The Laryngoscope
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As the newer high volume low pressure endotracheal tube cuffs have replaced the high pressure cuffs commonly used in the past, there has been a marked decline in the incidence of severe complication due to cuff injury. Studies have shown, however, that the respiratory epithelium of the trachea at the cuff site undergoes squamous metaplasia following prolonged intubation with low pressure cuffs. An experimental model utilizing the canine trachea has been developed to study cuff induced squamous metaplasia and the present study was undertaken to determine the effect of the induced squamous metaplasia on tracheal mucous velocity as well as to determine whether the induced epithelial changes are reversible following removal of the cuffed tube.
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Review Case Reports
Malignant hyperthermia in the head and neck surgery patient: an update and review.
Malignant hyperthermia, a disorder often initiated by exposure to a variety of anesthetic agents, continues to be of major importance to the head and neck surgeon because: 1. approximately 40% of all reported reactions have occurred during anesthesia for head and neck surgery; 2. the possibility of mortality still exists despite the use of new pharmacologic agents, such as dantrolene; and, 3. subtle variations in the intraoperative and postoperative presentation of malignant hyperthermia are being increasingly recognized and treated. The authors briefly tabulate the 280 cases--which have occurred worldwide during otolaryngologic, dental, facial plastic, ophthalmologic and neurosurgical procedures--that are registered with the Department of Anaesthesia, University of Toronto, Canada. A case report depicting a less-than-typical reaction is presented. The authors emphasize that early recognition of the clinical features of an ongoing reaction, whether mild or severe, is by far the most important factor in reducing morbidity and mortality of patients who suffer hyperthermic crises while undergoing head and neck surgery.
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A study was undertaken to assess the applicability of transtracheal ventilation in the instance of total upper airway obstruction. The effect of transtracheal jet ventilation through a variety of inflow catheters in the dog was studied. Arterial blood gas values, intratracheal pressure and minute ventilation were compared. ⋯ A dual-lumen needle, to provide exclusive respiratory access and support was then designed based on the preliminary data. Prolonged transtracheal jet ventilation with a totally obstructed upper airway was successfully conducted in a live canine subject. A review of the literature is presented.
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The ability of the thyroid gland to withstand infection is a well known phenomenon. In this regard, inflammatory disease of the thyroid gland in children is an uncommon occurrence. The frequency with which this proceeds to abscess formation is rare. ⋯ An overview of the management of these patients is detailed, including a discussion of the appropriate utilization of diagnostic studies. Demonstration of an internal fistula originating from the pyriform sinus underscores the need to consider a fourth branchial arch remnant as a possible source of infection. The importance of obtaining appropriate bacterial, fungal, and acid-fast cultures is stressed, as is the role of antibiotic therapy and definitive surgery once the diagnosis of thyroid abscess is made.