AANA journal
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Our present state of research and knowledge strongly suggests that the volatile agents, halothane, enflurane and isoflurane, present only a minimal threat to our environment. Nitrous oxide, however, has ozone-depleting potential as well as a greenhouse gas effect which may contribute much to the problem of global warming over the next few decades. ⋯ Each of us should play a critical role in monitoring harmful substances and should actively practice techniques which would lessen the hazards. We should be cognizant of the fact that sources not yet introduced into our environment may have adverse effects on our health and that vigilance and education are key factors in maintaining a safe work environment.
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Situations wherein patients cannot be ventilated or intubated rarely occur. When they do, however, death is imminent unless rapid and accurate actions are taken to restore adequate gas exchange. ⋯ Discussion of the cases and the therapeutic modality follows. The summary includes a call for the immediate availability of TTJV at all anesthetizing locations.
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A 64-year old female requiring prolonged ventilatory support was scheduled for an elective tracheostomy. Anesthesia consisted of surgical infiltration of 1% lidocaine and supplemental isoflurane. The patient was mechanically ventilated with an FIO2 of 1.0. ⋯ Proper management of an endotracheal tube fire includes stopping ventilation, disconnecting the oxygen source, removing the endotracheal tube, diagnosing injury, administering short-term steroids, administering antibiotics if indicated, providing ventilation and medical support as necessary and monitoring the patient for at least 24 hours. Extreme caution is necessary when using electrocautery in close proximity to an endotracheal tube. If electrocautery is used in close proximity to an endotracheal tube, an FIO2 of 0.3 or less with helium should be used.