Articles: intubation.
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A patient with previously undiagnosed Mounier-Kuhn syndrome (tracheobronchomegaly) was admitted with a head injury after a fall. The trachea was intubated with an oral tracheal tube with high-volume low-pressure cuff. The intracuff pressure was within the normal safe range recommended by the manufacturer. ⋯ The trachea was extubated on the 15th day, and it was noticed 48 hours later that the patient was developing a tracheal stenosis at the site of the previous dilatation. The stenosis was so severe that the patient underwent resection-anastomosis surgery of his stenotic tracheal segment 2 months after extubation. It may be preferable in patients with Mounier-Kuhn syndrome who require mechanical ventilation to intubate the trachea with an uncuffed tube and to pack the throat to decrease the chances of gas leak and inhalation.
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We describe our experience with a new orotracheal tube with low-pressure cuff for anesthesia during endoscopic laryngeal surgery. Twelve consecutive patients (ASA groups II and III) undergoing microlaryngoscopy for diagnostic or operative reasons were intubated orotracheally with the tube. No complications associated with intubation or anesthesia occurred. ⋯ Woodbridge tubes), the microlaryngeal tube gives the surgeon better operating conditions and still permits conventional intermittent positive pressure ventilation without excessive increases in ventilation pressure. The advantages from the low-pressure cuff could only be seen in 7 patients. With this foregoing restriction, we recommend the use of the new microlaryngeal tube for anesthesia during microlaryngoscopy.
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Fiberoptic endotracheal intubation is a procedure recently introduced that allows a safe and atraumatic intubation in those patients with anatomic difficulties and associated pathology. Our experience on 30 patients submitted to fiberoptic endotracheal intubation is described. ⋯ Due to fibroscope handling conditions and the careful procedure, it is not recommended in emergency situations. We conclude that the method is simple and safe and that its knowledge would spread among anesthesiologists.