Several studies have suggested that swallowing dysfunction and pulmonary aspiration occur in patients receiving prolonged ventilation. However, the incidence of swallowing dysfunction, its rate of resolution, and the sensitivity of tests used to characterize swallowing abnormalities are not well defined. The goals of our study were to evaluate swallowing function ...

PURPOSE: To assess the feasibility of performing percutaneous nephrostomy (PCN) on an outpatient basis in a select group of patients. MATERIALS AND METHODS: In 6 years, 60 PCN procedures were performed in a subgroup of 48 patients (22 men, 26 women) carefully selected from a larger group of 881 nephrostomy ...

Eight patients with male pseudohermaphroditism were treated between the years 1988-1994. They showed various physical-sexual anomalies. In 4 patients the existing penis was lengthened, the urethra was created and the split scrotum was fused. In the 4 remaining patients a new penis was created from lateral groin or abdominal tubed ...

Application of the topical anesthetic cream to the antecubital fossa 60 minutes before insertion of the peripherally inserted central catheters resulted in significant vasoconstriction and/or vasospasm in 24 patients. Catheter insertion was difficult in all 24 patients. Advancement of the peripherally inserted central catheter was impossible in six patients. Of ...

An analysis of 125 patients with closed head injury was completed in order to identify the risk factors involved in the development of early pneumonia. Pneumonia was diagnosed in 60% of the patients. Early pneumonia developed in 47.8% of the patients. Brain-injured patients who developed early pneumonia were found to ...

We investigated the incidence of postoperative laryngeal incompetence in 40 patients undergoing lower limb arthroplasty. Patients were randomly allocated to one of two groups using a standardised general anaesthetic/muscle relaxant technique; in group A the patients' lungs were ventilated via a laryngeal mask airway and in group B via a ...

Children with IgG2 deficiency commonly develop recurrent acute otitis media. It is believed that these infections are secondary to impaired antibody response rather than eustachian tube dysfunction and are therefore less responsive to treatment with tympanostomy tubes. The authors compared the incidence of acute otitis media in IgG2-deficient patients following ...

Bulbar involvement in amyotrophic lateral sclerosis (ALS) is often related to a worse prognosis on account of the higher risk of pulmonary aspiration and undernutrition due to dysphagia. The aim of our study was to assess the effects of enteral feeding by percutaneous endoscopic gastrostomy (PEG) in a long-term follow-up ...

The incidence of recurrent pneumothoraces was analyzed in mechanically ventilated patients with the adult respiratory distress syndrome (ARDS) or non-ARDS causes of respiratory failure who had ipsilateral chest tubes in place. The radiographs of 39 consecutive patients with 47 initial pneumothoraces were evaluated for pneumothorax recurrence and chest tube positioning, ...

The transoral-transpharyngeal approach is a reliable and technically sound method for gaining anterior extradural exposure to the craniocervical junction. We report 23 patients undergoing this approach for pathology lying between the inferior clivus and third cervical vertebra. Pathology included 6 patients with congenital malformations of the odontoid process, 4 patients ...

Intubation of the ileum during colonoscopy, although well described, is not routinely performed. It can establish the completeness of colonoscopic examinations and is useful in the diagnosis of inflammatory bowel disease. However, the diagnostic utility of routine ileoscopy during all colonoscopic procedures has not been well studied. We prospectively evaluated ...

Lightwands have been used to assist in the tracheal intubation of patients with difficult airways for many years. A new lightwand (Trachlight) with a brighter light source and a flexible stylet permits both oral and nasal intubation under ambient light. This study reports the effectiveness of the Trachlight in tracheal ...

The laryngeal mask airway (LMA) provides a view of the larynx and moving vocal cords without loss of airway control and can be used in flexible fibreoptic bronchoscopy for both anaesthetized and awake patients. In this retrospective review of 200 consecutive patients over a 30 month period, bronchoscopy was successful ...

OBJECTIVE: The objective of this study was to investigate whether reduced bronchial mucus transport velocity (BTV) is associated with a loss of cilia or ultrastructural abnormalities of cilia in intubated patients. DESIGN: The patients were studied prospectively in a convenience sample trial. SETTING: The study took place in a university ...

Even when performed by an experienced physician, endotracheal intubation is more traumatic than previously supposed. Following emergency intubation, patients have little probability of having a normal larynx. One-hundred patients underwent CT scan of the larynx 6 months or more following endotracheal intubation of short duration (up to 8 h). Ten ...

BACKGROUND: The purpose of this study was to assess the structure and function of the small intestine before and after enteral feeding given via a percutaneous feeding gastrostomy (PEG). It is not known whether this method of feeding provides a good luminal drive to the small intestine. METHODS: Studies were ...

A new type of V- or W-shaped intralesional incision for tissue expander insertion is presented. The experience with 50 of these incisions in 36 consecutive patients in the period 1990-93 without any complication has proved the safety of this approach and the advantages of V- or W-shaped incisions over tangential ...

Anesthesia with one-lung ventilation is a good anesthetic technique for patients receiving thoracotomy in various underlying diseases. One lung ventilation can be achieved successfully by the application of a double-lumen endotracheal tube through the oral route. However, there are several situations such as low body weight, young age, difficult intubation, ...

BACKGROUND: Endotracheal intubation may induce vagal mediated bronchoconstriction. As fenoterol possesses bronchodilation effects, we studied the efficacy of fenoterol pretreatment on the increased resistance of total respiratory system (Rrs) caused by reflex bronchoconstriction in endotracheal intubation. METHODS: Fifty patients were randomly allocated into two groups; group A (n = 25) ...

The pediatric laryngeal mask airway (LMA) is a scale-down version of the adult form, and no direct postmortem specimen work has been performed so far. There are several anatomical differences between pediatric and adult airways, and hence, the scale-down version of the adult LMA is not necessarily water-tight in pediatric ...

STUDY OBJECTIVE: To compare laryngoscopic appearance obtained during flexible fiberoptic laryngoscopy with the patient's atlanto-occipital joint in the neutral and extended positions. DESIGN: Controlled clinical trial with each patient (in the neutral position) acting as his or her own control. SETTING: University teaching hospital. PATIENTS: 20 adult ASA physical status ...

Of the 250,000 survivors of the polio epidemics, approximately 25% experience progressive muscle weakness known as postpolio syndrome (PPS). Laryngeal function in postpolio patients previously has not been studied. This paper presents data detailing laryngeal function in a group of postpolio patients who had been evaluated for swallowing complaints. Nine ...

We have studied cardiovascular and catecholamine responses to induction of anaesthesia and tracheal intubation in 13 patients with diabetic nephropathy, in 12 patients with uraemia of other origin and in 12 ASA I control patients. All uraemic patients were undergoing renal transplantation. Cardiovascular autonomic function tests indicated that severe autonomic ...

Responses to double burst stimulation were palpated every 15 s after intravenous administration of vecuronium 0.2 mg.kg-1 in 60 adult patients under anaesthesia. Intubating conditions and neuromuscular responses to tracheal intubation were assessed at disappearance of one or both palpable responses to double burst stimulation in groups of 30 patients ...

The results of swallowing therapy in 58 patients with neurologic disorders are presented. All patients received tube feeding, either partially or exclusively, at admission, and successful outcomes, defined as exclusively oral feeding, were achieved in 67% of patients over a median treatment interval of 15 weeks. A subset of 11 ...

The effects of laryngeal mask airway (LMA) insertion and tracheal intubation on circulatory responses were studied in normotensive (n = 24) and hypertensive (n = 22) patients. In a randomized, double-blind manner, LMA insertion or tracheal intubation was performed after induction of anaesthesia with thiopentone and muscle relaxation with succinylcholine. ...

The flexible fiberoptic laryngoscope is an excellent instrument for performing tracheal intubation in patients with abnormal upper airway anatomy. In order to prepare to use the fiberscope for the infrequent patient with a "difficult" airway, the anesthesiologist must initially learn and practice the technique in patients with normal anatomy. Orotracheal ...

Patients in critical care units are at risk for an altered nutritional status related to the increased nutritional demands of illness and the fact that many patients are unable to eat for a variety of reasons. The percutaneous endoscopic gastrostomy tube is an alternative to gastrostomy tube placement to provide ...

Fifteen patients with achalasia cardia underwent pneumatic dilatation using an indigenous pneumatic dilator. The dilator was prepared using a Levin's tube, latex condoms and silk cloth and was introduced under vision with the help of an endoscope. Clinical improvement was seen in all the patients whereas radiological improvement occurred in ...

The esophageal tracheal Combitube (ETC; Sheridan Catheter Corporation, Argyle, NY) is a twin-lumen tube used to establish emergency ventilation. After blind placement, ventilation is performed via the proximal lumen if it is in the esophagus or via the distal lumen if it is in the trachea. This investigation was designed ...

Middle ear effusion is a common occurrence in nasopharyngeal carcinoma, and is often treated by myringotomy and ventilation tube insertion. However, this can be complicated by a high rate of otorrhoea after radiotherapy. The natural history and management of middle ear effusion was examined in this retrospective study of 81 ...

We conducted a point prevalence study of motor neurone disease in the counties of South Glamorgan, Mid Glamorgan and Gwent, whose combined population is estimated at 1,394,400. A total of 56 patients were identified, giving a point prevalence for motor neurone disease in this area of 4.02/100,000 on 22/06/92. These ...

The endotracheal intubation of a patient for surgery requires an anaesthetist who is aided by a skilled and experienced helper. This paper explores reasons why some patients are difficult to intubate. Some are predictable on pre-operative assessment and others are not. Suggestions are given on how the helper is useful ...

The incidence of myocardial ischaemia during tracheal intubation and extubation was compared using ambulatory ECG monitoring in 60 patients undergoing a variety of different surgical operations. Seven patients had myocardial ischaemia after tracheal intubation and seven patients during tracheal extubation. The patients who developed myocardial ischaemia during tracheal extubation had ...

A prospective study evaluated potential risk factors associated with laryngeal injury after prolonged endotracheal tube intubation for longer than 3 days. Ninety-seven patients were evaluated after oral endotracheal tube intubation (mean, 9 days). This study updates a previously reported evaluation of 44 patients. The additional sample size has provided findings ...

The cause of anosognosia for hemiplegia (AHP) remains unclear. Weakness is detected when there is a mismatch between the expectancy of movement and the sensory perception of movement. The feed-forward hypothesis of AHP posits that there is a failure of detection because there is a loss of motor intention and ...

Twelve cases of post-anaesthetic pulmonary oedema (PO) secondary to upper airway obstruction (UAO) are reported. All were adult male patients undergoing uneventful elective surgical procedure under general anaesthesia. Post-anaesthetic laryngospasm was the single most important factor for the upper airway obstruction (UAO) in 5 (41.6%) patients. PO secondary to partial ...

Direct puncture of the small bowel under endoscopic guidance (direct EPJ) is possible in patients whose stomach has been removed or whose small bowel cannot be punctured by other methods. From January 1990 to June 1992 a total of 39 patients underwent successful direct EPJ at our institution. The indications ...

Epiglottitis (supraglottitis) is an acute infection involving the supraglottic larynx that usually occurs in children, but can also affect adult patients. The purpose of this study was to retrospectively analyze diagnostic and treatment methods in adults with epiglottitis seen over a 10-year period at the Winnipeg Health Sciences Centre. Forty-three ...

Respiratory catastrophes are the most common cause of anaesthesia-related brain deaths and death. If an airway is recognised to be difficult, endotracheal tube (ETT) intubation should be performed awake. Awake intubation demands proper preparation of the patient. When the patient is properly prepared any one of a number of ETT ...

We prospectively studied 282 consecutive tracheal intubations (243 patients) in a pediatric intensive care unit during a 7-month period to compare cuffed and uncuffed endotracheal tube (ETT) utilization and outcome. The incidence of postextubation stridor in each ETT group was the major outcome measure after controlling for various patient risk ...

Amyotrophic lateral sclerosis is a rapidly progressive disease of unknown etiology resulting in tetraparalysis, dysarthria, dysphagia, and ultimately death from respiratory insufficiency. In the course of the disease, recurrent episodes of aspiration, pneumonia, dehydration, and malnutrition may necessitate nasoenteral tube placement, an inconvenient and unattractive arrangement in patients with dribbling ...

PURPOSE: Enteral feeding via gastrostomy or gastrojejunostomy tubes has an established role in patients unable to maintain adequate oral intake. However, creation and maintenance of a site for long-term nutritional support can be significant problems in patients who have undergone previous surgery or in patients with chronic aspiration, abnormal stomach ...

STUDY OBJECTIVE: A prospective study of all unplanned adult extubations was conducted for 4 months period in four intensive care units (ICUs) of a community hospital. Our objective was to document the incidence of unplanned extubations, discern possible variables predictive of occurrence and outcome, and formulate preventive measures and guidelines ...

How unconscious does a patient need to be, to be intubated without drugs? In 76 comatose patients (Glasgow coma score [GCS] < or = 8) who were treated consecutively in an emergency department, the integrity of the cough reflex was not related to GCS. All comatose patients must be treated ...

Conjunctivodacryocystorhinostomy with a Jones tube is an accepted procedure for the treatment of epiphora resulting from obstructed canaliculi. Because of our clinical impression that a high rate of functional success after surgery is associated with a lower rate of patient satisfaction, we analyzed the results and patient satisfaction of 121 ...

41 patients (ASA I-II) were intubated using a new device for blind oral intubation (Augustine Guide). A group of 33 consecutive patients (Mallampati I and II), was studied for routine intubation. Another group of eight patients (Mallampati III and IV) was selected to study the guide in difficult airway management. ...

The purpose of this pilot study was to test methods to measure the effects of a fiber-fortified, enteral feeding (Jevity) on the bowel habits of an immobile, tube-fed group of patients. Three experimental patients received fiber-fortified feedings for seven weeks, whereas four control patients received their usual enteral feeding. Measurements ...

A technique for teaching fibreoptic orotracheal intubation in patients under general anaesthesia is described and evaluated. A standard general anaesthetic was administered to 60 patients presenting for elective gynaecological surgery. Patients were randomly assigned to receive either alfentanil 10 micrograms.kg-1 or a placebo, and to be intubated either by a ...

Difficulty with laryngoscopy and intubation is known to be the most frequent cause of anaesthetic related deaths. Awareness of the possibility of difficulty would enable the anaesthetist to be adequately prepared. 57 "normal" adult patients were examined pre-operatively and at laryngoscopy using the Mallampatti (1985) and the Cormack (1984) classification ...