European journal of anaesthesiology
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A retrospective survey was undertaken of 142 adults who had undergone cardiac surgery with cardiopulmonary bypass. According to the manufacturer's instructions for thromboelastography, patients were identified as showing evidence of fibrinolysis if after coming off bypass the Ly30 index was > or =7.5%. ⋯ It is possible that fibrinolysis is a marker for onset of systemic inflammation syndrome. It is recommended that, until the association between fibrinolysis and worse outcome is investigated further, patients showing fibrinolysis early after cardiopulmonary bypass should not be discharged too soon from intensive care.
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We present a case of a patient submitted for extirpation of a neoplasm of the larynx, by means of carbon dioxide laser surgery. High frequency jet ventilation was applied by means of orotracheal intubation with two Teflon catheters, 2 mm in external diameter and 30 cm in length, attached with three equally placed strips of adhesive paper tape. One catheter was used to inject the jet volume and the other used to measure the airway pressure. ⋯ Ventilation was interrupted and the catheters were removed. The patient was reintubated with an endotracheal tube of 6 mm ID and the surgical procedure was continued until the tumour was removed. Two factors contributed to the airway fire: the ignition of the lowest adhesive strip that had dried and the use of the laser in the mode of continuous pulsation.
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The anaesthetic management of a 25-year-old parturient with juvenile rheumatoid arthritis (Still's disease) and a difficult airway presenting for elective Caesarean section is described. Inadequate block after epidural anaesthesia necessitated general anaesthesia. This was safely accomplished by securing the airway with awake oral fibreoptic intubation before general anaesthesia was induced. The problems of performing an awake fibreoptic intubation in a pregnant patient are discussed and a simple method for performing the technique is described.