Canadian journal of anaesthesia = Journal canadien d'anesthésie
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To determine the relationship between the area of the laryngeal aperture (LA) seen fibreoptically during laryngoscopy and the difficulty of tracheal intubation in patients with difficult laryngoscopy ⋯ Inability of the laryngoscope to provide an adequate LA view is one cause of difficult intubation with the Macintosh laryngoscope in patients with difficult laryngoscopy.
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The aim of this study was to compare the severity of the acute lung injury after tracheal instillation of acidified soya-based or Enfalac infant formula, or human breast milk (HBM) in anesthetized rabbits. ⋯ The severity of the acute lung injury after intratracheal instillation of infant feeds in a volume of 0.8 ml x kg(-1) and at pH 1.8 in rabbits depends in part, on the type of feed: Enfalac approximately/= HBM > soya > control.
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Lidocaine instilled onto to the back of the tongue of a supine subject and aspirated has been reported to provide effective topical anesthesia of the airway. The purpose of this study was to observe endoscopically the fate of lidocaine so instilled and document the efficacy of anesthesia for awake fibreoptic intubation. ⋯ A combination of lidocaine gargles and lidocaine instilled on to the back of the tongue and aspirated provides effective anesthesia of the pharynx, larynx, and trachea for awake fibreoptic intubation.
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Case Reports
Epidural hematoma following epidural catheter placement in a patient with chronic renal failure.
We report a case of epidural hematoma in a surgical patient with chronic renal failure who received an epidural catheter for postoperative analgesia. Symptoms of epidural hematoma occurred about 60 hr after epidural catheter placement. ⋯ We report the first case of epidural hematoma formation in a surgical patient with chronic renal failure (CRF) and epidural postoperative analgesia. The only risk factor for the development of epidural hematoma was a history of CRF High-risk patients should be monitored closely for early signs of cord compression such as severe back pain, motor or sensory deficits. An opioid or opioid/local anesthetic epidural solution, rather than local anesthetic infusion alone, may allow continuous monitoring of neurological function and be a prudent choice in high-risk patients. If spinal hematoma is suspected, immediate MRI or CT scan should be done and decompressive laminectomy performed without delay.
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Comment Letter
The difficult airway and BURP--a truly Canadian perspective.