ABSTRACT
This prospective study compares the results of pre-operative clinical examination and simple ultrasound examination of the neck in 18 patients with proven head and neck primary tumours and palpable cervical lymphadenopathy, who then underwent 21 radical neck dissections. Neck palpation and ultrasound examination were compared with histological examination. Ultrasound did not add significantly to the information obtainable by simple neck palpation in this group of patients.
Subject(s)
Carcinoma, Squamous Cell/diagnosis , Head and Neck Neoplasms/diagnosis , Carcinoma, Squamous Cell/diagnostic imaging , Carcinoma, Squamous Cell/surgery , Head and Neck Neoplasms/diagnostic imaging , Head and Neck Neoplasms/surgery , Humans , Lymphatic Metastasis , Neck , Neck Dissection , Palpation , Prospective Studies , UltrasonographyABSTRACT
Airway aspiration of foreign materials in children and adults is probably more common than has been supposed. This study investigated the possibility of such aspiration in children while under general anesthesia for dental extractions. A radiopaque fluid was used to coat the oral tissues and showed that a significant number of children did aspirate material into the trachea, bronchi, and occasionally even lung tissue. The notion that safety may be improved by operating with the patient in the supine position was not confirmed. While careful placement of an oropharyngeal pack may prevent solid material from entering the trachea and bronchi, it should be realized that fluids such as blood, saliva, and pus could still contaminate the airway.
Subject(s)
Anesthesia, Dental/adverse effects , Anesthesia, General/adverse effects , Foreign Bodies/etiology , Tooth Extraction , Chi-Square Distribution , Child , Child, Preschool , Humans , Inhalation , Pneumonia, AspirationABSTRACT
A 70-year-old man with chronic obstructive airways disease was scheduled to undergo panendoscopy following a course of radiotherapy for carcinoma of the larynx. He was anaesthetized using a propofol infusion and high frequency jet ventilation (HFJV). The jet ventilation catheter was left in situ at the end of the procedure. This enabled oxygenation to be maintained in the presence of post-operative laryngospasm by re-attaching the jet ventilator. Subsequently he developed respiratory failure, and a Bullard laryngoscope was used to visualize the vocal folds despite oedema of the tumour which made direct laryngoscopy impossible. A catheter was passed through the biopsy channel of the Bullard, enabling HFJV to be commenced. A conventional endotracheal tube was then railroaded over the catheter to facilitate conventional ventilation.
Subject(s)
High-Frequency Jet Ventilation , Laryngeal Edema/etiology , Laryngeal Neoplasms/complications , Laryngoscopes , Laryngoscopy/adverse effects , Aged , Humans , MaleABSTRACT
An in vivo study was undertaken during hypothermic (28 degrees C) cardiopulmonary bypass to compare oxygenator exhaust capnography as a means of estimating arterial carbon dioxide tension (PaCO2) with bench blood gas analysis. A total of 123 pairs of measurements were made in 40 patients. Oxygenator exhaust capnographic measurements systematically underestimated PaCO2 measured by a bench blood gas analyzer. During the cooling and stable hypothermic phases of cardiopulmonary bypass, the relationship was reasonably accurate, but became far more variable during rewarming. Oxygenator exhaust capnography could be used as an inexpensive means of continuously monitoring PaCO2 during the cooling and stable hypothermic phases of cardiopulmonary bypass but should not be used during rewarming.
Subject(s)
Carbon Dioxide/analysis , Carbon Dioxide/blood , Cardiopulmonary Bypass , Oxygenators , Adult , Aged , Blood Gas Analysis/methods , Body Temperature , Carbon Dioxide/metabolism , Humans , Hypothermia, Induced , Middle Aged , Partial Pressure , Single-Blind MethodABSTRACT
Relaxant responses to halothane and isoflurane were compared in helical strips of dog epicardial coronary arteries of different sizes: proximal large coronary arteries with outside diameters (OD) larger than 2.5 mm and distal small arteries with 0.7-0.9 mm OD. Responses to pharmacologic vasodilators, including nitroglycerin (NTG) and adenosine, were also studied for comparison. The relaxation induced by halothane in concentrations of 0.8-2.3% and by NTG (10(-9)-10(-5) M) was greater in proximal large coronary arteries than in distal small ones contracted with 20 mM KCl. In contrast, the relaxation by isoflurane (1.2-3.5%) and by adenosine (10(-8)-10(-4) M) was greater in small coronary arteries than in large ones. These results suggest that isoflurane is, like adenosine, preferentially a small artery dilator.
Subject(s)
Coronary Vessels/drug effects , Halothane/pharmacology , Isoflurane/pharmacology , Adenosine/pharmacology , Animals , Dogs , Female , In Vitro Techniques , Male , Muscle Contraction/drug effects , Muscle, Smooth, Vascular/drug effects , Nitroglycerin/pharmacologyABSTRACT
Sixty-four cases of theophylline poisoning were reviewed. All but two cases represented international self poisoning. The majority of patients were young females who presented acutely after ingestion of sustained release preparations prescribed for asthma. Serum theophylline levels (mean 365 mumol/l, SD 177) indicated a high risk of toxicity. Electrolyte and metabolic abnormalities (hypokalaemia, hypomagnesaemia, hypophosphataemia, hyperglycaemia, acid-base disturbances and leucocytosis) were common. Serum potassium, serum glucose, leucocyte count and length of stay in the intensive care unit all correlated strongly with maximum serum theophylline level (p less than 0.001). The low incidence of life-threatening manifestations of severe toxicity (hypotension, serious arrhythmias or seizures) and excellent outcome, contrasts with many previous reports. The results support the use of a management regimen which emphasizes intensive supportive therapy and restricts the use of charcoal haemoperfusion.
