Preanesthetic Evaluation
Michele Barletta, Jane Quandt, Rachel Reed in 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.
Mediastinal goiters
Demetrius Pertsemlidis, William B. Inabnet III, Michel Gagner in Endocrine Surgery, 2017
Preoperative evaluation of the laryngeotracheal tree will help locate the position and opening of the laryngeal aditus [8]. Even though there may be considerable deviation of the trachea, the larynx will generally be in a normal position with a patent and open airway. Therefore, intubating these patients is usually not a difficult problem, especially if a small endotracheal tube is used. Although there appears to be considerable enthusiasm for intubating these patients while awake, it may be more dangerous due to trauma associated with endotracheal injury. Some anesthesiologists consider fiber-optic intubation, sometimes over a flexible bronchoscope, but any intubation in substernal goiter must be totally nontraumatic. The cuff of the endotracheal tube should also be well below the vocal cords and the patient extubated smoothly to avoid any intrathoracic rise of pressure—causing postoperative bleeding.
Laryngeal trauma
Declan Costello, Guri Sandhu in Practical Laryngology, 2015
In cases of cricotracheal separation (Figures 9.6a, b), following surgical exposure, a tracheostomy is fashioned or moved to a healthy part of the lower trachea prior to reanastomosis. During the surgery a small endotracheal tube is placed through the tracheostomy for ventilation and is replaced with a small tracheostomy tube at the end of the procedure. The repair begins with the posterior anastomosis using a combination of 3-0 absorbable sutures working towards the anterior trachea. All knots are extraluminal and the sutures run through the submucosal plane. Avascular and damaged tissue is resected. If there is an associated crush injury to the trachea, a temporary soft silastic stent may need to be placed in the lumen prior to anastomosis. In cases of massive laryngeal injury with significant tissue loss, a partial or total laryngectomy may be indicated, although this is rarely required.23
A mechatronic simulator for learning surgical procedures
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2019
C. Brèque, J. Danion, E. Oriot, T. Vendeuvre, J. P Faure, G. Donatini, D. Oriot, J. P Richer
Since 2013, we have developed a mechatronic system (called P4P ‘Pulse for Practice’) designed to be connected to a human body resulting from donation of the body to science and is acquiring the know-how to simulate ventilation and circulation on this human body, according to specifications defined by practitioners. As soon as bodies arrive in the center, they are prepared for this purpose. This involves draining the native blood from the body, and replacing it with a viscous liquid, by placing cannulas in the carotid and femoral vessels and using an injection pump. Cannulas are also introduced into the satellite veins of these arteries. Native human blood, which coagulates, is replaced by a liquid with the same mechanical properties, but without the coagulation effect (clots). An endotracheal tube is inserted into the trachea or a tracheostomy is performed to ventilate the lungs. The upper and lower limbs, as well as the cephalic end, are excluded through proximal ligatures at the venous and arterial levels so that only the trunk is re-vascularized. After 2 to 3 hours of preparation, the body is frozen at −20 °C with vascular cannulas and tracheostomy, without any preservative chemicals and thawed 3 days before using the model (Figure 1).
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.
Investigation on EMG Profiles of the Superior Laryngeal Nerve in a In Vivo Porcine Model
Published in Journal of Investigative Surgery, 2020
Yishen Zhao, Changlin Li, Xiaoli Liu, Le Zhou, Daqi Zhang, Jingwei Xin, Tie Wang, Shijie Li, Hui Sun, Gianlorenzo Dionigi
The amplitude profile of EMG varies during the monitoring of nerves due to several variables that are unrelated to the status of nerve [9–19]. Owing to this, the following issues were standardized: (a) type of induction or maintenance of anesthesia was the same for each porcine model; (b) the position of endotracheal tube was continuously verified through video laryngoscopy; (c) the internal diameter (ID) of EMG tube was identical for each piglet (#7ID); (d) no manipulation of the trachea was considered during stimulation; (e) precise stimulation of probe-nerve contact; (f) dry surgical field and nerve ensheathed by fascia; (g) the temperatures of operative room and piglet body were maintained constant, and no usage of cold or hot water in the surgical field; (h) no electrical cautery was used around the nerve [30].