J Formos Med Assoc
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Self-extubation is a potentially life-threatening event, but may also provide an opportunity to wean patients who should have been extubated earlier. The purpose of this study was to determine the risk factors for re-intubation after self-extubation. ⋯ About half of self-extubated patients may not require re-intubation. Pre-extubation FiO2, PaO2/FiO2, and ventilator mode, as well as gender, may be useful in determining the likelihood that a self-extubated patient will require re-intubation.
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Airway intubation injuries occur frequently but are often neglected because of spontaneous regression. Although most airway injuries that result from intubation resolve without sequelae, severe complications can develop even when initial symptoms of upper airway obstruction are absent. This retrospective study assessed the clinical features, flexible bronchoscopic findings, and clinical outcomes in children with airway intubation injuries. ⋯ The results of this study indicate that flexible bronchoscopy is a simple, safe, and useful technique for the diagnosis and follow-up of airway intubation injury. It should be performed on all patients who have symptoms of upper airway obstruction after extubation as well as those who have undergone long-term or emergency intubation.
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This clinical report is based on retrospective observation of the outcome and effects of patient-controlled epidural analgesia (PCEA) with bupivacaine infusion administered at home to five patients with intractable herpetic neuralgia. All patients had severe pain (9 or 10 visual analogue scale [VAS]points) confined to the affected dermatomes, which was refractory to medication. The interval between zoster onset and PCEA application ranged from 27 to 60 days (mean, 37.2 d). ⋯ No deleterious effects were found during PCEA therapy. After discontinuation of PCEA, two patients did not complain of pain but still had slight paresthesia, one of them required low-dose antidepressant for 17 days; three patients continued to have occasional sharp pain (VAS, 2-3) and required low-dose antidepressant and analgesic as-needed for one to six months. These results suggest that PCEA with bupivacaine infusion provides effective pain relief in patients with intractable herpetic neuralgia and is a feasible and effective home treatment modality with limited side effects.
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It is generally accepted that epidural injection with local anesthetics and narcotics administered when the cervix has dilated to a diameter exceeding 4 cm can adequately control labor pain. However, many nulliparous women still suffer from labor pain for a few hours prior to the administration of epidural analgesia. This study examined the effectiveness of relief of labor pain obtained by injection of narcotics epidurally once the labor pain begins and the subject requests analgesia. ⋯ The results indicate that once labor pain begins and the subject requests analgesia, epidural injection with fentanyl alone can relieve labor pain during the early period of the first stage. The analgesia does not cause adverse effects to the mothers or neonates. In addition, the labor course and the method of delivery are not affected.
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The clinical picture of patients with acute respiratory distress syndrome (ARDS) in Taiwan has seldom been reported, although new definitions of ARDS have been introduced over the past years. The purpose of this study was to investigate the clinical characteristics, modalities of management, and outcomes in patients with ARDS treated in a tertiary referral hospital. ⋯ The mortality in patients with ARDS was high in this tertiary referral institution. Our findings suggest that aggressive ventilatory, pharmacologic, and supportive therapy may be important to achieve a higher survival rate.