Middle East journal of anaesthesiology
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Middle East J Anaesthesiol · Jun 2009
Case ReportsIntubation-induced tracheal stenosis -- the urgent need for permanent solution.
The most common site for the occurrence of intubation-induced tracheal damage is at the area in contact with the inflatable cuff. After the change from high-pressure to low-pressure cuffs, major tracheal lesions still continue to occur. This is a case of tracheal stenosis that occurred after 7 days of intubation with standard cuffed tube whose cuff pressure was assessed by subjective means. ⋯ A month later, the patient had another cardiac arrest from which he did not recover. Our message in this report is to throw light and alert clinicians involved in tracheal intubation, of the presence of the Lanz endotracheal tube whose pilot balloon is designed to automatically regulate the intra-cuff pressure and thus prevent the occurrence of tracheal stenosis due to high pressure. We strongly recommend the presence of Lanz tracheal tubes as standard emergency equipment in intensive care settings and in any situation in which cuff pressure is likely to increase.
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Middle East J Anaesthesiol · Jun 2009
Case ReportsUneventful epidural analgesia in a patient with severe thrombocytopenia.
Epidural analgesia is the most effective method for analgesia in labor. It has, however, contraindications and carries many serious side effects. Though coagulopathy is an absolute contraindication for epidural and axial blocks, yet there are no absolute limits for platelet counts that stand in the way of providing epidural analgesia. In a patient who is writhing in pain due to severe uterine contractions, and in whom there exists a recent normal platelet screening and no history of bleeding disorders, it is internationally acceptable between anesthetists to provide epidural analgesia without waiting for a new platelet screening.