ABSTRACT
INTRODUCTION: Airway management in patients with middle third facial skeleton fractures is a challenge for anesthesiologists and surgeons, given that the natural routes for intubation--the nose and mouth--are both compromised by trauma. In this setting, the airway can only be accessed by tracheotomy. Tracheotomy, however, is an invasive technique that should be reserved for cases in which it is absolutely necessary. OBJECTIVES: To establish the utility of submental intubation as an alternative to tracheotomy in patients with middle third facial skeletal fractures. PATIENTS AND METHODS: We reviewed the cases of the 15 patients intubated with the aforementioned technique between 1996 and 2002 in Hospital Universitario La Paz in Madrid, Spain. We describe the surgical technique and postoperative course recorded for those patients. RESULTS: The courses of surgery and postoperative recovery were without complications. All extubations were uneventful and no patient required a tracheotomy. CONCLUSIONS: Submental intubation is a simple, useful technique for managing the airway of patients with middle third facial skeletal fractures. The technique has few complications.
Subject(s)
Facial Bones/injuries , Intubation/methods , Skull Fractures/therapy , Adult , Child , HumansABSTRACT
INTRODUCCIÓN: El manejo de la vía aérea en los pacientes afectados de fracturas de tercio medio facial constituye un reto para el anestesiólogo y el cirujano, ya que las vías naturales de intubación -nariz y boca- están comprometidas en por el traumatismo. En esta situación, la única vía de acceso a la vía aérea parece ser la traqueotomía. Sin embargo, esta última, es una técnica agresiva que debe reservarse para aquellos casos en los que sea estrictamente necesaria. OBJETIVOS: En el presente trabajo nos proponemos establecer la utilidad de la intubación submentoniana como alternativa a la traqueotomía en pacientes aquejados de fracturas de tercio medio facial. PACIENTES Y MÉTODOS: Revisamos las historias de los 15 pacientes intubados mediante esta técnica entre 1996 y 2002, en el H.U. "La Paz". Describimos la técnica quirúrgica y exponemos la evolución postoperatoria. RESULTADOS: Los tiempos quirúrgicos y postoperatorio cursaron sin complicaciones. Todos los pacientes fueron extubados sin problemas y ninguno precisó traqueotomía. CONCLUSIONES: La intubación submentoniana es una técnica útil, sencilla y con escasas complicaciones para el manejo de la vía aérea en pacientes afectados de fracturas de tercio medio facial (AU)
Subject(s)
Adult , Child , Humans , Facial Bones , Intubation , Skull Fractures , IntubationABSTRACT
The fungus Fusarium sacchari was isolated repeatedly from the blood of an immunosuppressed host. The infection was treated successfully with a small dose of amphotericin B. The strain was resistant to this antifungal in vitro. MICs and minimum fungicidal concentrations of six antifungals for the clinical isolate are provided. To our knowledge, this is the first report involving this fungus in a case of fungemia.
Subject(s)
Fungemia/diagnosis , Fusarium/isolation & purification , Immunosuppression Therapy/adverse effects , Adult , Amphotericin B/therapeutic use , Fungemia/drug therapy , Fusarium/classification , Fusarium/cytology , Humans , Kidney Transplantation/adverse effects , Male , Microbial Sensitivity TestsABSTRACT
Two fungal isolates recovered from the blood of two immunosuppressed patients are described as Phialemonium curvatum. One patient died, while the other, who was infected with Exophiala jeanselmei at the same time, survived after successful treatment with itraconazole. Analysis of internal transcribed spacer sequences demonstrated that the isolates belonged to the same strain and that the source of infection was probably a catheter. The taxonomic position of P. curvatum is discussed, and Phialemonium dimorphosporum is considered a synonym. The in vitro inhibitory activities of six antifungal agents (amphotericin B, itraconazole, ketaconazole, miconazole, flucytosine, and fluconazole) were determined against seven isolates of Phialemonium. Except for flucytosine, all of them were remarkably effective. Phialemonium should be added to the list of potential causes of nosocomial fungemia in cancer patients.
