Articles: intubation.
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Case Reports
Ankylosis of the temporo-mandibular joint after temporal craniotomy: a cause of difficult intubation.
It is not generally appreciated that surgery in the region of the temporal fossa commonly produces, within a few weeks, a contracture of the temporalis muscle with "pseudo" ankylosis of the jaw. This usually, but not always, resolves within six months. ⋯ Organization of haematoma. It is recommended that active and passive jaw exercises be started early after surgery in the temporal fossa and that such postcraniectomy patients be carefully assessed for jaw ankylosis prior to undertaking anaesthesia.
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Effects on haemodynamics and myocardial oxygenation of endotracheal intubation were examined in 17 patients after halothane induction and 12 after 1 mg X kg-1 of IV morphine. Six patients having each anaesthetic were pretreated with IV propranolol (0.1 mg X kg-1) 45 minutes earlier. Arterial and intracardiac pressures, cardiac output and total coronary sinus blood flow (CSBF), both by thermodilution, were determined plus arterial-coronary differences of oxygen, haemoglobin and lactate. ⋯ More myocardial oxygen was extracted and consumed after intubation, but lactate extraction continued: these data are evidence of adequate oxygen supply. Induction with either halothane or morphine effectively prevented the hypertensive response to intubation. Acute beta blockade led to less increase in heart rate from intubation.
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Physicians who are likely to encounter emergency situations should know how to secure an airway with techniques other than the standard methods of oral and nasal intubation. The approach and the equipment used depend on the clinician's abilities and experience. Aids and alternative techniques include use of the fiberoptic laryngoscope, guided retrograde transcricoid intubation, esophageal devices, cricothyrotomy, tracheotomy and transtracheal jet ventilation.
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Swiss medical weekly · Feb 1985
[Injury to the larynx and trachea following artificial respiration].
A general interdisciplinary survey of trends within intensive care units is necessary in order to further reduce the risk of laryngo-tracheal injury requiring treatment after prolonged intubation. Endoscopic controls of the larynx and cervical trachea should be recommended as urgent during long intubations, to ensure that a secondary tracheotomy does not ultimately occur too late. Only a perfectly performed tracheotomy minimises complications (stenoses). Repeated laryngoscopy and endoscopy of the trachea with a fibreoptic system (a few days after extubation) is recommended after every prolonged intubation.