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Sclerotherapy Of Esophageal Varices
Published in John P. Papp, Endoscopie Control of Gastrointestinal Hemorrhage, 2019
The flexible instrument in our hands is used to treat nonbleeding grade 1 to 3 varices and to perform acute injections when seeping variceal hemorrhage is seen at emergency endoscopy. Since grade 4 esophageal varices are difficult to control by the flexible fiberscope and view is insufficient in massive hemorrhage, the rigid esophagoscope is preferred. In addition, there is considerable danger of pulmonary aspiration in
Neurointensive care: Postoperative management
Published in Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor, Essentials of Geriatric Neuroanesthesia, 2019
Preventing postoperative pulmonary complications: Perioperative pulmonary aspiration can lead to serious postoperative complications (29). Various strategies can be implemented in the intraoperative period to prevent postoperative pulmonary complications (30). Regional analgesia, scalp blocks, and other nerve blocks should be used wherever possible.Short-acting muscle relaxants should be used where possible.Adequate reversal from neuromuscular blockage prior to extubation should be ensured.
Preoperative Care Including the High-Risk Surgical Patient
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
Patients with hiatus hernia, obesity, pregnancy and diabetes are at high risk of pulmonary aspiration, even if they have been NBM before elective surgery. Clear antacids, H2-receptor blockers, e.g. ranitidine, or proton pump inhibitors, e.g. omeprazole, may be given at an appropriate time in the preoperative period.
Awake intubation with C-MAC video-stylet versus fibreoptic bronchoscope in predicted difficult airway patients: Comparative randomised study
Published in Egyptian Journal of Anaesthesia, 2022
Rehab Abd El-Raof Abd El-Aziz, Yasser Mohamed Osman
After approval of Ethical Committee, written informed consents were taken from all participants in the study. This research work was done according to the World Medical Association Declaration of Helsinki Ethical Principles for medical research, and it was registered at ClinicalTrials.gov with registration number NCT04759287. The study included 80 patients aged between 18 and 60 years, of both gender of ASA Physical Status I and II. All the participants were undergoing elective surgeries and were scheduled for awake intubation due to the presence of any predictors of difficult intubation as score of Mallampati ≥3; thyromental distance ≤6 cm; inter-incisor distance ≤3 cm; obese patients with BMI ≥35 kg/m2; neck extension ≤80°from neck flexion; and also patients with past history of difficult endotracheal intubation or difficult maskventilation. Patients with any hazard of pulmonary aspiration, and any medical condition that may affect the morbidity or the studded parameters such as cardiac, respiratory, hepatic, and renal diseases were excluded from the study.
Clinical considerations when treating neonatal aspiration syndromes
Published in Expert Review of Respiratory Medicine, 2019
Andrea Calkovska, Daniela Mokra, Vladimir Calkovsky, Katarina Matasova, Mirko Zibolen
When swallowing, the closure of the vocal cords is mediated through LAR and is followed by elevation of the larynx. Laryngeal closure is completed by sphincter function of the glottis [4]. With the use of concurrent manometry and glottal ultrasonography, enabling the evaluation of temporal changes in glottal closure kinetics, two other mechanisms have been identified in premature infants. Esophagoglottal closure reflex most likely appears during retrograde transit of gastric content in belching, regurgitation, vomiting, and acid reflux events [21], while pharyngoglottal closure reflex protects against predeglutitive or deglutitive aspiration with pharyngeal swallows [22]. Two last mechanisms demonstrate a close functional relationship between the airway and the upper gastrointestinal tract to prevent pulmonary aspiration.
Prophylactic pre-esophagogastroduodenoscopy tracheal intubation in patients with upper gastrointestinal bleeding
Published in Baylor University Medical Center Proceedings, 2019
Abhilash Perisetti, Jonathan Kopel, Abdussalam Shredi, Saikiran Raghavapuram, Benjamin Tharian, Kenneth Nugent
Our study demonstrates that pulmonary aspiration occurs frequently in patients with UGIB undergoing pre-EGD ETI. The length of stay and mortality were also high in the pre-EGD ETI patients. The exact cause of the increased risk of pulmonary aspiration in pre-EGD intubated patients is unclear, but it may be related to the inherent risk of intubation in patients with vomiting and poor visualization of the upper airway.8–11 Given the high incidence of pulmonary aspiration in the intubated group, we investigated whether the timing of intubation affected the outcome. Compared to post-EGD ETI patients, pre-EGD ETI patients had less frequent pulmonary aspiration and ARDS and a shorter length of stay; however, these differences were not statistically significant. The post-EGD patients had a higher mortality rate, which might reflect more comorbidity.