Subject(s)
Anesthesia, Inhalation/instrumentation , Bronchodilator Agents/therapeutic use , Nitric Oxide/therapeutic use , Bronchodilator Agents/administration & dosage , Bronchodilator Agents/chemistry , Equipment Design , Equipment Safety , Humans , Nitric Acid/chemistry , Nitric Oxide/administration & dosage , Nitric Oxide/chemistry , Nitrogen Dioxide/analysis , Nitrogen Dioxide/chemistry , Oxygen/chemistryABSTRACT
Medical science has long made the improbable probable, saving lives and improving quality of life. Upon the introduction of medical devices that can deliver safe quantities of the poisonous gas nitric oxide to help patients with respiratory and other illnesses, the FDA requested ASTM Committee F29 on Anesthetic and Respiratory Equipment to provide standards for these devices. Dr. Daniel Supkis and Mark Graber explain the delicate process of delivering NO to patients and how ASTM standards now in development will increase the safety of this procedure.
Subject(s)
Nitric Oxide , Humans , Infant, Newborn , Nitric Oxide/standards , Nitric Oxide/therapeutic use , Nitric Oxide/toxicity , Respiratory Distress Syndrome, Newborn/drug therapy , Respiratory Insufficiency/drug therapy , United States , United States Food and Drug Administration , Vasodilator Agents/standards , Vasodilator Agents/therapeutic use , Vasodilator Agents/toxicityABSTRACT
The head and neck cancer patient should be in the best possible medical condition before facing surgery, bearing in mind the status of the tumor and the urgency of the procedure. Careful assessment of the patient's upper airway will enable the anesthesiologist to select an appropriate course of action to secure the airway before the operation begins. In many cases, the patient can be safely intubated after the induction of general anesthesia. In other situations, the patient may require an examination of the airway while awake with the aid of sedation and topical analgesia to determine the safest intubation technique. If the patient has evidence of a difficult airway, a flexible fiberoptic-guided intubation may be indicated to secure the airway in the awake patient patient before general anesthesia is induced. Some patients with severe airway obstruction or large, bulky supraglottic tumors usually undergo an initial tracheostomy with local anesthesia to secure the airway. Following surgery, extubation of the patient's trachea requires careful attention and may have to be performed over a jet-ventilating stylet.
Subject(s)
Anesthesia, General , Head and Neck Neoplasms/surgery , Airway Obstruction/complications , Anesthesia, Local , Fiber Optic Technology/instrumentation , Health Status , High-Frequency Jet Ventilation , Humans , Hypnotics and Sedatives/therapeutic use , Intubation, Intratracheal/instrumentation , Intubation, Intratracheal/methods , Laryngoscopes , TracheostomyABSTRACT
OBJECTIVE: To determine the current attitude about the use of minors as bone marrow donors in pediatric bone marrow transplantation (BMT) centers in North America. STUDY DESIGN: A questionnaire was mailed to 70 North American BMT centers. The questionnaire asked for opinions on a number of ethical and clinical issues pertaining to the use of minors as marrow donors. A case history was included and respondents were asked to check all appropriate answers listed in the survey. RESULTS: Fifty-six (80%) of 70 centers responded. There was general consensus on many issues. Pediatricians endorse the validity of parental consent, even in potentially controversial situations. Most are prepared to extract marrow from young (about 6 months of age) infants and are willing to use the same donor more than once. There is general approval of performing BMT with experimental protocols, and the projected outcome of BMT does not affect the decision to use a minor as a marrow donor. There is less consensus regarding the optimal management of minors donating a large volume of bone marrow. CONCLUSION: This survey shows a fairly consistent attitude among pediatric BMT centers about the use of minors as marrow donors. The actual management of such donors was not evaluated in detail and requires further study.
