Der Anaesthesist
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In single-step surgery of panfacial fractures or conversion osteotomies of the visceral cranium, nasal as well as oral intubation or tracheal intubation via tracheostomy is necessary. If complicated tracheostomy is not done, intraoperative nasal-oral repositioning of the tube is required. ⋯ After a laterosubmental fistula is created at the base of the mouth, directly behind the anterior mandibular dentition, the tube is guided through the oral floor, lateral to the muscles and the salivary duct, and fixed extraorally. The advantages of this method are: no more intraoperative repositioning of the endotracheal tube and no need for tracheostomy, thus eliminating the risks and side effects, as well as tracheal scarring, and free accessibility of the operative field.
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Continuous positive pressure ventilation (CPPV) is an established therapy for treatment of acute respiratory failure (ARF). However, cardiac performance may be severely disturbed due to elevated intrathoracic pressure, inducing a decrease in cardiac output (CO) and oxygen delivery (DO2). Alternatively, mechanical ventilation with prolonged inspiratory to expiratory duration ratio (inversed ratio ventilation IRV) has been successfully used in ARF. ⋯ Occlusion of the RIVA coronary artery typically induces an infarction of 35% of left ventricular muscle mass; however, non-ischaemic myocardium reveals an unchanged or increased contractility. Thus, a reduction of left ventricular preload secondary to CPPV mainly contributes to haemodynamic depression, which is less pronounced during IRV due to a lower peak inspiratory airway pressure and mean airway pressure. IRV may be useful for mechanical ventCntCo