Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery
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Choice of anesthesia for bronchoscopic laser surgery depends on the surgical technique. Fiberoptic bronchoscopy can be managed with either topical or general anesthesia, while rigid bronchoscopy usually requires general anesthesia. In either case precautions for laser surgery must be taken. ⋯ Preoperative medication should include an anticholinergic agent. The influence of total intravenous vs. inhaled anesthetics on prolonged respiratory depression is discussed, and the techniques for providing controlled vs. spontaneous respiration are described. Finally, postoperative care, including the management of airway obstruction and hemorrhage, is outlined.
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Otolaryngol Head Neck Surg · Dec 1984
The patient requiring mechanical ventilatory support: use of the cuffed tracheostomy "talk" tube to establish phonation.
Many patients requiring mechanical ventilatory support via a cuffed tracheostomy tube possess a normal larynx and intact linguistic and cognitive abilities yet are unable to communicate normally because of the interruption of airflow through the intact larynx. The usual alternative means of communication such as writing, gesturing, or the use of an electrolarynx have obvious limitations and are often impossible when there is neurologic motor impairment. Frustration, depression, and compromised medical care are frequent side effects of the patient's inability to communicate. ⋯ Reasons for success or failure have been unclear. We wish to report experience with the single-cuffed tracheostomy "talk" tube in 19 patients, 14 of whom acquired satisfactory functional laryngeal phonation. Indications for its use, technical aspects of the tube, solutions of common problems, and potential reasons for failure are discussed.
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Adrenal corticosteroids exert a strong suppressive influence on the basic inflammatory response that leads to tissue swelling. The corticosteroid effect is nonspecific. In upper airway obstruction caused by edema from infection, allergy, or trauma, corticosteroids will exert some degree of suppressive effect. ⋯ Dexamethasone and methylprednisolone produce high blood levels within 15 to 30 minutes of intramuscular injection. Recommended initial doses for acute airway obstruction are dexamethasone, 1.0 to 1.5 mg/kg, or methylprednisolone, 5 to 7 mg/kg. The risk of harm from steroid therapy of 24 hours or less is negligible.
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Otolaryngol Head Neck Surg · Dec 1983
Case ReportsPharyngoesophageal perforations after blunt trauma to the neck.
The neck with cartilaginous framework left intact still requires a high index of suspicion of a pharyngoesophageal perforation after blunt trauma. If the diagnosis is missed and/or prompt surgical drainage of the perforation is delayed, increased morbidity from deep neck abscesses and/or death may result. This is the first reported series of pharyngoesophageal perforations that follow blunt trauma. On the basis of this clinical experience and the literature, I have formulated a treatment protocol for upper aerodigestive tract perforations secondary to blunt trauma.