The Laryngoscope
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Minor blunt cervical injuries in children are relatively common occurrences leading to serious sequelae in only rare circumstances, yet sufficient impact of even a seemingly minor event may lead to a significant posterior tracheal wall laceration, resulting in pneumomediastinum with or without pneumothorax. Three cases demonstrate how the mechanism of injury does not always match either the severity of initial presentation or the consequent necessary level of emergent management. Pneumomediastinum without pneumothorax often can be treated conservatively; however, the onset of massive pneumomediastinum and pneumothorax may necessitate both tracheotomy and tube thoracostomy as initial treatment.
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We present the first use of tubeless superimposed combined high- and low-frequency jet ventilation (SHFJV) with a jet laryngoscope in laryngotracheal surgery in infants and children. Twenty-eight patients underwent 53 operative procedures. The average age of the patients was 7.3 years. ⋯ The duration of jet ventilation averaged 33 min. The gas exchange was sufficient in each case. The advantages of SHFJV in the surgery of the laryngotracheal area in infants and children are optimal view at the larynx and trachea, maximum space for the handling, application of the laser without risks, no time limitation, suitability for stenosis, and neither anesthetic nor surgical complications.
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Randomized Controlled Trial Comparative Study Clinical Trial
Optimal concentration of epinephrine for vasoconstriction in neck surgery.
The addition of epinephrine to local anesthetics decreases bleeding, reduces systemic toxicity, and increases duration of action. However, epinephrine has significant side effects. Four concentrations of epinephrine were compared to determine the minimum concentration required for maximal vasoconstriction. ⋯ There were no differences in blood flow reduction between epinephrine concentrations of 1:100,000, 1:200,000, and 1:400,000. However, epinephrine 1:800,000 provided significantly less vasoconstriction. We recommend using an epinephrine concentration of 1:200,000 or 1:400,000 to provide optimal initial hemostasis while minimizing potential side effects.
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Randomized Controlled Trial Comparative Study Clinical Trial
Bupivacaine for postoperative analgesia following endoscopic sinus surgery.
This prospective study was conducted to examine pain after endoscopic sinus surgery (ESS). The hypothesis was that a long-acting anesthetic agent would result in patients experiencing less pain in the 24-hour postoperative period and therefore needing fewer oral analgesics. We randomized 100 patients undergoing ESS to receive either lidocaine (1% or 2%) with epinephrine or bupivacaine (0.25% or 0.5%) with epinephrine as an anesthetic and for a sphenopalatine block. ⋯ We further found that the type of anesthetic used did not significantly affect postoperative pain; pain score changes and use of analgesics were similar between the two anesthesia groups. Postoperative pain was also similar between the "packing" and "no packing" groups. Although patients receiving packing had consistently lower increases in pain (and in fact many patients in this group had decreases in pain from baseline), none of the differences between group means was statistically significant.