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Preanesthetic Evaluation
Published in Michele Barletta, Jane Quandt, Rachel Reed, Equine Anesthesia and Pain Management, 2023
Note evidence of partial upper airway obstruction, such as laryngeal hemiplegia, nasal or pharyngeal neoplasia or guttural pouch disease. Make plans before anesthesia to manage complications such as airway obstruction.Endotracheal intubation may be difficult in these animals and may require use of an endotracheal tube with a smaller internal diameter than ideal. If an endoscope is available, it can be inserted inside the endotracheal tube and used to visually guide the tube into the larynx.A tracheotomy may be indicated either before induction of anesthesia, immediately after induction of anesthesia, or during anesthesia and before recovery.
Battlefield Chemical Inhalation Injury
Published in Jacob Loke, Pathophysiology and Treatment of Inhalation Injuries, 2020
In the event of continued environmental exposure, a gas mask will be required by the injured person. If upper airway occlusion occurs that is not relieved by head extension, laryngospasm is then presumed. Because a gas mask precludes normal endotracheal tube placement, tracheostomy/cricothyroidotomy should be considered. Such a procedure is undertaken if resolution of the laryngospasm does not occur within a few minutes. Devices have been developed to accomplish this easily and simultaneously provide a connection to a small, portable (possibly jet/high-frequency) ventilator. If there is no continued environmental exposure, in practiced hands an endotracheal tube can generally be placed even in the event of laryngospasm.
Intensive care medicine
Published in Roy Palmer, Diana Wetherill, Medicine for Lawyers, 2020
John H Coakley, Charles J Hinds
An endotracheal tube or tracheostomy (see Figure 5.1, page 58) secures the airway and allows mechanical ventilation of the lungs. They are inserted through the mouth or nose, or directly into the trachea, usually under general anaesthetic. They may be misplaced into the oesophagus or advanced too far (into the bronchi) or not far enough. A patient, relative or member of staff may unexpectedly remove them (not always accidentally). This may prove fatal.
Selected strategies to fight pathogenic bacteria
Published in Journal of Enzyme Inhibition and Medicinal Chemistry, 2023
Aiva Plotniece, Arkadij Sobolev, Claudiu T. Supuran, Fabrizio Carta, Fredrik Björkling, Henrik Franzyk, Jari Yli-Kauhaluoma, Koen Augustyns, Paul Cos, Linda De Vooght, Matthias Govaerts, Juliana Aizawa, Päivi Tammela, Raivis Žalubovskis
The challenge to establish a VAP mouse model lies not only in the technical, but also in the biological aspects. The selection of a bacterial strain is fundamental for the success of murine models88. The benefit of this animal model is the relative ease to establish a chronic infection (≥ 3 days)127,145 with S. aureus ATCC 25923. The limitation is that the delivery of bacteria at implantation of the device is initially different between the CPX and the TPU tubes, since the bacterial viable numbers are reduced during the pre-incubation step due to eluting CPX. However, in the clinical situation an endotracheal tube is placed in the trachea in contact with the fluid lining of the tracheal epithelium. In this humid environment, CPX elution will also start at the same time as the first contaminating bacteria will reach the tube. Thus, it might be argued that the exposure of the bacteria to CPX in the pre-incubation step represents the situation that may occur in vivo. In future studies, it would be interesting to focus on the pathophysiology by inserting non-colonized tubes and subsequently exposing mice to the bacteria. Other bacterial strains and even species could be used for this purpose, such as P. aeruginosa, since chronicity of infection has been previously obtained with the appropriate strain and methodology107,131.
Effect of COVID-19 on the incidence of postintubation laryngeal lesions
Published in Baylor University Medical Center Proceedings, 2023
Madison Buras, Nicole DeSisto, Randall Holdgraf
As previously mentioned, studies have shown that COVID-positive patients have increased risk factors for tissue damage. However, because increased risk of vocal fold injury in our study was associated directly with pronation rather than COVID infection, early laryngoscopy may be generalized to patients who undergo pronation therapy for other reasons. Pronation describes the act of placing a ventilated patient face down. It is not an uncommon maneuver, and in a multicenter randomized controlled trial by Guérin et al, it was shown to decrease the mortality of patients with acute respiratory distress syndrome from 32.8% to 16% in a 28-day period.13 Benefits from the prone position have been well described by many studies. These benefits include mobilizing secretions from the posterior lung fields, which allows for increased alveolar recruitment in those regions, thereby improving ventilation.14 However, pronation therapy has risks. Repositioning the patient can cause the endotracheal tube to shift or dislodge. Movement of the endotracheal tube and the increased pressure that pronation causes on areas such as the posterior commissure can increase the risk of laryngeal trauma. According to the American Thoracic Society, the benefits of pronation therapy outweigh the potential adverse events, so it recommends that patients with acute respiratory distress syndrome be positioned face down for 12 to 16 hours a day.14
Chondrolaryngoplasty in transgender women: Prospective analysis of voice and aesthetic satisfaction
Published in International Journal of Transgender Health, 2021
Mateus Morais Aires, Daniela de Vasconcelos, Bruno Teixeira de Moraes
In our study, the midpoint of the height of the thyroid cartilage was used as a parameter for insertion of the anterior commissure, with an additional safety margin of 3 mm. This parameter for localization of the anterior commissure was objectively measured by Sagiv et al. (2016) and Enver et al. (in press). It proved to be simple, easy to perform and safe. Furthermore, unlike Spiegel and Rodriguez (2008) technique, it can be executed under general anesthesia with endotracheal tube. We chose an airway approach using endotracheal tube because most patients underwent another sex reassignment procedure simultaneously (Wendler glottoplasty, vaginoplasty, augmentation mammoplasty and facial feminizing procedure). Furthermore, the thyroid cartilage excision could lead to blood in the airway causing vocal fold irritation and laryngospasm, as reported by Spiegel and Rodriguez (2008). In these situations, an endotracheal tube approach is recommended due to the duration of the procedure and safety in an anesthetic complication scenario. (Sturm & Chaiet, 2019).