Anaesthesia and intensive care
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Anaesth Intensive Care · Apr 2003
Case ReportsUse of a Fogarty catheter as a bronchial blocker through a single-lumen endotracheal tube in patients with subglottic stenosis.
One-lung ventilation can be achieved with a double-lumen tube or a bronchial blocker. However, the larger outer diameters of double-lumen or Univent tubes may prevent their passage through an area of subglottic stenosiss. ⋯ The outer diameters of a double-lumen tube, Univent tube and single-lumen tube were compared. Despite special equipment designed for one-lung ventilation, the use of a bronchial blocker through a single-lumen tube, which has the thinnest available wall thickness, seems to be one of the most effective and safest ways of achieving one-lung ventilation in patients with subglottic stenosis or narrowing.
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Larsen syndrome is a rare congenital connective tissue disorder which is characterized by multiple dislocations of major joints, typical facial appearance, cervical spine narrowing and instability and respiratory difficulties secondary to laryngotracheomalacia. A case of general anaesthesia for laparoscopic hernia repair in a male child aged 16 months with this syndrome is presented. Anaesthesia was well tolerated though intubation proved difficult. Cervical spine instability and postoperative respiratory complications are potential problems.
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Anaesth Intensive Care · Apr 2003
An evaluation of the flexiguide introducer with the flexible laryngeal mask airway.
Insertion of the flexible Laryngeal Mask Airway has been achieved by a variety of techniques. We have evaluated the Flexiguide for aiding introduction of a flexible Laryngeal Mask Airway in 100 anaesthetised patients. We were successful in establishing a clear airway on the first attempt on 84 (84%) occasions and within two attempts in 97 (97%). ⋯ Minor complications occurred in three (3%) patients: two coughed and one experienced minor tissue trauma during mask insertion. There were no complications associated with use of the Flexiguide during the procedure or after anaesthesia. The Flexiguide is a useful tool to assist insertion of the flexible Laryngeal Mask Airway and is associated with few complications.
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The management of six awake, spontaneously breathing patients with acute severe asthma who responded to a subanesthetic dose of an inhalational agent is described. All of these patients were on maximal medical treatment, the next intervention likely to be tracheal intubation and mechanical ventilation in the face of further deterioration. All six patients initially responded dramatically, although one required mechanical ventilation after initial response.
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Anaesth Intensive Care · Apr 2003
Randomized Controlled Trial Comparative Study Clinical TrialA comparison of four intravenous sedation techniques and Bispectral Index monitoring in sinonasal surgery.
This study was performed to investigate the quality of different intravenous sedation techniques, and the correlation between the Bispectral Index (BIS) values and the Observer's Assessment of Alertness/Sedation (OAA/S) scores. Eighty patients undergoing sinonasal surgery were randomly assigned to one of four groups. Group MF received midazolam and fentanyl, group PF received propofol and fentanyl, group MR received midazolam and remifentanil, and group PR received propofol and remifentanil. ⋯ A positive relationship existed between the BIS values and OAA/S scores during the operation in all groups and the strongest correlation was observed in group PR (r = 0.565 and P < 0.001). In conclusion, these four intravenous sedation techniques did not change mean arterial pressure, heart rate or SpO2 clinically and produced a similar level of light sedation. The BIS was useful for monitoring of sedation during sinonasal surgery under local anaesthesia with intravenous sedation.