Résumé
Tracheal injury in neonates is a rare but serious complication of endotracheal intubation. The morbidity and mortality are associated with early recognition and adequate management. Herein, we reported a case of perioperative management of neonatal tracheal injury following multiple attempts at endotracheal intubation caused by unanticipated difficulty.
Sujets)
Humains , Nouveau-né , Intubation trachéale , MortalitéRésumé
Massive hemoptysis is respiratory compromise which should be managed as a life-threatening condition. In our case, the bronchial blocker played a role in hemostasis of tracheal bleeding very close to the carina and prevented further spillage into the contralateral lung. Right-sided one-lung isolation in an 87-year-old female, who received cardiopulmonary resuscitation due to myocardial infarction, was requested due to hemoptysis. Right-sided bronchial bleeding was suspected on auscultation, but esophageal and tracheal bleeding due to violent intubation with a stylet was also considered. We attempted one-lung isolation with the bronchial blocker. The bronchial blocker was inadvertently advanced to the left mainstem bronchus, but the inflated balloon of the bronchial blocker compressed the site of bleeding, which was within 1 cm proximal and left posterior to the carina. Tracheal bleeding stopped, and we confirmed that hemostasis was achieved with the balloon of the bronchial blocker using a fiberoptic bronchoscope.
Sujets)
Sujet âgé de 80 ans ou plus , Femelle , Humains , Auscultation , Bronches , Bronchoscopes , Réanimation cardiopulmonaire , Hémoptysie , Hémorragie , Hémostase , Intubation , Poumon , Infarctus du myocardeRésumé
PURPOSE: The pain related to burn is moderate to severe and difficult to control regardless of medications. We evaluated the effect of intravenous patient-controlled analgesia (IV PCA) with weight-compensated regimen of fentanyl and ketorolac in burn surgery. METHODS: consecutive 82 patients received IV PCA after burn surgery. They were divided into two groups according to total body surface area% (TBSA%): group I (TBSA> or =25%, n=21) group II (TBSA or =25%) was difficult to control by conventional IV PCA, even through weight-compensated regimen. Pain of burn (TBSA> or =25%) should be controlled by increased dose of analgesics and approaches other than conventional medication.
Sujets)
Humains , Analgésie autocontrôlée , Analgésiques , Brûlures , Fentanyl , Kétorolac , Anaphylaxie cutanée passiveRésumé
No abstract available.
Sujets)
Humains , Nerf laryngé récurrent , Glande thyroide , Paralysie des cordes vocalesRésumé
BACKGROUND: During laparoscopic surgery, high airway pressures are generally followed by a diaphragmatic shift and hyperventilation. We hypothesize that normocapnea can be maintained with the same amount of CO2 output (VCO2) during pneumoperitoneum (PP). METHODS: Six anesthetized rabbits were mechanically ventilated at a respiratory rate of 20/min with FIO2 0.5. At the end of the expiratory limb of the ventilator, the mean partial pressure of CO2 was measured. The internal carotid artery was catheterized. Baseline values for blood pressure, heart rate, arterial blood gas analysis, and ventilatory variables were obtained. CO2 gas was introduced into the peritoneum with an intra-abdominal pressure of 12 mmHg. The measurements at baseline and at PP1 were compared. The respiratory rate was changed from (20/min PP1, to 40/min PP2, 80/min PP3 or 120/min PP4) while calculating VCO2 and comparing ventilatory variables under PP at the same time. RESULTS: The peak inspiratory pressure (PIP) and tidal volume (VT) at PP1 increased, compared with baseline. With the same PaCO2, the VT decreased significantly from (45 +/- 8 ml PP1 to 29 +/- 5 ml PP2, 19 +/- 4 ml PP3 and 15 +/- 2 ml PP4), respectively. The PIP was reduced. However, the dead space to tidal volume ratio (VD/VT) was greater at higher RR during PP. CONCLUSIONS: PP increased the PIP and VT for the removal of overloaded CO2. Less VT at a higher respiratory rate could be used with the same amount of VCO2 during PP. However, the VD/VT was elevated by the induction of PP and by the increase in respiratory rate.
Sujets)
Lapins , Gazométrie sanguine , Pression sanguine , Carbone , Artère carotide interne , Cathéters , Membres , Rythme cardiaque , Hyperventilation , Laparoscopie , Pression partielle , Péritoine , Pneumopéritoine , Fréquence respiratoire , Volume courant , Respirateurs artificielsRésumé
A 76-year-old, 148-cm woman was scheduled for right upper lobectomy. A 32 Fr left-sided double lumen tube was placed using a conventional technique. Despite several attempts under fiberoptic bronchoscope-guidance, we could not locate the double lumen tube properly. We thus decided to proceed with the bronchial tube in the right mainstem bronchus. During surgery, 8-cm-long laceration was noted on the posterolateral side of the trachea. To check the possibility of laceration of the proximal trachea, the double lumen tube was changed to an LMA for use as a conduit for fiberoptic bronchoscopic evaluation in the lateral position. A plain endotracheal tube with the cuff modified and collapsed was re-intubated after evaluation. And then she was transferred to SICU.