Ann Oto Rhinol Laryn
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Ann Oto Rhinol Laryn · Jan 2004
Factors associated with postoperative delirium after major head and neck surgery.
Postoperative delirium (POD) is an acute change in cognitive status characterized by fluctuating consciousness and is associated with high incidences of morbidity, high complication rates, and long hospitalizations. This study was performed to determine the incidence of POD and the perioperative risk factors in order to predict which patients have an increased risk and thus to prevent POD after major head and neck surgery. ⋯ A multivariate analysis showed that older age, hypertension, low postoperative O2 saturation, and decreased postoperative hemoglobin levels were risk factors for POD (p < .05). Postoperative delirium is preventable, and its incidence can be decreased by predicting these risk factors during the preoperative and postoperative periods.
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Ann Oto Rhinol Laryn · Oct 2003
Decannulation and survival following tracheostomy in an intensive care unit.
We investigated the long-term outcome of patients requiring tracheostomy in an intensive care unit (ICU) in an attempt to identify risk factors that would indicate a low probability of early decannulation. A retrospective study was conducted of a consecutive series of 106 patients who underwent tracheostomy in the period between January 1, 2001, and December 31, 2001, during their admission to the ICU at the Royal Melbourne Hospital, Melbourne, Australia. There were 61 male and 39 female patients with a median age of 65 years. ⋯ Multivariate analysis showed that the effect of an unstable or obstructed airway was independent of the remaining group variables. We conclude that ICU patients who need a tracheostomy have a high mortality rate. Only the indication for tracheostomy insertion predicts early decannulation, and other patient variables are not significant predictors.
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The authors, each with 40 years of experience in laryngology, aim to lay out the general principles and details of a systematic method of direct laryngoscopy for adults, children, and infants. Advances in laryngoscope design and application, advantages of telescopes, use of the operating microscope, and principles of modem anesthesia are highlighted. ⋯ With the recent renewed interest in investigation and treatment of laryngeal problems and a better understanding of laryngeal physiology and voice production, the future will, no doubt, see new procedures to treat and restore laryngeal function. The fundamentals in this report form a basis for direct laryngoscopy, endolaryngeal microsurgery, laser surgery, and phonosurgery.
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Ann Oto Rhinol Laryn · Jul 2003
Case ReportsAcute edema of the tongue: a life-threatening condition.
Acute macroglossia is rare, but may cause upper airway obstruction requiring emergency intervention. The cause of the problem is often obscure. ⋯ We present several cases of acute edema of the tongue, in 3 cases causing life-threatening airway obstruction. Among these, we present the first case of acute enlargement of the tongue due to the ingestion of artichoke.
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Ann Oto Rhinol Laryn · Jun 2003
Microsurgical anatomy of the perigeniculate ganglion area as seen from the middle cranial fossa approach.
The middle cranial fossa approach is useful for decompressing the perigeniculate ganglion area of the facial nerve in patients with serviceable hearing. The present study was designed to investigate the microsurgical anatomy of the perigeniculate ganglion area of the facial nerve from the point of view of the middle cranial fossa. ⋯ These were found to be 22.7 degrees +/- 2.2 degrees and 6.5 +/- 0.3 mm, respectively. Detailed knowledge about the microsurgical anatomy of the perigeniculate ganglion area of the facial nerve from the point of view of the middle cranial fossa is imperative for facial nerve decompression by a middle cranial fossa approach.