The dissection of reinforced endotracheal tube internal wall causing intraoperative airway obstruction under general anesthesia: case report.

Endotracheal intubation is performed to establish a secure airway. However, this carries its risks and obstruction of an endotracheal tube (ETT) is a potentially life-threatening event. We report two cases with an obstruction of the resterilized, single use, spiral, reinforced endotracheal tubes by dissection of the internal wall. As a conclusion, we suggest not reusing and resterilizing single tubes in these cases to avoid a complication like dissection of the internal wall of the tube, as this has been the main cause.

Dissecção da parede interna de tubo endotraqueal aramado que causa obstrução das vias aéreas no intraoperatório sob anestesia geral: relato de caso / The dissection of reinforced endotracheal tube internal wall causing intraoperative airway obstruction under general anesthesia: case report / Disección de la pared interna del tubo endotraqueal reforzado que causa obstrucción de las vías aéreas en el intraoperatorio bajo anestesia general: relato de caso

A intubação endotraqueal é feita para estabelecer uma via aérea segura; contudo, pode trazer riscos. A obstrução de um tubo endotraqueal (TET) é um evento potencialmente fatal. Relatamos dois casos de obstrução de TET reesterilizado, de uso único, aramado por causa da dissecção da parede interna. Como conclusão, sugerimos não reesterilizar tubos individuais em tais casos, para evitar uma complicação como dissecção da parede interna do tubo, pois essa foi a causa principal.

Endotracheal intubation is performed to establish a secure airway. However, this carries its risks and obstruction of an endotracheal tube (ETT) is a potentially life-threatening event. We report two cases with an obstruction of the resterilized, single use, spiral, reinforced endotracheal tubes by dissection of the internal wall. As a conclusion, we suggest not reusing and resterilizing single tubes in these cases to avoid a complication like dissection of the internal wall of the tube, as this has been the main cause.

La intubación endotraqueal se hace para establecer una vía aérea segura; sin embargo, puede traer riesgos. La obstrucción de un tubo endotraqueal (TET) es un evento potencialmente fatal. Relatamos aquí dos casos de obstrucción de TET re-esterilizado de uso único, en formato de espiral y reforzado a causa de la disección de la pared interna. Como conclusiones, sugerimos no re-esterilizar los tubos individuales en esos casos, para evitar una complicación como la disección de la pared interna del tubo, porque esa fue la causa principal.

Bone pain assessment and relationship with parathyroid hormone and health-related quality of life in hemodialysis.

Renal osteodystrophy is a common problem in renal failure patients. Bone pain is a common manifestation of renal osteodystrophy. The aim of the study was to assess the intensity of chronic bone pain via visual analog scale (VAS) and its relationship with parathyroid hormone, health-related quality of life (HRQoL), and depression in hemodialysis patients. Ninety-five patients recruited were asked to rate chronic bone pain via VAS. Depressive symptoms and HRQoL were assessed by Beck Depression Inventory (BDI) and Short-Form 36, respectively. VAS was positively correlated with intact parathyroid hormone (r = +0.322, p = 0.001), phosphorus (r = +0.300, p = 0.003), alkaline phosphatase (r = +0.275, p = 0.009), and negatively correlated with physical component (r = -0.320, p = 0.002) and mental component summary scores (r = -0.247, p = 0.016). In multivariate linear regression analysis, logVAS was independently associated with serum phosphorus (ß = 0.072, 95% confidence interval: 0.020-0.123, p = 0.007), log intact parathyroid hormone (ß = 0.176, 95% confidence interval: 0.041-0.310, p = 0.011), and physical component summary score (ß = -0.018, 95% confidence interval: -0.031-(-0.005), p = 0.008). VAS is correlated with bone metabolism markers, namely, intact parathyroid hormone, and may be used to assess the intensity of chronic bone pain. The intensity of chronic bone pain is related with HRQoL in hemodialysis patients.

Comparison of intravenous morphine, epidural morphine with/ without bupivacaine or ropivacaine in post-thoracotomy pain management with patient controlled analgesia technique.

BACKGROUND AND OBJECTIVES: The aim of this randomized, double-blinded, prospective study was to determine the effectiveness and side effects of intravenous or epidural use of morphine, bupivacaine or ropivacaine on post-thoracotomy pain management. METHODS: Sixty patients undergoing elective thoracotomy procedure were randomly allocated into 4 groups by the sealed envelope technique. Group IVM, EM, EMB and EMR received patient controlled intravenous morphine, and epidural morphine, morphine-bupivacaine and morphine-ropivacaine, respectively. Perioperative heart rate, blood pressure and oxygen saturation and postoperative pain at rest and during cough, side effects and rescue analgesic requirements were recorded at the 30(th) and 60(th) minutes and the 2(nd), 4(th), 6(th), 12(th), 24(th), 36(th), 48(th), and 72(nd) hour. RESULTS: Diclofenac sodium requirement during the study was lower in Group EM. Area under VAS-time curve was lower in Group EM compared to Group IVM, but similar to Group EMB and EMR. Pain scores at rest were higher at the 12, 24, 36, and 48(th) hour in Group IVM compared to Group EM. Pain scores at rest were higher at the 30(th) and 60(th) minutes in Group EM and Group IVM compared to Group EMB. Pain scores during cough at the 30(th) minute were higher in Group EM compared to Group EMB. There was no difference between Group IVM and Group EMR. CONCLUSIONS: Morphine used at the epidural route was found more effective than the intravenous route. While Group EM was more effective in the late period of postoperative, Group EMB was more effective in the early period. We concluded that epidural morphine was the most effective and preferred one.

Comparison of intravenous morphine, epidural morphine with/without bupivacaine or ropivacaine in postthoracotomy pain management with patient controlled analgesia technique.

BACKGROUND AND OBJECTIVES: The aim of this randomized, double-blinded, prospective study was to determine the effectiveness and side effects of intravenous or epidural use of morphine, bupivacaine or ropivacaine on post-thoracotomy pain management. METHODS: Sixty patients undergoing elective thoracotomy procedure were randomly allocated into 4 groups by the sealed envelope technique. Group IVM, EM, EMB and EMR received patient controlled intravenous morphine, and epidural morphine, morphine-bupivacaine and morphine-ropivacaine, respectively. Perioperative heart rate, blood pressure and oxygen saturation and postoperative pain at rest and during cough, side effects and rescue analgesic requirements were recorded at the 30(th) and 60(th) minutes and the 2(nd), 4(th), 6(th), 12(th), 24(th), 36(th), 48(th), and 72(nd) hour. RESULTS: Diclofenac sodium requirement during the study was lower in Group EM. Area under VAS-time curve was lower in Group EM compared to Group IVM, but similar to Group EMB and EMR. Pain scores at rest were higher at the 12, 24, 36, and 48(th) hour in Group IVM compared to Group EM. Pain scores at rest were higher at the 30(th) and 60(th) minutes in Group EM and Group IVM compared to Group EMB. Pain scores during cough at the 30(th) minute were higher in Group EM compared to Group EMB. There was no difference between Group IVM and Group EMR. CONCLUSIONS: Morphine used at the epidural route was found more effective than the intravenous route. While Group EM was more effective in the late period of postoperative, Group EMB was more effective in the early period. We concluded that epidural morphine was the most effective and preferred one.

The dissection of reinforced endotracheal tube internal wall causing intraoperative airway obstruction under general anesthesia. Case report.

Endotracheal intubation is performed to establish a secure airway. However, this carries its risks and obstruction of an endotracheal tube (ETT) is a potentially life-threatening event. We report two cases with an obstruction of the resterilized, single use, spiral, reinforced endotracheal tubes by dissection of the internal wall. As a conclusion, we suggest not reusing and resterilizing single tubes in these cases to avoid a complication like dissection of the internal wall of the tube, as this has been the main cause.