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Interventional radiology
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
These techniques are based on bronchography. Balloon dilation of acquired tracheobronchial stenoses is easy and effective. The procedure is analogous to esophageal dilation. The airway can be accessed through an endotracheal or tracheostomy tube, or a laryngeal mask airway. The measurement facilities on modern angiographic equipment are helpful because accurate assessment of the diameter and length of the balloon to be used is very important. Fluoroscopic guidance is useful because it allows accurate positioning of the balloon, and abolition of the waist confirms that complete inflation has been achieved. A description of stenting and other pediatric airway intervention is beyond the scope of this chapter.
Anaesthesia and pain relief
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
Loss of muscle tone as a result of general anaesthesia means that the patient can no longer keep their airway open. Therefore, the patients need their airway maintained for them. The use of muscle relaxants will mean that they will also be unable to breathe for themselves and so will require artificial ventilation. Head tilt, chin lift and jaw thrust manoeuvres, along with adjuncts such as oropharyngeal airways, are used to facilitate bag-mask ventilation while induction agents exert full effect. Laryngeal mask airway or endotracheal tube are then inserted and the patient is allowed to breathe spontaneously or is ventilated during the procedure.
Anesthesia for in vitro fertilization
Published in David K. Gardner, Ariel Weissman, Colin M. Howles, Zeev Shoham, Textbook of Assisted Reproductive Techniques, 2017
Alexander Izakson, Tiberiu Ezri
GA is induced and maintained in a hospital setting by specially trained personnel using either i.v. or inhalational agents. The i.v. agents include propofol, narcotics, and sedatives. The inhalational agents include nitrous oxide (N2O) and volatile anesthetics such as isoflurane, desflurane, or sevoflurane. Spontaneous ventilation is usually maintained through a face mask or laryngeal mask airway. Rarely, mechanical ventilation through endotracheal tube or laryngeal mask airway is required.
Primary Probing with and without Monoka Silastic Stent Intubation for Epiphora in Older Children and Adults
Published in Current Eye Research, 2020
In pediatric patients, the patients were taken into the operating room and then the mean arterial pressure (MAP), heart rate (HR), peripheral oxygen saturation (SpO2) and end-tidal carbon dioxide levels were monitored (DatexOhmeda S/5, Helsinki, Finland). Without premedication, the children were induced by the inhalation anesthesia in the presence of one of their parents. After the loss of consciousness, an intravenous i.v line was inserted and 1 mg/kg propofol and 1.5µg/kg i.v fentanyl was administered. After a few minutes of mask ventilation, a laryngeal mask airway (LMA) was inserted and anesthesia was maintained with 2% sevoflurane and 50% N2O-O2. Neuromuscular blockers were not used. At the end of the surgery, the LMA was removed in the operating room when the patient could breathe spontaneously.
Comparison Of The I-Gel Supraglottic And King Laryngotracheal Airways In A Simulated Tactical Environment
Published in Prehospital Emergency Care, 2018
Juan A. March, Theresa E. Tassey, Noel B. Resurreccion, Roberto C. Portela, Stephen E. Taylor
Some readers may argue that in a tactical environment we should instead use a laryngeal mask airway (LMA). Yet, in a meta-analysis the IGA was found to take less time and was easier to insert than an LMA, but since this was a general anesthesia study the other benefits were not relevant (2). While others may advocate that neither the LMA or IGA are ideal due to the potential risk of aspiration. The oropharyngeal leak pressure (OLP) for both devices are sufficiently high to protect the patient's airway (2). Gibbison et al. described two cases where the IGA prevented aspiration in patients that regurgitated (6). Schmidbauer el al. found that the IGA was found to have a lower esophageal seal than both the classic LMA and Proseal LMA and also found to more effectively drain regurgitated fluid thus decreasing the risk of aspiration (7). Theiler et al. in a study with 2,049 patients found a complication rate of 1.2% laryngospasm, 3.9% blood staining on the device, 2 cases of transient nerve damage, and one case of glottic hematoma after uncomplicated device insertion. These complication rates are better than or comparable to other supraglottic airways. Unlike other supraglottic devices the IGA cuff is not inflated and thus exerts very low little or no pressures on the mucosal tissues of the hypopharynx, distal oropharynx, base of the tongue, or perilaryngeal area (8, 9).
Diaphragm pacing using the minimally invasive cervical approach
Published in The Journal of Spinal Cord Medicine, 2023
Don B. Headley, Antonio G. Martins, Kevin J. McShane, David A. Grossblat
If a cuffed tracheostomy tube is present, it can be utilized for the laparoscopic technique. A double lumen endotracheal tube is typically used when employing the VATS technique. When using the cervical technique, the tracheostomy tube is removed, the tracheostomy site is then covered with an occlusive dressing such as TegadermTM or OpsiteTM, in order to maintain an adequate seal for positive pressure ventilation and isolate the tracheostomy site from the surgical field. A laryngeal mask airway could also be placed if the patient was deemed an appropriate candidate and able to maintain spontaneous respiration. At the completion of the case, most patients meet extubation criteria and are taken to the recovery room without an airway adjunct.