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Gyeong Bo Kim, Sung Yeon Hwang, Tae Gun Shin, Tae Rim Lee, Won Chul Cha, Min Seob Sim, Ik Joon Jo, Keun Jeong Song, Joong Eui Rhee, Yeon Kwon Jeong
A 59-year-old man presented to the emergency department with a chief complaint of sore throat after swallowing sodium picosulfate/magnesium citrate powder for bowel preparation, without first dissolving it in water. The initial evaluation showed significant mucosal injury involving the oral cavity, pharynx, and epiglottis. Endotracheal intubation was performed for airway protection in the emergency department, because the mucosal swelling resulted in upper airway compromise. After conservative treatment in the intensive care unit, he underwent tracheostomy because stenosis of the supraglottic and subglottic areas was not relieved...
June 2016: Clin Exp Emerg Med
Yong Tack Kong, Hyun Jung Lee, Ji Ung Na, Dong Hyuk Shin, Sang Kuk Han, Jeong Hun Lee, Pil Cho Choi
OBJECTIVE: To compare the effectiveness of the GlideRite stylet with the conventional malleable stylet (CMS) in endotracheal intubation (ETI) by the Macintosh laryngoscope. METHODS: This study is a randomized, crossover, simulation study. Participants performed ETI using both the GlideRite stylet and the CMS in a normal airway model and a tongue edema model (simulated difficult airway resulting in lower percentage of glottic opening [POGO]). RESULTS: In both the normal and tongue edema models, all 36 participants successfully performed ETI with the two stylets on the first attempt...
March 2016: Clin Exp Emerg Med
Jung-In Ko, Sang Ook Ha, Min Seok Koo, Miyoung Kwon, Jieun Kim, Jin Jeon, So Hee Park, Sangwoo Shim, Youjin Chang, Taejin Park
OBJECTIVE: Airway management in patients with suspected cervical spine injury is classified as a "difficult airway." The best device for managing difficult airways is not known. Therefore, we conducted an intubation study simulating patients with cervical spine injury using three devices: a conventional Macintosh laryngoscope, a video laryngoscope (GlideScope), and a fiberoptic bronchoscope (MAF-TM). Success rates, intubation time, and complication rates were compared. METHODS: Nine physician experts in airway management participated in this study...
December 2015: Clin Exp Emerg Med
John F Gamble, Dinesh J Kurian, Andrea G Udani, Nathaniel H Greene
We present a case of a 3-month-old female with Wolf-Hirschhorn syndrome (WHS) undergoing general anesthesia for laparoscopic gastrostomy tube placement with a focus on airway management. WHS is a rare 4p microdeletion syndrome resulting in multiple congenital abnormalities, including craniofacial deformities. Microcephaly, micrognathia, and glossoptosis are common features in WHS patients and risk factors for a pediatric airway that is potentially difficult to intubate. We discuss anesthesia strategies for airway preparation and management in a WHS patient requiring general anesthesia with endotracheal intubation...
2016: Case Reports in Pediatrics
Jonathan Kei, Donald P Mebust
BACKGROUND: It has been suggested that an adult 8.0 endotracheal tube (ETT) connected to a neonatal meconium aspirator would improve suctioning during emergent endotracheal intubation compared to the Yankauer suction instrument, the standard tool used by emergency physicians. OBJECTIVES: This study was designed to compare the effectiveness of a Yankauer vs. an ETT-meconium aspirator set-up in suctioning liquids of different viscosities. METHODS: The Yankauer and ETT-meconium aspirator device underwent a head-to-head timed comparison, suctioning 250 mL of three different fluids, varying in viscosity...
October 14, 2016: Journal of Emergency Medicine
Charlayne McStay, Richard Pierce, Carley Riley
Zonisamide is a sulfonamide drug used primarily for the treatment of partial seizures in adults. We describe the case of a 15-year-old woman with a mood disorder who survived without complications after ingestion of an estimated 7.5 g of zonisamide. To the best of our knowledge, there are 4 case reports of individuals with intentional ingestion of more than 4 g of zonisamide as a single agent. Our patient developed coma and hypotension 4 hours after ingestion and was treated with a catecholamine infusion, endotracheal intubation, and mechanical ventilation...
September 30, 2016: Pediatric Emergency Care
Hai Wang, Jiang-Li Sun, Zheng-Hai Bai, Xiao-Bo Wang, Zheng-Liang Zhang, Hong-Hong Pei
Preoxygenation can rapidly improve oxygenation and enhance the security of endotracheal intubation, so it is very essential before endotracheal intubation. The conventional preoxygenation method self-inflating bag (SIB) is not very effective in case of emergency. So our study aims to find a more effective method of preoxygenation in a critical situation.We retrospectively analyzed data of 105 patients in this study. A total of 49 patients with preoxygenation with invasive ventilator in volume control mode (VCM) and 56 patients with preoxygenation with SIB were included...
October 2016: Medicine (Baltimore)
Keiko Imai, Taku Doi, Kenji Kayashima
We experienced difficulty inserting cuffed inner diameter (ID) 4.5- and 5.0-mm endotracheal tubes (ETTs) in a 5-year-old boy. Postoperative ultrasound investigations showed that the internal transverse width of the cricoid cartilage was 8.0 mm. The maximum outer diameter (OD) of the deflated cuff portion of the cuffed ID 4.5- and 5.0-mm ETTs was 8.5 and 9.6 mm, respectively. The OD of an uncuffed ID 5.5-mm ETT was 7.6 mm; this tube passed the cricoid cartilage. Hence, the transverse width of the cricoid cartilage and ETT diameter including cuff folds should be considered when selecting cuffed ETTs...
October 5, 2016: A & A Case Reports
Jenny Feldman Eskildsen, Brian D Thorp, Hemanth A Baboolal
Management of anesthesia for a child with an upper airway foreign body is fraught with particular challenges. We present the case of a 3-year-old girl who presented to the emergency department with a 12-cm sewing needle protruding from her mouth and unknown vascular involvement. We were faced with establishing a secure airway despite exclusion of mask ventilation or use of a laryngeal mask airway. Moreover, peripheral intravenous access was lost before adequate sedation. Ultimately, we were able to safely induce anesthesia and achieve endotracheal intubation...
October 5, 2016: A & A Case Reports
Donald Nuss, Robert J Obermeyer, Robert E Kelly
Repair of pectus excavatum began at the beginning of the 20(th) century before endotracheal intubation was standard practice. Surgeons therefore developed techniques that corrected the deformity using an open procedure via the anterior chest wall. Initial techniques were unsatisfactory, but by the 1930s the partial rib resection and sternal osteotomy technique had been developed and was used in combination with external traction post-operatively to prevent the sternum from sinking back into the chest. In 1949, Ravitch recommended complete resection of the costal cartilages and complete mobilization of the sternum without external traction, and in 1961 Adkins and Blades introduced the concept of a substernal strut for sternal support...
September 2016: Annals of Cardiothoracic Surgery
Mauro R Tucci, Eduardo L V Costa, Maria A M Nakamura, Caio C A Morais
Noninvasive ventilation (NIV) is commonly used to prevent endotracheal intubation in patients with acute respiratory distress syndrome (ARDS). Patients with hypoxemic acute respiratory failure who fail an NIV trial carry a worse prognosis as compared to those who succeed. Additional factors are also knowingly associated with worse outcomes: higher values of ICU severity score, presence of severe sepsis, and lower ratio of arterial oxygen tension to fraction of inspired oxygen. However, it is still unclear whether NIV failure is responsible for the worse prognosis or if it is merely a marker of the underlying disease severity...
September 2016: Journal of Thoracic Disease
Seshasailam Venkateswaran, Orlando David Henrique Dos Santos, Emma Scholefield, Annamaria Lilienkampf, Peter J Gwynne, David G Swann, Kevin Dhaliwal, Maurice P Gallagher, Mark Bradley
Infections arising from contaminated medical devices are a serious global issue, contributing to antibiotic resistance and imposing significant strain on healthcare systems. Since the majority of medical device-associated infections are biofilm related, efforts are being made to generate either bacteria-repellent or antibacterial coatings aimed at preventing bacterial colonisation. Here, we utilise a nanocapsule mediated slow release of a natural antimicrobial to improve the performance of a bacteria repellent polymer coating...
August 28, 2016: Journal of Materials Chemistry. B, Materials for Biology and Medicine
Abhyuday Kumar, Anita Seth, Smita Prakash, Mangilal Deganwa, Anoop Raj Gogia
BACKGROUND: The present study was undertaken to compare and evaluate the efficacy of intravenous (IV) fentanyl and lignocaine airway nebulization and a combination of both in attenuating the hemodynamic response to laryngoscopy and tracheal intubation. MATERIALS AND METHODS: Ninety-six patients of either sex aged between 18 and 65 years of age, belonging to the American Society of Anesthesiologists (ASA) health status Classes I and II, undergoing elective surgery requiring general anesthesia with endotracheal intubation were included in the study...
September 2016: Anesthesia, Essays and Researches
P Rani, V R Hemanth Kumar, M Ravishankar, T Sivashanmugam, R Sripriya, M Trilogasundary
BACKGROUND: Fentanyl and dexmedetomidine have been tried to attenuate airway and circulatory reflexes during emergence and extubation individually but have not been compared with respect to the level of sedation to evolve a reliable technique for rapid and smooth extubation. AIM: To compare the effects of fentanyl and dexmedetomidine in attenuating airway and circulatory reflexes during emergence and extubation of the endotracheal tube. SETTING AND DESIGN: This double-blind, randomized, controlled study was done in patients undergoing surgery under general anesthesia belonging to the American Society of Anesthesiologists physical status 1 or 2...
September 2016: Anesthesia, Essays and Researches
Shruti Jain, Nazia Nazir, Rashid M Khan, Syed M Ahmed
INTRODUCTION: Extubation in deep plane of anesthesia followed by Guedel's oropharyngeal airway (OPA™) insertion is a routine method to avoid hemodynamic changes associated with tracheal extubation. Exchange of endotracheal tube (ETT) with Classic laryngeal mask airway (LMA™) prior to emergence from anesthesia also serves similar purpose. We had compared the hemodynamic changes involved during this ETT/LMA™ and ETT/OPA™ exchange technique. MATERIAL AND METHODS: This was a randomized prospective study on ASA I and 2 patients undergoing elective surgery under general anesthesia...
September 2016: Anesthesia, Essays and Researches
Aparna Shukla, Shilpi Misra
CONTEXT: Clinical need for a nondepolarizing agent with a rapid onset time and a brief duration of action has led to the development of rocuronium bromide. AIMS: The aim of this study was to evaluate optimal dose of rocuronium bromide for intubation and to compare the onset time, duration of action, intubating conditions, and hemodynamic effects of two doses of rocuronium bromide. SETTINGS AND DESIGN: A prospective, randomized, double-blind study...
September 2016: Anesthesia, Essays and Researches
H D Rashmi, H K Komala
BACKGROUND: The procedures in anesthesia such as laryngoscopy and endotracheal intubation are the most important skills to be mastered by an anesthesiologist. However, they produce marked cardiovascular responses such as hypertension and tachycardia. Various drugs have been used to suppress this response. One of those is a novel centrally acting α2 agonist - dexmedetomidine. It has numerous uses in anesthesia as it is having sedative, analgesic, hypnotic, and opioid sparing effects. It is also known to suppress the hemodynamic response to laryngoscopy and intubation...
September 2016: Anesthesia, Essays and Researches
U N Swarnamba, K Veena, Safiya I Shaikh
BACKGROUND AND OBJECTIVES: Laryngoscopy and intubation elicits huge spectrum of stress response which is hazardous in high-risk patients. Many drugs and techniques have been used to attenuate the stress response. Lornoxicam 16 mg is a potent nonsteroidal anti-inflammatory drug agent with analgesic potency equivalent to morphine 10 mg, fentanyl 100 μg and tramadol 100 mg. Lornoxicam has been found to attenuate stress response in some studies. We compared the lornoxicam with fentanyl in attenuating stress response...
September 2016: Anesthesia, Essays and Researches
Radhe Sharan, Brij Mohan, Harkomal Kaur, Anju Bala
BACKGROUND: Fiberoptic intubation is a technique commonly used for difficult airways. Conscious sedation is desirable to make this procedure tolerable, and it is essential that patients are cooperative, relaxed, and comfortable especially when difficult airway anatomy or pathology is encountered. OBJECTIVE: To compare the safety and efficacy of propofol versus midazolam in oral fiberoptic endotracheal intubation in terms of hemodynamic changes, level of sedation, ease of intubation, and patient comfort and complications...
September 2016: Anesthesia, Essays and Researches
Chih-Cheng Lai, Chin-Ming Chen, Shyh-Ren Chiang, Wei-Lun Liu, Shih-Feng Weng, Mei-I Sung, Shu-Chen Hsing, Kuo-Chen Cheng
The aim of this study was to establish predictors for successfully planned extubation, which can be followed by medical personnel. The patients who were admitted to the adult intensive care unit of a tertiary hospital and met the following criteria between January 2005 and December 2014 were collected retrospectively: intubation > 48 hours; and candidate for extubation. The patient characteristics, including disease severity, rapid shallow breath index (RSBI), maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), cuff leak test (CLT) before extubation, and outcome, were recorded...
October 2016: Medicine (Baltimore)
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