Anesthesia and analgesia
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The last decade has witnessed a proliferation of devices or methods that facilitate intubation in difficult circumstances, maintain ventilation, or which do both. These all require properly functioning and specially designed apparatus, the use of which requires variable degrees of expertise. This technical communication describes the author's experience with a simple technique that uses virtually universally available materials--a nasal trumpet (airway) and an endotracheal tube (ETT) connector--to rescue patients in the cannot-ventilate/cannot-intubate scenario. The methodology is straightforward, ventilation is usually immediate, stomach contents can be evacuated while ventilation proceeds, and it does not require mouth opening. Moreover, while ventilation and oxygenation is continuing, a fiber-optic intubation can proceed without interference. ⋯ A simple technique is proposed that can be used to rescue patients who are in a condition of cannot intubate/cannot ventilate. The described maneuver may save patients from requiring a surgical airway.
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Anesthesia and analgesia · Feb 2002
Case ReportsDifficult retrograde endotracheal intubation: the utility of a pharyngeal loop.
Direct laryngoscopy and tracheal intubation remains the technique of choice to achieve control of the airway. Alternative or additional techniques of airway control are required whenever an airway is deemed difficult because of anatomical and/or technical reasons. The retrograde intubation technique is an important option for gaining airway access from below the vocal cords in such situations (1). We report successful management and the problems encountered while gaining the upper airway by the retrograde catheter method in a patient having bilateral fibrous ankylosis of the temporomandibular joint (TMJ). ⋯ A 30-yr-old woman presented for redo-release of bilateral temporomandibular joint ankylosis under general anesthesia. During the previous anesthetic for primary release of ankylosis, tracheostomy was done, as conventional blind nasotracheal and retrograde intubation attempts failed several times. This case report describes the method for overcoming the difficulties of a retrograde intubation procedure in removing the guiding catheter nasally by using a pharyngeal loop assembly.
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Anesthesia and analgesia · Feb 2002
Case ReportsInterscalene and infraclavicular block for bilateral distal radius fracture.
Brachial plexus blockade is a suitable technique for surgery of the forearm, because it provides good intraoperative anesthesia as well as prolonged postoperative analgesia when long-acting local anesthetics are used. However, simultaneous blockade of both upper extremities has rarely been performed (1), because local anesthetic toxicity caused by the amount of drug needed to achieve an efficient block on both sides may be a problem. We report a case of successful bilateral brachial plexus block with ropivacaine in a patient with bilateral distal radius fracture, with each fracture requiring an open osteosynthesis. ⋯ This case report presents the performance of a simultaneous blockade of both upper extremities in a patient who sustained a bilateral distal radius fracture. The patient was known to be difficult to intubate and to have a severe hypersensitivity to opioids.