Articles: intubation.
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This study investigates postoperative hoarseness by comparing the patient's subjective assessment of change in voice following intubation with objective measures made using the laryngograph. Twenty-five patients admitted for routine surgery were assessed pre- and postoperatively. An Fx histogram was recorded on the laryngograph. ⋯ These measures can be recorded as the change in spread, standard deviation of the Fx histogram. The transient postoperative hoarseness following intubation is due to laryngeal damage. This damage has 2 mechanisms; in most cases it is due to direct mucosal trauma but in other cases a deeper muscular damage occurs.
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An endoscopic procedure has been developed to enable constant monitoring of the mucous membrane of the larynx and trachea. The examination can be divided into four stages. 1. Transnasal inspection. 2. ⋯ A final check on the above-mentioned critical points during complete extubation after long-term intubation. Regular examination by this atraumatic method provides an early diagnosis of any mucosal damage caused by tubes. The recommendation that a secondary tracheotomy should be carried out after 48 h, and at the latest after a week, can no longer be supported, provided the necessary modern anaesthetic equipment and management is available.
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Case Reports
Fibreoptic bronchoscopic nasotracheal intubation of a neonate with Pierre Robin syndrome.
A case of nasotracheal intubation using a fibreoptic bronchoscope and the Seldinger technique is described. A guide wire was passed through the suction channel of the fiberscope after the epiglottis and the vocal cords were seen; the fiberscope was removed and a nasotracheal tube passed over the wire into the trachea.