Anesthesiology clinics of North America
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Left-sided double-lumen endotracheal tubes should be the tube of choice for most cases in which lung isolation is required. A right-sided double-lumen endotracheal tube can be used effectively when a contraindication to placing a left-sided double-lumen endotracheal tube exists. ⋯ Based on clinical reports, Univents or WEB blockers may be a better choice for patients with difficult airways who require one-lung ventilation or for when a selective lobar blockade is needed. For all selective intubation, the method of choice for proper tube placement and bronchial blockade is fiberoptic bronchoscopy with the patient in a supine position at first or in a lateral decubitus position later, or if a malposition occurs.
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Anesthesiol Clin North America · Sep 2001
ReviewLessons from lung transplantation for everyday thoracic anesthesia.
Patients with end-stage lung disease are at significant risk of hypoxia and dynamic hyperinflation during mechanical ventilation, particularly during one-lung ventilation. This article describes aspects of care such as patients, including acceptance of permissive hypercapnia, adjustment of ventilator settings, and methods to optimize recovery from anesthesia.
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Pain relief has come a long way in 20 years. Many aspects of the relief of pain of thoracic surgery must be rationalized and modernized to meet the demands placed on services and subject to new dynamics. To place the present state of practice and knowledge in the context of an anticipation that such attitudes will impact on and, ultimately, drive services for relief of pain, the key issues of safety, defining and measuring quality, and giving value for money must be addressed. ⋯ Disaggregation analysis, pain profiling, a revisitiation of respiratory restoration factor, and optimization modeling are suggested ways forward to meet the clinical and organizationally holistic population forces being generated on the cusp of the third millennium. Increasingly, we live in a world defined by guidelines and protocols. The challenge is ensuring that these measure up to the watchwords--effective, safe, affordable.
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Neural tube defects of the brain and spinal cord, among the most common birth defects in the United States, cause neurologic morbidity from the lesions themselves and from associated hydrocephalus and Arnold-Chiari malformation. Because the myelomeningoceles, and encephaloceles are repaired surgically within hours of birth, neonatal anesthetic management with attention to fluids, body temperature, intravenous access, and monitoring is important. Anesthesia for treatment of hydrocephalus and Arnold-Chiari malformation takes into consideration the presence of intracranial hypertension and the need for manipulation of vital structures in the posterior fossa.
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Anesthesiologists are often consulted to help in the management of pediatric otolaryngologic emergencies. These include airway obstruction in children suffering from acute epiglottitis and croup. Surgical otolaryngologic emergencies such as foreign body aspiration, post-tonsillectomy bleeding, obstructive laryngeal papillomatosis, peritonsillar abscess, and laryngeal trauma can be life threatening. The pathophysiology, clinical course, and anesthetic management of these conditions are addressed with special emphasis on the details of airway management in each case.