Articles: intubation.
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The rapid and safe establishment and maintenance of an adequate airway in patients with acute, severe head injuries is of central importance in the "ABC" approach to the trauma victim. It is also necessary before hyperventilation can be instituted as a means of controlling intracranial pressure. A method of establishing an airway in a manner that best protects the patient from unnecessary elevations in intracranial pressure with the least possible risk is presented. This method can be applied in virtually all emergency departments, from community hospitals to teaching centers, using materials and expertise currently available.
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The airway management of 176 consecutive traumatized patients aeromedically transported from the scene of injury was reviewed. In particular, the frequency of performance and time requirements for both blind nasotracheal intubation and cricothyrotomy were analyzed. Airway control was attempted in 70 (39.5%) patients and successful in 67 (95.7%). ⋯ The remaining three patients were nasotracheally intubated in the emergency department. Neuromuscular blockade was not used in either setting. Despite the difference in patient acuity, there was no statistically significant difference in scene or transport times between those patients emergently intubated and those who were not (P greater than .05).
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Patients with the mucopolysaccharidoses show widespread, progressive involvement and derangement of many organs and tissues which can have profound implications for the anaesthetist. These disorders are uncommon and few anaesthetists care for these patients on a regular basis although individual patients often undergo multiple anaesthetics for procedures intended to improve their quality of life. There is a relative paucity of literature dealing with clinical anaesthetic experience with these patients. ⋯ The establishment and maintenance of an adequate airway represents the most commonly encountered anaesthetic-related problem in these patients. We found an overall incidence of airway-related problems of 26 per cent. In patients with the Hurler or Hunter syndromes the incidence of airway-related problems was 53 per cent.
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Otolaryngol Head Neck Surg · Jan 1988
Emergency endotracheal intubation under fiberoptic endoscopic guidance for malignant laryngeal obstruction.
Endotracheal intubation under fiberoptic flexible scope guidance is an easy technique to master and can be performed under local anesthesia. It provides immediate and safe intubation of malignant obstructive lesions of the larynx and allows surgical resection and reconstruction to be carried out as an emergency procedure. Ten patients with malignant obstructive lesion of the larynx were intubated and managed successfully in this manner. Refinements of intubation techniques under fiberoptic endoscopic guidance were described.
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Nitrous oxide is an important and widely used anesthetic agent. However, during lengthy surgical procedures, significant amounts of nitrous oxide diffuse into the endotracheal tube cuff, causing sequelae that may include increased cuff pressures, tracheal trauma, increased postoperative discomfort, and cuff rupture. In this paper, two cases are presented in which the endotracheal tube cuff used to deliver this anesthetic agent ruptured after more than four hours of surgery. Two simple means of limiting the diffusion of nitrous oxide into the cuff and thus preventing this occurrence are described.