International anesthesiology clinics
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Int Anesthesiol Clin · Jan 2000
ReviewPhysiology of the lateral decubitus position and one-lung ventilation.
OLV is most frequently utilized to provide a quiet field for the performance of many different surgical procedures. In some patients, severe hypoxemia may result, mandating the implementation of other therapies to provide adequate oxygenation. ⋯ Our technique is performed with the goal of maintaining adequate gas exchange and protecting the ventilated lung from potential overdistension and injury. It remains for future study to determine if the use of a lung protective strategy during intraoperative OLV offers any benefit to patients at risk for postoperative lung injury, such as those undergoing major lung resections.
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Traumatic airway injuries fortunately are rare. While sometimes injuries are obvious and initial management straightforward, frequently the diagnosis is difficult. ⋯ Importantly, a patient's airway can be lost because of injudicious use of sedation or failure to be properly cautious during attempts at airway management and endotracheal intubation. Mortality rates and the incidence of late complications remain high and have been related to delays in diagnosis and definitive treatment.
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The difficult airway, although rare, still occurs with a frequency sufficient to require that all personnel associated with airway management be familiar with methods to use when confronted with a challenging airway. Methods of airway assessment are helpful but lack adequate sensitivity and specificity. The most effective means of anticipating a difficult airway lies in an integrated approach utilizing the history, physical exam, and the patient's medical record. ⋯ Most importantly, extubation must only occur after a plan has been designed to ensure that the patient may be adequately supported in the event of a premature extubation. Certain injuries to the airway and esophagus are more common in patients in whom intubation was difficult. Such patients should be closely watched and informed about the signs and symptoms of tracheal and esophageal injury.