Ear, nose, & throat journal
-
Review Case Reports
Endotracheal tube obstruction: a rare complication in laser ablation of recurrent laryngeal papillomas.
During the past 25 years, use of the carbon dioxide (CO2) laser has been accepted as the most appropriate surgical method for the treatment of recurrent laryngeal papillomatosis. Although CO2 laser technology and surgical techniques continue to improve, laser-related complications still occur. We describe a case of a very rare complication--to our knowledge, only the second such case reported in the literature--in which an endotracheal tube was almost completely obstructed by a piece of papillomatous tissue during CO2 laser microlaryngoscopy for the treatment of recurrent laryngeal papillomatosis.
-
Malignant hyperthermia is a rare disorder that can occur in patients who are sensitive to certain agents used in general anesthesia. The treatment of malignant hyperthermia has not changed over the years, but prevention strategies have evolved. These strategies include an increased emphasis on how patients are managed prior to a surgical procedure, on the selection of the particular anesthetic agent, and on postoperative vigilance. ⋯ All local anesthetics--including lidocaine, which had been previously contraindicated--are now considered to be safe for use in patients who are susceptible to malignant hyperthermia. In this article, we review the prevention, diagnosis, and management of malignant hyperthermia. We also report our experience in anesthetizing a patient who had a history of malignant hyperthermia--a case that illustrates the uncertainty that can complicate the management of such patients.
-
We report the results of our study of 25 children who underwent tonsillectomy and/or adenoidectomy under endotracheal general anesthesia with respect to their risk of fire in the oropharynx. We also attempt to explain the reasons for the difference between the relatively high incidence of airway explosions and fires that have occurred during tracheostomy with electrosurgery and electrocautery and the low incidence of these events during electrosurgical dissection of the tonsils. Finally, we review the precautions that physicians can take to lower the risk of operating-room fires and explosions.
-
Comparative Study
Comparison of direct vision and video imaging during bronchoscopy for pediatric airway foreign bodies.
Rigid ventilation bronchoscopy is a most useful means of detecting and removing foreign bodies in the airway. We performed a retrospective study of 114 children who had undergone such a procedure during a 12-year period. During bronchoscopy, 48 of these patients had been examined under direct vision and 66 by videotape recording. ⋯ The condition of the mucosa postprocedurally was described in every case after video imaging but after only 41.7% of the direct-vision cases--a statistically significant difference (p < 0.001). Video imaging provides the physician with a clear, magnified view of the area under examination. It allows for later review of the videotape when necessary, and it reduces the risk that residual foreign-body material will remain in the airway.