake nasal intubation using the Pentax-Aiway Scope (AWS) in three patients with restricted neck movement, in whom awake fibreoptic intubation had failed. ⋯ Although it was possible to insert a fibreoptic bronchoscope into the trachea while the neck was stabilized with a Halo vest, it was impossible to advance a tube over the fibrescope. Awake nasotracheal intubation using the Pentax-AWS was achieved within 15 s. The Pentax-AWS may be useful for nasotracheal intubation in awake patients with restricted necks.
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Cricoid pressure or to be more exact cricoid force (CF) can cause airway obstruction and subsequent difficulty with airway management during an emergency induction. ⋯ Forces well below the recommended value of 30 N will cause significant compression/distortion of the airway in a child.
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Narrow-bore cricothyrotomy retains a clinical role, due to the availability of its component equipment in acute clinical environments, ease of assembly, and operator preference. However, due to infrequent use, there is a need to model this for research and teaching. We present mathematical and laboratory models. ⋯ We can exploit the contrasting changes in inspiratory and expiratory times with the upper airway resistance to optimize conditions for emergent cannula cricothyrotomy ventilation.