Otolaryngologic clinics of North America
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The use of tracheostomy in palliative care offers a viable option for airway control. Through a dialogue with the patient, family, and a multidisciplinary set of providers, this procedure can be a useful component to a patient's overall palliative care plan. The authors discuss techniques for placing a tracheostomy tube and indications for placement in palliative care for alleviation of chronic and acute symptoms.
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Otolaryngol. Clin. North Am. · Feb 2009
Principles and core competencies of surgical palliative care: an overview.
The concept of palliation is as old as surgery itself, perhaps so old that it has been taken for granted rather than conceptualized as a primary framework for surgical care. The experience and success of the hospice movement in the United States and abroad was followed by the extension of its basic concepts to the much larger population of patients with advanced, but not necessarily terminal, illness. This collective experience has provided the necessary background and stimulus for developing a specific set of principles and competencies applicable to surgical palliative care. Surgical palliative care is the treatment of suffering and the promotion of quality of life for seriously or terminally ill patients under surgical care.
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Otolaryngol. Clin. North Am. · Oct 2008
ReviewSedation and analgesia in the pediatric Intensive Care Unit following laryngotracheal reconstruction.
Deep levels of sedation and analgesia are needed in the majority of children who require prolonged tracheal intubation after laryngotracheal reconstruction (LTR). Drug doses may be determined most appropriately using validated scoring tools for sedation and analgesia; these scales continue to evolve and are used with increasing regularity in the pediatric intensive care unit (PICU). In this presentation, the validated scoring tools used to assess sedation and analgesia are reviewed, and specific agents used to manage sedation, analgesia, and neuromuscular blockade in the PICU after LTR are discussed.
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Subglottic hemangioma is a rare condition that can be potentially life threatening because of airway obstruction. It is common for subglottic hemangioma to be misdiagnosed as croup initially. Infants with a subglottic hemangioma and cutaneous facial hemangiomas in a "beard" distribution should be evaluated for PHACE syndrome. ⋯ Open excision of subglottic hemangioma is an excellent option, particularly in patients with bilateral or circumferential subglottic hemangioma. It is a more extensive surgery when compared with endoscopic laser resection. Surgeons who do not have access to a pediatric intensive care unit staffed by experienced pediatric intensivists should not use this procedure.
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Infections of the upper airways are a frequent cause of morbidity in children. Viral laryngotracheobronchitis (croup) is the most common cause of stridor in children and usually has a self-limited course with occasional relapses in early childhood. ⋯ It can be rapidly fatal, however, if not promptly recognized and appropriately managed. This article reviews the pathogenesis, epidemiology, clinical presentation, diagnosis, and management of these pediatric upper airway infections.