Ann Oto Rhinol Laryn
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Ann Oto Rhinol Laryn · Jul 1982
Cricothyroidotomy: the impact of antecedent endotracheal intubation.
In light of the current debate regarding cricothyroidotomy, we elected to study the procedure at our institution. Cricothyroidotomy was instituted whenever tracheotomy was necessary for airway management. After a fairly short period of time, some significant complications of cricothyroidotomy were apparent and the study was aborted prior to achieving statistically significant results. ⋯ The major underlying factor in patients who developed complications was prolonged intubation prior to the institution of cricothyroidotomy. The study suggests that cricothyroidotomy should not be performed after prolonged intubation. The issue of primary cricothyroidotomy for short-term airway control remains unanswered.
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Laryngeal complications secondary to nasogastric intubation have been reported rarely in recent literature. Recent experience with three patients who developed laryngeal injuries related to nasogastric tubes prompted retrospective, experimental, and prospective studies to determine the mechanism of laryngeal injury. A review of the literature, as well as the clinical findings in our three patients, point to midline tube placement and the subsequent development of cricoid chondritis as the underlying etiology. ⋯ Six percent of the patients had nasogastric tubes in the midline. Patients who have nasogastric tubes in place for more than three days or have a severe amount of discomfort should have an x-ray film to determine position of the tube. Midline tubes should be removed or replaced.
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Between 1970 and 1979 152 infants born with the anomaly of esophageal atresia with or without tracheoesophageal fistula or of congenital tracheoesophageal fistula without atresia were treated at the Royal Alexandra Hospital for Children, Sydney. Recent developments in endoscopic equipment and new techniques of anesthesia allow detailed examination of the respiratory tract and esophagus with minimum trauma and maximum safety. Symptomatology relating to the airway and to the esophagus after surgical repair often occurs in patients who may have tracheomalacia, esophageal anastomotic stricture, esophageal reflux and sometimes recurrent or residual fistula. ⋯ Careful examination of the trachea and esophagus allows identification of an elusive recurrent fistula or an H-type fistula. As the primary results of surgery for esophageal atresia and tracheoesophageal fistula improve, long-term problems are becoming increasingly important. The role of the pediatric endoscopist is vital in the care of these patients.
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Ann Oto Rhinol Laryn · Jul 1981
Video laryngoscopy using a rigid telescope and video home system color camera. A useful office procedure.
A simple but reliable method of videotaping the larynx using the Nagashima rigid laryngoscope (telescope) and a low-cost home video color camera is described. Video laryngoscopy using this technique is a useful office procedure. The video material obtained was of high quality and of great value for teaching, voice analysis, preoperative and postoperative evaluation and documentation of various laryngeal disorders.
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Ann Oto Rhinol Laryn · Sep 1980
Acute upper airway obstruction in infants and children. Evaluation by the fiberoptic bronchoscope.
All infants and children seen by the pediatric pulmonary service who display symptoms of upper airway obstruction undergo transnasal fiberoptic evaluation with the 3.2 mm flexible instrument. The procedure enables the observer to immediately visualize the nasopharynx, supraglottic, glottic and subglottic structures. Instrumentation is done in the sitting upright position and takes the skilled observer about 20 seconds to perform. ⋯ The fiberoptic instrument is often utilized both as a diagnostic and therapeutic tool. It can be utilized to intubate cases of epiglottitis and to evaluate the epiglottis to determine the appropriate time for extubation. This procedure is superior to oral airway examination because it does not distort airway anatomy, can be performed in the upright position, and does not further exacerbate airway obstruction.