Articles: intubation.
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A case is presented of retrobulbar haemorrhage following anaesthesia for the removal of a chicken bone from the pharynx of a patient with systemic lupus erythematosus. The aetiology and treatment are discussed.
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The development of a tactile clinical test of the positioned orotracheal tube is described which allows confirmation of its location within the larynx. It was possible, after preliminary experience with the test, to confirm laryngeal placement confidently in an average of 97% of cases in two concurrent series each of which consisted of 100 patients. ⋯ The implications of this test are discussed in relation to difficult intubation, obstetric anaesthesia, the teaching of applied anatomy and checking by their trainers of intubations performed by very junior anaesthetists. Familiarity with this test should be considered essential for its reliable implementation.
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Endotracheal tube (ETT) fire has been reported secondary to laser and electrocautery ignition. The flammability of polyvinylchloride (PVC), silicone (Si), and red rubber (RR) ETTs in oxygen (O2) and/or nitrous oxide (N2O) in nitrogen was determined and compared by means of the O2 and N2O indices of flammability. The O2 index of flammability is the minimum O2 fraction in nitrogen that will support candle-like flame using a standard ignition source. ⋯ Flammability is a valid method of comparing safety of various endotracheal tube materials. There is a need for new endotracheal tube material with a higher index of flammability. The significance of these findings and the clinical applications are discussed.
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As the capabilities of modern medicine allow the survival of babies with increasingly lower gestational ages and birth weights, there is an increasing concern regarding the development of subglottic stenosis in those infants subjected to prolonged intubation. In this study, the general safety of neonatal intubation is assessed by a retrospective analysis of neonates who required intubation at Columbus (Ohio) Children's Hospital during a three-year period from 1977 to 1980. Of 343 surviving neonates, five (1.5%) developed clinically significant subglottic stenosis. The conclusion of this study is that endotracheal intubation is a safe method of airway management in neonates, even when used for extended periods.