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 ...

Postpyloric feedings are a widely practiced form of enteral nutrition. We prospectively randomized two groups of hospital patients to receive a standard feeding tube or a feeding tube that uses a pH sensor to facilitate postpyloric placement and compared placement speed and accuracy, displacement detection, and costs for the two ...

The initial clinical experience with the use of a triple lumen long tube designed for gastrointestinal decompression and enteroclysis is reported in 150 patients. Based on clinical observations, this tube is effective in suctioning retained gastric and intestinal fluid but requires frequent irrigation of the sump port for effective decompression ...

Adductor laryngeal breathing dystonia (ALBD) is a rare disorder in which patients have persistent inspiratory stridor, usually normal voice, and cough. Physical exam is characterized by paradoxical movement of the vocal cords on inspiration. These patients have involuntary action-induced spasms of the adductor laryngeal muscles on inspiration. There has been ...

PURPOSE: Therapeutic role of fallopian tube catheterization was prospectively studied in patients with bilateral fallopian tube obstruction. MATERIALS AND METHODS: Catheterization was performed in 42 patients with bilateral obstruction; 36 of the patients (67 fallopian tubes) underwent recanalization. RESULTS: Fifty-two tubes with 54 proximal obstructions were successfully recanalized (technical success ...

BACKGROUND: Sevoflurane is a new inhalational anesthetic agent having low solubility in blood and a relatively nonpungent odor. As such it should be useful as an inhalation induction in pediatric patients. The objectives of the study were to determine both the minimum alveolar concentration (MAC) and the concentration required for ...

Chest tubes are placed to empty the pleural space of air or fluid which prohibits full lung expansion. The function of these tubes is dependent on adequate placement, effective drainage and frequent re-evaluation of the patient and the chest drainage system. Knowledge of the principles of chest tube drainage is ...

Fifty-two patients who had otitis media with effusion associated with head and neck malignancies were identified and studied retrospectively. Forty-three of the patients underwent myringotomy and tube for treatment of the effusion. Ten (23%) of the 43 patients had either multiple infections or continuous otorrhea necessitating tube removal. The patients ...

This paper reviews the experience of managing 31 patients with severe dysphagia in motor neurone disease. Thirteen patients were fed nasogastrically and the remaining 18 were managed conservatively without a nasogastric tube. The introduction of nasogastric feeding led to the development of new problems in some patients, without any significant ...

Flow-volume loops were monitored continuously in 39 patients undergoing thoracic surgery requiring one-lung ventilation. In 26 of the 39 patients (67%), auto-positive end-expiratory pressure (auto-PEEP) was seen on the flow-volume curves during both two-lung and one-lung ventilation. Eighty-seven percent of the patients whose trachea was intubated with a smaller size ...

We report our experience with 28 patients using percutaneous endoscopic gastrostomy (PEG) for decompression of gastrointestinal obstruction as a result of carcinomatosis secondary to gynecologic malignancy. PEG could be performed successfully in 26 of the 28 patients. In two patients, intubation was not possible for technical reasons and the procedure ...

Laryngeal necrosis is a rare complication of therapeutic radiation, but when it does occur there is no established, definitive treatment and laryngectomy is frequently required. This report is a retrospective review of all patients referred for hyperbaric oxygen (HBO) therapy to a single hyperbaric medicine unit for treatment of their ...

We performed percutaneous endoscopic gastrostomy (PEG) in 30 patients with prolonged swallowing difficulty (> 4 weeks duration). The average procedure time was 25 minutes. PEG insertion was done on an outpatient basis in four patients. The complication rate was 10% and included failed insertion, peristomal infection and herniation of the ...

Patients with ventricular assist devices must necessarily have percutaneous leads linking the internal device to the external console. In the chronic circumstance, the percutaneous lead insertion site may become the location of irritation or infection. At the University of Pittsburgh, a procedure has been developed for care of this site. ...

The case notes and anaesthetic charts of 44 patients with dystrophic epidermolysis bullosa were reviewed retrospectively. A total of 390 general anaesthetics were performed for 469 surgical procedures over a 10-year period. Procedures included repair of syndactyly, dilatation of oesophageal strictures, extraction of teeth, excision of skin tumours and other ...

The laryngeal mask airway was used to facilitate fibreoptic bronchoscopy under general anaesthesia in 140 adult patients. Following placement, the position of the mask was observed through the fibreoptic bronchoscope. Three different positions were identified. In 120 patients (86%) the concave surface of the mask faced the larynx directly with ...

PURPOSE: This study examines the difference in success between bedside insertions of peripherally inserted central catheters (PICCs) performed by clinicians and fluoroscopically assisted insertions by cardiovascular/interventional (CV/I) radiologists. PATIENTS AND MATERIALS: Four hundred four PICCs were inserted in 305 patients, with a mean age of 48 years (range, 8-78 years), ...

BACKGROUND: The esophageal detector device (EDD) is a diagnostic tool for confirmation of tracheal intubation. Capnography is the accepted standard for such confirmation. The purpose of this investigation was to determine whether results using the EDD and capnography agree. METHODS: Five hundred patients were divided into three separate studies. In ...

The ease of insertion of the laryngeal mask airway with the patient's head in the standard position and the neutral position was compared, in a study of 80 healthy patients. Successful insertion was assessed by fibreoptic bronchoscopy and the functioning of the airway. In terms of function the successful insertion ...

Eight infertility patients with proximal tubal occlusion by HSG and at least one other independent method underwent falloposcopy to evaluate the etiology of uterotubal occlusion. Patency was established in 9 of 12 tubes evaluated. Falloposcopy revealed 5 tubes with multiple or extensive intratubal lesions that would be unsuitable for unilocular ...

A total of 379 patients admitted to the ICU for mechanical ventilation were prospectively investigated for lesions on the nose, nasal cavity, ears and larynx during and after nasotracheal intubation. One to two years later, the surviving patients were questioned to investigate late persisting sequelae. During intubation and up to ...

The conditions for emergency tracheal intubation of patients with cervical spine injury were simulated in 157 patients during induction of anaesthesia for routine surgery. The view of the larynx obtained during laryngoscopy with the head in the optimum intubating position was compared with that obtained when manual in-line stabilisation of ...

A frequent mechanical problem encountered with small-bore feeding tubes is lumenal obstruction of the tube. A number of studies have described methods to prevent tube occlusion and restore patency once the tube becomes occluded. It has been observed that most intact protein formulas will clot when acidified to a pH ...

The incidence of pancreatitis after cardiopulmonary bypass is reported as < 0.1%. We report a milder form of pancreatitis characterized by hyperlipasemia and early intolerance to enteral nutrition without overt signs of clinical pancreatitis. A retrospective study was conducted in 72 patients who had received tube feeding. A statistically (p ...

Scintigraphy was used to detect gastroesophageal reflux, determine whether percutaneous gastrostomy (PG) tubes cause reflux, and help in the choice between PG tubes versus percutaneous gastrojejunostomy (PGJ) tubes. During a 2-year period, 46 patients were evaluated with scintigraphy immediately before and 1 week after PG tube placement. Findings in the ...

The purpose of this study was to determine the complication rates associated with the use of the endotracheal tube (ET) and the use of the esophageal obturator airway/esophageal gastric tube airway (EOA/EGTA) during the treatment of patients with prehospital cardiac arrest. A descriptive, quasi-experimental study of 509 consecutive adults, cardiac ...

Gastrostomy can be a valuable adjunct to patient care, and percutaneous endoscopic gastrostomy is often considered the method of choice for gastrostomy placement. As with all surgical procedures, however, patient selection is important no matter how the gastrostomy is placed. In a retrospective review of 125 randomly selected patients having ...

It is difficult to predict from clinical signs and symptoms which patients suffer from subglottic penetration of foods. Most investigators attempting to predict aspiration have used small numbers of patients and relatively unsophisticated statistical techniques. In this study, we utilized 249 patients to examine the predictive value of several clinical ...

Percutaneous endoscopic gastrostomy (PEG) was performed in 33 patient with head injury, one with laryngeal cancer, and one with gastric volvulus. The gastrostomy tube was prepared from 20 F Foley catheter and a plastic micropipette tip. The complications encountered included peritubal leak in three patients (9%) and abdominal wall hematoma ...

Estimation of the correct length of a tracheal tube is extremely important and should be tailored to the needs of the individual patient. One hundred and eight patients who required tracheal intubation during anaesthesia were studied. The predicted length was estimated in each patient before induction of anaesthesia. The upper ...

Children with laryngotracheal stenosis undergo laryngotracheal reconstruction (LTR) to permit tracheostomy decannulation. We conducted voice assessments of 8 pediatric LTR patients with voice problems. Perceptual ratings and acoustic measures were taken in 5 patients and videolaryngoscopy/laryngostroboscopy was conducted in all 8. Results of perceptual evaluation were abnormal for hoarseness, breathiness ...

OBJECTIVE: To determine whether or not the presence of a nasogastric tube causes a change in the bacterial flora in the oropharynx. STUDY DESIGN: Cohort (prospective) design with concurrent control. SETTING: General Surgical and Ear, Nose, and Throat Units of a tertiary care hospital. PATIENTS: Sixteen patients with and 14 ...

The first metatarsal of six feet in four patients was surgically lengthened. Brachymetatarsia was caused by a congenital defect in two patients, nonunion after metatarsal osteotomy in one patient, and premature physeal closure associated with pin placement across the physis in one patient. In each patient, middiaphyseal osteotomy was performed, ...

The results of the pelvic pouch procedure were reviewed to assess the surgical complication rate and outcome of patients who had had the procedure performed with a stapled ileo-anal anastomosis with and without a defunctioning ileostomy. Between December 1982 and March 1992, 483 patients underwent a pelvic pouch (PP) procedure. ...

A patient's tolerance of fiberoptic bronchoscopy depends on the effectiveness of local anesthesia. This study compares the three different methods of local anesthesia in common use After sedation, patients (n = 53) received either 4 ml of 2.5 percent cocaine by intratracheal injection (TI) (n = 18), by bronchoscopic injection ...

Condensation in the external airways of patient ventilation systems using conventional warm-water humidifiers increases the risk of bacterial contamination. Condensate formation can be reduced by heating the external airway and reducing the length of tubing between the patient and humidifier. The method described incorporates the humidifying element within the interconnecting ...

A total of 6 pregnant women with obstructing urinary calculi was managed by percutaneous nephrostomy drainage placed under ultrasound guidance with the patient under local anesthesia. All patients initially had relief of acute obstruction. However, occlusion of the percutaneous nephrostomy tubes with debris necessitated tube changes in 5 of 6 ...

The effect of preoxygenation with varying inspired oxygen concentration on the arterial oxygen saturation during induction of anaesthesia and intubation was studied using the pulse oximeter. Sixty-five healthy, young adults, (American Society of Anaesthesiologists Class I) undergoing elective surgery were randomly divided into three groups. Group I patients were not ...

Transesophageal echocardiography greatly enhances the examination of patients difficult to image transthoracically. While of low patient risk, a potential for harm from human bites to the echocardiography staff and to the transesophageal probe remains, particularly when dealing with uncooperative patients. This risk potential prompted implementation of additional anti-bite protection in ...

Difficult intubation has been much discussed in the anaesthetic literature. The incidence of difficult intubation (11:560) was higher in obstetric patients (6:277) as compared to gynaecological patients (5:283) in our hospital. We tested the Mallampati's classification as a predictor of difficult intubation in 277 obstetric and 283 gynaecological patients. We ...

Patients may not receive prescribed oxygen because the oxygen face mask becomes displaced. Using video, we have observed the position of the face mask in 20 postoperative patients and recorded the timing and the events associated with mask displacement. Correct placement of the mask was confirmed at the start of ...

Laryngeal chondrosarcomas are uncommon, and those that contain a distinct, nonchondroid, high-grade spindle cell sarcoma (the so-called "dedifferentiated" chondrosarcoma or chondrosarcoma with additional malignant mesenchymal component [CAMMC]) are extremely rare. Laryngeal CAMMC merit special attention, as CAMMC in other sites portends a poor prognosis. Eleven patients with laryngeal chondrosarcomas are ...

OBJECTIVE: To evaluate the occurrence of complications and patient deteriorations during the air and ground transportation of intubated pediatric patients, performed by a nonphysician-based team under the direction of an intensive care attending physician or fellow. DESIGN: Retrospective chart review. SETTING: A 600-bed university hospital with a 16-bed neonatal ICU ...

Bismuth subgallate (BSG) is a heavy metal compound which is effective in lowering the incidence of hemorrhage after adenotonsillectomy and has been demonstrated to activate Factor XII. In a minority of children, the paste has been suctioned from the cuffless oral endotracheal tube after adenotonsillectomy. No pulmonary sequelae have been ...

STUDY OBJECTIVE: To determine whether anesthesia in the presence of a mild upper respiratory infection (URI) was associated with episodes of desaturation or reactive airway problems. DESIGN: A prospective study. SETTING: Inpatient and outpatient units of a university medical center. PATIENTS: Four hundred two pediatric patients. INTERVENTIONS: Patients were monitored ...

To determine the clinical usefulness of the thromboelastogram in the prediction of postoperative hemorrhage in cardiac patients, we related the results of routine coagulation tests (RCTs) and thromboelastography with the amount of chest tube drainage postoperatively in 101 patients requiring cardiopulmonary bypass. Our data indicated that there was no correlation ...

When a patient is intubated with an endotracheal tube for artificial ventilation the humidifying, warming and filtering functions of the nose and upper airways are bypassed. This article reviews the need for the provision of artificial humidification, optimal levels that should be provided and the two types of device which ...

One hundred seven consecutive patients seen over a 6-year period with dysphagia secondary to advanced primary carcinoma of the esophagus underwent intubation. One hundred five patients underwent pulsion intubation. In 2 patients pulsion intubation was not possible, and laparotomy and traction intubation was performed. For the intubated group there were ...

We describe three stroke patients with prolonged swallowing difficulty whose rehabilitation had been unsuccessful due to recurrent aspiration pneumonia and/or nasogastric tube dislodgement. Percutaneous endoscopic gastrostomy tube feeding, initiated 4-6 months following the onset of stroke, was associated with nutritional improvement, marked functional recovery and eventual discharge from hospital. This ...

A retrospective analysis was completed of the charts of the 1,727 patients with the diagnosis of croup seen during two years (1985 and 1986) in the Emergency Department of The Hospital for Sick Children in Toronto. Cough (91.4%) was the most common presenting symptom. Other presenting signs and symptoms included ...