American journal of otolaryngology
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We compare estimated blood loss (EBL) during endoscopic sinus surgery (ESS) between patients receiving transoral greater palatine canal (GPC) and transnasal infiltration (combined group) to patients receiving only transnasal infiltration (control group). CT stage, endoscopic stage, revision surgery, presence of polyps, degree of resident involvement, and operative time (OT) are also evaluated. ⋯ Increased endoscopic and CT stages, presence of polyps, and revision surgery may all lead to greater EBL in ESS. Although there was a trend towards decreased EBL in the combined group, this however did not reach statistical significance. Combined injection through the GPC and nasal cavity appears to be a safe method to decrease EBL during ESS.
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Case Reports
An unusual instance of stridor: airway obstruction from a nasogastric tube knot in a 1-month old infant.
We report a 1 month old infant with a spontaneously knotted nasogastric tube. Attempted removal of the nasogastric tube was unsuccessful, prompting further investigation. Plain radiographs revealed a large, multi-looped knot impacted in the nasopharynx and oropharynx. The tube was subsequently removed through the mouth under general anesthesia without complication, revealing a large, impressive knot of the distal end of the nasogastric tube.
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Case Reports
Neurologic toxicity of lidocaine during awake intubation in a patient with tongue base abscess. Case report.
Lidocaine is commonly used for topical anesthesia of the upper airway in patient with anticipated difficult tracheal intubation undergoing awake fiberoptic intubation. Lidocaine toxicity is dose related and proportional to its plasma level. Although neurologic toxicity has been frequently observed with intravenous use, it has also been reported for topical use. ⋯ Moreover, conditions such as hypercarbia, dysphagia, or hepatic diseases are known to facilitate onset of lidocaine neurologic toxicity with serum concentration lower than normal. These findings should be kept in mind before administering topical anesthesia of the upper airway. In the presence of any of these conditions above, either the total dose of local anesthetic or its concentration should be reduced as much as possible.