Critical care medicine
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Critical care medicine · Apr 1984
Use of the anterior cricoid split operation in infants with acquired subglottic stenosis.
Ten infants with acquired subglottic stenosis were treated successfully using the anterior cricoid split operation. Eight had been preterm infants who required endotracheal intubation and assisted ventilation for the respiratory distress syndrome. Two had been born at term; 1 required mechanical ventilation for aspiration of meconium and the other intubation for obstructive apnea. ⋯ All were extubated at the end of this period without evidence of stridor or obstructive apnea. One patient developed a subglottic granuloma at the level of the cricoid cartilage 4 months after the operation; this was successfully excised with the carbon dioxide laser. The other 9 patients remain asymptomatic 1 month to 1 yr after the surgical repair.
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Critical care medicine · Apr 1984
Effects of aerosolized lidocaine on circulatory responses to laryngoscopy and tracheal intubation.
Topical anesthesia of oropharynx with lidocaine aerosol (6 ml of 4% for 5 min) prevented hypertension and tachycardia during laryngoscopy and tracheal intubation. In the control group (saline aerosol), systolic and mean BP as well as heart rate (HR) significantly increased during laryngoscopy and intubation. ⋯ The pressor response and tachycardia observed during laryngoscopy and tracheal intubation were, thus, successfully prevented by lidocaine aerosolization. This simple technique for oropharyngeal anesthesia before laryngoscopy intubation may be considered, particularly in patients with intracranial pathology and/or decreased myocardial reserve.
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Critical care medicine · Apr 1984
Pulmonary ventilation by continuous flow using a modified Carlen's tube.
Carlen's tubes were modified by introducing a manometer line into each lumen to allow both bronchi to be insufflated continuously. During such continuous-flow ventilation (CFV) with a gas flow of 1 L/kg body weight X min in 6 anesthetized dogs, both CO2 and O2 homeostasis were maintained. ⋯ The mean PaO2 was stable at 80 torr and 451 torr using air and oxygen, respectively, as the insufflating gas. When the CFV was reduced to 0.75 L/kg X min, there was a rise in mean PaCO2 from 34 to 53 torr in 12 min; PaCO2 was then reduced to 40 torr when 4 breath/min was introduced with a mean tidal volume of 375 ml.