Acta clinica Croatica
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Acta clinica Croatica · Sep 2012
Randomized Controlled TrialExtubation after anaesthesia: a randomised comparison of three techniques.
The mode of ventilation used during awake extubation has not previously been studied. We conducted a randomised controlled trial comparing spontaneous respiration, intermittent positive pressure ventilation, and pressure support ventilation (each n = 13) for incidence and severity of peri-extubation complications following routine elective surgery. ⋯ Other peri-extubation complications and time to extubation following cessation of anaesthesia were not significantly different across the three groups. We suggest that the use of pressure support ventilation for awake extubation may offer an advantage over spontaneous and intermittent positive pressure ventilation extubation strategies.
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Acta clinica Croatica · Sep 2012
Case ReportsRichter type of incarcerated obturator hernia: misleading all the way.
Obturator hernia is a rare type of abdominal hernia where herniation occurs through the obturator canal. It develops predominantly in elderly underweight women. It has unspecific early symptoms, which is the reason these hernias are usually discovered only after they have become incarcerated. ⋯ The patient recovered without complications. Obturator hernia, due to its rarity and unspecific early symptoms, can still be misleading even to the most experienced surgeons. Delayed diagnosis of obturator hernia can lead to bowel necrosis and perforation with significant postoperative morbidity and mortality.
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Acta clinica Croatica · Sep 2012
Huge multinodular goiter with mid trachea obstruction: indication for fiberoptic intubation.
Goiter or thyromegaly is one of the most common causes of mid tracheal obstruction (external compression or stenosis), which may be associated with difficult larynx visualization and/or difficult airway management, depending on the goiter size, type and ingrowth into the surrounding tissue. Iodine deficiency disorders are still one of the most common causes of goiter in the population of the African continent. These patients with goiter generally present for medical examination at an advanced stage of the disease. ⋯ Only two predicting factors for difficult airway assessment were identified in these patients: cancerous goiter (especially if compressive signs are present) and Cormack and Lehane grade III/IV. The indication for fiberoptic intubation is tracheal compression or initial tracheal stenosis. Conventional tracheostomy has to be performed in goiter patients with identified tracheomalacia and/or high degree or tracheal stenosis.
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Acta clinica Croatica · Sep 2012
Case ReportsDifficult airway in advanced Bechterew's disease: case report.
Advanced Bechterew's disease presents with increasing ossification of spinal column, from lower lumbar segments upwards, first causing impossibility to place spinal block in lumbar region, and later, due to stiffness of cervical spine, difficult intubation because of inability to extend and/or flex the neck during direct laryngoscopy and intubation. Mask ventilation, on the other hand, usually is possible. ⋯ The bronchoscope passed easily down to tracheal bifurcation, but placing the endotracheal tube was unexpectedly impossible due to the consequences of broken nose the patient had suffered at the age of 8. Fiber bronchoscope was therefore retracted, and we used the Bonfils rigid fiberscope after induction of general anesthesia, achieving intubation in first attempt.
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Acta clinica Croatica · Sep 2012
Difficult airway management at Sestre Milosrdnice University Hospital Center.
Difficult airway has gained increasing interest due to a relatively high number of adverse effects following unsuccessful intubation. Besides traditional techniques, several alternative methods are available today. ⋯ Hypoxia is one of the most frequent causes of death or severe neurologic defects in anesthesia. Therefore, it is necessary to have an easy alternative to secure the airways in critical situations.