WorldWideScience

Sample records for intubation gastrointestinal

  1. Evaluation of the effect of nasogastric intubation on gastrointestinal function after gastrectomy in gastric cancer patients

    Directory of Open Access Journals (Sweden)

    Chamanzari Hamid

    2016-08-01

    Full Text Available Background and Objective: The optimal treatment strategy for patients with gastric cancer is gastrectomy. Typically, nasogastric intubation is used after this type of surgery to feed patients; however, there seems to be no unanimity of opinion on this topic. Therefore, this study aimed to evaluate the effect of nasogastric intubation on gastrointestinal function after gastrectomy in gastric cancer patients. Materials and Method: This clinical trial was conducted on gastric cancer patients, admitted to the general ward of Imam Reza Hospital in Mashhad, Iran in 2015. In total, 68 patients were selected through randomized convenience sampling and divided into two intervention and control groups of 34 individuals. Nasogastric tube insertion was applied for the intervention group after the surgery. Patients of the study groups were fasted for three days after the surgery, which was followed by the removal of nasogastric tubes and initiation of oral feeding. Gastrointestinal function of all the participants was evaluated six hours after transferring to the ward up to seven days after the surgery on a daily basis using nausea and vomiting assessment tools and researcher-made questionnaire of gastrointestinal function. Data analysis was performed in SPSS version 16 using Fisher’s exact test, Chi-square, Mann-Whitney U, repeated measures ANOVA and paired t-test. Results: In this study, the severity of nausea and vomiting, the first time of passing gas and severity of flatulence Intensity were less observed in the control group, compared to the intervention group. Moreover, postoperative food tolerance was higher in the patients of the control group, compared to the other study group (P<0.05. Conclusion: According to the results of this study, nasogastric intubation can delay normal gastrointestinal function after gastrectomy. Therefore, it is not recommended to use this method after gastrectomy.

  2. Failed endotracheal intubation

    Directory of Open Access Journals (Sweden)

    Sheykhol Islami V

    1995-07-01

    Full Text Available The incidence of failed intubation is higher in obstetric than other surgical patients. Failed intubation was the 2nd commonest cause of mortality during anesthesia. Bearing in mind that failre to intubate may be unavoidable in certain circumstances, it is worth reviewing. The factors, which may contribute to a disastrous out come. Priorities of subsequent management must include maintaining oxygenation and preventing aspiration of gastric contents. Fiber optic intubation is now the technique of choice with a high success rate and with least trauma to the patient.

  3. Blind Naso-Endotracheal Intubation

    African Journals Online (AJOL)

    Difficult endotracheal intubation techniques include, use of fiberoptic bronchoscope, intubating laryngeal mask airway, tracheostomy, blind nasotracheal and retrograde intubation. According to the Difficult Airway Society guidelines, intubating with the aid of a fiberoptic scope has taken its place as the standard adjuvant for.

  4. Cost effective oesophageal intubation

    African Journals Online (AJOL)

    with an ante-grade or retrograde approach for traction. In the latter cases railroading was done. Following placement, the tube was anchored with one or two stitches through the tube and the abdominal oesophagus. Results. Thirty-four patients were intubated during a twenty- four month study period (1988-1990). Eighteen ...

  5. Failed tracheal intubation using a laryngoscope and intubating laryngeal mask.

    Science.gov (United States)

    Asai, T; Hirose, T; Shingu, K

    2000-04-01

    To report unexpected failed tracheal intubation using a laryngoscope and an intubating laryngeal mask, and difficult ventilation via a facemask, laryngeal mask and intubating laryngeal mask, in a patient with an unrecognized lingual tonsillar hypertrophy. A 63-yr-old woman, who had undergone clipping of an aneurysm seven weeks previously, was scheduled for ventriculo-peritoneal shunt. At the previous surgery, there had been no difficulty in ventilation or in tracheal intubation. Her trachea remained intubated nasally for 11 days after surgery. Preoperatively, her consciousness was impaired. There were no restrictions in head and neck movements or mouth opening. The thyromental distance was 7 cm. After induction of anesthesia, manual ventilation via a facemask with a Guedel airway was suboptimal and the chest expanded insufficiently. At laryngoscopy using a Macintosh or McCoy device, only the tip of the epiglottis, but not the glottis, could be seen, and tracheal intubation failed. There was a partial obstruction during manual ventilation through either the intubating laryngeal mask or conventional laryngeal mask; intubation through each device failed. Digital examination of the pharynx, after removal of the laryngeal mask, indicated a mass occupying the vallecula. Lingual tonsillar hypertrophy (1 x 1 x 2 cm) was found to be the cause of the failure. Awake fibrescope-aided tracheal intubation was accomplished. Unexpected lingual tonsillar hypertrophy can cause both ventilation and tracheal intubation difficult, and neither the laryngeal mask nor intubating laryngeal mask may be helpful in the circumstances.

  6. Rapid duodenal and jejunal intubation

    International Nuclear Information System (INIS)

    Nolan, D.J.

    1979-01-01

    A size 12 French radiopaque catheter, 135 cm long, suitable for rapid duodenal and jejunal intubation, is described. Its size and flexibility enable it to be passed with ease through the nose, stomach and duodenum. A guide wire is used to act as a stiffener as the catheter is passed through the stomach. The catheter is suitable for infusing barium directly into the small intestine and for performing hypotonic duodenography. The technique for duodenal and jejunal intubation is discussed. (author)

  7. Thyroid abscess following traumatic intubation

    Directory of Open Access Journals (Sweden)

    Marc A. Polacco, MD

    2017-09-01

    Full Text Available Thyroid abscess is a rare condition, and consequently diagnosis is often delayed. Causes include 3rd and 4th branchial cleft anomalies, hematogenous spread of infection, trauma from esophageal foreign body, and fine needle aspiration. Thyroid abscesses carry potential morbidity with thyroid and parathyroid gland destruction, tracheal compression, tracheal or esophageal fistula, internal jugular vein thrombophlebitis, and sepsis. The authors report a case of a 33-year old woman with a thyroid abscess following traumatic intubation. Thyroid abscess should be considered in patients presenting with anterior neck pain and swelling with a recent history of traumatic intubation, ultrasound or CT with contrast being the ideal diagnostic modalities.

  8. An incidentaloma at ileal intubation.

    LENUS (Irish Health Repository)

    Donnellan, Fergal

    2012-02-01

    The authors report the case of a primary small bowel lymphoma discovered incidentally in a 33-year-old male following ileal intubation at colonoscopy. The patient subsequently underwent curative treatment with chemotherapy. This case not only highlights the importance of routine ileoscopy but also the successful use of chemotherapy in a disease for which the optimal treatment modality has not been well characterized.

  9. Laryngeal morbidity after tracheal intubation

    DEFF Research Database (Denmark)

    Sørensen, M K; Rasmussen, N; Kristensen, M S

    2013-01-01

    BACKGROUND: Tracheal intubation may cause vocal fold damage. The trial was designed to assess laryngeal morbidity comparing the Endoflex(®) tube with a conventional endotracheal tube with stylet. We hypothesised that laryngeal morbidity within the first 24 h after extubation would be lower...... with the Endoflex tube than with the conventional endotracheal tube with stylet because of less rigidity. METHODS: This randomised trial included 130 elective surgical patients scheduled for general anaesthesia with endotracheal intubation. Pre- and post-operative assessment of hoarseness, vocal fold pathology......% with the Endoflex tube and 55% with the endotracheal tube with stylet at 24 h after extubation (P = 0.44). Post-operative vocal fold injury was present in 23% in the Endoflex tube group and in 36% in the endotracheal tube with stylet group (P = 0.13). The increase in shimmer, the voice analysis variable reflecting...

  10. Aerosol delivery in intubated, mechanically ventilated patients

    International Nuclear Information System (INIS)

    MacIntyre, N.R.; Silver, R.M.; Miller, C.W.; Schuler, F.; Coleman, R.E.

    1985-01-01

    To study the effects of respiratory failure and mechanical ventilation on aerosol delivery to the lungs, nuclear scans were performed after aerosolization of 5 to 9 mCi of Tc-99m diethylenetriamine pentaacetic acid in seven stable, intubated, and mechanically ventilated patients. The radioactivity reaching the lungs was 2.9 +/- .7% (mean +/- SD) of the administered dose, an amount significantly less than that in three healthy nonintubated subjects and also less than what would be expected in nonintubated subjects from other published reports. A subsequent study was performed in 15 additional mechanically ventilated patients who were receiving aerosolized bronchodilators through their endotracheal tube. In these patients, heart rate and lung mechanical function values before and after treatment were not significantly different. It is concluded from these studies that aerosol delivery in mechanically ventilated patients is significantly reduced and that this is probably due to a combination of suboptimal breathing pattern, intrinsic airway disease, and the endotracheal tube functioning as both a site for aerosol deposition through impaction as well as a barrier to gastrointestinal absorption

  11. Laryngotracheal Injury following Prolonged Endotracheal Intubation

    Directory of Open Access Journals (Sweden)

    J. Mehdizadeh

    2006-07-01

    Full Text Available Background: Prolonged endotracheal intubation is a growing method for supporting ventilation in patients who require intensive care. Despite considerable advancement in endotracheal intubation, this method still has some complications; the most important is laryngo-tracheal injuries. Methods: Over a 2-year period, this retrospective study was conducted on 57 patients with history of prolonged intubation who were referred to the ENT Department of Amir Alam Hospital. For each patient, a complete evaluation including history, physical examination, and direct laryngoscopy and bronchoscopy was done under general anesthesia. Results: Fifty-seven patients (44 male; mean age, 23.014.7 years were studied. Mean intubation period was 15.88 days. The most common presenting symptom was dyspnea (62%. Head trauma was responsible for most cases of intubation (72.4%. The most common types of tracheal and laryngeal lesions were tracheal (56.9% and subglottic (55.2% stenosis, respectively. Mean length of tracheal stenosis was 0.810.83 cm. There was a statistically significant relationship between length of tracheal stenosis and intubation period (P=0.0001 but no relation was observed between tracheal stenosis and age, sex, and etiology of intubation (All P=NS. Among the glottic lesions, inter- arytenoids adhesion was the most common lesion (25.9%. No statistically significant relation was found between glottic and subglottic lesions and age, sex and intubation period (all P=NS. Length of stenosis and intubation period was significantly greater in tracheal/ subglottic lesions than those in glottic/ supraglottic lesions (all P=NS. Conclusion: After prolonged endotracheal intubation, laryngo-tracheal lesions had no relation with patient’s age, sex, and cause of intubation.There was direct relation between length of tracheal stenosis and intubation period. Glottic lesions were more commonly observed in head trauma patients. Lesion length and intubation

  12. Oral alimentation following intubation for esophageal carcinoma.

    Science.gov (United States)

    Haffejee, A A; Angorn, I B

    1977-01-01

    The nutritional status of 15 patients suffering from unresectable carcinoma of the midthoracic esophagus was evaluated before and after palliative pulsion intubation. All patients showed evidence of protein-calorie malnutrition, prior to intubation. Oral alimentation using a formulated hospital ward diet with an elemental dietary supplement reversed the nutritional deficit. A mean daily positive nitrogen balance of seven grams was achieved three weeks following intubation. No episode of tube blockage was observed and the elemental diet supplement was well tolerated. PMID:74985

  13. Difficult intubation: are you prepared for it?

    Science.gov (United States)

    Balcom, C

    1994-01-01

    The endotracheal intubation of a patient for surgery requires an anaesthetist who is aided by a skilled and experienced helper. This paper explores reasons why some patients are difficult to intubate. Some are predictable on pre-operative assessment and others are not. Suggestions are given on how the helper is useful to the anaesthetist in this potentially critical situation.

  14. Intubation of the morbidly obese patient

    DEFF Research Database (Denmark)

    Ydemann, Mogens; Rovsing, Marie Louise; Lindekaer, A L

    2012-01-01

    Several potential problems can arise from airway management in morbidly obese patients, including difficult mask ventilation and difficult intubation. We hypothesised that endotracheal intubation of morbidly obese patients would be more rapid using the GlideScope(®) (GS) (Verathon Inc Corporate H...... Headquarters, Bothell, WA, USA) than with the Fastrach™ (FT) (The Laryngeal Mask Company Ltd, Le Rocher, Victoria, Mahe, Seychelles)....

  15. Complications following nasotracheal intubation using cuffed ...

    African Journals Online (AJOL)

    A total of 46.8% of nasal trauma were inferior turbinate trauma involving the inferior medial aspect. Conclusion: The use of untreated cuffed polyvinyl chloride tube for nasotracheal intubation in unprepared nostrils is associated with a high incidence of epistaxis and nasal trauma. Keywords: nasotracheal intubation, epistaxis ...

  16. The invention of fiberoptic videoguide intubation | Saadatmand ...

    African Journals Online (AJOL)

    Introduction: Airway management is one of the most important medical priorities. Despite its benefits, intubation can be sometimes associated with many complications and hardships. Hard intubation can have dangerous consequences, including hypoxia, increased intracranial pressure, cardiac collapse-vascular, traumatic ...

  17. The intubating laryngeal mask produces less heart rate response to ...

    African Journals Online (AJOL)

    Pc

    We compared heart rate and blood pressure changes to intubation produced by conventional laryngoscopic-guided intubation to those produced by blind intubation through the intubating laryngeal mask (ILM) in normotensive adults with normal airways. Forty paralysed, anaesthetised adults undergoing elective surgery ...

  18. Crisis management during anaesthesia: difficult intubation.

    Science.gov (United States)

    Paix, A D; Williamson, J A; Runciman, W B

    2005-06-01

    Anaesthetists may experience difficulty with intubation unexpectedly which may be associated with difficulty in ventilating the patient. If not well managed, there may be serious consequences for the patient. A simple structured approach to this problem was developed to assist the anaesthetist in this difficult situation. To examine the role of a specific sub-algorithm for the management of difficult intubation. The potential performance of a structured approach developed by review of the literature and analysis of each of the relevant incidents among the first 4000 reported to the Australian Incident Monitoring Study (AIMS) was compared with the actual management as reported by the anaesthetists involved. There were 147 reports of difficult intubation capable of analysis among the first 4000 incidents reported to AIMS. The difficulty was unexpected in 52% of cases; major physiological changes occurred in 37% of these cases. Saturation fell below 90% in 22% of cases, oesophageal intubation was reported in 19%, and an emergency transtracheal airway was required in 4% of cases. Obesity and limited neck mobility and mouth opening were the most common anatomical contributing factors. The data confirm previously reported failures to predict difficult intubation with existing preoperative clinical tests and suggest an ongoing need to teach a pre-learned strategy to deal with difficult intubation and any associated problem with ventilation. An easy-to-follow structured approach to these problems is outlined. It is recommended that skilled assistance be obtained (preferably another anaesthetist) when difficulty is expected or the patient's cardiorespiratory reserve is low. Patients should be assessed postoperatively to exclude any sequelae and to inform them of the difficulties encountered. These should be clearly documented and appropriate steps taken to warn future anaesthetists.

  19. Warming Endotracheal Tube in Blind Nasotracheal Intubation throughout Maxillofacial Surgeries

    Directory of Open Access Journals (Sweden)

    Hamzeh Hosseinzadeh

    2013-12-01

    Conclusion: In conclusion, our study showed that using an endotracheal tube softened by warm water could reduce the incidence and severity of epistaxis during blind nasotracheal intubation; however it could not facilitate blind nasotracheal intubation.

  20. Gastrointestinal tuberculosis.

    Science.gov (United States)

    Galloway, D J; Scott, R N

    1986-10-01

    In the developed countries gastrointestinal tuberculosis is no longer common in clinical practice. In this setting the importance of the condition lies in the vagaries of its presentation and the fact that it is eminently treatable, usually by a combination of chemotherapy and surgery. The clinical features and complications of gastrointestinal tuberculosis are highlighted by the seven cases which we report. Diagnosis and treatment of this condition is discussed and attention is drawn to the importance of case notification. Clinicians should bear in mind the diagnosis of gastrointestinal tuberculosis when dealing with any patient with non-specific abdominal symptoms.

  1. Mordified Submental Endotracheal Intubation Technique in ...

    African Journals Online (AJOL)

    over a two-year period. Each patient required maxillomandibular fixation following trauma.Acommon feature in these patients was depressed fracture of the frontonasal bone which could not permit nasal intubation. These patients were reluctant to have tracheostomy if there was an alternative option of securing their airway.

  2. Flexible Fiberoptic Endoscopy in Difficult Intubations

    NARCIS (Netherlands)

    Edens, E. Th.; Sia, R. L.

    1981-01-01

    Intubation problems sometimes occur very suddenly and can be divided into two groups. The expected ones include the patients with a short neck and long teeth, cellulitis of the tongue, large oropharyngeal tumors, obstructing laryngeal tumors, congenital and acquired maxillofacial deformities,

  3. Treatment of hypertension following endotracheal intubation

    African Journals Online (AJOL)

    Treatment of hypertension following endotracheal intubation. A study comparing the efficacy of labetalol, practolol and placebo. R. J. MAHARAJ, M. THOMPSON, J. G. BROCK-UTNE,. J. W. DOWNING. R. WI LLlAMSON,. Summary. Labetalol, a new adrenergic receptor antagonist, has both a- and B-blocking properties.

  4. Gastrointestinal bleeding

    Science.gov (United States)

    ... Sigmoidoscopy Alternative Names Lower GI bleeding; GI bleeding; Upper GI bleeding; Hematochezia Images GI bleeding - series Fecal occult blood test References Kovacs TO, Jensen DM. Gastrointestinal hemorrhage. In: Goldman L, Schafer AI, eds. Goldman- ...

  5. Learning endotracheal intubation using a novel videolaryngoscope improves intubation skills of medical students.

    Science.gov (United States)

    Herbstreit, Frank; Fassbender, Philipp; Haberl, Helge; Kehren, Clemens; Peters, Jürgen

    2011-09-01

    Teaching endotracheal intubation to medical students is a task provided by many academic anesthesia departments. We tested the hypothesis that teaching with a novel videolaryngoscope improves students' intubation skills. We prospectively assessed in medical students (2nd clinical year) intubation skills acquired by intubation attempts in adult anesthetized patients during a 60-hour clinical course using, in a randomized fashion, either a conventional Macintosh blade laryngoscope or a videolaryngoscope (C-MAC®). The latter permits direct laryngoscopy with a Macintosh blade and provides a color image on a video screen. Skills were measured before and after the course in a standardized fashion (METI Emergency Care Simulator) using a conventional laryngoscope. All 1-semester medical students (n = 93) were enrolled. The students' performance did not significantly differ between groups before the course. After the course, students trained with the videolaryngoscope had an intubation success rate on a manikin 19% higher (95% CI 1.1%-35.3%; P incidence of "difficult (manikin) laryngoscopy" was less frequent in the group trained with the videolaryngoscope (8% vs 34%; P = 0.005). Education using a video system mounted into a traditional Macintosh blade improves intubation skills in medical students.

  6. Tracheal intubation in patients with anticipated difficult airway using Boedeker intubation forceps and McGrath videolaryngoscope

    DEFF Research Database (Denmark)

    Strøm, C; Barnung, S; Kristensen, M S

    2015-01-01

    BACKGROUND: Videolaryngoscopes with sharp angulated blades improve the view of the vocal cords but this does not necessarily result in higher success rates of intubation The aim of this study was to evaluate the efficacy of using Boedeker intubation forceps in conjunction with McGrath Series 5 Vi...... by using a styletted tube. CONCLUSION(S): Most patients with anticipated difficult intubation can be successfully intubated with Boedeker intubation forceps and MVL. However, endotracheal tube placement failed in 3/25 patients despite a good laryngeal view....

  7. Post intubation tracheal stenosis in children

    Directory of Open Access Journals (Sweden)

    Marco Caruselli

    2014-12-01

    Full Text Available Many authors have reported that tracheal stenosis is a complication that can follow tracheal intubation in both adults and children. The symptoms, when they do appear, can be confused with asthma, with subsequent treatment providing only mild and inconsistent relief. We report here the case of an 8 year old girl admitted to our hospital for whooping cough that was not responding to therapy.

  8. Preparing to perform an awake fiberoptic intubation.

    LENUS (Irish Health Repository)

    Walsh, M E

    2012-02-03

    Fiberoptically guided tracheal intubation represents one of the most important advances in airway management to occur in the past thirty years. Perhaps its most important role is in management of the anticipated difficult airway. This is a situation in which the dangers of encountering the life-threatening "can\\'t intubate, can\\'t ventilate" situation can be avoided by placement of an endotracheal tube while the patient is awake. Although skill at the procedure of endoscopy is obviously necessary in this setting, these authors hold that success or failure of the technique frequently depends on the adequacy of preparation. These measures include 1) pre-operative assessment of the patient; 2) careful explanation of what lies in store; 3) "setting the stage"; 4) preparing the equipment to be used; and 5) preparing the patient (antisialogue, sedation, application of topical anesthesia to the upper airway). If these preparatory measures are carried out meticulously, the likelihood of performing a successful and comfortable awake fiberoptic tracheal intubation is greatly increased.

  9. Gastrointestinal System

    NARCIS (Netherlands)

    Jepson, Mark A.; Bouwmeester, Hans

    2017-01-01

    The epithelial lining of the gastrointestinal tract (GIT) acts as a barrier to uptake of potentially dangerous material while allowing absorption of processed food. The gut may be exposed to a diverse range of engineered nanomaterials due to their deliberate addition to food and consumer products

  10. Awake fiberoptic or awake video laryngoscopic tracheal intubation in patients with anticipated difficult airway management

    DEFF Research Database (Denmark)

    Rosenstock, Charlotte Vallentin; Thøgersen, Bente; Afshari, Arash

    2012-01-01

    Awake flexible fiberoptic intubation (FFI) is the gold standard for management of anticipated difficult tracheal intubation. The purpose of this study was to compare awake FFI to awake McGrath® video laryngoscope, (MVL), (Aircraft Medical, Edinburgh, Scotland, United Kingdom) intubation in patients...... with an anticipated difficult intubation. The authors examined the hypothesis that MVL intubation would be faster than FFI....

  11. Submental Intubation in Patients with Complex Maxillofacial Injuries

    Science.gov (United States)

    Cheong, Yuseon; Kang, Seong Sik; Kim, Minsoo; Son, Hee Jeong; Park, Jaewoo; Kim, Jeong-Mo

    2016-01-01

    Airway management in patients with complex maxillofacial injuries is a challenge to anesthesiologists. Submental intubation is a useful technique that is less invasive than tracheostomy in securing the airways where orotracheal and nasotracheal intubation cannot be performed. This procedure avoids the use of tracheostomy and bypasses its associated morbidities. A flexible and kink-resistant reinforced endotracheal tube with detachable universal connector is commonly used for submental intubation. Herein, we report cases involving submental intubation using a reinforced endotracheal tube with a non-detachable universal connector in patients with complex maxillofacial injuries. PMID:27924286

  12. A new retrograde transillumination technique for videolaryngoscopic tracheal intubation

    DEFF Research Database (Denmark)

    Biro, P; Fried, E; Schlaepfer, M

    2018-01-01

    This single-centre, prospective trial was designed to assess the efficacy of a new retrograde transillumination device called the 'Infrared Red Intubation System' (IRRIS) to aid videolaryngoscopic tracheal intubation. We included 40 adult patients, who were undergoing elective urological surgery......-10])), credibility (10 (8-10 [5-10])) and ease of use (10 (9-10 [8-10])). Tracheal intubation with the system lasted 26 (16-32 [6-89]) s. No alternative technique of securing the airway was necessary. The lowest SpO2 during intubation was 98 (97-99 [91-100])%. We conclude that this method of retrograde...

  13. Geospatial Analysis of Pediatric EMS Run Density and Endotracheal Intubation

    Directory of Open Access Journals (Sweden)

    Matthew Hansen

    2016-09-01

    Full Text Available Introduction: The association between geographic factors, including transport distance, and pediatric emergency medical services (EMS run clustering on out-of-hospital pediatric endotracheal intubation is unclear. The objective of this study was to determine if endotracheal intubation procedures are more likely to occur at greater distances from the hospital and near clusters of pediatric calls. Methods: This was a retrospective observational study including all EMS runs for patients less than 18 years of age from 2008 to 2014 in a geographically large and diverse Oregon county that includes densely populated urban areas near Portland and remote rural areas. We geocoded scene addresses using the automated address locator created in the cloud-based mapping platform ArcGIS, supplemented with manual address geocoding for remaining cases. We then use the Getis-Ord Gi spatial statistic feature in ArcGIS to map statistically significant spatial clusters (hot spots of pediatric EMS runs throughout the county. We then superimposed all intubation procedures performed during the study period on maps of pediatric EMS-run hot spots, pediatric population density, fire stations, and hospitals. We also performed multivariable logistic regression to determine if distance traveled to the hospital was associated with intubation after controlling for several confounding variables. Results: We identified a total of 7,797 pediatric EMS runs during the study period and 38 endotracheal intubations. In univariate analysis we found that patients who were intubated were similar to those who were not in gender and whether or not they were transported to a children’s hospital. Intubated patients tended to be transported shorter distances and were older than non-intubated patients. Increased distance from the hospital was associated with reduced odds of intubation after controlling for age, sex, scene location, and trauma system entry status in a multivariate logistic

  14. gastrointestinal tract

    Directory of Open Access Journals (Sweden)

    Rolandas Vaicekauskas

    2016-07-01

    Full Text Available Introduction : Accurate diagnosis of subepithelial lesions (SELs in the gastrointestinal tract depends on a variety of methods: endoscopy, endoscopic ultrasound and different types of biopsy. Making an error-free diagnosis is vital for the subsequent application of an appropriate treatment. Aim: To evaluate the efficacy of deep biopsy via the endoscopic submucosal dissection (ESD technique for SELs in the upper gastrointestinal tract. Material and methods: It was a case series study. Deep biopsy via the ESD technique was completed in 38 patients between November 2012 and October 2014. Thirty-eight SELs in the upper gastrointestinal tract of varying size (very small ≤ 1 cm, small 1–2 cm and large ≥ 2 cm by means of the ESD technique after an incision with an electrosurgical knife of the overlying layers and revealing a small part of the lesion were biopsied under direct endoscopic view. Results: Deep biopsy via the ESD technique was diagnostic in 28 of 38 patients (73.3%; 95% CI: 59.7–89.7%. The diagnostic yield for SELs with a clear endophytic shape increased to 91.3%. An evident endophytic appearance of a subepithelial lesion, the mean number of biopsied samples (6.65 ±1.36 and the total size in length of all samples per case (19.88 ±8.07 mm were the main criteria influencing the positiveness of deep biopsy in the diagnostic group compared to the nondiagnostic one (p = 0.001; p = 0.025; p = 0.008. Conclusions : Deep biopsy via the ESD technique is an effective and safe method for the diagnosis of SELs especially with a clear endophytic appearance in a large number of biopsied samples.

  15. ONSET TIME AND EVALUATION OF INTUBATING CONDITIONS - ROCURONIUM IN PERSPECTIVE

    NARCIS (Netherlands)

    AGOSTON, S

    The customary methods for assessment of intubating conditions, namely the onset time in the adductor pollicis muscle and qualitative rating scales of the conditions at intubation, are unsatisfactory. The onset time of neuromuscular block in the adductor pollicis is not a meaningful, quantifiable

  16. Molar Intubation for Intra Oral Swellings:Our Experience

    Directory of Open Access Journals (Sweden)

    Meenoti Potdar

    2008-01-01

    Full Text Available Molar intubation is a technique of laryngoscopy that can be used for anticipated difficult intubation in cases where standard laryngoscopy technique is difficult due to presence of any intraoral mass that anatomically hampers laryngoscopy or that bleeds on touch. This technique is very easy, reliable and rewarding but should be practiced on normal patients for easy application in actual difficult cases.

  17. Management of Tracheal Deformity During Intubation: A Case Report

    Directory of Open Access Journals (Sweden)

    Sheng-Hua Wu

    2007-06-01

    Full Text Available Failure or difficulty in intubating the trachea can be either due to inability to visualize the glottis or some pathology at the level of or below the cords. This report describes a case of difficult intubation suspected of being related to neck scarring from previous surgery. Computed tomography (CT was used to evaluate the patient's airway and revealed upper tracheal angulation. We describe a method to secure the airway in this patient with a two-person technique by rotating an oral endotracheal tube 180° counterclockwise to adjust to the curvature of the trachea. Problems with intubation should be anticipated in patients with scarring of the neck, and equipment for aiding intubation should be on hand. Furthermore, we found that CT contributed to the assessment of the difficulty of intubation in this kind of patient.

  18. Recurred Post-intubation Tracheal Stenosis Treated with Bronchoscopic Cryotherapy

    Science.gov (United States)

    Jung, Ye-Ryung; Taek Jeong, Joon; Kyu Lee, Myoung; Kim, Sang-Ha; Joong Yong, Suk; Jeong Lee, Seok; Lee, Won-Yeon

    2016-01-01

    Post-intubation tracheal stenosis accounts for the greatest proportion of whole-cause tracheal stenosis. Treatment of post-intubation tracheal stenosis requires a multidisciplinary approach. Surgery or an endoscopic procedure can be used, depending on the type of stenosis. However, the efficacy of cryotherapy in post-intubation tracheal stenosis has not been validated. Here, we report a case of recurring post-intubation tracheal stenosis successfully treated with bronchoscopic cryotherapy that had previously been treated with surgery. In this case, cryotherapy was effective in treating web-like fibrous stenosis, without requiring more surgery. Cryotherapy can be considered as an alternative or primary treatment for post-intubation tracheal stenosis. PMID:27853078

  19. Tracheal intubation with rocuronium using a "modified timing principle".

    Science.gov (United States)

    Kwon, Min A; Song, Jaegyok; Kim, Ju-Ri

    2013-03-01

    Rapid sequence induction (RSI) is indicated in various situations. Succinylcholine has been the muscle relaxant of choice for RSI, and rocuronium has become an alternative medicine for patients who cannot be administered succinylcholine for various reasons. Although rocuronium has the most rapid onset time among non-depolarizing muscle relaxants, the standard dose of rocuronium (0.6 mg/kg) takes 60 seconds to achieve appropriate muscle relaxation. We evaluated intubating conditions using the "modified timing principle" with rocuronium and succinylcholine. In this prospective controlled blinded study, all patients received 1.5 µg/kg fentanyl intravenously with preoxygenation for 2 minutes and were randomized to receive 0.6 mg/kg rocuronium followed by 1.5 mg/kg propofol or 1.5 mg/kg propofol and 1.5 mg/kg succinylcholine. The rocuronium group was intubated just after confirming loss of consciousness, and the succinylcholine group was intubated 1 minute after injecting succinylcholine. Intubation condition, timing of events, and complications were recorded. All patients were successfully intubated in both groups. Apnea time of the rocuronium group (38.5 seconds) was significantly shorter than that in the succinylcholine group (100.7 seconds). No significant differences were observed in loss of consciousness time or intubation time. The succinylcholine group tended to show better intubation conditions, but no significant difference was observed. None of the patients complained awareness of the intubation procedure or had respiratory difficulty during a postoperative interview. The modified RSI with rocuronium showed shorter intubation sequence, acceptable intubation conditions, and a similar level of complications compared to those of conventional RSI with succinylcholine.

  20. COMPARATIVE STUDY OF ROCURONIUM AND SUXAMETHONIUM IN ENDOTRACHEAL INTUBATION

    Directory of Open Access Journals (Sweden)

    Dadichiluka Veeragouri Sankararao

    2017-06-01

    Full Text Available BACKGROUND Tracheal intubation is one of the best methods of securing a patent airway. Good intubating conditions minimise the risk of trauma associated with tracheal intubation. Intubating conditions (muscle tone, vocal cords position, reaction to laryngoscopy and tube positioning depend on depth of anaesthesia and kind of anaesthetic used. Tracheal intubation is commonly facilitated by muscle relaxation. Rocuronium has rapid onset of action, which is comparable to suxamethonium. It has been shown to produce intubating conditions similar to those produced by suxamethonium. This study compares rocuronium and suxamethonium in tracheal intubation. MATERIALS AND METHODS A total of 100 patients of ASA grade 1 and 2 for elective surgeries under general anaesthesia were recruited for this study after obtaining clearance from institutional ethics committee and informed consent from the patients. These 100 patients were divided into 2 groups, group R received rocuronium and group S received suxamethonium. All patients underwent through preanaesthetic checkup on the day before surgery. Thorough airway assesssment was done to rule out difficult intubation. Patients were advised to be nil orally from 10 p.m. onwards, the night before surgery. RESULTS The intubating conditions in the rocuronium group were found to be excellent in 50%, fair in 34% and satisfactory in 16% of the patients compared to excellent in 68%, fair in 32% in suxamethonium group. Clinically, acceptable intubating conditions were seen in 84% and 100% of patients administered rocuronium and suxamethonium, respectively. CONCLUSION Rocuronium in a dose of 0.6 mg/kg is a suitable alternative to suxamethonium in a dose of 1.5 mg/kg in premedicated and anaesthetised patients scheduled for elective surgeries.

  1. Gastrointestinal Traumatic Injuries: Gastrointestinal Perforation.

    Science.gov (United States)

    Revell, Maria A; Pugh, Marcia A; McGhee, Melanie

    2018-03-01

    The abdomen is a big place even in a small person. Gastrointestinal trauma can result in injury to the stomach, small bowel, colon, or rectum. Traumatic causes include blunt or penetrating trauma, such as gunshot wounds, stabbings, motor vehicle collisions, and crush injuries. Nontraumatic causes include appendicitis, Crohn disease, cancer, diverticulitis, ulcerative colitis, blockage of the bowel, and chemotherapy. The mechanism of injury will affect both the nature and severity of any resulting injuries. Treatment must address the critical and emergent nature of these injuries as well as issues that affect all trauma situations, which include management of hemodynamic instability. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. Timing of intubation and ventilator-associated pneumonia following injury.

    Science.gov (United States)

    Evans, Heather L; Zonies, David H; Warner, Keir J; Bulger, Eileen M; Sharar, Sam R; Maier, Ronald V; Cuschieri, Joseph

    2010-11-01

    In an emergency medical system with established rapid-sequence intubation protocols, prehospital (PH) intubation of patients with trauma is not associated with a higher rate of ventilator-associated pneumonia (VAP) than emergency department (ED) intubation. Retrospective observational cohort. Level I trauma center. Adult patients with trauma intubated in a PH or an ED setting from July 1, 2007, through July 31, 2008. Diagnosis of VAP by means of bronchoscopic alveolar lavage or clinical assessment when bronchoscopic alveolar lavage was impossible. Secondary outcomes included time to VAP, length of hospitalization, and in-hospital mortality. Of 572 patients, 412 (72.0%) underwent PH intubation. The ED group was older than the PH group (mean ages, 46.4 vs 39.1 years; P VAP (30 [18.8%] vs 71 [17.2%]; P = .66) or mean time to diagnosis (8.1 [1.2] vs 7.8 [1.0] days; P = .89). Logistic regression analysis identified history of drug abuse, lowest recorded ED systolic blood pressure, and injury severity score as 3 independent factors predictive of VAP. Prehospital intubation of patients with trauma is not associated with higher risk of VAP. Further investigation of intubation factors and the incidence and timing of aspiration is required to identify potentially modifiable factors to prevent VAP.

  3. Oesophageal intubation can be undetected by auscultation of the chest

    DEFF Research Database (Denmark)

    Andersen, K H; Schultz-Lebahn, T

    1994-01-01

    Prompt detection of oesophageal intubation is a primary concern in anaesthetic practice. This blind, randomised study evaluates three widely used tests of intubation. Forty patients had both their trachea and oesophagus intubated, each patient was studied twice. Auscultation of the epigastrium......, right and left axilla is more reliable than auscultation of the chest, and the anaesthetist's feeling when he squeezes the bag. P = 0.001 and P = 0.048, respectively. The tests were carried out after gastric distension with gas had occurred. We conclude that auscultation of epigastrium, right and left...

  4. State of the art: Rescue intubation through supraglottic airways

    Directory of Open Access Journals (Sweden)

    R. Hofmeyr*

    2013-12-01

    Full Text Available The use of supraglottic airways as rescue devices in failed intubation and resuscitation has become well accepted in emergency practice. Many offer or advertise the possibility of intubation through the device, but techniques and success rates vary greatly. Intubation can be achieved blindly, with the use a bougie or introducer, or with fiberoptic guidance. In this review, I examine the evidence behind different devices with various techniques, present the data from our on-going research, suggest further research directions and propose practical guidelines for clinical use in emergencies.

  5. Recurrent epistaxis following nasotracheal intubation--a case report.

    Science.gov (United States)

    Chen, Y H; Chen, J Y; Hsu, C S; Huang, C T; So, E

    1996-06-01

    Epistaxis is one of the common complications of nasotracheal intubation. Clinical patterns of all nasal bleeding are mild and may stop spontaneously in most patients. Serious nasal bleeding requiring hospitalization are rare. Nasal bleeding occurs more frequently in children than in adults. Among adults, men have a higher incidence than women. Although numerous publications have reported the cases of initial epistaxis caused by nasotracheal intubation, recurrent epistaxis was reported rarely. We experienced a case of recurrent epistaxis occurring in the 6th, 8th, 15th and 18th day after nasotracheal intubation. Herein, we describe the clinical events and discuss the causes of epistaxis.

  6. Intubation and mechanical ventilation: knowledge of medical officers ...

    African Journals Online (AJOL)

    Linda van Deventer

    2014-08-20

    Aug 20, 2014 ... intubation is an effective means of ensuring a patent airway, as well as adequate .... appropriate initial tidal volume per kg of ideal body weight for a patient with acute ... oxygenation in diffuse lung injury or lung infiltration.

  7. Errors and clinical supervision of intubation attempts by the ...

    African Journals Online (AJOL)

    Existing publications focus mainly on trainees in emergency settings and ... development in patients with anticipated straightforward airways in a controlled environment has received little attention. ..... Elements associated with failed intubation have been divided ... explicit training of supervisors, anaesthetic assistants and.

  8. Nasotracheal Intubation in Children for Outpatient Dental Surgery: Is ...

    African Journals Online (AJOL)

    2018-02-23

    Feb 23, 2018 ... groups, systolic blood pressure (SBP) and heart rate (HR) ... Hemodynamic responses to FOB-guided intubation .... head of the patient was the in supine position and an ... different between the two groups after the induction.

  9. Orotracheal Intubation Using the Retromolar Space: A Reliable Alternative Intubation Approach to Prevent Dental Injury

    Directory of Open Access Journals (Sweden)

    Linh T. Nguyen

    2016-01-01

    Full Text Available Despite recent advances in airway management, perianesthetic dental injury remains one of the most common anesthesia-related adverse events and cause for malpractice litigation against anesthesia providers. Recommended precautions for prevention of dental damage may not always be effective because these techniques involve contact and pressure exerted on vulnerable teeth. We describe a novel approach using the retromolar space to insert a flexible fiberscope for tracheal tube placement as a reliable method to achieve atraumatic tracheal intubation. Written consent for publication has been obtained from the patient.

  10. Gastrointestinal tract

    International Nuclear Information System (INIS)

    James, R.D.; Pointon, R.C.S.

    1985-01-01

    At the time of writing, radiotherapy is of only minor use in the management of adenocarcinoma of the gastrointestinal tract, for a number of reasons. First, an exploratory laparotomy is generally needed for diagnosis, and if possible the tumour is resected or by-passed. Second, radiotherapy planning in the upper abdomen is complicated by the proximity of small bowel, kidneys, and spinal cord. Third, it has been assumed that these tumours cause death largely as a result of distant metastases, so that local radiotherapy, even if effective, would contribute little to survival. The continued interest in radiotherapy for this group of tumours arises out of the poor survival rates following surgery, which have not changed for many years, and the morbidity associated with their resection. It was hoped that the addition of cytotoxic agents to radical surgery would improve survival rates in carcinoma of the stomach and intraperitoneal colon. Despite a large number of well-organised prospective trials, using a variety of cytotoxic drugs, there is so far no evidence that the addition of chemotherapy to radical surgery improves survival for either tumour site. The authors are therefore faced with a group of tumours which are not only common, but commonly fatal and many surgeons would accept that a new approach using modern radiotherapy techniques may well be justified. There is evidence that this movement is already taking place for carcinoma of the rectum, and the indications for radiotherapy in this condition will be dealt with below. Before considering these it is worth dwelling briefly on recent changes in surgical and radiological practices which, if they fulfil expectations, might allow radiotherapy to be used for carcinoma of the colon, stomach, and pancreas as it is now used for rectal cancer

  11. Ease of intubation: A randomized, double-blind study to compare two doses of rocuronium bromide for endotracheal intubation.

    Science.gov (United States)

    Shukla, Aparna; Misra, Shilpi

    2016-01-01

    Clinical need for a nondepolarizing agent with a rapid onset time and a brief duration of action has led to the development of rocuronium bromide. The aim of this study was to evaluate optimal dose of rocuronium bromide for intubation and to compare the onset time, duration of action, intubating conditions, and hemodynamic effects of two doses of rocuronium bromide. A prospective, randomized, double-blind study. All the patients were divided in a randomized, double-blind fashion into two groups of twenty patients each. Group I patients received rocuronium bromide 0.6 mg/kg intravenously and intubated at 60 s, Group II patients received rocuronium bromide 0.9 mg/kg and intubated at 60 s. The neuromuscular block was assessed using single twitch stimulation of 0.1 Hz at adductor pollicis muscle of hand at every 10 s. The results were compiled and analyzed statistically using Chi-square test for qualitative data and Student's t -test for quantitative data. Time of onset was significantly shorter ( P Rocuronium bromide 0.9 mg/kg is a safer alternative to rocuronium bromide 0.6 mg/kg for endotracheal intubation with shorter time of onset and better intubating conditions.

  12. Endotracheal intubation skill acquisition by medical students

    Directory of Open Access Journals (Sweden)

    Henry E. Wang MD MS

    2011-08-01

    Full Text Available During the course of their training, medical students may receive introductory experience with advanced resuscitation skills. Endotracheal intubation (ETI – the insertion of a breathing tube into the trachea is an example of an important advanced resuscitation intervention. Only limited data characterize clinical ETI skill acquisition by medical students. We sought to characterize medical student acquisition of ETI procedural skill.11Presented as a poster discussion on 17 October 2007 at the annual meeting of the American Society of Anesthesiologists in San Francisco, CA.The study included third-year medical students participating in a required anesthesiology clerkship. Students performed ETI on operating room patients under the supervision of attending anesthesiologists. Students reported clinical details of each ETI effort, including patient age, sex, Mallampati score, number of direct laryngoscopies and ETI success. Using mixed-effects regression, we characterized the adjusted association between ETI success and cumulative ETI experience.ETI was attempted by 178 students on 1,646 patients (range 1–23 patients per student; median 9 patients per student, IQR 6–12. Overall ETI success was 75.0% (95% CI 72.9–77.1%. Adjusted for patient age, sex, Mallampati score and number of laryngoscopies, the odds of ETI success improved with cumulative ETI encounters (odds ratio 1.09 per additional ETI encounter; 95% CI 1.04–1.14. Students required at least 17 ETI encounters to achieve 90% predicted ETI success.In this series medical student ETI proficiency was associated with cumulative clinical procedural experience. Clinical experience may provide a viable strategy for fostering medical student procedural skills.

  13. Haemodynamic changes and intubating conditions during tracheal intubation in children under anaesthesia: a comparative study of two induction regiments

    Directory of Open Access Journals (Sweden)

    Katarina Šakić

    2009-02-01

    Full Text Available Aim To compare the haemodynamic changes and intubation conditionsfollowing induction of anaesthesia with alfentanil-propofol-rocuronium with those following alfentanil-propofol combinationin children.Methods A prospective, non-randomized and non blinded trialwas performed in 208 children ( ASA I-II, both gender, aged 2-12years undergoing elective adenoidectomy with or without tonsillectomy.Children scheduled for tonsillectomy or adenotonsillectomyreceived alfentanil 0.02 mg kg-1, propofol 2 mg kg-1 androcuronium 0.45 mg kg-1 before tracheal intubation (R-group.Children scheduled for adenoidectomy received alfentanil 0.02mg kg-1and propofol 3 mg kg-1 before intubation (C-group. Haemodynamicvalues (heart rate, systolic arterial pressure, diastolicarterial pressure, mean arterial pressure were recorded at predeterminedtime intervals before surgical incision. The intubatingconditions were evaluated applying the Copenhagen Scoring System(excellent, good, poor.Results There was no statistical difference in haemodynamicbaseline values, neither prior nor after the intubation betweenthe two groups. There was a statistically significant increase inheart rate, systolic and diastolic arterial pressure after intubationin both groups (p<0.05. Mean arterial pressure after the intubationincreased statistically significantly only in R-group (p=0.001.There was no hypotension, bradycardia, hypoxemia or other complications.Overall intubation conditions were scored excellent in72.3%, good in 21.5% and poor in 6.2% patients. There were nosignificant differences in intubation conditions between the twogroups (p=0.244Conclusion Both induction regiments provided the clinically acceptablehaemodynamics and intubation conditions during trachealintubation in children.

  14. Zinc and gastrointestinal disease

    Institute of Scientific and Technical Information of China (English)

    Sonja; Skrovanek; Katherine; DiGuilio; Robert; Bailey; William; Huntington; Ryan; Urbas; Barani; Mayilvaganan; Giancarlo; Mercogliano; James; M; Mullin

    2014-01-01

    This review is a current summary of the role that both zinc deficiency and zinc supplementation can play in the etiology and therapy of a wide range of gastrointestinal diseases. The recent literature describing zinc action on gastrointestinal epithelial tight junctions and epithelial barrier function is described. Zinc enhancement of gastrointestinal epithelial barrier function may figure prominently in its potential therapeutic action in several gastrointestinal diseases.

  15. Transoral tracheal intubation of rodents using a fiberoptic laryngoscope.

    Science.gov (United States)

    Costa, D L; Lehmann, J R; Harold, W M; Drew, R T

    1986-06-01

    A fiberoptic laryngoscope which allows direct visualization of the deep pharynx and epiglottis has been developed for transoral tracheal intubation of small laboratory mammals. The device has been employed in the intubation and instillation of a variety of substances into the lungs of rats, and with minor modification, has had similar application in mice, hamsters, and guinea pigs. The simplicity and ease of handling of the laryngoscope permits one person to intubate large numbers of enflurane anesthetized animals either on an open counter top or in a glove-box, as may be required for administration of carcinogenic materials. Instillation of 7Be-labeled carbon particles into the lungs of mice, hamsters, rats, and guinea pigs resulted in reasonably consistent interlobal distribution of particles for each test animal species with minimal tracheal deposition. However, actual lung tissue doses of carbon exhibited some species dependence.

  16. Difficult Tracheal Intubation in Obese Gastric Bypass patients

    DEFF Research Database (Denmark)

    Dohrn, Niclas; Sommer, Thorbjørn; Bisgaard, J.

    2016-01-01

    Endotracheal intubation is commonly perceived to be more difficult in obese patients than in lean patients. Primarily, we investigated the association between difficult tracheal intubation (DTI) and obesity, and secondarily, the association between DTI and validated scoring systems used to assess...... the airways, the association between DTI and quantities of anesthetics used to induce general anesthesia, and the association between DTI and difficulties with venous and arterial cannulation. This is a monocentric prospective observational clinical study of a consecutive series of 539 obese patients...... was 3.5 % and the patients with DTI were more frequently males, had higher CLC, higher American Society of Anesthesiologists physical status classification (ASA), and noticeably, a lower BMI compared to the patients with easy tracheal intubation. After adjustment with multivariable analyses body mass...

  17. Rocuronium versus succinylcholine for rapid sequence induction intubation.

    Science.gov (United States)

    Tran, Diem T T; Newton, Ethan K; Mount, Victoria A H; Lee, Jacques S; Wells, George A; Perry, Jeffrey J

    2015-10-29

    Patients often require a rapid sequence induction (RSI) endotracheal intubation technique during emergencies or electively to protect against aspiration, increased intracranial pressure, or to facilitate intubation. Traditionally succinylcholine has been the most commonly used muscle relaxant for this purpose because of its fast onset and short duration; unfortunately, it can have serious side effects. Rocuronium has been suggested as an alternative to succinylcholine for intubation. This is an update of our Cochrane review published first in 2003 and then updated in 2008 and now in 2015. To determine whether rocuronium creates intubating conditions comparable to those of succinylcholine during RSI intubation. In our initial review we searched all databases until March 2000, followed by an update to June 2007. This latest update included searching the Cochrane Central Register of Controlled Trials (CENTRAL; 2015, Issue 2), MEDLINE (1966 to February Week 2 2015), and EMBASE (1988 to February 14 2015 ) for randomized controlled trials (RCTs) or controlled clinical trials (CCTs) relating to the use of rocuronium and succinylcholine. We included foreign language journals and handsearched the references of identified studies for additional citations. We included any RCT or CCT that reported intubating conditions in comparing the use of rocuronium and succinylcholine for RSI or modified RSI in any age group or clinical setting. The dose of rocuronium was at least 0.6 mg/kg and succinylcholine was at least 1 mg/kg. Two authors (EN and DT) independently extracted data and assessed methodological quality for the 'Risk of bias' tables. We combined the outcomes in Review Manager 5 using a risk ratio (RR) with a random-effects model. The previous update (2008) had identified 53 potential studies and included 37 combined for meta-analysis. In this latest update we identified a further 13 studies and included 11, summarizing the results of 50 trials including 4151 participants

  18. Predictive factors for oropharyngeal dysphagia after prolonged orotracheal intubation.

    Science.gov (United States)

    Oliveira, Ana Carolina Martins de; Friche, Amélia Augusta de Lima; Salomão, Marina Silva; Bougo, Graziela Chamarelli; Vicente, Laélia Cristina Caseiro

    2017-09-13

    Lesions in the oral cavity, pharynx and larynx due to endotracheal intubation can cause reduction in the local motility and sensitivity, impairing the swallowing process, resulting in oropharyngeal dysphagia. To verify the predictive factors for the development of oropharyngeal dysphagia and the risk of aspiration in patients with prolonged orotracheal intubation admitted to an intensive care unit. This is an observational, analytical, cross-sectional and retrospective data collection study of 181 electronic medical records of patients submitted to prolonged orotracheal intubation. Data on age; gender; underlying disease; associated comorbidities; time and reason for orotracheal intubation; Glasgow scale on the day of the Speech Therapist assessment; comprehension; vocal quality; presence and severity of dysphagia; risk of bronchoaspiration; and the suggested oral route were collected. The data were analyzed through logistic regression. The level of significance was set at 5%, with a 95% Confidence Interval. The prevalence of dysphagia in this study was 35.9% and the risk of aspiration was 24.9%. As the age increased, the altered vocal quality and the degree of voice impairment increased the risk of the presence of dysphagia by 5-; 45.4- and 6.7-fold, respectively, and of aspiration by 6-; 36.4- and 4.8-fold. The increase in the time of orotracheal intubation increased the risk of aspiration by 5.5-fold. Patients submitted to prolonged intubation who have risk factors associated with dysphagia and aspiration should be submitted to an early speech-language/audiology assessment and receive appropriate and timely treatment. The recognition of these predictive factors by the entire multidisciplinary team can minimize the possibility of clinical complications inherent to the risk of dysphagia and aspiration in extubated patients. Copyright © 2017. Published by Elsevier Editora Ltda.

  19. Risk factors for laryngeal trauma and granuloma formation in pediatric intubations.

    Science.gov (United States)

    Jang, Minyoung; Basa, Krystyne; Levi, Jessica

    2018-04-01

    Intubation has been associated with laryngeal injury that often resolves spontaneously without complication. We present a case of a child intubated for less than 48 hours, who presented with dysphonia and intermittent dyspnea two months after intubation due to epiglottic and vocal process granulomas. This is unusual in that multiple granulomas were found in the posterior glottis and supraglottis after short-term intubation. Our objective was to determine if there are risk factors for developing persistent post-intubation sequelae, including the delayed presentation and unusual location of post-intubation granulomas in our case. Case report and systematic literature review. Pubmed database, which is inclusive of MEDLINE, was used to perform a literature review with the search terms ((pediatric OR children OR neonatal OR infant) AND (laryngeal OR supraglottic) AND intubation AND (granuloma OR injury OR complication)). Only English language results were reviewed. Titles and abstracts from 379 results were reviewed. Full text was reviewed from all original studies which included human pediatric subjects and endoscopic examinations after endotracheal intubation. In our case, laryngeal granuloma size reduced significantly after starting anti-reflux medications. The remainder was removed with laryngeal microdebrider with no recurrence at 3 weeks and 2.5 years post-operatively. Overall, 28 of the 379 studies reviewed identified evidence of laryngeal trauma due to intubation, however only 6 studies documented any type of supraglottic injury. Risk factors identified for developing post-intubation sequelae included intubation duration greater than 24 h; trauma to the larynx via various mechanisms including traumatic intubation, need for reintubation and tube changes, and increased movement while intubated; and presence of respiratory tract infection during intubation. Trauma to the larynx during intubation should be avoided to minimize post-intubation injury in pediatric

  20. Awake tracheal intubation using Pentax airway scope in 30 patients: A Case series

    Directory of Open Access Journals (Sweden)

    Payal Kajekar

    2014-01-01

    Full Text Available Background and Aims: Pentax airway scope (AWS has been successfully used for managing difficult intubations. In this case series, we aimed to evaluate the success rate and time taken to complete intubation, when AWS was used for awake tracheal intubation. Methods: We prospectively evaluated the use of AWS for awake tracheal intubation in 30 patients. Indication for awake intubation, intubation time, total time to complete tracheal intubation, laryngoscopic view (Cormack and Lehane grade, total dose of local anaesthetic used, anaesthetists rating and patient′s tolerance of the procedure were recorded. Results: The procedure was successful in 25 out of the 30 patients (83%. The mean (standard deviation intubation time and total time to complete the tracheal intubation was 5.4 (2.4 and 13.9 (3.7 min, respectively in successful cases. The laryngeal view was grade 1 in 24 and grade 2 in one of 25 successful intubations. In three out of the five patients where the AWS failed, awake tracheal intubation was successfully completed with the assistance of flexible fibre optic scope (FOS. Conclusion: Awake tracheal intubation using AWS was successful in 83% of patients. Success rate can be further improved using a combination of AWS and FOS. Anaesthesiologists who do not routinely use FOS may find AWS easier to use for awake tracheal intubation using an oral route.

  1. Modified Technique of Retrograde Intubation in TMJ Ankylosis

    Directory of Open Access Journals (Sweden)

    Shaila Kamat

    2008-01-01

    Full Text Available We are presenting a case report on the anaesthetic management of a case of ankylosis of temporomandibular joint for corrective surgery in a 7 year old child. Anticipated difficult airway in paediatric population has always been a perplexing problem, awake fibreoptic intubation almost impossible due to obvious difficulties with co-operation. Here we are describing a new approach to this problem, in which the patients were kept under GA with spontaneous ventilation while retrograde intubation was done quite comfortably by the conventional method.

  2. Guidelines for Induction and Intubation Sequence Fast in Emergency Service

    OpenAIRE

    Pérez Perilla, Patricia; Pontificia Universidad Javeriana-Hospital Universitario San Ignacio; Moreno Carrillo, Atilio; Pontificia Universidad Javeriana-Hospital Universitario San Ignacio; Gempeler Rueda, Fritz E.; Pontificia Universidad Javeriana-Hospital Universitario San Ignacio

    2012-01-01

    The rapid sequence intubation (RSI) is a procedure designed to minimize the time spent in securing the airway by endotracheal tube placement in emergency situations in patients at high risk of aspiration. Being clear about this situation, it is unquestionable the importance of education and training related to rapid sequence intubation to be made to the physicians responsible for the recovery rooms, emergency services and paramedics responsible for managing emergencies and disasters field . T...

  3. Parotid Duct Repair with Intubation Tube: Technical Note

    Science.gov (United States)

    Öztürk, Muhammed Beşir; Barutca, Seda Asrufoğlu; Keskin, Elif Seda; Atik, Bekir

    2017-01-01

    The parotid duct can be damaged in traumatic injuries and surgical interventions. Early diagnosis and treatment of a duct injury is of great importance because complications such as sialocele and salivary gland fistula may develop if the duct is not surgically repaired. We think the cuff of an intubation tube is an ideal material in parotid duct repair, because of its technical characteristics, easiness of availability, and low-cost. In this paper, we described the use of the cuff cannula of an intubation tube for the diagnosis and treatment of parotid duct laceration, as a low-cost and easy to access material readily available in every operating room. PMID:28713751

  4. Problematic fine bore nasogastric intubation: A radiographer led service development

    International Nuclear Information System (INIS)

    Law, Robert

    2008-01-01

    Developing from the intubation and performing of small bowel enteroclysis a consultant radiographer led service expanded to include problematic gastric, enteric and colonic intubations for diagnostic, therapeutic and interventional purposes. The radiographer led service has also extended to include 'hot reporting' chest images taken to check siting of ward placed nasogastric tubes as well as resiting those tubes that were misplaced. The service has demonstrated itself to be safe and efficient. It has also proven to be both cost and clinically effective. The protracted discomfort and distress to the patient are reduced by minimizing the delay in correctly relocating misplaced tubes

  5. Intubation simulation with a cross-sectional visual guidance.

    Science.gov (United States)

    Rhee, Chi-Hyoung; Kang, Chul Won; Lee, Chang Ha

    2013-01-01

    We present an intubation simulation with deformable objects and a cross-sectional visual guidance using a general haptic device. Our method deforms the tube model when it collides with the human model. Mass-Spring model with the Euler integration is used for the tube deformation. For the trainee's more effective understanding of the intubation process, we provide a cross-sectional view of the oral cavity and the tube. Our system also applies a stereoscopic rendering to improve the depth perception and the reality of the simulation.

  6. Intubação traqueal Tracheal intubation

    Directory of Open Access Journals (Sweden)

    Toshio Matsumoto

    2007-05-01

    Full Text Available OBJETIVO: Revisar os conceitos atuais relacionados ao procedimento de intubação traqueal na criança. FONTES DOS DADOS: Seleção dos principais artigos nas bases de dados MEDLINE, LILACS e SciELO, utilizando as palavras-chave intubation, tracheal intubation, child, rapid sequence intubation, pediatric airway, durante o período de 1968 a 2006. SÍNTESE DOS DADOS: O manuseio da via aérea na criança está relacionado à sua fisiologia e anatomia, além de fatores específicos (condições patológicas inerentes, como malformações e condições adquiridas que influenciam decisivamente no seu sucesso. As principais indicações são manter permeável a aérea e controlar a ventilação. A laringoscopia e intubação traqueal determinam alterações cardiovasculares e reatividade de vias aéreas. O uso de tubos com balonete não é proibitivo, desde que respeitado o tamanho adequado para a criança. A via aérea difícil pode ser reconhecida pela escala de Mallampati e na laringoscopia direta. A utilização da seqüência rápida de intubação tem sido recomendada cada vez mais em pediatria, por facilitar o procedimento e apresentar menores complicações. A intubação traqueal deve ser realizada de modo adequado em circunstâncias especiais (alimentação prévia, disfunção neurológica, instabilidade de coluna espinal, obstrução de vias aéreas superiores, lesões laringotraqueais, lesão de globo ocular. A extubação deve ser meticulosamente planejada, pois pode falhar e necessitar de reintubação. CONCLUSÕES: A intubação traqueal de crianças necessita conhecimento, aprendizado e experiência, pois o procedimento realizado por pediatras inexperientes pode resultar em complicações ameaçadoras da vida.OBJECTIVE: To review current concepts related to the procedure of tracheal intubation in children. SOURCES: Relevant articles published from 1968 to 2006 were selected from the MEDLINE, LILACS and SciELO databases, using the

  7. Randomized controlled trial of the Pentax AWS, Glidescope, and Macintosh laryngoscopes in predicted difficult intubation.

    LENUS (Irish Health Repository)

    Malik, M A

    2009-11-01

    The purpose of this study was to determine the potential for the Pentax AWS and the Glidescope to reduce the difficulty of tracheal intubation in patients at increased risk for difficult tracheal intubation, in a randomized, controlled clinical trial.

  8. Endotracheal intubation in patients with cervical spine immobilization: a comparison of macintosh and airtraq laryngoscopes.

    LENUS (Irish Health Repository)

    Maharaj, Chrisen H

    2007-07-01

    The Airtraq laryngoscope (Prodol Ltd., Vizcaya, Spain) is a novel single-use tracheal intubation device. The authors compared ease of intubation with the Airtraq and Macintosh laryngoscopes in patients with cervical spine immobilization in a randomized, controlled clinical trial.

  9. A Retrospective Study of Success, Failure, and Time Needed to Perform Awake Intubation.

    Science.gov (United States)

    Joseph, Thomas T; Gal, Jonathan S; DeMaria, Samuel; Lin, Hung-Mo; Levine, Adam I; Hyman, Jaime B

    2016-07-01

    Awake intubation is the standard of care for management of the anticipated difficult airway. The performance of awake intubation may be perceived as complex and time-consuming, potentially leading clinicians to avoid this technique of airway management. This retrospective review of awake intubations at a large academic medical center was performed to determine the average time taken to perform awake intubation, its effects on hemodynamics, and the incidence and characteristics of complications and failure. Anesthetic records from 2007 to 2014 were queried for the performance of an awake intubation. Of the 1,085 awake intubations included for analysis, 1,055 involved the use of a flexible bronchoscope. Each awake intubation case was propensity matched with two controls (1:2 ratio), with similar comorbidities and intubations performed after the induction of anesthesia (n = 2,170). The time from entry into the operating room until intubation was compared between groups. The anesthetic records of all patients undergoing awake intubation were also reviewed for failure and complications. The median time to intubation for patients intubated post induction was 16.0 min (interquartile range: 13 to 22) from entrance into the operating room. The median time to intubation for awake patients was 24.0 min (interquartile range: 19 to 31). The complication rate was 1.6% (17 of 1,085 cases). The most frequent complications observed were mucous plug, endotracheal tube cuff leak, and inadvertent extubation. The failure rate for attempted awake intubation was 1% (n = 10). Awake intubations have a high rate of success and low rate of serious complications and failure. Awake intubations can be performed safely and rapidly.

  10. Transient nerve damage following intubation for trans-sphenoidal hypophysectomy

    NARCIS (Netherlands)

    Evers, KA; Eindhoven, GB; Wierda, JMKH

    1999-01-01

    Purpose: To describe a case of transient lingual and hypoglossal nerve damage following intubation for a transsphenoidal hypophysectomy. Clinical features: A 56-yr-old acromegalic man was scheduled for trans-sphenoidal hypophysectomy. He had been treated with octreotide six months previously which

  11. Successful di cult airway intubation using the Miller laryngoscope ...

    African Journals Online (AJOL)

    with the use of a Miller laryngoscope blade (straight blade) and paraglossal technique, achieving Cormack and Lehane views superior to those seen using Macintosh blades.7 As early as 1997,. Henderson8 questioned the role of curved blades for di cult airway intubation and proposed that paraglossal straight blade.

  12. Intubation without muscle relaxation for suspension laryngoscopy: A ...

    African Journals Online (AJOL)

    2013-11-12

    Nov 12, 2013 ... laryngoscopy under intubation with propofol and remifentanil alone for vocal fold nodule (VFN) excision. ... laryngological procedure, achieves a definitive treatment ... Hospital, Dongying, 4Department of Gastroenterology, The Second Hospital ..... on the dose and infusion rate of propofol and remifentanil.

  13. Tracheal intubation in the ICU: Life saving or life threatening?

    Directory of Open Access Journals (Sweden)

    Jigeeshu V Divatia

    2011-01-01

    Full Text Available Tracheal intubation (TI is a routine procedure in the intensive care unit (ICU, and is often life saving. However, life-threatening complications occur in a significant proportion of procedures, making TI perhaps one the most common but underappreciated airway emergencies in the ICU. In contrast to the controlled conditions in the operating room (OR, the unstable physiologic state of critically ill patients along with underevaluation of the airways and suboptimal response to pre-oxygenation are the major factors for the high incidence of life-threatening complications like severe hypoxaemia and cardiovascular collapse in the ICU. Studies have shown that strategies planned for TI in the OR can be adapted and extrapolated for use in the ICU. Non-invasive positive-pressure ventilation for pre-oxygenation provides adequate oxygen stores during TI for patients with precarious respiratory pathology. The intubation procedure should include not only airway management but also haemodynamic, gas exchange and neurologic care, which are often crucial in critically ill patients. Hence, there is a necessity for the implementation of an Intubation Bundle during routine airway management in the ICU. Adherence to a plan for difficult airway management incorporating the use of intubation aids and airway rescue devices and strategies is useful.

  14. Intubation without muscle relaxation for suspension laryngoscopy: A ...

    African Journals Online (AJOL)

    Objective and Aim: The objective of the following study is to examine the effectiveness and safety of suspension laryngoscopy under intubation with propofol and remifentanil alone for vocal fold nodule (VFN) excision. Materials and Methods: A total of 40 patients were equally and randomly assigned to elective VFN excision ...

  15. Cecal Intubation Rate During Colonoscopy at a Tertiary Hospital in ...

    African Journals Online (AJOL)

    2016-06-14

    Jun 14, 2016 ... diseases, and for colorectal cancer screening program. Complete colonoscopy is therefore crucial for the success of any screening program. One important measure of the quality of colonoscopy is the cecal intubation rate (CIR). Aim: This was to assess the CIR at our endoscopy unit and evaluate the factors ...

  16. Cecal intubation rate during colonoscopy at a tertiary hospital in ...

    African Journals Online (AJOL)

    Background: Colonoscopy is useful in the diagnosis, treatment of colorectal diseases, and for colorectal cancer screening program. Complete colonoscopy is therefore crucial for the success of any screening program. One important measure of the quality of colonoscopy is the cecal intubation rate (CIR). Aim: This was to ...

  17. Case report: Awake insertion of the intubating laryngeal mask ...

    African Journals Online (AJOL)

    Case report: Awake insertion of the intubating laryngeal mask airway using dexmedetomidine sedation. P Dhar, TR Tedore. Abstract. No Abstract. Full Text: EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT · http://dx.doi.org/10.1080/22201173.2003.10872999.

  18. Dexmedetomidine versus Remifentanil for Sedation during Awake Fiberoptic Intubation

    Directory of Open Access Journals (Sweden)

    Davide Cattano

    2012-01-01

    Full Text Available This study compared remifentanil and dexmedetomidine as awake fiberoptic intubation (AFOI anesthetics. Thirty-four adult ASA I-III patients were enrolled in a double-blinded randomized pilot study to receive remifentanil (REM or dexmedetomidine (DEX for sedation during AFOI (nasal and oral. Thirty patients completed the study and received 2 mg midazolam IV and topical anesthesia. The REM group received a loading dose of 0.75 mcg/kg followed by an infusion of 0.075 mcg/kg/min. The DEX group received a loading dose of 0.4 mcg/kg followed by an infusion of 0.7 mcg/kg/hr. Time to sedation, number of intubation attempts, Ramsay sedation scale (RSS score, bispectral index (BIS, and memory recall were recorded. All thirty patients were successfully intubated by AFOI (22 oral intubations/8 nasal. First attempt success rate with AFOI was higher in the REM group than the DEX group, 72% and 38% (P=0.02, respectively. The DEX group took longer to attain RSS of ≥3 and to achieve BIS <80, as compared to the REM group. Postloading dose verbal recall was poorer in the DEX group. Dexmedetomidine seems a useful adjunct for patients undergoing AFOI but is dependent on dosage and time. Further studies in the use of dexmedetomidine for AFOI are warranted.

  19. Errors and clinical supervision of intubation attempts by the ...

    African Journals Online (AJOL)

    Background: Tracheal intubation is an essential skill for anaesthetists and other disciplines that require emergency establishment of a secure airway. Early attempts in patients often meet with failure. Existing publications focus mainly on trainees in emergency settings and highlight the role of experience in success; most ...

  20. Intubation using the Miller and Airtraq™ laryngoscopes: A paediatric manikin study

    Directory of Open Access Journals (Sweden)

    N. Castle

    2011-03-01

    Discussion: The Airtraq™ resulted in a 100% of all intubation attempts being successful and over half of all student paramedics believed it to be easier to use. The Airtraq™ was no faster that traditional intubation but intubation speed may have been affected by student familiarity with the Airtraq™.

  1. Pre-hospital intubation factors and pneumonia in trauma patients.

    Science.gov (United States)

    Evans, Heather L; Warner, Keir; Bulger, Eileen M; Sharar, Sam R; Maier, Ronald V; Cuschieri, Joseph

    2011-10-01

    We reported similar rates of ventilator-associated pneumonia (VAP) previously in trauma patients intubated either in a pre-hospital (PH) venue or the emergency department. A subset of PH intubations with continuous quality assessment was re-examined to identify the intubation factors associated with VAP. The subgroup was derived from an existing data set of consecutive adult trauma patients intubated prior to Level I trauma center admission July 2007-July 2008. Intubation details recorded included bag-valve mask ventilation (BVM) and the presence of material in the airway. The diagnosis of VAP was made preferentially by quantitative bronchoalveolar lavage (BAL) cultures (≥ 10⁴ colony-forming units indicating infection). Baseline data, injury characteristics, and circumstances of intubation of patients with and without VAP were compared by univariable analysis. Detailed data were available for 197 patients; 32 (16.2%) developed VAP, on average 6.0±0.7 days after admission. Baseline characteristics were similar in the groups, but diabetes mellitus was more common in the VAP group (4 [12.5%] vs. 5 [3.0%]; p=0.02). There was a higher rate of blunt injury in the VAP patients (28 [87.5%] vs. 106 [64.2%]; p=0.01) and higher injury severity scores (33.1±2.8 vs. 23.0±1.0; p=0.0002) and chest Abbreviated Injury Scores (2.6±0.3 vs. 1.5±0.1; p=0.002). Lower Glasgow Coma Scale scores (7.9±0.9 vs. 9.9±0.4; p=0.04) and greater use of BVM (18 [56.3%] vs. 56 [34.0%]; p=0.02) were observed in patients who developed VAP. Among aspirations, 10 (31.3%) of patients with emesis developed VAP compared with only 4 (12.5%) with blood in the airway (p=0.003). Aspiration, along with depressed consciousness and greater injury severity, may predispose trauma patients to VAP. Prospective studies should focus on the quality and timing of aspiration relative to intubation to determine if novel interventions can prevent aspiration or decrease the risk of VAP after aspiration.

  2. Avoiding never events: Improving nasogastric intubation practice and standards

    International Nuclear Information System (INIS)

    Law, Robert L.; Pullyblank, Ann M.; Eveleigh, Mark; Slack, Nicola

    2013-01-01

    Aim: To identify and rectify weaknesses in nasogastric (NG) intubation practice in the North Bristol NHS Trust that resulted in the occurrence of a National patient Safety Agency defined “never event”. Material and methods: Root-cause analysis identified that a change in culture was required. Recommendations divided into four categories: documentation, intubation, interpretation training, and radiology. A 6 month prospective audit covering all aspects of NG intubation practice preceded implementation of the recommendations. All patients whose tubes were mis-sited formed the cohort of the study. A re-audit was undertaken 12 months after the implementation of the recommended changes. Results: Re-audit suggested significant improvements had occurred in all categories, particularly junior doctor check image interpretation errors, which in the study group were reduced from seven to one, and documentation, which has so far improved by 22%. Protocols and guidelines associated with NG tube check imaging have now been developed for radiologists and radiographers with check imaging and image interpretation being made a priority and respiratory tract intubation treated as an emergency. Conclusion: The service is still not perfect, but there is a focal awareness of patient safety associated with intubation practice, and image interpretation by junior doctors significantly improved with the introduction of the e-learning package. However, it is considered that the responsibility for developing safe practice with respect to NG tube check image interpretation ultimately lies with the department of radiology, which should take the lead on reducing the risk of never events being caused by the misinterpretation of these images

  3. Nonvariceal upper gastrointestinal bleeding

    International Nuclear Information System (INIS)

    Burke, Stephen J.; Weldon, Derik; Sun, Shiliang; Golzarian, Jafar

    2007-01-01

    Nonvariceal upper gastrointestinal bleeding (NUGB) remains a major medical problem even after advances in medical therapy with gastric acid suppression and cyclooxygenase (COX-2) inhibitors. Although the incidence of upper gastrointestinal bleeding presenting to the emergency room has slightly decreased, similar decreases in overall mortality and rebleeding rate have not been experienced over the last few decades. Many causes of upper gastrointestinal bleeding have been identified and will be reviewed. Endoscopic, radiographic and angiographic modalities continue to form the basis of the diagnosis of upper gastrointestinal bleeding with new research in the field of CT angiography to diagnose gastrointestinal bleeding. Endoscopic and angiographic treatment modalities will be highlighted, emphasizing a multi-modality treatment plan for upper gastrointestinal bleeding. (orig.)

  4. Nonvariceal upper gastrointestinal bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Burke, Stephen J.; Weldon, Derik; Sun, Shiliang [University of Iowa, Department of Radiology, Iowa, IA (United States); Golzarian, Jafar [University of Iowa, Department of Radiology, Iowa, IA (United States); University of Iowa, Department of Radiology, Carver College of Medicine, Iowa, IA (United States)

    2007-07-15

    Nonvariceal upper gastrointestinal bleeding (NUGB) remains a major medical problem even after advances in medical therapy with gastric acid suppression and cyclooxygenase (COX-2) inhibitors. Although the incidence of upper gastrointestinal bleeding presenting to the emergency room has slightly decreased, similar decreases in overall mortality and rebleeding rate have not been experienced over the last few decades. Many causes of upper gastrointestinal bleeding have been identified and will be reviewed. Endoscopic, radiographic and angiographic modalities continue to form the basis of the diagnosis of upper gastrointestinal bleeding with new research in the field of CT angiography to diagnose gastrointestinal bleeding. Endoscopic and angiographic treatment modalities will be highlighted, emphasizing a multi-modality treatment plan for upper gastrointestinal bleeding. (orig.)

  5. Gastrointestinal nuclear imaging

    International Nuclear Information System (INIS)

    Anon.

    1988-01-01

    This book contains paper grouped under the headings of: salivary scintigraphy, abscess detection with radionuclides; pediatric gastroenterology; liver spleen, and miscellaneous GI studies: gastrointestinal

  6. Evaluation of the Airtraq and Macintosh laryngoscopes in patients at increased risk for difficult tracheal intubation.

    LENUS (Irish Health Repository)

    Maharaj, C H

    2008-02-01

    The Airtraq, a novel single use indirect laryngoscope, has demonstrated promise in the normal and simulated difficult airway. We compared the ease of intubation using the Airtraq with the Macintosh laryngoscope, in patients at increased risk for difficult tracheal intubation, in a randomised, controlled clinical trial. Forty consenting patients presenting for surgery requiring tracheal intubation, who were deemed to possess at least three characteristics indicating an increased risk for difficulty in tracheal intubation, were randomly assigned to undergo tracheal intubation using a Macintosh (n = 20) or Airtraq (n = 20) laryngoscope. All patients were intubated by one of three anaesthetists experienced in the use of both laryngoscopes. Four patients were not successfully intubated with the Macintosh laryngoscope, but were intubated successfully with the Airtraq. The Airtraq reduced the duration of intubation attempts (mean (SD); 13.4 (6.3) vs 47.7 (8.5) s), the need for additional manoeuvres, and the intubation difficulty score (0.4 (0.8) vs 7.7 (3.0)). Tracheal intubation with the Airtraq also reduced the degree of haemodynamic stimulation and minor trauma compared to the Macintosh laryngoscope.

  7. Emergency Department Intubation Success With Succinylcholine Versus Rocuronium: A National Emergency Airway Registry Study.

    Science.gov (United States)

    April, Michael D; Arana, Allyson; Pallin, Daniel J; Schauer, Steven G; Fantegrossi, Andrea; Fernandez, Jessie; Maddry, Joseph K; Summers, Shane M; Antonacci, Mark A; Brown, Calvin A

    2018-05-07

    Although both succinylcholine and rocuronium are used to facilitate emergency department (ED) rapid sequence intubation, the difference in intubation success rate between them is unknown. We compare first-pass intubation success between ED rapid sequence intubation facilitated by succinylcholine versus rocuronium. We analyzed prospectively collected data from the National Emergency Airway Registry, a multicenter registry collecting data on all intubations performed in 22 EDs. We included intubations of patients older than 14 years who received succinylcholine or rocuronium during 2016. We compared the first-pass intubation success between patients receiving succinylcholine and those receiving rocuronium. We also compared the incidence of adverse events (cardiac arrest, dental trauma, direct airway injury, dysrhythmias, epistaxis, esophageal intubation, hypotension, hypoxia, iatrogenic bleeding, laryngoscope failure, laryngospasm, lip laceration, main-stem bronchus intubation, malignant hyperthermia, medication error, pharyngeal laceration, pneumothorax, endotracheal tube cuff failure, and vomiting). We conducted subgroup analyses stratified by paralytic weight-based dose. There were 2,275 rapid sequence intubations facilitated by succinylcholine and 1,800 by rocuronium. Patients receiving succinylcholine were younger and more likely to undergo intubation with video laryngoscopy and by more experienced providers. First-pass intubation success rate was 87.0% with succinylcholine versus 87.5% with rocuronium (adjusted odds ratio 0.9; 95% confidence interval 0.6 to 1.3). The incidence of any adverse event was also comparable between these agents: 14.7% for succinylcholine versus 14.8% for rocuronium (adjusted odds ratio 1.1; 95% confidence interval 0.9 to 1.3). We observed similar results when they were stratified by paralytic weight-based dose. In this large observational series, we did not detect an association between paralytic choice and first-pass rapid sequence

  8. Inoperable oesophageal and cardia cancer. Benefits from Celestin intubation

    DEFF Research Database (Denmark)

    Qvist, N; Ryttov, N; Larsen, K E

    1987-01-01

    During a 12-year period, 77 consecutive patients with unresectable malignant stricture of the oesophagus or cardia were treated with a Celestin tube for relief of dysphagia of varying degree. Pull-through technique and gastrotomy were used for insertion of the tube in 72 patients, and endoscopy....... When there is dysphagia for liquid food, insertion of a Celestin tube may be considered, but intubation should not be done when dysphagia is confined to solid foods....

  9. Preventing Silicone Tube Extrusion after Nasolacrimal Duct Intubation in Children

    Directory of Open Access Journals (Sweden)

    Ali-Akbar Sabermoghaddam

    2010-01-01

    Full Text Available Herein we report our experience with a simple technique for reducing the rate of silicone tube extrusion after nasolacrimal duct (NLD intubation for congenital NLD obstruction. Medical records of children older than 2 years, with or without history of failed probing, who had undergone NLD intubation with a Crawford silicone tube over a period of 4 years were reviewed. In all subjects, one end of the Crawford tube was passed through a piece of scalp vein tubing followed by applying one or two knots. All Crawford tubes were removed after 3 months. Main outcome measures included complications such as tube extrusion, nasal discharge, crust formation and pyogenic granuloma formation. Fifty-seven patients, including 49 unilateral and 8 bilateral cases with mean age of 3.8΁1.6 (range, 2 to 11.5 years were operated. No complications such as tube dislodgement, significant nasal discharge, crust or pyogenic granuloma formation occurred prior to Crawford tube removal. All silicone tubes were successfully removed from the nasal cavity. In conclusion, passing one end of the Crawford tube through a small piece of scalp vein tubing before knotting it in the nasal cavity seems to decrease the rate of tube extrusion which is the most common complication following NLD intubation in children.

  10. Simple and fast orotracheal intubation procedure in rats.

    Science.gov (United States)

    Tomasello, Giovanni; Damiani, Francesco; Cassata, Giovanni; Palumbo, Vincenzo Davide; Sinagra, Emanuele; Damiani, Provvidenza; Bruno, Antonino; Cicero, Luca; Cupido, Francesco; Carini, Francesco; Lo Monte, Attilio Ignazio

    2016-05-06

    Endotracheal intubation in the rat is difficult because of the extremely small size of anatomical structures (oral cavity, epiglottis and vocal cords), small inlet for an endotracheal tube and the lack of proper technical instruments. In this study we used seventy rats weighting 400-500 g. The equipment needed for the intubation was an operating table, a longish of cotton, a cotton tip, orotracheal tube, neonatal laryngoscope blades, KTR4 small animal ventilator and isoflurane for inhalation anaesthesia. Premedication was carried out by medetomidine hydrochloride 1 mg/mL; then, thanks to a closed glass chamber, a mixture of oxygen and isoflurane was administered. By means of a neonatal laryngoscope the orotracheal tube was advanced into the oral cavity until the wire guide was visualized trough the vocal cords; then it was passed through them. The tube was introduced directly into the larynx over the wire guide; successively, the guide was removed and the tube placed into the trachea. Breathing was confirmed using a glove, cut at the end of a finger, simulating a small balloon. We achieved a fast and simple orotracheal intubation in all animals employed. We believe that our procedure is easier and faster than those previously reported in scientific literature.

  11. Gastrointestinal polyposis in Cowden disease

    International Nuclear Information System (INIS)

    Kullnig, P.; Steiner, H.; Porsch, G.; Smolle, J.

    1987-01-01

    A case of Cowden disease (multiple hamartoma syndrome) with marked gastrointestinal polyposis is presented. The differential diagnosis of gastrointestinal polyposis syndromes is discussed. (orig.) [de

  12. Degree of obesity is not associated with more than one intubation attempt: a large centre experience.

    Science.gov (United States)

    Saasouh, W; Laffey, K; Turan, A; Avitsian, R; Zura, A; You, J; Zimmerman, N M; Szarpak, L; Sessler, D I; Ruetzler, K

    2018-05-01

    The role of obesity as a risk factor for difficult intubation remains controversial. We primarily assessed the association between body mass index (BMI) and difficult tracheal intubation. We analysed electronic records of more than 67 000 adults having elective non-cardiac surgery requiring tracheal intubation at the Cleveland Clinic between 2011 and 2015. The association between BMI and difficult intubation, defined as more than one intubation attempt, was assessed using multivariable logistic regression adjusting for pre-specified confounders. Amongst 40 183 patients with BMI <30 kg m -2 and 27 519 with BMI ≥30 kg m -2 , 9% required more than one intubation attempt. Increasing BMI up to 30 kg m -2 was significantly associated with increased odds of more than one intubation attempt [odds ratio (OR): 1.03; 97.5% confidence interval (CI): 1.02, 1.04] per unit increase in BMI, P < 0.001. However, the odds of difficult intubation remained unchanged once BMI exceeded 30 kg m -2 (P = 0.08). The results were similar when analysis was restricted to patients without history of airway abnormalities in whom intubation was attempted using a standard direct laryngoscope (OR: 1.03; 99.4% CI: 1.01, 1.04) per kg m -2 increase in BMI <30 kg m -2 ). Increasing BMI was associated with increasing odds of difficult intubation in the lean range. At higher BMI, the odds of difficult intubation remain elevated, but there is no additional increase in odds with further increase in BMI. Obese patients were thus harder to intubate than lean ones, but difficult intubation was no more likely in morbidly obese patients than in those who were only slightly obese. Copyright © 2018 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.

  13. Videolaryngoscopy versus Fiber-optic Intubation through a Supraglottic Airway in Children with a Difficult Airway: An Analysis from the Multicenter Pediatric Difficult Intubation Registry.

    Science.gov (United States)

    Burjek, Nicholas E; Nishisaki, Akira; Fiadjoe, John E; Adams, H Daniel; Peeples, Kenneth N; Raman, Vidya T; Olomu, Patrick N; Kovatsis, Pete G; Jagannathan, Narasimhan; Hunyady, Agnes; Bosenberg, Adrian; Tham, See; Low, Daniel; Hopkins, Paul; Glover, Chris; Olutoye, Olutoyin; Szmuk, Peter; McCloskey, John; Dalesio, Nicholas; Koka, Rahul; Greenberg, Robert; Watkins, Scott; Patel, Vikram; Reynolds, Paul; Matuszczak, Maria; Jain, Ranu; Khalil, Samia; Polaner, David; Zieg, Jennifer; Szolnoki, Judit; Sathyamoorthy, Kumar; Taicher, Brad; Riveros Perez, N Ricardo; Bhattacharya, Solmaletha; Bhalla, Tarun; Stricker, Paul; Lockman, Justin; Galvez, Jorge; Rehman, Mohamed; Von Ungern-Sternberg, Britta; Sommerfield, David; Soneru, Codruta; Chiao, Franklin; Richtsfeld, Martina; Belani, Kumar; Sarmiento, Lina; Mireles, Sam; Bilen Rosas, Guelay; Park, Raymond; Peyton, James

    2017-09-01

    The success rates and related complications of various techniques for intubation in children with difficult airways remain unknown. The primary aim of this study is to compare the success rates of fiber-optic intubation via supraglottic airway to videolaryngoscopy in children with difficult airways. Our secondary aim is to compare the complication rates of these techniques. Observational data were collected from 14 sites after management of difficult pediatric airways. Patient age, intubation technique, success per attempt, use of continuous ventilation, and complications were recorded for each case. First-attempt success and complications were compared in subjects managed with fiber-optic intubation via supraglottic airway and videolaryngoscopy. Fiber-optic intubation via supraglottic airway and videolaryngoscopy had similar first-attempt success rates (67 of 114, 59% vs. 404 of 786, 51%; odds ratio 1.35; 95% CI, 0.91 to 2.00; P = 0.16). In subjects less than 1 yr old, fiber-optic intubation via supraglottic airway was more successful on the first attempt than videolaryngoscopy (19 of 35, 54% vs. 79 of 220, 36%; odds ratio, 2.12; 95% CI, 1.04 to 4.31; P = 0.042). Complication rates were similar in the two groups (20 vs. 13%; P = 0.096). The incidence of hypoxemia was lower when continuous ventilation through the supraglottic airway was used throughout the fiber-optic intubation attempt. In this nonrandomized study, first-attempt success rates were similar for fiber-optic intubation via supraglottic airway and videolaryngoscopy. Fiber-optic intubation via supraglottic airway is associated with higher first-attempt success than videolaryngoscopy in infants with difficult airways. Continuous ventilation through the supraglottic airway during fiber-optic intubation attempts may lower the incidence of hypoxemia.

  14. [Tracheal Intubation by Paramedics in a Local Community: Current Situation and Future Challenges].

    Science.gov (United States)

    Takinami, Yoshikazu

    2016-03-01

    As of April 2013, 164 paramedics are certified to perform tracheal intubation in Fukui Prefecture. This study investigated the current situation surrounding tracheal intubation performed by paramedics in prehospital care. Subjects were 58 paramedics who completed practical training at our hospital. Post-training duration, number of tracheal intubation cases, number of attempts before successful tracheal intubation, disease involved, rate of return of spontaneous circulation, and prognosis were examined. Tracheal intubation was successful on the first attempt in 92% of cases. Rate of return of spontaneous circulation was high in paramedics whose post-training duration was short. No return of spontaneous circulation occurred after a second attempt. Four patients survived asphyxia or aspiration. It is important to perform successful tracheal intubation on the first attempt, to recognize the probability of successful resuscitation in patients with exogenous disease, and to strengthen the medical control system.

  15. Experience of monitoring the recurrent laryngeal nerve in thyroid surgery with endotracheal intubation

    Directory of Open Access Journals (Sweden)

    Liang Feng

    2017-01-01

    Full Text Available Purpose:To analysis clinical experience of applying recurrent laryngeal monitoring endotracheal tube (NIM EMG Endotracheal Tube in the surgery of thyroid. Method: A retrospective analysis of 84 patients who underwent endotracheal intubation laryngeal nerve monitoring by thyroid surgery in the Chinese-Japanese Friendship Hospital of Jilin University from March to December in 2015. To summarize the experience of intubation with NIM EMG Endotracheal Tube. Result 77 (91.7%had initial intubation achievement in the 84 patients.FROM the 77 cases we had gotten s atisfactory nerve monitoring signal.Whereas there are 7 cases (8.3% appear abnormal EMG or signal missing, in the 7 cases there is one which being intubated too deep, 3 cases which being intubated too shallow and 3 cases with malrotation intubation.Conclusion: We got the satisfactory signals after adjust1ing the tube by using the visual laryngoscope.

  16. A randomized comparison of ultrathin and standard colonoscope in cecal intubation rate and patient tolerance.

    Science.gov (United States)

    Luo, Derek J Y; Hui, Aric Josun; Yan, Kenneth Kar-Lung; Ng, Siew Chien; Wong, Vincent Wai-Sun; Chan, Francis Ka-Leung; Cheong, Jessica P K; Lam, Phyllis P Y; Tse, Yee Kit; Lau, James Y W

    2012-03-01

    Complete colonoscopy examination cannot be performed in as many as 10% of cases. The new 9.2-mm ultrathin colonoscope (UTC) with an extra bending section may improve procedure tolerance and allow improvement in colonoscopy completion rate compared with a 12.9-mm standard colonoscope (SC). To compare the performance of the 9.2-mm UTC with that of the 12.9-mm SC. Prospective, randomized, controlled trial. Academic endoscopic unit. Subjects 18 years and older undergoing their first colonoscopy. Subjects were randomized to either the UTC or SC group. First and rescue successful cecal intubation rates, subject satisfaction scores, and sedation requirements were compared. A total of 1121 patients (56% women, mean age 53.6 years) were randomized to the UTC group (n = 551) or the SC group (n = 570). There was no statistically significant difference in the first successful cecal intubation rate between the UTC and SC groups (98.9% vs 97.4%, P = .057). The mean (standard deviation) dose of midazolam and pethidine used was significantly lower in the UTC group (2.65 [0.65] mg vs 2.82 [0.85] mg, P < .001 and 27.6 [7.4] mg vs 29.7 [9.6] mg, P < .001, respectively). The mean (standard deviation) patient satisfaction score was similar between groups (6.99 [2.89] vs 7.04 [3.06], P = .762). Of the 21 patients (1.9%) with an incomplete initial colonoscopy (6 in the UTC group and 15 in the SC group), all 6 in the UTC group had their procedure completed with an SC. Eleven of 15 patients in the SC group had their procedures completed with a UTC in the same session. Low failure rate may mask any difference between the 2 colonoscopes as a rescue instrument. The 9.2-mm UTC has performance characteristics similar to those of an SC in Chinese subjects undergoing their first colonoscopy performed by experienced and trainee endoscopists. ( NCT01142167.). Copyright © 2012 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.

  17. The LMACTrach, a Aew Approach for Endotracheal Intubation: Apilot Study in 100 Patients Undergoing Elective Surgery

    OpenAIRE

    Valiollah Hassani; Maryam Zafarghandi; Mohammad Farhadi

    2010-01-01

    Backgroundand endotracheal intubation under direct vision in both anticipated and unexpecteddifficult intubation situations.: The LMA CTrach system is a new device for airway managementMethodsdifferent types of elective surgeries. After randomly selecting the patients for intubationwith this new device, the airway characteristics, height,weight, dental overbiteand thyromental distance were all evaluated before induction.Our goal was to exploreprimarily the success rate of intubation with LMAC...

  18. Tracheal intubation in the emergency department: the Scottish district hospital perspective.

    Science.gov (United States)

    Stevenson, A G M; Graham, C A; Hall, R; Korsah, P; McGuffie, A C

    2007-06-01

    Tracheal intubation is the accepted gold standard for emergency department (ED) airway management. It may be performed by both anaesthetists and emergency physicians (EPs), with or without drugs. To characterise intubation practice in a busy district general hospital ED in Scotland over 40 months between 2003 and 2006. Crosshouse Hospital, a 450-bed district general hospital serving a mixed urban and rural population; annual ED census 58,000 patients. Prospective observational study using data collection sheets prepared by the Scottish Trauma Audit Group. Proformas were completed at the time of intubation and checked by investigators. Rapid-sequence induction (RSI) was defined as the co-administration of an induction agent and suxamethonium. 234 intubations over 40 months, with a mean of 6 per month. EPs attempted 108 intubations (46%). Six patients in cardiac arrest on arrival were intubated without drugs. 29 patients were intubated after a gas induction or non-RSI drug administration. RSI was performed on 199 patients. Patients with trauma constituted 75 (38%) of the RSI group. 29 RSIs (15%) were immediate (required on arrival at the ED) and 154 (77%) were urgent (required within 30 min of arrival at the ED). EPs attempted RSI in 88 (44%) patients and successfully intubated 85 (97%). Anaesthetists attempted RSI in 111 (56%) patients and successfully intubated 108 (97%). Anaesthetists had a higher proportion of good views at first laryngoscopy and there was a trend to a higher rate of successful intubation at the first attempt for anaesthetists. Complication rates were comparable for the two specialties. Tracheal intubations using RSI in the ED are performed by EPs almost as often as by anaesthetists in this district hospital. Overall success and complication rates are comparable for the two specialties. Laryngoscopy training and the need to achieve intubation at the first (optimum) attempt needs to be emphasised in EP airway training.

  19. The usefulness of design of experimentation in defining the effect difficult airway factors and training have on simulator oral-tracheal intubation success rates in novice intubators.

    Science.gov (United States)

    Thomas, Frank; Carpenter, Judi; Rhoades, Carol; Holleran, Renee; Snow, Gregory

    2010-04-01

    This exploratory study examined novice intubators and the effect difficult airway factors have on pre- and posttraining oral-tracheal simulation intubation success rates. Using a two-level, full-factorial design of experimentation (DOE) involving a combination of six airway factors (curved vs. straight laryngoscope blade, trismus, tongue edema, laryngeal spasm, pharyngeal obstruction, or cervical immobilization), 64 airway scenarios were prospectively randomized to 12 critical care nurses to evaluate pre- and posttraining first-pass intubation success rates on a simulator. Scenario variables and intubation outcomes were analyzed using a generalized linear mixed-effects model to determine two-way main and interactive effects. Interactive effects between the six study factors were nonsignificant (p = 0.69). For both pre- and posttraining, main effects showed the straight blade (p = 0.006), tongue edema (p = 0.0001), and laryngeal spasm (p = 0.004) significantly reduced success rates, while trismus (p = 0.358), pharyngeal obstruction (p = 0.078), and cervical immobilization did not significantly change the success rate. First-pass intubation success rate on the simulator significantly improved (p = 0.005) from pre- (19%) to posttraining (36%). Design of experimentation is useful in analyzing the effect difficult airway factors and training have on simulator intubation success rates. Future quality improvement DOE simulator research studies should be performed to help clarify the relationship between simulator factors and patient intubation rates.

  20. Pediatric Intubation by Paramedics in a Large Emergency Medical Services System: Process, Challenges, and Outcomes.

    Science.gov (United States)

    Prekker, Matthew E; Delgado, Fernanda; Shin, Jenny; Kwok, Heemun; Johnson, Nicholas J; Carlbom, David; Grabinsky, Andreas; Brogan, Thomas V; King, Mary A; Rea, Thomas D

    2016-01-01

    Pediatric intubation is a core paramedic skill in some emergency medical services (EMS) systems. The literature lacks a detailed examination of the challenges and subsequent adjustments made by paramedics when intubating children in the out-of-hospital setting. We undertake a descriptive evaluation of the process of out-of-hospital pediatric intubation, focusing on challenges, adjustments, and outcomes. We performed a retrospective analysis of EMS responses between 2006 and 2012 that involved attempted intubation of children younger than 13 years by paramedics in a large, metropolitan EMS system. We calculated the incidence rate of attempted pediatric intubation with EMS and county census data. To summarize the intubation process, we linked a detailed out-of-hospital airway registry with clinical records from EMS, hospital, or autopsy encounters for each child. The main outcome measures were procedural challenges, procedural success, complications, and patient disposition. Paramedics attempted intubation in 299 cases during 6.3 years, with an incidence of 1 pediatric intubation per 2,198 EMS responses. Less than half of intubations (44%) were for patients in cardiac arrest. Two thirds of patients were intubated on the first attempt (66%), and overall success was 97%. The most prevalent challenge was body fluids obscuring the laryngeal view (33%). After a failed first intubation attempt, corrective actions taken by paramedics included changing equipment (33%), suctioning (32%), and repositioning the patient (27%). Six patients (2%) experienced peri-intubation cardiac arrest and 1 patient had an iatrogenic tracheal injury. No esophageal intubations were observed. Of patients transported to the hospital, 86% were admitted to intensive care and hospital mortality was 27%. Pediatric intubation by paramedics was performed infrequently in this EMS system. Although overall intubation success was high, a detailed evaluation of the process of intubation revealed specific

  1. The effects of succinylcholine or low-dose rocuronium to aid endotracheal intubation of adult sows

    Science.gov (United States)

    Duke-Novakovski, Tanya; Ambros, Barbara; Auckland, Crissie D.; Harding, John C.S.

    2012-01-01

    This randomized, prospective, blinded study compared the use of succinylcholine or rocuronium to aid endotracheal intubation of 27 adult sows [mean body weight 261 ± 28 (standard deviation) kg]. Preliminary trials allowed development of the intubation technique and skills. The sows were premedicated with azaperone, atropine, and morphine, and anesthesia was induced with thiopental [6 mg/kg body weight (BW)]. Nine sows each received succinylcholine (1.0 mg/kg BW), rocuronium (0.5 mg/kg BW), or saline (15 mL) after induction. Increments of thiopental (1 mg/kg BW) were used if swallowing impaired intubation. Intubation was performed 45 s after injection of the test drug and was timed and scored. The intubation scores were analyzed with Kruskal-Wallis analysis of variance (ANOVA). Time taken for intubation, body weight, and total dose of thiopental were analyzed with ANOVA and Bonferroni’s multiple-comparisons test. No significant differences (at P < 0.05) were found between the groups with regard to intubation score, time taken for intubation, or total thiopental dose. Thus, neuromuscular blocking agents did not aid endotracheal intubation of adult sows anesthetized with thiopental. PMID:22754096

  2. Laryngeal mask airway guided tracheal intubation in a neonate with the Pierre Robin syndrome

    DEFF Research Database (Denmark)

    Hansen, Tom Giedsing; Joensen, Henning; Henneberg, Steen Winther

    1995-01-01

    Endotracheal intubation in infants with the Pierre Robin syndrome may sometimes be impossible to accomplish by conventional means. To aid difficult tracheal intubation many different techniques have been described. We present a case, in which we successfully intubated a small-for-date newborn boy...... with the Pierre Robin syndrome by using a modified laryngeal mask airway (no. 1) as a guide for the endotracheal tube. The technique is easy to perform, less traumatic and less time-consuming than multiple attempts at laryngoscopy or blind tracheal intubation....

  3. Angiography and the gastrointestinal bleeder

    International Nuclear Information System (INIS)

    Baum, S.

    1982-01-01

    The role of angiography in the diagnosis and treatment of gastrointestinal hemorrhage is discussed. Three categories of gastrointestinal bleeding are considered: upper gastrointestinal bleeding due to gastroesophageal varices, upper gastrointestinal bleeding of arterial or capillary origin, and lower gastrointestinal bleeding. The advantages and disadvantages of angiography are compared with those of radionuclide scanning and endoscopy or colonoscopy. It is anticipated that, as radionuclide scans are more widely employed, angiography will eventually be performed only in those patients with positive scans

  4. Comparison of the air-Q intubating laryngeal airway and the cobra perilaryngeal airway as conduits for fiber optic-guided intubation in pediatric patients.

    Science.gov (United States)

    Girgis, Karim K; Youssef, Maha M I; ElZayyat, Nashwa S

    2014-10-01

    One of the methods proposed in cases of difficult airway management in children is using a supraglottic airway device as a conduit for tracheal intubation. The aim of this study was to compare the efficacy of the Air-Q Intubating Laryngeal Airway (Air-Q) and the Cobra Perilaryngeal Airway (CobraPLA) to function as a conduit for fiber optic-guided tracheal intubation in pediatric patients. A total of 60 children with ages ranging from 1 to 6 years, undergoing elective surgery, were randomized to have their airway managed with either an Air-Q or CobraPLA. Outcomes recorded were the success rate, time and number of attempts required for fiber optic-guided intubation and the time required for device removal after intubation. We also recorded airway leak pressure (ALP), fiber optic grade of glottic view and occurrence of complications. Both devices were successfully inserted in all patients. The intubation success rate was comparable with the Air-Q and the CobraPLA (96.7% vs. 90%), as was the first attempt success rate (90% vs. 80%). The intubation time was significantly longer with the CobraPLA (29.5 ± 10.9 s vs. 23.2 ± 9.8 s; P fiber optic grade of glottic view was comparable with the two devices. The CobraPLA was associated with a significantly higher incidence of blood staining of the device on removal and post-operative sore throat. Both the Air-Q and CobraPLA can be used effectively as a conduit for fiber optic-guided tracheal intubation in children. However, the Air-Q proved to be superior due to a shorter intubation time and less airway morbidity compared with the CobraPLA.

  5. Management of in-tube projectiles using acoustic channel

    Science.gov (United States)

    Kostina, M. A.; Bortalevich, S. I.; Loginov, E. L.; Shinyakov, Y. A.; Sukhorukov, M. P.

    2018-03-01

    The article describes the method of measuring the distance from the operator's console installed outside the pipe to the in-tube projectile. A method for measuring distance in the absence of an echo signal is proposed. To do this, two identical ultrasonic locators operating at different frequencies were installed inside and outside the pipeline. The change in the duration of an acoustic pulse propagating in a circular waveguide with rigid walls is shown, which leads to a decrease in the data transfer rate.

  6. Comparison of Ambu® AuraGain™ laryngeal mask and air-Q™ intubating laryngeal airway for blind tracheal intubation in adults: A randomized controlled trial

    OpenAIRE

    Sameer Sethi; Souvik Maitra; Vikas Saini; Tanvir Samara

    2017-01-01

    Background: This study has been designed to compare the performance of Ambu® AuraGain™ laryngeal mask with the air-Q™ as a conduit for blind tracheal intubation in adult patients. Methods: In this prospective randomized controlled trial blind endotracheal intubation success rates were compared between Ambu® AuraGain™ and air-Q™ intubating laryngeal airway in 90 adult patients. Patients were randomized in two equal groups: Group Ambu® AuraGain™ (n = 45) and Group air-Q™ (n = 45). Results...

  7. Intubation learning curve: comparison between video and direct laryngoscopy by inexperienced students.

    Science.gov (United States)

    Aghamohammadi, H; Massoudi, N; Fathi, M; Jaffari, A; Gharaei, B; Moshki, A

    2015-01-01

    Background: Direct laryngoscopy (DL) is considered the most common method of tracheal intubation. On the other hand, evidence shows the growing role of video laryngoscopy in danger airway administration. Objectives: Due to the importance of a proper training to accomplish an accurate and fast intubation by the student of anesthesia, this research was conducted to assess the effects of DL and video laryngoscopy (Glidescope VL) training on the success rate of tracheal intubation by low-skill students. Materials/Patients and styles: 50 undergraduate students of anesthesiology took part in this randomized control educational intervention. Having no considerable experience in intubation, they were selected and divided randomly into two equal groups (n = 25); video-laryngoscopy via GlideScope VL and direct laryngoscopy (DL) via a Macintosh blade were prepared by the same experienced anesthesiologist. All the participants practiced intubation six times on the same mannequin within a routine airway situation. The maximum acceptable time for each intubation was 3 minutes and three times of successful intubation was considered as an appropriate intubation skill. The required time for laryngoscopy and intubation at each stage, the grade of glottis view, the reasons for an unsuccessful intubation and the amount of successful intubations were recorded and compared between groups. Results: There was a clear variation between the 2 teams, in all the steps, based on the required time for laryngoscopy and intubation (p = 0.0001). Data analysis was performed by using repeated measures data which demonstrated that the necessary time for laryngoscopy and intubation during the study was clearly lower in the GlideScope VL team (p = .0001). In first five rounds of training, the glottis view in the DL group was significantly better than in the VL group (p < 0.05). Conclusion: Based on the result of today' study, routine airway intubation by using GlideScope VL is significantly faster than

  8. Inspection of the nasopharynx prior to fiberoptic-guided nasotracheal intubation reduces the risk epistaxis.

    Science.gov (United States)

    Kwon, Min A; Song, Jaegyok; Kim, Seokkon; Ji, Seong-Mi; Bae, Jeongho

    2016-08-01

    Various complications may occur during nasotracheal intubation. This may include epistaxis and damage to the nasopharyngeal airway. We tested the hypothesis that the use of fiberoptic bronchoscopy (FOB)-guided intubation is superior to endotracheal tube (ETT) obturated with an inflated esophageal stethoscope. Patients were randomly assigned to 1 of 2 groups (n=22 each): either an FOB-guided intubation group or ETT obturated with an inflated esophageal stethoscope group. After the induction of general anesthesia, patients in the FOB group received an FOB inspection through the nostril without advancement of ETT. Then, after confirming the placement of the bronchoscope tip in the trachea, the lubricated ETT was advanced via the nostril to the trachea along the bronchoscope. In the obturated ETT insertion group, the proximal opening of the ETT was blunted with an inflated esophageal stethoscope. The ETT was inserted into the selected nostril and advanced blindly into the posterior oropharynx. Then, the esophageal stethoscope was removed and tracheal intubation was performed with the bronchoscope. The number of attempts for successful tracheal intubation, the degree of difficulty during insertion, and bleeding during bronchoscopy were recorded. Another anesthesiologist, blinded to the intubation method, estimated the severity of epistaxis 5minutes after the intubation and postoperative complications. The FOB group had significantly less epistaxis during bronchoscopy, better navigability, and fewer intubation attempts and redirections. Fiberoptic-guided nasotracheal intubation was associated with less epistaxis. It also showed better navigability and less redirection rate. Therefore, FOB as an intubation guide is superior to ETT with an inflated esophageal stethoscope when intubating a patient via the nasotracheal route. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Does ultrasonographic volume of the thyroid gland correlate with difficult intubation? An observational study

    Directory of Open Access Journals (Sweden)

    Basak Ceyda Meco

    Full Text Available BACKGROUND AND OBJECTIVES: Preoperative ultrasonographic evaluation of the thyroid gland done by surgeons could let us foresee airway management challenges. The aim of this observational study was to evaluate the effects of thyroid-related parameters assessed preoperatively by surgeons via ultrasonography and chest X-ray on intubation conditions. METHODS: Fifty patients undergoing thyroid surgery were enrolled. Thyromental distance, Mallampati score, neck circumference and range of neck movement were evaluated before the operation. Thyroid volume, signs of invasion or compression and tracheal deviation on chest X-ray were also noted. The intubation conditions were assessed with Cormack and Lehane score and the intubation difficulty scale. Statistical analyses were done with SPSS 15.0 software. RESULTS: The mean thyroid volume of the patients was 26.38 ± 14 mL. The median intubation difficulty scale was 1 (0-2. Thyromental distance (p = 0.011; r = 0.36; 95% CI 0.582-0.088, Mallampati score (p = 0.041; r = 0.29; 95% CI 0.013-0.526, compression or invasion signs (p = 0.041; r = 0.28; 95% CI 0.006-0.521 and tracheal deviation on chest X-ray (p = 0.041; r = 0.52; 95% CI 0.268-0.702 were correlated with intubation difficulty scale. Also patients were classified into two groups related to their intubation difficulty scale (Group I, n = 19: intubation difficulty scale = 0; Group II, n = 31: 1 < intubation difficulty scale ≤ 5 and difficult intubation predictors and thyroid-related parameters were compared. Only Mallampati score was significantly different between groups (p = 0.025. CONCLUSION: The thyroid volume is not associated with difficult intubation. However clinical assessment parameters may predict difficult intubation.

  10. Tracheal intubation in the emergency department: a comparison of GlideScope® video laryngoscopy to direct laryngoscopy in 822 intubations.

    Science.gov (United States)

    Sakles, John C; Mosier, Jarrod M; Chiu, Stephen; Keim, Samuel M

    2012-04-01

    Video laryngoscopy has, in recent years, become more available to emergency physicians. However, little research has been conducted to compare their success to conventional direct laryngoscopy. To compare the success rates of GlideScope(®) (Verathon Inc., Bothell, WA) videolaryngoscopy (GVL) with direct laryngoscopy (DL) for emergency department (ED) intubations. This was a 24-month retrospective observational study of all patients intubated in a single academic ED with a level I trauma center. Structured data forms were completed after each intubation and entered into a continuous quality improvement database. All patients intubated in the ED with either the GlideScope(®) standard, Cobalt, Ranger, or traditional Macintosh or Miller laryngoscopes were included. All patients intubated before arrival were excluded. Primary analysis evaluated overall and first-attempt success rates, operator experience level, performance characteristics of GVL, complications, and reasons for failure. There were 943 patients intubated during the study period; 120 were excluded due to alternative management strategies. DL was used in 583 (62%) patients, and GVL in 360 (38%). GVL had higher first-attempt success (75%, p = 0.03); DL had a higher success rate when more than one attempt was required (57%, p = 0.003). The devices had statistically equivalent overall success rates. GVL had fewer esophageal intubations (n = 1) than DL (n = 18); p = 0.005. The two techniques performed equivalently overall, however, GVL had a higher overall success rate, and lower number of esophageal complications. In the setting of ED intubations, GVL offers an excellent option to maximize first-attempt success for airway management. Published by Elsevier Inc.

  11. Rapid sequence induction and intubation with rocuronium-sugammadex compared with succinylcholine

    DEFF Research Database (Denmark)

    Sørensen, M K; Bretlau, C; Gätke, M R

    2012-01-01

    An unanticipated difficult airway may arise during rapid sequence induction and intubation (RSII). The aim of the trial was to assess how rapidly spontaneous ventilation could be re-established after RSII. We hypothesized that the time period from tracheal intubation to spontaneous ventilation wo...... would be shorter with rocuronium-sugammadex than with succinylcholine....

  12. Retention of tracheal intubation skills by novice personnel: a comparison of the Airtraq and Macintosh laryngoscopes.

    LENUS (Irish Health Repository)

    Maharaj, C H

    2007-03-01

    Direct laryngoscopic tracheal intubation is a potentially lifesaving manoeuvre, but it is a difficult skill to acquire and to maintain. These difficulties are exacerbated if the opportunities to utilise this skill are infrequent, and by the fact that the consequences of poorly performed intubation attempts may be severe. Novice users find the Airtraq laryngoscope easier to use than the conventional Macintosh laryngoscope. We therefore wished to determine whether novice users would have greater retention of intubation skills with the Airtraq rather than the Macintosh laryngoscope. Twenty medical students who had no prior airway management experience participated in this study. Following brief didactic instruction, each took turns performing laryngoscopy and intubation using the Macintosh and Airtraq devices in easy and simulated difficult laryngoscopy scenarios. The degree of success with each device, the time taken to perform intubation and the assistance required, and the potential for complications were then assessed. Six months later, the assessment process was repeated. No didactic instruction or practice attempts were provided on this latter occasion. Tracheal intubation skills declined markedly with both devices. However, the Airtraq continued to provide better intubating conditions, resulting in greater success of intubation, with fewer optimisation manoeuvres required, and reduced potential for dental trauma, particularly in the difficult laryngoscopy scenarios. The substantial decline in direct laryngoscopy skills over time emphasise the need for continued reinforcement of this complex skill.

  13. Dexmedetomidine premedication for fiberoptic intubation in patients of temporomandibular joint ankylosis: A randomized clinical trial

    Directory of Open Access Journals (Sweden)

    Kumkum Gupta

    2012-01-01

    Full Text Available Background : Fiberoptic intubation is the gold standard technique for difficult airway management in patients of temporomandibular joint. This study was aimed to evaluate the clinical efficacy and safety of dexmedetomidine as premedication with propofol infusion for fiberoptic intubation. Methods: Consent was obtained from 46 adult patients of temporomandibular joint ankylosis, scheduled for gap arthroplasty. They were enrolled for thisdouble-blind, randomized, prospective clinical trial with two treatment groups - Group D and Group P, of 23 patients each. Group D patients had received premedication of dexmedetomidine 1 μg/kg infused over 10 min followed by sedative propofol infusion and the control Group P patients were given only propofol infusion to achieve sedation. Condition achieved at endoscopy, intubating conditions, hemodynamic changes and postoperative events were evaluated as primary outcome. Results : The fiberoptic intubation was successful with satisfactory endoscopic and intubating condition in all patients. Dexmedetomidine premedication has provided satisfactory conditions for fiberoptic intubation and attenuated the hemodynamic response of fiberoptic intubation than the propofol group. Conclusion : Fiberoptic intubation was found to be easier with dexmedetomidine premedication along with sedative infusion of propofol with complete amnesia of the procedure, hemodynamic stability and preservation of patent airway.

  14. Correlation between oro and hypopharynx shape and position with endotracheal intubation difficulty

    Directory of Open Access Journals (Sweden)

    Daher Rabadi

    2014-12-01

    Full Text Available Background and objective: Prediction of intubation difficulty can save patients from major preoperative morbidity or mortality. The purpose of this paper is to assess the correlation between oro-hypo pharynx position, neck size, and length with endotracheal intubation difficulty. The study also explored the diagnostic value of Friedman Staging System in prediction cases with difficult intubation. Method: The consecutive 500 ASA (I, II adult patients undergoing elective surgery were evaluated for oro and hypopharynx shape and position by modified Mallampati, Cormack and Lehane score as well as Friedman obstructive sleep apnea classification systems. Neck circumference and length were also measured. All cases were intubated by a single anesthesiologist who was uninformed of the above evaluation and graded intubation difficulty in visual analog score. Correlation between these findings and difficulty of intubation was assessed. Sensitivity, Specificity, Positive and Negative Predictive Values were also reported. Results: Cormack-Lehane grade had the strongest correlation with difficulty of intubation followed by Friedman palate position. Friedman palate position was the most sensitive and had higher positive and negative predictive values than modified Mallampati classification. Cormack-Lehane grade was found to be the most specific with the highest negative predictive value among the four studied classifications. Conclusion: Friedman palate position is a more useful, valuable and sensitive test compared to the modified Mallampati screening test for pre-anesthetic prediction of difficult intubation where its involvement in Multivariate model may raise the accuracy and diagnostic value of preoperative assessment of difficult airway.

  15. A comparative study of effect of sevoflurane on intubating conditions with rocuronium in neurosurgical patients.

    Science.gov (United States)

    Mitra, Saikat; Purohit, Shobha; Bhatia, Sonali; Kalra, Poonam; Sharma, Satya Prakash

    2015-12-01

    Rocuronium may not always be the preferred relaxant for rapid sequence intubation. When 2% sevoflurane is used in conjunction with rocuronium, it may reduce the time required for achieving complete skeletal muscle relaxation with the intubating dose of rocuronium. This study was prospective, randomised, double-blind in nature and compared the effect of sevoflurane on intubation time and intubating conditions when used along with rocuronium. Thirty adult patients belonging to American Society of Anesthesiologists physical status Grades 1 and 2, of either gender aged between 30 and 65 years undergoing neurosurgical operations were randomly allocated into two equal groups: Group R received 0.8 mg/kg rocuronium, and Group RS received 0.8 mg/kg of rocuronium with 2% sevoflurane. Onset time of intubation was assessed using train-of-four stimuli. The intubating conditions were compared using the Cooper scoring system and the haemodynamic responses were compared between the two groups. The onset time of intubation was 101.73 ± 10.28 s in Group R and 60.4 ± 4.1 s in Group RS (P Rocuronium 0.8 mg/kg along with 2% sevoflurane provides excellent intubating conditions within 60-66 s from its administration.

  16. Endotracheal intubation in patients with difficult airway: Using laryngeal mask airway with bougie versus video laryngoscopy

    Directory of Open Access Journals (Sweden)

    Hesameddin Modir

    2017-01-01

    Full Text Available Airway management is essential for safe anesthesia and endotracheal intubation is the most important procedure by which critically ill patients can be better managed, especially if done quickly and successfully. This study aimed to compare the techniques of intubation through laryngeal mask airway (LMA using a bougie versus video laryngoscopy (VL regarding to intubation success and the quality of intubation indices in patients with difficult airways. This randomized clinical trial was performed on 96 patients aged 16–76 years with Mallampati class 3 or 4 who underwent elective surgery. Once the demographics were recorded, patients were randomly divided into two groups and the first group intubated with VL, and the second group intubated through laryngeal mask using a bougie. Then vital signs, arterial oxygen saturation, the time required for successful intubation, and ease of intubation were recorded. Here t-tests, chi-square, Fisher exact tests, and analysis of variance for repeated measurement were used to analyze the data in SPSS software. The overall success rates of intubation in VL and LMA groups were 46 (96% and 44 (92%, respectively. The mean duration of intubation for the LMA and VL groups was 18.70 ± 6.73 and 14.21 ± 4.14 seconds, respectively (P < 0.001. Moreover, visual analogue scale score for pain in throat was significantly lower in VL group than LMA (1.65 ± 0.76 vs. 1.33 ± 0.52. Moreover, easy intubation in bougie group was 50%, while the easy intubation in VL was 73% (P = 0.023. In addition, incidence of cough was 31% in the LMA with bougie group and 9% in VL group (P = 0.005. The VL technique is an easier method and has a shorter intubation time than LMA using bougie, and causes a lower incidence of coughing, laryngospasm in patients that need intubation. Moreover, cough and discomfort in the throat tend to be less in VL, and the LMA could be used as replacement of VL in hard situations.

  17. COMPARISON OF ROCURONIUM BROMIDE AND SUCCINYLCHOLINE CHLORIDE FOR USE DURING RAPID SEQUENCE INTUBATION IN ADULTS

    Directory of Open Access Journals (Sweden)

    Ch. Penchalaiah

    2015-08-01

    Full Text Available BACKGROUND AND OBJECTIVE : The goal of rapid sequence intubation is to secure the patients airway smoothly and quickly, minimizing the chances of regurgitation and aspiration of gastric contents. Traditionally succinylcholine chloride has been the neuromuscular blocking drug of choi ce for use in rapid sequence intubation because of its rapid onset of action and profound relaxation. Succinylcholine chloride remains unsurpassed in providing ideal intubating conditions. However the use of succinylcholine chloride is associated with many side effects like muscle pain, bradycardia, hyperkalaemia and rise in intragastric and intraocular pressure. Rocuronium bromide is the only drug currently available which has the rapidity of onset of action like succinylcholine chloride. Hence the present study was undertaken to compare rocuronium bromide with succinylcholine chloride for use during rapid sequence intubation in adult patients. METHODOLOGY : The study population consisted of 90 patients aged between 18 - 60 years posted for various elective su rgeries requiring general anaesthesia . S tudy population was randomly divided into 3 groups with 30 patients in each sub group. 1. Group I : Intubated with 1 mg kg - 1 of succinylcholine chloride (n=30 . 2. Grou p II : Intubated with rocuronium bromide 0.6 mg kg - 1 (n=30 . 3. Group III : Intubated with rocuronium bromide 0.9 mg kg - 1 (n=30 . Intubating conditions were assessed at 60 seconds based on the scale adopted by Toni Magorian et al. 1993. The haemodynamic para meters in the present study were compared using p - value obtained from student t - test . RESULTS : It was noted that succinylcholine chloride 1 mg kg - 1 body weight produced excellent intubating conditions in all patients. Rocuronium bromide 0.6 mg kg - 1 body we ight produced excellent intubating conditions in 53.33% of patients but produced good to excellent intubating conditions in 96.67% of patients. Rocuronium bromide 0.9 mg kg - 1

  18. Nasogastric intubation causes gastroesophageal reflux in patients undergoing elective laparotomy.

    LENUS (Irish Health Repository)

    Manning, B J

    2012-02-03

    BACKGROUND: The routine use of nasogastric tubes in patients undergoing elective abdominal operation is associated with an increased incidence of postoperative fever, atelectasis, and pneumonia. Previous studies have shown that nasogastric tubes have no significant effect on the incidence of gastroesophageal reflux or on lower esophageal sphincter pressure in healthy volunteers. We hypothesized that nasogastric intubation in patients undergoing laparotomy reduces lower esophageal sphincter pressure and promotes gastroesophageal reflux in the perioperative period. METHODS: A prospective randomized case-control study was undertaken in which 15 consenting patients, admitted electively for bowel surgery, were randomized into 2 groups. Group 1 underwent nasogastric intubation after induction of anesthesia, and Group 2 did not. All patients had manometry and pH probes placed with the aid of endoscopic vision at the lower esophageal sphincter and distal esophagus, respectively. Nasogastric tubes, where present, were left on free drainage, and sphincter pressures and pH were recorded continuously during a 24-hour period. Data were analyzed with 1-way analysis of variance. RESULTS: The mean number of reflux episodes (defined as pH < 4) in the nasogastric tube group was 137 compared with a median of 8 episodes in the group managed without nasogastric tubes (P =.006). The median duration of the longest episode of reflux was 132 minutes in Group 1 and 1 minute in Group 2 (P =.001). A mean of 13.3 episodes of reflux lasted longer than 5 minutes in Group 1, with pH less than 4 for 37.4% of the 24 hours. This was in contrast to Group 2 where a mean of 0.13 episodes lasted longer than 5 minutes (P =.001) and pH less than 4 for 0.2% of total time (P =.001). The mean lower esophageal sphincter pressures were lower in Group 1. CONCLUSIONS. These findings demonstrate that patients undergoing elective laparotomy with routine nasogastric tube placement have significant gastroesophageal

  19. Effects of nicardipine on the onset time and intubation conditions of rocuronium-induced neuromuscular blockade.

    Science.gov (United States)

    Lee, Sun-Yeul; Kim, Yoon-Hee; Ko, Young-Kwon; Park, Sang-Il; Lee, Jung-Un; Chung, Woo-Suk; Lim, Chae-Seong

    2016-08-01

    The objective of this study was to identify the effects of nicardipine on neuromuscular blockade of rocuronium, such as the onset time and intubation conditions, using a nicardipine dose that attenuates cardiovascular responses during endotracheal intubation. Randomized, double-blinded, placebo-controlled clinical comparison was used as the design of this study The study was conducted at the operating room of a university hospital. Participants of this study comprise 78 American Society of Anesthesiologists physical status 1 and 2 patients, aged 18 to 60 years who were undergoing elective surgery under general anesthesia. The nicardipine group was given an intravenous bolus of 20 μg/kg nicardipine before tracheal intubation: the control group was given an intravenous bolus of a comparable volume of normal saline before tracheal intubation. Using a TOF-Watch SX monitor, the time from the end of the injection of rocuronium to maximum depression of T1 (onset time) was measured. Intubation was performed 1 minute after rocuronium administration, and the status of the intubation conditions was assessed. The mean blood pressure and heart rate were each measured after endotracheal intubation. Rate pressure product values were also calculated. Intubation conditions were clinically acceptable in 37 (94.9%) of 39 patients in group N compared with 29 (74.4%) of 39 in group C (P rocuronium was significantly faster in group N than in group C (P .05). Pretreatment with 20 μg/kg nicardipine improves intubation conditions, shortens the onset time of rocuronium, and attenuates cardiovascular responses to tracheal intubation. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. A comparative study of effect of sevoflurane on intubating conditions with rocuronium in neurosurgical patients

    Directory of Open Access Journals (Sweden)

    Saikat Mitra

    2015-01-01

    Full Text Available Background and Aims: Rocuronium may not always be the preferred relaxant for rapid sequence intubation. When 2% sevoflurane is used in conjunction with rocuronium, it may reduce the time required for achieving complete skeletal muscle relaxation with the intubating dose of rocuronium. Methods: This study was prospective, randomised, double-blind in nature and compared the effect of sevoflurane on intubation time and intubating conditions when used along with rocuronium. Thirty adult patients belonging to American Society of Anesthesiologists physical status Grades 1 and 2, of either gender aged between 30 and 65 years undergoing neurosurgical operations were randomly allocated into two equal groups: Group R received 0.8 mg/kg rocuronium, and Group RS received 0.8 mg/kg of rocuronium with 2% sevoflurane. Onset time of intubation was assessed using train-of-four stimuli. The intubating conditions were compared using the Cooper scoring system and the haemodynamic responses were compared between the two groups. Results: The onset time of intubation was 101.73 ± 10.28 s in Group R and 60.4 ± 4.1 s in Group RS (P < 0.001, with excellent intubating conditions in both groups and without any adverse effects. Significant differences in heart rate and mean arterial pressure were seen immediately after intubation, at 1 and 3 min (P < 0.05 between the two groups. Conclusion: Rocuronium 0.8 mg/kg along with 2% sevoflurane provides excellent intubating conditions within 60-66 s from its administration.

  1. Management of gastrointestinal hemorrhage.

    OpenAIRE

    Hilsden, R. J.; Shaffer, E. A.

    1995-01-01

    Acute gastrointestinal hemorrhage is a common problem that requires prompt recognition and management to prevent serious morbidity and mortality. Management goals are stabilization of the patient with vigorous fluid resuscitation followed by investigation and definitive treatment of the bleeding source. Endoscopy is often the initial diagnostic test and allows therapeutic measures to be performed at the same time.

  2. Comparison of rocuronium at two different doses and succinylcholine for endotracheal intubation in adult patients for elective surgeries

    Directory of Open Access Journals (Sweden)

    S G Chavan

    2016-01-01

    Conclusion: Rapid sequence induction of anesthesia with propofol and fentanyl, succinylcholine allowed a more rapid endotracheal intubation sequence and created superior intubation conditions than rocuronium. However, the technique of using a large dose of rocuronium to achieve perfect conditions for tracheal intubation may have application whenever succinylcholine is relatively contraindicated.

  3. Management of avulsed permanent maxillary central incisors during endotracheal intubation

    Directory of Open Access Journals (Sweden)

    Ritesh R Kalaskar

    2016-01-01

    Full Text Available Avulsion is serious injury that may encounter during endotracheal intubation and its management often presents a challenge. Replantation of the avulsed tooth can restore esthetic appearance and occlusal function shortly after the injury. The present article describes the management of air-dried maxillary permanent incisors that have been avulsed due to direct laryngoscopy during the induction of general anesthesia for tonsillectomy procedure. The replanted maxillary central incisors had maintained its function and esthetic for 1 year after replantation. Children in a mixed dentition phase are high-risk group children for traumatic dental injury during laryngoscopy; therefore, Anesthetic Departments should have local protocols to refer patients for dental treatment postoperatively in the event of trauma.

  4. Intubation Success in Critical Care Transport: A Multicenter Study.

    Science.gov (United States)

    Reichert, Ryan J; Gothard, Megan; Gothard, M David; Schwartz, Hamilton P; Bigham, Michael T

    2018-02-21

    Tracheal intubation (TI) is a lifesaving critical care skill. Failed TI attempts, however, can harm patients. Critical care transport (CCT) teams function as the first point of critical care contact for patients being transported to tertiary medical centers for specialized surgical, medical, and trauma care. The Ground and Air Medical qUality in Transport (GAMUT) Quality Improvement Collaborative uses a quality metric database to track CCT quality metric performance, including TI. We sought to describe TI among GAMUT participants with the hypothesis that CCT would perform better than other prehospital TI reports and similarly to hospital TI success. The GAMUT Database is a global, voluntary database for tracking consensus quality metric performance among CCT programs performing neonatal, pediatric, and adult transports. The TI-specific quality metrics are "first attempt TI success" and "definitive airway sans hypoxia/hypotension on first attempt (DASH-1A)." The 2015 GAMUT Database was queried and analysis included patient age, program type, and intubation success rate. Analysis included simple statistics and Pearson chi-square with Bonferroni-adjusted post hoc z tests (significance = p success was lowest in neonates (59.3%, 617 attempts), better in pediatrics (81.7%, 519 attempts), and best in adults (87%, 2900 attempts), p success versus pediatric- and neonatal-focused teams (86.9% vs. 63.5%, p success (86.5% vs. 75.3%, p success are higher in adult patients and adult-focused CCT teams. TI success rates are higher in CCT than other prehospital settings, but lower than in-hospital success TI rates. Identifying factors influencing TI success among high performers should influence best practice strategies for TI.

  5. Orotracheal intubation and temporomandibular disorder: a longitudinal controlled study

    Directory of Open Access Journals (Sweden)

    Cláudia Branco Battistella

    2016-04-01

    Full Text Available ABSTRACT BACKGROUND AND OBJECTIVES: To determine the incidence of signs and symptoms of temporomandibular disorder in elective surgery patients who underwent orotracheal intubation. METHODS: This was a longitudinal controlled study with two groups. The study group included patients who underwent orotracheal intubation and a control group. We used the American Academy of Orofacial Pain questionnaire to assess the temporomandibular disorder signs and symptoms one-day postoperatively (T1, and the patients' baseline status prior to surgery (T0 was also recorded. The same questionnaire was used after three months (T2. The mouth opening amplitude was measured at T1 and T2. We considered a pvalue of less than 0.05 to be significant. RESULTS: We included 71 patients, with 38 in the study group and 33 in the control. There was no significant difference between the groups in age (study group: 66.0 [52.5-72.0]; control group: 54.0 [47.0-68.0]; p = 0.117 or in their belonging to the female gender (study group: 57.9%; control group: 63.6%; p = 0.621. At T1, there were no statistically significant differences between the groups in the incidence of mouth opening limitation (study group: 23.7% vs. control group: 18.2%;p = 0.570 or in the mouth opening amplitude (study group: 45.0 [40.0-47.0] vs. control group: 46.0 [40.0-51.0];p = 0.278. At T2 we obtained similar findings. There was no significant difference in the affirmative response to all the individual questions in the American Academy of Orofacial Pain questionnaire. CONCLUSIONS: In our population, the incidence of signs and symptoms of temporomandibular disorder of muscular origin was not different between the groups.

  6. Cecal intubation rates in different eras of endoscopic technological development.

    Science.gov (United States)

    Matyja, Maciej; Pasternak, Artur; Szura, Mirosław; Pędziwiatr, Michał; Major, Piotr; Rembiasz, Kazimierz

    2018-03-01

    Colonoscopy plays a critical role in colorectal cancer (CRC) screening and has been widely regarded as the gold standard. Cecal intubation rate (CIR) is one of the well-defined quality indicators used to assess colonoscopy. To assess the impact of new technologies on the quality of colonoscopy by assessing completion rates. This was a dual-center study at the 2 nd Department of Surgery at Jagiellonian University Medical College and at the Specialist Center "Medicina" in Krakow, Poland. The CIR and cecal intubation time (CIT) in three different eras of technological advancement were determined. The study enrolled 27 463 patients who underwent colonoscopy as part of a national CRC screening program. The patients were divided into three groups: group I - 3408 patients examined between 2000 and 2003 (optical endoscopes); group II - 10 405 patients examined between 2004 and 2008 (standard electronic endoscopes); and group III - 13 650 patients examined between 2009 and 2014 (modern endoscopes). There were statistically significant differences in the CIR between successive eras. The CIR in group I (2000-2003) was 69.75%, in group II (2004-2008) was 92.32%, and in group III (2009-2014) was 95.17%. The mean CIT was significantly reduced in group III. Our study shows that the technological innovation of novel endoscopy devices has a great influence on the effectiveness of the CRC screening program. The new era of endoscopic technological development has the potential to reduce examination-related patient discomfort, obviate the need for sedation and increase diagnostic yields.

  7. A Novel Artificial Intelligence System for Endotracheal Intubation.

    Science.gov (United States)

    Carlson, Jestin N; Das, Samarjit; De la Torre, Fernando; Frisch, Adam; Guyette, Francis X; Hodgins, Jessica K; Yealy, Donald M

    2016-01-01

    Adequate visualization of the glottic opening is a key factor to successful endotracheal intubation (ETI); however, few objective tools exist to help guide providers' ETI attempts toward the glottic opening in real-time. Machine learning/artificial intelligence has helped to automate the detection of other visual structures but its utility with ETI is unknown. We sought to test the accuracy of various computer algorithms in identifying the glottic opening, creating a tool that could aid successful intubation. We collected a convenience sample of providers who each performed ETI 10 times on a mannequin using a video laryngoscope (C-MAC, Karl Storz Corp, Tuttlingen, Germany). We recorded each attempt and reviewed one-second time intervals for the presence or absence of the glottic opening. Four different machine learning/artificial intelligence algorithms analyzed each attempt and time point: k-nearest neighbor (KNN), support vector machine (SVM), decision trees, and neural networks (NN). We used half of the videos to train the algorithms and the second half to test the accuracy, sensitivity, and specificity of each algorithm. We enrolled seven providers, three Emergency Medicine attendings, and four paramedic students. From the 70 total recorded laryngoscopic video attempts, we created 2,465 time intervals. The algorithms had the following sensitivity and specificity for detecting the glottic opening: KNN (70%, 90%), SVM (70%, 90%), decision trees (68%, 80%), and NN (72%, 78%). Initial efforts at computer algorithms using artificial intelligence are able to identify the glottic opening with over 80% accuracy. With further refinements, video laryngoscopy has the potential to provide real-time, direction feedback to the provider to help guide successful ETI.

  8. Prehospital rapid sequence intubation improves functional outcome for patients with severe traumatic brain injury: a randomized controlled trial.

    Science.gov (United States)

    Bernard, Stephen A; Nguyen, Vina; Cameron, Peter; Masci, Kevin; Fitzgerald, Mark; Cooper, David J; Walker, Tony; Std, B Paramed; Myles, Paul; Murray, Lynne; David; Taylor; Smith, Karen; Patrick, Ian; Edington, John; Bacon, Andrew; Rosenfeld, Jeffrey V; Judson, Rodney

    2010-12-01

    To determine whether paramedic rapid sequence intubation in patients with severe traumatic brain injury (TBI) improves neurologic outcomes at 6 months compared with intubation in the hospital. Severe TBI is associated with a high rate of mortality and long-term morbidity. Comatose patients with TBI routinely undergo endo-tracheal intubation to protect the airway, prevent hypoxia, and control ventilation. In many places, paramedics perform intubation prior to hospital arrival. However, it is unknown whether this approach improves outcomes. In a prospective, randomized, controlled trial, we assigned adults with severe TBI in an urban setting to either prehospital rapid sequence intubation by paramedics or transport to a hospital emergency department for intubation by physicians. The primary outcome measure was the median extended Glasgow Outcome Scale (GOSe) score at 6 months. Secondary end-points were favorable versus unfavorable outcome at 6 months, length of intensive care and hospital stay, and survival to hospital discharge. A total of 312 patients with severe TBI were randomly assigned to paramedic rapid sequence intubation or hospital intubation. The success rate for paramedic intubation was 97%. At 6 months, the median GOSe score was 5 (interquartile range, 1-6) in patients intubated by paramedics compared with 3 (interquartile range, 1-6) in the patients intubated at hospital (P = 0.28).The proportion of patients with favorable outcome (GOSe, 5-8) was 80 of 157 patients (51%) in the paramedic intubation group compared with 56 of 142 patients (39%) in the hospital intubation group (risk ratio, 1.28; 95% confidence interval, 1.00-1.64; P = 0.046). There were no differences in intensive care or hospital length of stay, or in survival to hospital discharge. In adults with severe TBI, prehospital rapid sequence intubation by paramedics increases the rate of favorable neurologic outcome at 6 months compared with intubation in the hospital.

  9. [Usefullness of bronchofiberscopy for difficult intubation in patients with severe motor and intellectual disabilities].

    Science.gov (United States)

    Mizuno, Yuji; Ukaji, Koutarou

    2005-11-01

    In 21 patients with severe motor and intellectual disabilities, bronchofiberoptic intubation was performed because of difficulty in tracheal intubation by direct laryngoscopy. The patients ranged from 3 to 35 years old (mean age: 20.2 years). Twenty patients (95.2%) were bedridden. Among the 21 patients, 15 had cerebral palsy and 20 had hypertonia. The reason for intubation were acute respiratory failure due to pneumonia in 17 cases, suffocation after aspiration of food in 2 cases, hypovolemic shock in 1 case, and laryngotracheomalacia in 1 case. Intubation was done pernasally in 15 patients and perorally in 10. It was successful in 20 cases without any significant complications. The Cormack score ranged from 3rd degree in 4 cases to 4th in 17 cases. The 20 cases of successful fiberoptic intubation were divided into 7 patients with and 13 without tracheostomy. The mortality rate was 14.3% in patients with tracheostomy and 30.8% in those without tracheostomy. When more than 4 intubation trials were needed, there was a significantly higher mortality rate. In neurologically handicapped patients with deformity or hypertonia of the oral, cervical, or airway structures, a bronchofiberoptic procedure may be recommended when there is difficulty with intubation.

  10. Airway registry and training curriculum improve intubation outcomes in the intensive care unit

    Directory of Open Access Journals (Sweden)

    Malo J

    2018-04-01

    Full Text Available Background: Intubation in critically ill patients remains a highly morbid procedure, and the optimal approach is unclear. We sought to improve the safety of intubation by implementing a simulation curriculum and monitoring performance with an airway registry. Methods and Methods: This is a prospective, single-center observational study of all intubations performed by the medical intensive care unit (ICU team over a five-year period. All fellows take part in a simulation curriculum to improve airway management performance and minimize complications. An airway registry form is completed immediately after each intubation to capture relevant patient, operator, and procedural data. Results: Over a five-year period, the medical ICU team performed 1411 intubations. From Year 1 to Year 5, there were significant increases in first-attempt success (72.6 vs. 88.0%, p<0.001, use of video laryngoscopy (72.3 vs. 93.5%, p<0.001, and use of neuromuscular blocking agents (73.5 vs. 88.4%, p<0.001. There were concurrent decreases in rates of desaturation (25.6 vs. 17.1%, p=0.01 and esophageal intubations (5 vs. 1%, p=0.009. Low rates of hypotension (8.3% and cardiac arrest (0.6% were also observed. Conclusions: The safety of intubation in critically ill patients can be markedly improved through joint implementation of an airway registry and simulation curriculum.

  11. Tracheal intubation by inexperienced medical residents using the Airtraq and Macintosh laryngoscopes--a manikin study.

    LENUS (Irish Health Repository)

    Maharaj, Chrisen H

    2006-11-01

    The Airtraq laryngoscope is a novel intubation device that may possess advantages over conventional direct laryngoscopes for use by personnel that are infrequently required to perform tracheal intubation. We conducted a prospective study in 20 medical residents with little prior airway management experience. After brief didactic instruction, each participant took turns performing laryngoscopy and intubation using the Macintosh (Welch Allyn, Welch Allyn, NY) and Airtraq (Prodol Ltd. Vizcaya, Spain) devices, in 3 laryngoscopy scenarios in a Laerdal Intubation Trainer (Laerdal, Stavanger, Norway) and 1 scenario in a Laerdal SimMan manikin (Laerdal, Kent, UK). They then performed tracheal intubation of the normal airway a second time to characterize the learning curve. In all scenarios tested, the Airtraq decreased the duration of intubation attempts, reduced the number of optimization maneuvers required, and reduced the potential for dental trauma. The residents found the Airtraq easier to use in all scenarios compared with the Macintosh laryngoscope. The Airtraq may constitute a superior device for use by personnel infrequently required to perform tracheal intubation.

  12. Nasal Cannula Apneic Oxygenation Prevents Desaturation During Endotracheal Intubation: An Integrative Literature Review

    Directory of Open Access Journals (Sweden)

    Bill R. Christian

    2018-02-01

    Full Text Available Patients requiring emergency airway management may be at greater risk of acute hypoxemic events because of underlying lung pathology, high metabolic demands, insufficient respiratory drive, obesity, or the inability to protect their airway against aspiration. Emergency tracheal intubation is often required before complete information needed to assess the risk of procedural hypoxia is acquired (i.e., arterial blood gas level, hemoglobin value, or chest radiograph. During pre-oxygenation, administering high-flow nasal oxygen in addition to a non-rebreather face mask can significantly boost the effective inspired oxygen. Similarly, with the apnea created by rapid sequence intubation (RSI procedures, the same high-flow nasal cannula can help maintain or increase oxygen saturation during efforts to secure the tube (oral intubation. Thus, the use of nasal oxygen during pre-oxygenation and continued during apnea can prevent hypoxia before and during intubation, extending safe apnea time, and improve first-pass success attempts. We conducted a literature review of nasal-cannula apneic oxygenation during intubation, focusing on two components: oxygen saturation during intubation, and oxygen desaturation time. We performed an electronic literature search from 1980 to November 2017, using PubMed, Elsevier, ScienceDirect, and EBSCO. We identified 14 studies that pointed toward the benefits of using nasal cannula during emergency intubation.

  13. [Inductions and intubating conditions with sevoflurane and different doses of remifentanil without muscle relaxant in children].

    Science.gov (United States)

    Wei, Ling-Xin; Deng, Xiao-Ming; Liu, Ju-Hui; Luo, Mao-Ping; Tong, Shi-Yi; Zhang, Yan-Ming; Liao, Xu; Xu, Kun-Lin

    2008-12-01

    To observe the clinical effectiveness of inductions and tracheal intubating conditions with 3% sevoflurane and different doses of remifentanil without muscle relaxant in children. Totally 120 peadiatric patients (aged 4-10 years, American Society of Anesthesiologists grade I for inhalational induction) were randomly allocated into group I (remifentanil 1 microg/kg), group II (remifentanil 2 microg/kg), group III (remifentanil 3 microg/kg), and control group (vecuronium bromide 0.1 mg/kg). After inhalational induction with 3% sevoflurane and 60% nitrous oxide in 40% oxygen for 2 minutes, remifentanil 1 microg/kg, 2 microg/ kg, and 3 microg/kg were intravenously injected over 1 minute into patients in group I , group II, and group III, respectively. After remifentanil administration and manual ventilation for 1 minute, the trachea was intubated. In the control group, 2 minutes after intravenous administration of vecuronium bromide 0.1 mg/kg, tracheal intubation was attempted. Agitation, intubating satisfactoriness, and the circulation changes after tracheal intubation and anesthesia induction were observed. In these four groups, agitation occurred in 37.5% of patients during sevoflurane induction. Satisfactory intubation rate was 70.0% in group I, 86.7% in group II, 90.0% in group III, and 93.3% in the control group. Compared with the control group, the impact of tracheal intubation on the circulatory system was smaller in group I , II , and III. Induction with 3% sevoflurane combined with remifentanil can be smoothly performed, followed by the successful tracheal intubation. The intubating conditions are more satisfactory with 3% sevoflurane combined with remifentanil 2 microg/kg or 3 microg/kg.

  14. Endotracheal Intubation in Patients with Unstable Cervical Spine Using LMA-Fastrach and Gum Elastic Bogie

    International Nuclear Information System (INIS)

    Khan, M. U.

    2014-01-01

    Objective: To evaluate the success of alternative technique of ET- intubation in patients with unstable cervical spine with Philadelphia collar around the neck. Study Design: Case series. Place and Duration of Study: The Department of Anaesthesia, College of Medicine, King Saud University, Riyadh, Saudi Arabia, from June 2009 to June 2012. Methodology: Adult patients of either gender with unstable cervical spine wearing Philadelphia collar electively scheduled for cervical spine decompression and fixation more than one level were included. Those with anticipated difficult intubation, mouth opening 27 kg/m2 were excluded. After induction of anaesthesia FT-LMA was inserted. Correct position of FT-LMA was confirmed then soft straight end of gum elastic bogie was passed through FTLMA into trachea. FT-ILMA was removed on bogie. Reinforced silicon ET- tube was rail road on bogie. The bogie was pulled out and position of ET- tube was confirmed with ETCO2, chest movement and auscultation on bag ventilation. The ease of insertion of FT-LMA, ET- intubation and maximum time taken for successful intubation was noted. Results: 26 patients were studied with mean age of 59.3 A +- 2.93 years and M: F ratio of 7:3. The mean time taken from the insertion of gum elastic bogie to the ET intubation was 38.9 A +- 1.20 seconds. The success rate of ET- intubation in the first attempt was 88.4% and 7.6% in two attempts. Intubation failed in one patient. The mean ease of insertion of FT-LMA and ET- intubation in all patients was 46.7 A +- 2.59 and 46.5 A +- 2.66 respectively on VAS ( 0-100). No complication was noted in any patient. Conclusion: This technique is safe and reliable for achieving adequate ventilation and intubation in patients with unstable cervical spine with Philadelphia collar in place. (author)

  15. Influence of GlideScope assisted endotracheal intubation on intraocular pressure in ophthalmic patients

    Directory of Open Access Journals (Sweden)

    Nauman Ahmad

    2015-01-01

    Full Text Available Background: Traditional Macintoch laryngoscopy is known to cause a rise in intraocular pressure (IOP, tachycardia and hypertension. These changes are not desirable in patients with glaucoma and open globe injury. GlideScope is a video laryngoscope that functions independent of the line of sight, reduces upward lifting forces for glottic exposure and requires less cervical neck movement for intubation, making it less stimulating than Macintosh laryngoscopy. Aim: The aim was to assess the variations in IOP and hemodynamic changes after GlideScope assisted intubation. Materials and Methods: After approval of the local Institutional Research and Ethical Board and informed patient consent, 50 adult American Society of Anesthesiologist I and II patients with normal IOP were enrolled in a prospective, randomized study for ophthalmic surgery requiring tracheal intubation. In all patients, trachea was intubated using either GlideScope or Macintoch laryngoscope. IOP of nonoperated eye, heart rate and blood pressure were measured as baseline, 1 min after induction, 1 min and 5 min after tracheal intubation. Results: IOP was not significantly different between groups before and after anesthetic induction and 5 min after tracheal intubation (P = 0.217, 0.726, and 0.110 respectively. The only significant difference in IOP was at 1 min after intubation (P = 0.041. No significant difference noted between groups in mean arterial pressure (P = 0.899, 0.62, 0.47, 0.82 respectively and heart rate (P = 0.21, 0.72, 0.07, 0.29, respectively at all measurements. Conclusion: GlideScope assisted tracheal intubation shown lesser rise in IOP at 1 min after intubation in comparison to Macintoch laryngoscope, suggesting that GlideScope may be preferable to Macintosh laryngoscope.

  16. GASTROINTESTINAL STROMAL TUMOR (GIST

    Directory of Open Access Journals (Sweden)

    Luigi eTornillo

    2014-11-01

    Full Text Available Gastrointestinal stromal tumors are the most frequent mesenchymal tumors of the gastrointestinal tract. The discovery that these tumors, formerly thought of smooth muscle origin, are indeed better characterized by specific activating mutation in genes coding for the receptor tyrosine kinases CKIT and PDGFRA and that these mutations are strongly predictive for the response to targeted therapy with receptor tyrosine kinase inhibitors has made GISTs the typical example of the integration of basic molecular knowledge in the daily clinical activity. The information on the mutational status of these tumors is essential to predict (and subsequently to plan the therapy. As resistant cases are frequently wild-type, other possible oncogenic events, defining other entities, have been discovered (e.g. succinil dehydrogenase mutation/dysregulation, insuline growth factor expression, mutations in the RAS-RAF-MAPK pathway. The classification of disease must nowadays rely on the integration of the clinico-morphological characteristics with the molecular data.

  17. Radiology illustrated. Gastrointestinal tract

    International Nuclear Information System (INIS)

    Choi, Byung Ihn

    2015-01-01

    Radiology Illustrated: Gastrointestinal Tract is the second of two volumes designed to provide clear and practical guidance on the diagnostic imaging of abdominal diseases. The book presents approximately 300 cases with 1500 carefully selected and categorized illustrations of gastrointestinal tract diseases, along with key text messages and tables that will help the reader easily to recall the relevant images as an aid to differential diagnosis., Essential points are summarized at the end of each text message to facilitate rapid review and learning. Additionally, brief descriptions of each clinical problem are provided, followed by case studies of both common and uncommon pathologies that illustrate the roles of the different imaging modalities, including ultrasound, radiography, computed tomography, and magnetic resonance imaging.

  18. Radiology illustrated. Gastrointestinal tract

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Byung Ihn (ed.) [Seoul National University Hospital (Korea, Republic of). Dept. of Radiology

    2015-02-01

    Radiology Illustrated: Gastrointestinal Tract is the second of two volumes designed to provide clear and practical guidance on the diagnostic imaging of abdominal diseases. The book presents approximately 300 cases with 1500 carefully selected and categorized illustrations of gastrointestinal tract diseases, along with key text messages and tables that will help the reader easily to recall the relevant images as an aid to differential diagnosis., Essential points are summarized at the end of each text message to facilitate rapid review and learning. Additionally, brief descriptions of each clinical problem are provided, followed by case studies of both common and uncommon pathologies that illustrate the roles of the different imaging modalities, including ultrasound, radiography, computed tomography, and magnetic resonance imaging.

  19. Gastrointestinal Complications of Obesity

    Science.gov (United States)

    Camilleri, Michael; Malhi, Harmeet; Acosta, Andres

    2017-01-01

    Obesity usually is associated with morbidity related to diabetes mellitus and cardiovascular diseases. However, there are many gastrointestinal and hepatic diseases for which obesity is the direct cause (eg, nonalcoholic fatty liver disease) or is a significant risk factor, such as reflux esophagitis and gallstones. When obesity is a risk factor, it may interact with other mechanisms and result in earlier presentation or complicated diseases. There are increased odds ratios or relative risks of several gastrointestinal complications of obesity: gastroesophageal reflux disease, erosive esophagitis, Barrett’s esophagus, esophageal adenocarcinoma, erosive gastritis, gastric cancer, diarrhea, colonic diverticular disease, polyps, cancer, liver disease including nonalcoholic fatty liver disease, cirrhosis, hepatocellular carcinoma, gallstones, acute pancreatitis, and pancreatic cancer. Gastroenterologists are uniquely poised to participate in the multidisciplinary management of obesity as physicians caring for people with obesity-related diseases, in addition to their expertise in nutrition and endoscopic interventions. PMID:28192107

  20. Gastrointestinal food allergies.

    Science.gov (United States)

    Heine, Ralf G

    2015-01-01

    Gastrointestinal food allergies present during early childhood with a diverse range of symptoms. Cow's milk, soy and wheat are the three most common gastrointestinal food allergens. Several clinical syndromes have been described, including food protein-induced enteropathy, proctocolitis and enterocolitis. In contrast with immediate, IgE-mediated food allergies, the onset of gastrointestinal symptoms is delayed for at least 1-2 hours after ingestion in non-IgE-mediated allergic disorders. The pathophysiology of these non-IgE-mediated allergic disorders is poorly understood, and useful in vitro markers are lacking. The results of the skin prick test or measurement of the food-specific serum IgE level is generally negative, although low-positive results may occur. Diagnosis therefore relies on the recognition of a particular clinical phenotype as well as the demonstration of clear clinical improvement after food allergen elimination and the re-emergence of symptoms upon challenge. There is a significant clinical overlap between non-IgE-mediated food allergy and several common paediatric gastroenterological conditions, which may lead to diagnostic confusion. The treatment of gastrointestinal food allergies requires the strict elimination of offending food allergens until tolerance has developed. In breast-fed infants, a maternal elimination diet is often sufficient to control symptoms. In formula-fed infants, treatment usually involves the use an extensively hydrolysed or amino acid-based formula. Apart from the use of hypoallergenic formulae, the solid diets of these children also need to be kept free of specific food allergens, as clinically indicated. The nutritional progress of infants and young children should be carefully monitored, and they should undergo ongoing, regular food protein elimination reassessments by cautious food challenges to monitor for possible tolerance development. © 2015 S. Karger AG, Basel.

  1. Upper gastrointestinal bleeding.

    Science.gov (United States)

    Feinman, Marcie; Haut, Elliott R

    2014-02-01

    Upper gastrointestinal (GI) bleeding remains a commonly encountered diagnosis for acute care surgeons. Initial stabilization and resuscitation of patients is imperative. Stable patients can have initiation of medical therapy and localization of the bleeding, whereas persistently unstable patients require emergent endoscopic or operative intervention. Minimally invasive techniques have surpassed surgery as the treatment of choice for most upper GI bleeding. Copyright © 2014 Elsevier Inc. All rights reserved.

  2. Endoscopic Intubation with Aid of Mechanical Ventilation via a Dedicated Nasopharyngeal Airway

    Directory of Open Access Journals (Sweden)

    Wen-Jue Soong

    2007-09-01

    Full Text Available A young child with jaw-neck-sternum immobility suffering from acute upper airway obstruction was treated with nasotracheal intubation using flexible endoscope (FE. During this difficult intubation, an inserted trimming endotracheal tube acted as a nasopharyngeal airway and simultaneous supplement with mechanical ventilation through the tube successfully resuscitated and improved the patient's ventilation and oxygenation. This management can greatly facilitate visualization of the laryngeal apparatus and translaryngeal passage of the FE. This technique can be helpful in resuscitative ventilation and difficult intubation in a critical upper airway emergency.

  3. Lightwand-Guided Endotracheal Intubation Performed by the Nondominant Hand is Feasible

    Directory of Open Access Journals (Sweden)

    Yi-Wei Kuo

    2007-10-01

    Full Text Available The aim of this study was to evaluate the efficiency of lightwand-guided endotracheal intubation (LWEI performed using either the right (dominant or left (nondominant hand. Two hundred and forty patients aged 21–64 years, with a Mallampati airway classification grade of I—II and undergoing endotracheal intubation under general anesthesia, were enrolled in this randomized and controlled study. Induction of anesthesia was initiated by intravenous administration of fentanyl (2 mg/kg and thiopentone (5mg/kg, and tracheal intubation was facilitated by intravenous atracurium (0.5 mg/kg. In the direct-vision laryngoscope group (group D; n = 80, the intubator held the laryngoscope in the left hand and inserted the endotracheal tube (ETT into the glottic opening with the right hand. In the group in which LWEI was performed with the right hand (group R; n = 80, the intubator lifted the patients' jaws with the left hand and inserted the ETT-LW unit into the glottic openings with the right hand. On the contrary, in the group in which LWEI was performed with the left hand (group L; n = 80, the intubator lifted the jaws with the right hand and inserted the ETT-LW unit with the left hand. Data including total intubation time, the number of intubation attempts, hemodynamic changes during intubation, and side effects following intubation, were collected. Regardless of whether lightwand manipulation was performed with the left hand (group L; 11.4 ± 9.3 s or the right-hand (group R; 12.4 ± 9.2 s, less time was consumed in the LWEI groups than in the laryngoscope group (group D; 17.9 ± 9.9s (p 95% on their first intubation attempts. The changes in mean arterial blood pressure and heart rate were similar among the three groups. A higher incidence of intubation-related oral injury and ventricular premature contractions (VPC was found in group D compared with groups L and R (oral injury: group D 8.5%, group L 1.3%, group R 0%, p = 0.005; VPC: group D 16

  4. Orexins and gastrointestinal functions.

    Science.gov (United States)

    Baccari, M C

    2010-03-01

    Orexin A (OXA) and orexin B (OXB) are recently discovered neuropeptides that appear to play a role in various distinct functions such as arousal and the sleep-wake cycle as well as on appetite and regulation of feeding and energy homeostasis. Orexins were first described as neuropeptides expressed by a specific population of neurons in the lateral hypothalamic area, a region classically implicated in feeding behaviour. Orexin neurons project to numerous brain regions, where orexin receptors have been shown to be widely distributed: both OXA and OXB act through two subtypes of receptors (OX1R and OX2R) that belong to the G protein-coupled superfamily of receptors. Growing evidence indicates that orexins act in the central nervous system also to regulate gastrointestinal functions: animal studies have indeed demonstrated that centrally-injected orexins or endogenously released orexins in the brain stimulates gastric secretion and influence gastrointestinal motility. The subsequent identification of orexins and their receptors in the enteric nervous system (including the myenteric and the submucosal plexuses) as well as in mucosa and smooth muscles has suggested that these neuropeptides may also play a local action. In this view, emerging studies indicate that orexins also exert region-specific contractile or relaxant effects on isolated gut preparations. The aim of the proposed review is to summarize both centrally- and peripherally-mediated actions of orexins on gastrointestinal functions and to discuss the related physiological role on the basis of the most recent findings.

  5. Learning and performance of tracheal intubation by novice personnel: a comparison of the Airtraq and Macintosh laryngoscope.

    LENUS (Irish Health Repository)

    Maharaj, C H

    2006-07-01

    Direct laryngoscopic tracheal intubation is taught to many healthcare professionals as it is a potentially lifesaving procedure. However, it is a difficult skill to acquire and maintain, and, of concern, the consequences of poorly performed intubation attempts are potentially serious. The Airtraq Laryngoscope is a novel intubation device which may possess advantages over conventional direct laryngoscopes for use by novice personnel. We conducted a prospective trial with 40 medical students who had no prior airway management experience. Following brief didactic instruction, each participant took turns in performing laryngoscopy and intubation using the Macintosh and Airtraq devices under direct supervision. Each student was allowed up to three attempts to intubate in three laryngoscopy scenarios using a Laerdal Intubation Trainer and one scenario in a Laerdal SimMan Manikin. They then performed tracheal intubation of the normal airway a second time to characterise the learning curve for each device. The Airtraq provided superior intubating conditions, resulting in greater success of intubation, particularly in the difficult laryngoscopy scenarios. In both easy and simulated difficult laryngoscopy scenarios, the Airtraq decreased the duration of intubation attempts, reduced the number of optimisation manoeuvres required, and reduced the potential for dental trauma. The Airtraq device showed a rapid learning curve and the students found it significantly easier to use. The Airtraq appears to be a superior device for novice personnel to acquire the skills of tracheal intubation.

  6. Prophylactic endotracheal intubation in patients with upper gastrointestinal bleeding undergoing endoscopy: A systematic review and meta-analysis

    Directory of Open Access Journals (Sweden)

    Fayez Alshamsi

    2017-01-01

    Conclusions: Low- to very low-quality evidence from observational studies suggests that PEI in the setting of UGIB may be associated with higher rates of respiratory complications and, less likely, with increased mortality. Although the results are alarming, the lack of higher quality evidence calls for randomized trials to inform practice.

  7. Timing of tracheal intubation: monitoring the orbicularis oculi, the adductor pollicis or use a stopwatch?

    DEFF Research Database (Denmark)

    Koscielniak-Nielsen, Z J; Horn, A; Sztuk, F

    1996-01-01

    The most suitable time for tracheal intubation, following vecuronium 0.1 mg kg-1, was estimated in 120 patients. The trachea was intubated at cessation of the visually observed response of the orbicularis oculi muscle to facial nerve stimulation (group 1; n = 30), or of the manually detected...... response of the adductor pollicis to ulnar nerve stimulation (group 2; n = 30), or after waiting 3 min (group 3; n = 30), or 4 min (group 4; n = 30). There were no significant differences in intubation scores between the four groups of patients. Loss of response to train-of-four stimulation occurred...... significantly sooner in group 1 (orbicularis oculi) than in group 2 (adductor pollicis) P = 0.021). However, intubating conditions were poor in four patients (14%) in group 1, compared with none in group 2 and one in groups 3 and 4, respectively. Thus, contrary to expectations, the cessation of the response...

  8. Endotracheal intubation: application of virtual reality to emergency medical services education.

    Science.gov (United States)

    Mayrose, James; Myers, Jeffrey W

    2007-01-01

    Virtual reality simulation has been identified as an emerging educational tool with significant potential to enhance teaching of residents and students in emergency clinical encounters and procedures. Endotracheal intubation represents a critical procedure for emergency care providers. Current methods of training include working with cadavers and mannequins, which have limitations in their representation of reality, ethical concerns, and overall availability with access, cost, and location of models. This paper will present a human airway simulation model designed for tracheal intubation and discuss the aspects that lend itself to use as an educational tool. This realistic and dynamic model is used to teach routine intubations, while future models will include more difficult airway management scenarios. This work provides a solid foundation for future versions of the intubation simulator, which will incorporate two haptic devices to allow for simultaneous control of the laryngoscope blade and endotracheal tube.

  9. An economical model for mastering the art of intubation with different video laryngoscopes

    Directory of Open Access Journals (Sweden)

    Jitin N Trivedi

    2014-01-01

    Full Text Available Video laryngoscope (VL provides excellent laryngeal exposure in patients when anaesthesiologists encounter difficulty with direct laryngoscopy. Videolaryngoscopy, like flexible fibreoptic laryngoscopy demands a certain level of training by practitioners to become dexterous at successful intubation with a given instrument. Due to their cost factors, VLs are not easily available for training purposes to all the students, paramedics and emergency medical services providers in developing countries. We tried to develop a cost-effective instrument, which can work analogous to various available VLs. An inexpensive and easily available instrument was used to create an Airtraq Model for VL guided intubation training on manikin. Using this technique, successful intubation of manikin could be achieved. The Airtraq Model mimics the Airtraq Avant ® and may be used for VL guided intubation training for students as well as paramedics, and decrease the time and shorten the learning curve for Airtraq ® as well as various other VLs.

  10. High levels of IGF-1 predict difficult intubation of patients with acromegaly.

    Science.gov (United States)

    Zhang, Yu; Guo, Xiaopeng; Pei, Lijian; Zhang, Zhuhua; Tan, Gang; Xing, Bing

    2017-08-01

    To investigate the characteristics of difficult intubation and identify novel efficient predictors in patients with acromegaly. Patients with either untreated acromegaly or non-functional pituitary adenomas were enrolled. Patients with acromegaly underwent hormone assays, upper airway computed tomography and magnetic resonance imaging examinations and preoperative overnight polysomnography. The modified Mallampati classification, mouth opening, neck circumference, and neck extension were assessed, and the Cormack-Lehane grades and the time of tracheal intubation were recorded. Patients with acromegaly had a higher incidence of difficult intubation (62.5%). The time of tracheal intubation was prolonged, the neck circumference was enlarged, and the neck extension was confined. In patients with acromegaly and difficult intubation, the insulin-like growth factor 1 levels and apnea/hypoxia index were significantly higher compared to patients without difficult intubation (1115.40 ± 253.73 vs. 791.67 ± 206.62 ng/ml, P = 0.020; 22.17 ± 23.25 vs. 2.47 ± 2.84, P = 0.026, respectively). The bilateral regression analysis revealed that high levels of insulin-like growth factor 1 were an independent risk factor for developing difficult intubation (p = 0.042, Exp B = 1.006). The modified Mallampati classification was positively correlated with apnea/hypoxia index and could be calculated using the following logarithmic equation: MMC = 0.2982 * ln (AHI) + 2.1836. In patients with acromegaly, neck movement is confined, the time of tracheal intubation is prolonged, and the neck circumference is enlarged, and these patients suffer from an increased incidence of difficult intubation (62.5%) during anesthesia induction. The apnea/hypoxia index and insulin-like growth factor 1 levels are both increased in acromegalic patients with difficult intubation, and elevated insulin-like growth factor 1 levels are an independent risk factor of difficult

  11. Prehospital Use of the Intubating Laryngeal Mask Airway in Patients with Severe Polytrauma: A Case Series

    Directory of Open Access Journals (Sweden)

    Andrew M. Mason

    2009-01-01

    Full Text Available A case series of five patients is described demonstrating the utility of the intubating laryngeal mask airway in the prehospital setting, both as a primary airway rescue device and as a bridge to tracheal intubation. All patients were hypoxaemic, had sustained severe polytrauma and were trapped in their vehicles following road traffic collisions. A probability of survival study showed better-than-predicted outcomes for the group as a whole.

  12. Comparison of Transcanalicular Multidiode Laser Dacryocystorhinostomy with and without Silicon Tube Intubation

    OpenAIRE

    Yildirim, Yildiray; Kar, Taner; Topal, Tuncay; Cesmeci, Enver; Kaya, Abdullah; Colakoglu, Kadir; Aksoy, Yakup; Sonmez, Murat

    2016-01-01

    Aim. To compare the surgical outcomes of surgery with and without bicanalicular silicon tube intubation for the treatment of patients who have primary uncomplicated nasolacrimal duct obstruction. Methods. This retrospective study is comprised of 113 patients with uncomplicated primary nasolacrimal duct obstruction. There were 2 groups in the study: Group 1 (n = 58) patients underwent transcanalicular diode laser dacryocystorhinostomy surgery with bicanalicular silicon tube intubation and Grou...

  13. Difficult intubation in a parturient with syringomyelia and Arnold–Chiari malformation: Use of Airtraq™ laryngoscope

    Science.gov (United States)

    Mustapha, Bensghir; Chkoura, K.; Elhassani, M.; Ahtil, R.; Azendour, H.; Kamili, N. Drissi

    2011-01-01

    Anesthetic technique in parturient with syringomyelia and Arnold–Chiari malformation is variable depending on the teams. Difficult intubation is one of the risks when general anesthesia is opted. Different devices have been used to manage the difficult intubation in pregnant women. We report the use of Airtraq™ laryngoscope after failed standard laryngoscopy in a parturient with syringomyelia and Arnold–Chiari type I malformation. PMID:22144932

  14. Awake Fibreoptic Intubation in the Sitting Position in a Patient with a Huge Goitre

    OpenAIRE

    K C, Suhas; Shetty, Sukhen N; S, Padmanabha

    2015-01-01

    A 46-year-old woman was anesthetized for total thyroidectomy. The thyroid was massive, deviating the trachea to the right and causing attenuation of the trachea radiologically. She had symptoms of respiratory obstruction in the supine position. Awake FOB-guided intubation was done in sitting position after airway topicalisation, and the airway was intubated with difficulty with 7.0 mm cuffed orotracheal tube. We describe this case in detail and discuss the significance of careful approach to ...

  15. Difficult intubation in a parturient with syringomyelia and Arnold-Chiari malformation: Use of Airtraq™ laryngoscope

    Directory of Open Access Journals (Sweden)

    Bensghir Mustapha

    2011-01-01

    Full Text Available Anesthetic technique in parturient with syringomyelia and Arnold-Chiari malformation is variable depending on the teams. Difficult intubation is one of the risks when general anesthesia is opted. Different devices have been used to manage the difficult intubation in pregnant women. We report the use of Airtraq™ laryngoscope after failed standard laryngoscopy in a parturient with syringomyelia and Arnold-Chiari type I malformation.

  16. Critical Analyses and Development of Training Mechanisms: Cholinergic Crisis and Pediatric/Neonatal Intubation

    Science.gov (United States)

    2015-02-01

    See Appendix 8 for results. Task 2g . Integrate videos into multimedia application. Complete. See Appendix 8 for results. Task 2h. Test...Model. In-process. Estimated Q1 2015 completion. Task 3g . Write training objectives for pediatric and neonatal intubation training In-process...virtual images: Learning with the mobile telementoring intubating video laryngoscope. Studies in Health Technology & Informatics. 2007;125:49-54

  17. Electrohydrodynamic enhancement of in-tube convective condensation heat transfer

    Energy Technology Data Exchange (ETDEWEB)

    Sadek, H.; Robinson, A.J.; Ching, C.Y.; Shoukri, M. [McMaster University, Department of Mechanical Engineering, Hamilton, Ont. (Canada); Cotton, J.S. [Dana Corporation, Long Manufacturing Division, Oakville, Ont. (Canada)

    2006-05-15

    An experimental investigation of electrohydrodynamic (EHD) augmentation of heat transfer for in-tube condensation of flowing refrigerant HFC-134a has been performed in a horizontal, single-pass, counter-current heat exchanger with a rod electrode placed in the centre of the tube. The effects of varying the mass flux (55kg/m{sup 2}s=

  18. Dacryocystorhinostomy without intubation with intraoperative mitomycin-c

    International Nuclear Information System (INIS)

    Rahman, A.; Channa, S.; Memon, M.S.; Niazi, J.H.

    2006-01-01

    To evaluate the success rate and complications of intraoperative Mitomycin-C in dacryocystorhinostomy surgery. This study included total 90 eyes of 90 patients fulfilling the inclusion criteria.The surgical procedure of external DCR done with intraoperative Mitomycin-C with a neurosurgical cottonoid soaked with 0.2mg/ml. Mitomycin C was applied to the anastomosed flaps and osteotomy site for 10 minutes, without Silicon tube intubation. Surgery was done under local as well as general anesthesia. Patients were followed for 6 months. Out of 90 patients included in this study, only 2 patients complained of persistent epiphora after 6 months follow-up and were labeled as failed DCR. Remaining 88 had either no tearing or significant improvement of tearing after 6 months follow up and patent lacrimal system by syringing without pressure. Success rate in this procedure was 97.77% (p-value< 0.001). This study showed very high rate of success. Only complication noted was excessive nasal bleeding which was easily controlled. Intraoperative Mitomycin-C application in external DCR is safe, effective, cheap adjunct that helps to achieve good results of DCR surgery. (author)

  19. Embolization for gastrointestinal hemorrhages

    International Nuclear Information System (INIS)

    Kraemer, S.C.; Goerich, J.; Rilinger, N.; Aschoff, A.J.; Vogel, J.; Brambs, H.J.; Siech, M.

    2000-01-01

    Retrospective evaluation of interventional embolization therapy in the treatment of gastrointestinal hemorrhage over a long-term observation period from 1989 to 1997. Included in the study were 35 patients (age range 18-89 years) with gastrointestinal bleeding (GI) referred for radiological intervention either primarily or following unsuccessful endoscopy or surgery. Sources of GI bleeding included gastric and duodenal ulcers (n = 7), diverticula (n = 3), erosion of the intestinal wall secondary to malignancy (n = 6), vascular malformations (n = 4), and hemorrhoids (n = 2), as well as from postoperative (n = 6), posttraumatic (n = 2), postinflammatory (n = 4) or unknown (n = 1) causes. Ethibloc (12 cases) or metal coils (14 cases) were predominantly used as embolisates. In addition, combinations of tissue adhesive and gelfoam particles and of coils and Ethibloc were used (six cases). Finally, polyvinyl alcohol particles, a coated stent, and an arterial wire dissection were utilized in one case each. Bleeding was stopped completely in 29 of 35 cases (83 %). In one case (3 %) the source of bleeding was recognized but the corresponding vessel could not be catheterized. In five other cases (14 %) there was partial success with reduced, though still persistent, bleeding. The rate of complications was 14 %, including four instances of intestinal ischemia with fatal outcome in the first years, and, later, one partial infarction of the spleen without serious consequences. Gastrointestinal hemorrhage can be controlled in a high percentage of patients, including the seriously ill and those who had previously undergone surgery, with the use of minimally invasive interventional techniques. The availability of minicoils instead of fluid embolization agents has reduced the risk of serious complications. (orig.)

  20. Embolization for gastrointestinal hemorrhages

    Energy Technology Data Exchange (ETDEWEB)

    Kraemer, S.C.; Goerich, J.; Rilinger, N.; Aschoff, A.J.; Vogel, J.; Brambs, H.J. [Dept. of Diagnostic Radiology, University of Ulm (Germany); Siech, M. [Dept. of Abdominal Surgery, University of Ulm (Germany)

    2000-05-01

    Retrospective evaluation of interventional embolization therapy in the treatment of gastrointestinal hemorrhage over a long-term observation period from 1989 to 1997. Included in the study were 35 patients (age range 18-89 years) with gastrointestinal bleeding (GI) referred for radiological intervention either primarily or following unsuccessful endoscopy or surgery. Sources of GI bleeding included gastric and duodenal ulcers (n = 7), diverticula (n = 3), erosion of the intestinal wall secondary to malignancy (n = 6), vascular malformations (n = 4), and hemorrhoids (n = 2), as well as from postoperative (n = 6), posttraumatic (n = 2), postinflammatory (n = 4) or unknown (n = 1) causes. Ethibloc (12 cases) or metal coils (14 cases) were predominantly used as embolisates. In addition, combinations of tissue adhesive and gelfoam particles and of coils and Ethibloc were used (six cases). Finally, polyvinyl alcohol particles, a coated stent, and an arterial wire dissection were utilized in one case each. Bleeding was stopped completely in 29 of 35 cases (83 %). In one case (3 %) the source of bleeding was recognized but the corresponding vessel could not be catheterized. In five other cases (14 %) there was partial success with reduced, though still persistent, bleeding. The rate of complications was 14 %, including four instances of intestinal ischemia with fatal outcome in the first years, and, later, one partial infarction of the spleen without serious consequences. Gastrointestinal hemorrhage can be controlled in a high percentage of patients, including the seriously ill and those who had previously undergone surgery, with the use of minimally invasive interventional techniques. The availability of minicoils instead of fluid embolization agents has reduced the risk of serious complications. (orig.)

  1. in upper gastrointestinal endoscopy

    Directory of Open Access Journals (Sweden)

    Sinan Uzman

    2016-07-01

    Full Text Available Introduction : There is increasing interest in sedation for upper gastrointestinal endoscopy (UGE. Prospective randomized studies comparing sedation properties and complications of propofol and midazolam/meperidine in upper gastrointestinal endoscopy (UGE are few. Aim: To compare propofol and midazolam/meperidine sedation for UGE in terms of cardiopulmonary side effects, patient and endoscopist satisfaction and procedure-related times. Material and methods: This was a prospective, randomized, double-blind study of propofol versus midazolam and meperidine in 100 patients scheduled for diagnostic upper gastrointestinal endoscopy. The patients were divided into propofol and midazolam/meperidine groups. Randomization was generated by a computer. Cardiopulmonary side effects (hypotension, bradycardia, hypoxemia, procedure-related times (endoscopy time, awake time, time to hospital discharge, and patient and endoscopist satisfaction were compared between groups. Results: There was no significant difference between the groups with respect to the cost, endoscopy time, or demographic and clinical characteristics of the patients. Awake time and time to hospital discharge were significantly shorter in the propofol group (6.58 ±4.72 vs. 9.32 ±4.26 min, p = 0.030 and 27.60 ±7.88 vs. 32.00 ±10.54 min, p = 0.019. Hypotension incidence was significantly higher in the propofol group (12% vs. 0%, p = 0.027. The patient and endoscopist satisfaction was better with propofol. Conclusions : Propofol may be preferred to midazolam/meperidine sedation, with a shorter awake and hospital discharge time and better patient and endoscopist satisfaction. However, hypotension risk should be considered with propofol, and careful evaluation is needed, particularly in cardiopulmonary disorders.

  2. Gastrointestinal Headache; a Narrative Review

    OpenAIRE

    Majid T Noghani; Hossein Rezaeizadeh; Sayed Mohammad Baqer Fazljoo; Mahmoud Yousefifard; Mansoor Keshavarz

    2016-01-01

    There are studies reporting primary headaches to be associated with gastrointestinal disorders, and some report resolution of headache following the treatment of the associated gastrointestinal disorder. Headache disorders are classified by The International Headache Society as primary or secondary; however, among the secondary headaches, those attributed to gastrointestinal disorders are not appreciated. Therefore, we aimed to review the literature to provide evidence for headaches, which or...

  3. Gastrointestinal and hepatobiliary radiology

    International Nuclear Information System (INIS)

    Graham, R.N.J.; Perriss, R.W.; Scarsbrook, A.F.

    2006-01-01

    This is the fifth in the series of short reviews of internet-based radiological learning resources and will focus on gastrointestinal (GI) and hepatobiliary radiology. Below are details of a few of the higher quality resources currently available. Most of the sites cater for medical students and trainee or non-specialist radiologists, but may be also be of interest to specialists, especially for use in teaching. Hyperlinks are available in the electronic version of this article and were all active at the time of going to press (May 2006)

  4. Gastrointestinal stromal tumors

    International Nuclear Information System (INIS)

    Sufliarsky, J.

    2011-01-01

    Gastrointestinal stromal tumours (GISTs) are the most common mesenchymal tumours of the digestive tract. Better understanding of the molecular characteristics of GISTs led to the clinical development of imatinib for treating patients with this disease. New immuno markers and mechanisms of primary and secondary resistance were discovered. Adjuvant imatinib in intermediate or high risk GIST has improved the recurrence-free survival. Sunitinib in patients with intolerance or progression on imatinib demonstrated significant improvements in progression-free and overall survival versus placebo. Second-generation tyrosine kinase inhibitors, such as sorafenib, dasatinib, and nilotinib, have shown activity in patients with imatinib- and sunitinib-resistant GIST. (author)

  5. A systematic review and meta-regression analysis of mivacurium for tracheal intubation.

    Science.gov (United States)

    Vanlinthout, L E H; Mesfin, S H; Hens, N; Vanacker, B F; Robertson, E N; Booij, L H D J

    2014-12-01

    We systematically reviewed factors associated with intubation conditions in randomised controlled trials of mivacurium, using random-effects meta-regression analysis. We included 29 studies of 1050 healthy participants. Four factors explained 72.9% of the variation in the probability of excellent intubation conditions: mivacurium dose, 24.4%; opioid use, 29.9%; time to intubation and age together, 18.6%. The odds ratio (95% CI) for excellent intubation was 3.14 (1.65-5.73) for doubling the mivacurium dose, 5.99 (2.14-15.18) for adding opioids to the intubation sequence, and 6.55 (6.01-7.74) for increasing the delay between mivacurium injection and airway insertion from 1 to 2 min in subjects aged 25 years and 2.17 (2.01-2.69) for subjects aged 70 years, p < 0.001 for all. We conclude that good conditions for tracheal intubation are more likely by delaying laryngoscopy after injecting a higher dose of mivacurium with an opioid, particularly in older people. © 2014 The Association of Anaesthetists of Great Britain and Ireland.

  6. Gastrointestinal Manifestations of Cystic Fibrosis

    Science.gov (United States)

    2016-01-01

    Cystic fibrosis has historically been considered a pulmonary disease, but with the increasing life expectancy of these patients, gastrointestinal manifestations are becoming more important. Furthermore, nutritional status is closely linked to pulmonary function and, thus, overall mortality. This article discusses gastrointestinal manifestations (which involve nutritional, pancreatic, hepatobiliary, and, in particular, gastrointestinal tract issues) of cystic fibrosis as well as management of the disease. In addition, the article discusses studies that have been critical to our understanding of gastrointestinal manifestations of cystic fibrosis. PMID:27330503

  7. Gastrointestinal Eosinofilic Disorders

    International Nuclear Information System (INIS)

    Rodriguez Maria, Roberto; Bohorquez, Maria Amalia; Gonzalez, Irene; Torregroza, Gustavo

    2007-01-01

    The gastrointestinal eosinofilic disorders are little frequent diseases, of etiopatogenia little clear, that are characterized by the presence of an infiltrated eosinofilo that can affect the different layers of the wall of the alimentary canal in absence of known causes of eosinofilia. The clinical manifestations are variable and the symptoms are conditioned by the degree of eosinofilia of the wall, the number of layers affected and the segment of the gastrointestinal tract implied. The presentations symptoms vary from diarrhea, vomits, abdominal pain and loss of weigh until the acute intestinal obstruction. They are characterized to present peripherical eosinofilia, although it is not a forced criterion. Its definite diagnosis is anatomopatologic. The steroid use is considered as the angular stone of the treatment. We present two cases, with different clinical presentation forms, with initial answer to steroids and later relapse after the suspension of these, remaining without symptoms actually with dependency of low doses of steroids. Next we will do the revision of the available literature emphasizing the pathophysiologic data, the clinical evaluation and the therapeutic aspects

  8. Gastrointestinal medications and breastfeeding.

    Science.gov (United States)

    Hagemann, T M

    1998-09-01

    Medications used to treat gastrointestinal symptoms are increasingly being used as more have been gained nonprescription status. Most of the gastrointestinal medications, such as laxatives, antacids, and antidiarrheal agents, are used short term. Women who breastfeed should be aware of the risks of taking any medications, whether prescription or nonprescription. There is little information describing transfer into breast milk for many of these products. Cimetidine, atropine, cascara, cisapride, loperamide, magnesium sulfate, and senna are the only products identified by the AAP as compatible with breast feeding. Metoclopramide is listed by the AAP as a drug whose effect on nursing infants is unknown but may be of potential concern, although studies published to date have not reported any adverse effects. The safest laxatives and antidiarrheals are those that are not absorbed and should be considered first-line therapy for conditions of constipation or loose stools. Famotidine and nizatidine are excreted into breast milk to a lesser extent than cimetidine or ranitidine and may be the preferred histamine antagonists. Despite the limited data on the use of cisapride in nursing women, it is considered safe by the AAP and may be preferred over metoclopramide for first-line prescription treatment of heartburn. Although most of these agents appear safe in the nursing infant, caretakers should be aware of the potential adverse reactions that may occur in infants whose mothers require these products.

  9. Gastrointestinal Headache; a Narrative Review

    Directory of Open Access Journals (Sweden)

    Majid T Noghani

    2016-08-01

    Full Text Available There are studies reporting primary headaches to be associated with gastrointestinal disorders, and some report resolution of headache following the treatment of the associated gastrointestinal disorder. Headache disorders are classified by The International Headache Society as primary or secondary; however, among the secondary headaches, those attributed to gastrointestinal disorders are not appreciated. Therefore, we aimed to review the literature to provide evidence for headaches, which originate from the gastrointestinal system. Gastrointestinal disorders that are reported to be associated with primary headaches include dyspepsia, gastro esophageal reflux disease (GERD, constipation, functional abdominal pain, inflammatory bowel syndrome (IBS, inflammatory bowel disorders (IBD, celiac disease, and helicobacter pylori (H. Pylori infection. Some studies have demonstrated remission or improvement of headache following the treatment of the accompanying gastrointestinal disorders. Hypotheses explaining this association are considered to be central sensitization and parasympathetic referred pain, serotonin pathways, autonomic nervous system dysfunction, systemic vasculopathy, and food allergy. Traditional Persian physicians, namely Ebn-e-Sina (Avicenna and Râzi (Rhazes believed in a type of headache originating from disorders of the stomach and named it as an individual entity, the "Participatory Headache of Gastric Origin". We suggest providing a unique diagnostic entity for headaches coexisting with any gastrointestinal abnormality that are improved or cured along with the treatment of the gastrointestinal disorder.

  10. Impact of post-intubation interventions on mortality in patients boarding in the emergency department.

    Science.gov (United States)

    Bhat, Rahul; Goyal, Munish; Graf, Shannon; Bhooshan, Anu; Teferra, Eshetu; Dubin, Jeffrey; Frohna, Bill

    2014-09-01

    Emergency physicians frequently perform endotracheal intubation and mechanical ventilation. The impact of instituting early post-intubation interventions on patients boarding in the emergency department (ED) is not well studied. We sought to determine the impact of post-intubation interventions (arterial blood gas sampling, obtaining a chest x-ray (CXR), gastric decompression, early sedation, appropriate initial tidal volume, and quantitative capnography) on outcomes of mortality, ventilator-associated pneumonia (VAP), ventilator days, and intensive care unit (ICU) length-of-stay (LOS). This was an observational, retrospective study of patients intubated in the ED at a large tertiary-care teaching hospital and included patients in the ED for greater than two hours post-intubation. We excluded them if they had incomplete data, were designated "do not resuscitate," were managed primarily by the trauma team, or had surgery within six hours after intubation. Of 169 patients meeting criteria, 15 died and 10 developed VAP. The mortality odds ratio (OR) in patients receiving CXR was 0.10 (95% CI 0.01 to 0.98), and 0.11 (95% CI 0.03 to 0.46) in patients receiving early sedation. The mortality OR for patients with 3 or fewer interventions was 4.25 (95% CI 1.15 to 15.75) when compared to patients with 5 or more interventions. There was no significant relationship between VAP rate, ventilator days, or ICU LOS and any of the intervention groups. The performance of a CXR and early sedation as well as performing five or more vs. three or fewer post-intubation interventions in boarding adult ED patients was associated with decreased mortality.

  11. Failure to achieve first attempt success at intubation using video laryngoscopy is associated with increased complications.

    Science.gov (United States)

    Hypes, Cameron; Sakles, John; Joshi, Raj; Greenberg, Jeremy; Natt, Bhupinder; Malo, Josh; Bloom, John; Chopra, Harsharon; Mosier, Jarrod

    2017-12-01

    The purpose of this investigation was to investigate the association between first attempt success and intubation-related complications in the Intensive Care Unit after the widespread adoption of video laryngoscopy. We further sought to characterize and identify the predictors of complications that occur despite first attempt success. This was a prospective observational study of consecutive intubations performed with video laryngoscopy at an academic medical Intensive Care Unit. Operator, procedural, and complication data were collected. Multivariable logistic regression was used to examine the relationship between the intubation attempts and the occurrence of one or more complications. A total of 905 patients were intubated using a video laryngoscope. First attempt success occurred in 739 (81.7 %), whereas >1 attempt was needed in 166 (18.3 %). One or more complications occurred in 146 (19.8 %) of those intubated on the first attempt versus 107 (64.5 %, p 1 attempt is associated with 6.4 (95 % CI 4.4-9.3) times the adjusted odds of at least one complication. Pre-intubation predictors of at least one complication despite first attempt success include vomit or edema in the airway as well as the presence of hypoxemia or hypotension. There are increased odds of complications with even a second attempt at intubation in the Intensive Care Unit. Complications occur frequently despite a successful first attempt, and as such, the goal of airway management should not be simply first attempt success, but instead first attempt success without complications.

  12. Just-in-Time Video Laryngoscopy Versus Direct Laryngoscopy for Neonatal Intubation.

    Science.gov (United States)

    Grgurich, Erin; Arnemann, Cynthia; Amon, Kim; Horton, Rose; Carlson, Jestin N

    As neonatal endotracheal intubation (ETI) is a low-frequency, high-consequence event, it is essential that providers have access to resources to aid in ETI. We sought to determine the impact of video laryngoscopy (VL) with just-in-time training on intubation outcomes over direct laryngoscopy (DL) when performed by neonatal nurses. We conducted a prospective, randomized, crossover study with neonatal nurses employed at a level 2 neonatal intensive care unit (NICU). Nurses performed both DL and VL on a neonatal mannequin using a CMAC (Karl Storz Corp, Tuttlingen, Germany) either with the assistance of the screen (VL) or without (DL). Before performing the intubation, providers were given a just-in-time, brief education presentation and allowed to practice with the device. Each ETI attempt was reviewed to obtain the percentage of glottic opening (POGO) score, time to intubation (TTI, time from insertion of the blade into the mouth until the first breath was delivered), and time from blade insertion until the best POGO score. We enrolled 19 participants, with a median (interquartile range) of 20 (9-26) years of experience and having a median of 2 (1-3) intubations within the past year. None had used VL in the NICU previously. Median TTI did not differ between DL and VL: 19.9 (15.3-41.5) vs 20.3 (17.9-24.4) (P = 1). POGO scores and the number of attempts also did not differ between DL and VL. In our simulated setting, just-in-time VL training provided similar intubation outcomes compared with DL in ETI performed by neonatal nurses. Just-in-time VL education may be an alternative to traditional DL for neonatal intubations.

  13. Scintigraphic assessment of gastrointestinal motility

    DEFF Research Database (Denmark)

    Madsen, Jan Lysgård

    2014-01-01

    intestinal and colonic transit. This article reviews current imaging techniques, methods for data processing and principles for evaluating results when scintigraphy is used to assess gastrointestinal motility. Furthermore, clinical indications for performing scintigraphy are reviewed.......Gastrointestinal transit reflects overall gastrointestinal motor activity and is regulated by a complex interplay between neural and hormonal stimuli. Thus, transit measurements provide a measure of the combined effects of gastrointestinal muscular activity and feedback from the gut and brain....... Dysmotility in the different major segments of the gastrointestinal tract may give rise to similar symptoms; hence, localizing transit abnormalities to a specific segment is a valuable element of diagnostic evaluation. Scintigraphy is an effective noninvasive tool to assess gastric emptying as well as small...

  14. The gastrointestinal tract

    DEFF Research Database (Denmark)

    Bartels, Else M.; Harrison, Adrian Paul

    2009-01-01

    The gastrointestinal tract (GIT) has always been and remains a major source of interest in terms of both its function, and its malfunction. Our current knowledge of age-related changes in this system, as well as drug-food interactions, however, remains relatively limited. Paradoxically, the GIT......-related GIT damage and dysfunction. New and novel aspects of drug delivery and drug-dietary supplement interactions are discusses and much needed areas of focus in terms of drug GIT testing are identified....... is not one of the core battery of tests that pharmaceutical companies are obliged to investigate as part of drug development. This review aims to cover the basics of GIT function before highlighting aspects of relevance for safety pharmacology in terms of age, cancerogenesis, and noth drug and diet...

  15. Gastrointestinal infections in children.

    Science.gov (United States)

    Mönkemüller, K E; Wilcox, C M

    2001-01-01

    Gastrointestinal infections in children are a major cause of morbidity and mortality worldwide. Children living in developing countries are particularly susceptible to infectious diarrhea because of poor standards of hygiene and sanitation. Although the magnitude of diarrheal illnesses in developed countries is less, costly hospital admissions are still frequent. The causal agent of infectious diarrhea is most frequently related to age, geographical location, lifestyle habits, use of antibiotics, associated medical conditions, social circumstances, and degree of immune competence. In this article we present some of the most important articles published in the field during the last year. The role of Helicobacter pylori in the pathogenesis of gastritis and peptic ulcer disease has been shown in adults and children. Information about the natural history of H. pylori, symptomatology, and diagnostic therapeutic approaches for children are being generated constantly; we discuss some of the most relevant information in this review.

  16. Estrogen and gastrointestinal malignancy.

    LENUS (Irish Health Repository)

    Hogan, A M

    2012-02-01

    The concept that E2 exerts an effect on the gastrointestinal tract is not new and its actions on intestinal mucosa have been investigated for at least three decades. An attempt to consolidate results of these investigations generates more questions than answers, thus suggesting that many unexplored avenues remain and that the full capabilities of this steroid hormone are far from understood. Evidence of its role in esophageal, gastric and gallbladder cancers is confusing and often equivocal. The most compelling evidence regards the protective role conferred by estrogen (or perhaps ERbeta) against the development and proliferation of colon cancer. Not only has the effect been described but also many mechanisms of action have been explored. It is likely that, along with surgery, chemotherapy and radiotherapy, hormonal manipulation will play an integral role in colon cancer management in the very near future.

  17. Lower gastrointestinal malignancies

    International Nuclear Information System (INIS)

    Minsky, Bruce D.

    1995-01-01

    Objective: This refresher course will review the current knowledge as well as ongoing and future research strategies in lower gastrointestinal malignancies. Radiation therapy has a significant role in the adjuvant treatment of lower gastrointestinal malignancies. Furthermore, there are data to suggest that radiation therapy is an integral component of the conservative management (organ preservation) of rectal and anal cancers. 1. Colon cancer. The standard adjuvant treatment for node positive or high risk transmural colon cancer is postoperative 5-FU and Levamisole. There are retrospective data to suggest that certain subsets of high risk patients may benefit from postoperative radiation therapy. 2. Rectal cancer. Randomized trials have revealed an advantage of postoperative radiation therapy plus chemotherapy in transmural and/or node positive rectal cancer. In the adjuvant setting the use of continuous infusion 5-FU may be more beneficial compared with bolus 5-FU. Despite the improvement in survival, postoperative therapies are associated with an approximately 35% incidence of grade 3+ toxicity. Recent data suggest that the use of preoperative combined modality therapy may be associated with less toxicity as well as increase the chance of sphincter preservation. New Intergroup trials addressing these issues will be presented. In patients with locally advanced unresectable rectal cancer, the addition of intraoperative radiation therapy may further improve local control. 3. Anal cancer. The use of combined 5-FU/Mitomycin-C and pelvic radiation therapy is effective in the treatment of anal carcinoma. The RTOG has recently completed a randomized trial addressing the question of the effectiveness and toxicity of Mitomycin-C. The replacement Intergroup Phase III trial will be presented

  18. Stromal gastrointestinal tumors (GIST)

    International Nuclear Information System (INIS)

    Balev, B.; Boykova, K.

    2015-01-01

    Full text: GIST are a heterogeneous group of mesenchymal tumors of the gastrointestinal tract with varying tumor grade and frequency of 1: 100 000 per year. Mazur and Clark introduced the term for the first time in 1983. GIST constitute approximately 2% of the tumors in the gastrointestinal tract. The average age is 60 years. The most common locations are the stomach (60%), small intestine (30%), esophagus (1%), and rectum (5%). Learning objective: to demonstrate the imaging characteristics of the disease according to the current ESMO guidelines and to present the diagnostic accuracy of different imaging modalitiesnbased on review of literature and on own observations. GIST originate from interstitial cells (of Cajal) in the GIT wall, belonging to the autonomic nervous system, which is responsible for motility. 90% of GIST show overexpression of the KIT receptor, also known as CD117 or stem cell factor receptor. those that do not express c-KIT mutations, activate mutations in PDGFRA gene. Tumor’s macromorphology determines the imaging features on different modalities. Most of these tumors are exophytic, subepithelial, reach large size and enhance inhomogeneous due to necrosis. They usually do not cause obstruction. Ultrasound as the initiation method shows low sensitivity and specificity in GIST detection, CT with intravenous contrast is the gold standard. MRI contributes with assessing the vascularisation, cellularity and pH. FDG-PET/CT registers the metabolism of intratumoral acidosis. CT is the method of choice in the early diagnosis and determination of resectability of GIST. MRI is an additional method. PET FDG-CT is useful for the monitoring of patients treated with Imatinib

  19. Lower gastrointestinal malignancies

    International Nuclear Information System (INIS)

    Minsky, Bruce D.

    1996-01-01

    Objective: This refresher course will review the current knowledge as well as ongoing and future research strategies in lower gastrointestinal malignancies. Radiation therapy has a significant role in the adjuvant treatment of lower gastrointestinal malignancies. Furthermore, there are data to suggest that radiation therapy is an integral component of the conservative management (organ preservation) of rectal and anal cancers. 1. Colon cancer. The standard adjuvant treatment for node positive or high risk transmural colon cancer is postoperative 5-FU and Levamisole. There are retrospective data to suggest that certain subsets of high risk patients may benefit from postoperative radiation therapy. 2. Rectal cancer. Randomized trials have revealed an advantage of postoperative radiation therapy plus chemotherapy in transmural and/or node positive rectal cancer. In the adjuvant setting the use of continuous infusion 5-FU may be more beneficial compared with bolus 5-FU. Despite the improvement in survival, postoperative therapies are associated with an approximately 35% incidence of grade 3+ toxicity. Recent data suggest that the use of preoperative combined modality therapy may be associated with less toxicity as well as increase the chance of sphincter preservation. New Intergroup trials addressing these issues will be presented. In patients with locally advanced unresectable rectal cancer, the addition of intraoperative radiation therapy may further improve local control. 3. Anal cancer. The use of combined 5-FU/Mitomycin-C and pelvic radiation therapy is effective in the treatment of anal carcinoma. The RTOG has recently completed a randomized trial addressing the question of the effectiveness and toxicity of Mitomycin-C. The replacement Intergroup Phase III trial will be presented

  20. Attenuation of Hemodynamic Responses to Intubation by Gabapentin in Coronary Artery Bypass Surgery: a Randomized Clinical Trial

    Directory of Open Access Journals (Sweden)

    Seyed Mojtaba Marashi

    2015-12-01

    Full Text Available A varieties of medications have been suggested to prevent hemodynamic instabilities following laryngoscopy and endotracheal intubation. This study was conducted to determine the beneficial effects of gabapentin on preventing hemodynamic instabilities associated with intubation in patients who were a candidate for coronary artery bypass surgery (CABG. This double blinded randomized, parallel group clinical trial was carried out on 58 normotensive patients scheduled for elective CABG under general anesthesia with endotracheal intubation in Shariati Hospital. Patients were randomly allocated to two groups of 29 patients that received 1200 mg of gabapentin in two dosages (600 mg, 8 hours before anesthesia induction and 600 mg, 2 hours before anesthesia induction as gabapentin group or received talc powder as placebo (placebo group. Heart rate, mean arterial pressure, systolic and diastolic blood pressure were measured immediately before intubation, during intubation, immediately after intubation, 1 and 2 minutes after tracheal intubation. Inter-group comparisons significantly showed higher systolic and diastolic blood pressure, mean arterial pressure and heart rate immediately before intubation, during intubation, immediately after intubation, 1 and 2 minutes after tracheal intubation in the placebo group in comparison to gabapentin group. The median of anxiety  verbal analog scale (VAS at the pre-induction room in gabapentin and placebo groups were 2 and 4,  respectively that was significantly lower in the former group (P. value =0.04 ; however, regarding median of pain score no difference was observed between them (P. value =0.07. Gabapentin (1200mg given preoperatively can effectively attenuate the hemodynamic response to laryngoscopy, intubation and also reduce preoperative related anxiety in patients who were a candidate for CABG.

  1. Comparative efficacy of Combination of Propofol or Thiopental with Remifentanil on Tracheal Intubation without Muscle Relaxants

    Directory of Open Access Journals (Sweden)

    k Naseri

    2007-10-01

    Full Text Available Introduction & Objective: In some medical situations administration of muscle relaxants after intravenous anesthetics for tracheal intubation may be unnecessary or sometimes could be hazardous. In such situations, replacing an alternative drug for the facilitation of tracheal intubation is obvious. Remifentanil is a short acting opioid drug which may be useful in solving this problem. The aim of this study was to compare the effects of propofol or thiopental in combination with remifentanil in the absence of muscle relaxants on larengoscopy and intubation conditions in general anesthesia. Materials & Methods: This is a randomized double-blind clinical trial which was performed in 1386 in Be’sat hospital of Sanandaj. Forty two ASA 1 and 2 patients recruited to receive propofol, 2 Mg/Kg, or thiopental, 5Mg/K. All patients received lidocaine, 1.5 Mg/Kg, and remifentanil, 2.5 µg/Kg, 30 seconds before anesthetics administration. larengoscopy and tracheal intubation were done 90 seconds after induction of anesthesia. On the basis of mask ventilation, jaw relaxation, vocal cords position and patient's response to intubations and endotracheal tube cuff inflation the intubation conditions were assessed and recorded as excellent, good ,acceptable or poor. The mean arterial pressure and heart rate were measured before and after anesthetics administration and also 45 seconds and two and five minutes after intubations. Data were analyzed by X2, fisher exact test ant student T-test using SPSS software. Results: Excellent or good larengoscopy and intubation conditions were observed in 9 (%42.9 of thiopental patients and 20 (%95.2 of propofol patients (p<0.05. Mean arterial pressure and heart rate decreased more significantly in propofol group in comparison with the thiopental group (p<0.05. Conclusion: Combination of remifentanil and propofol or thiopental could facilitate ventilation via face mask in all patients. Although combination of propofol and

  2. Tracheal intubation in critically ill patients: a comprehensive systematic review of randomized trials.

    Science.gov (United States)

    Cabrini, Luca; Landoni, Giovanni; Baiardo Radaelli, Martina; Saleh, Omar; Votta, Carmine D; Fominskiy, Evgeny; Putzu, Alessandro; Snak de Souza, Cézar Daniel; Antonelli, Massimo; Bellomo, Rinaldo; Pelosi, Paolo; Zangrillo, Alberto

    2018-01-20

    We performed a systematic review of randomized controlled studies evaluating any drug, technique or device aimed at improving the success rate or safety of tracheal intubation in the critically ill. We searched PubMed, BioMed Central, Embase and the Cochrane Central Register of Clinical Trials and references of retrieved articles. Finally, pertinent reviews were also scanned to detect further studies until May 2017. The following inclusion criteria were considered: tracheal intubation in adult critically ill patients; randomized controlled trial; study performed in Intensive Care Unit, Emergency Department or ordinary ward; and work published in the last 20 years. Exclusion criteria were pre-hospital or operating theatre settings and simulation-based studies. Two investigators selected studies for the final analysis. Extracted data included first author, publication year, characteristics of patients and clinical settings, intervention details, comparators and relevant outcomes. The risk of bias was assessed with the Cochrane Collaboration's Risk of Bias tool. We identified 22 trials on use of a pre-procedure check-list (1 study), pre-oxygenation or apneic oxygenation (6 studies), sedatives (3 studies), neuromuscular blocking agents (1 study), patient positioning (1 study), video laryngoscopy (9 studies), and post-intubation lung recruitment (1 study). Pre-oxygenation with non-invasive ventilation (NIV) and/or high-flow nasal cannula (HFNC) showed a possible beneficial role. Post-intubation recruitment improved oxygenation , while ramped position increased the number of intubation attempts and thiopental had negative hemodynamic effects. No effect was found for use of a checklist, apneic oxygenation (on oxygenation and hemodynamics), videolaryngoscopy (on number and length of intubation attempts), sedatives and neuromuscular blockers (on hemodynamics). Finally, videolaryngoscopy was associated with severe adverse effects in multiple trials. The limited available

  3. Pushed monocanalicular intubation versus probing as a primary management for congenital nasolacrimal obstruction

    Directory of Open Access Journals (Sweden)

    Elsawaby EA

    2016-09-01

    Full Text Available Emad Abdelaal Elsawaby, Rania Asem El Essawy, Sameh Hassan Abdelbaky, Yomna Magdy Ismail Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt Purpose: Evaluation of efficiency, complications, and advantages of pushed monocanalicular intubation using Masterka® tube versus simple probing in patients with congenital nasolacrimal duct obstruction (CNLDO.Patients and methods: This is a case-controlled study that included 60 eyes (of 53 patients; 30 eyes underwent probing and 30 eyes intubation using the Masterka tube as a primary treatment for CNLDO. The children were aged between 6 months and 36 months at the time of surgery, with no previous nasolacrimal surgical procedure, and had one or more of the following clinical signs of nasolacrimal duct obstruction: epiphora, mucous discharge, and/or increased tear lake.Results: We defined success by absence of epiphora, mucous discharge, or increased tear lake 1 month after tube removal. The overall success rate in the probing group was 80%, while it was 83.3% in the intubation group.Conclusion: Pushed monocanalicular intubation is an effective method for treatment of CNLDO; it requires only mask inhalation anesthesia and could be considered as an appropriate alternative procedure with imperceptible complications. Keywords: epiphora, probing, intubation, monocanalicular, nasolacrimal

  4. Comparison of Transcanalicular Multidiode Laser Dacryocystorhinostomy with and without Silicon Tube Intubation

    Directory of Open Access Journals (Sweden)

    Yildiray Yildirim

    2016-01-01

    Full Text Available Aim. To compare the surgical outcomes of surgery with and without bicanalicular silicon tube intubation for the treatment of patients who have primary uncomplicated nasolacrimal duct obstruction. Methods. This retrospective study is comprised of 113 patients with uncomplicated primary nasolacrimal duct obstruction. There were 2 groups in the study: Group 1 (n=58 patients underwent transcanalicular diode laser dacryocystorhinostomy surgery with bicanalicular silicon tube intubation and Group 2 (n=55 patients underwent transcanalicular diode laser dacryocystorhinostomy surgery without bicanalicular silicon tube intubation. The follow-up period was 18.42±2.8 months for Group 1 and 18.8±2.1 months for Group 2. Results. Success was defined by irrigation of the lacrimal system without regurgitation and by the absence of epiphora. Success rates were 84.4% for Group 1 and 63.6% for Group 2 (P=0.011. Statistically a significant difference was found between the two groups. Conclusion. The results of the study showed that transcanalicular diode laser dacryocystorhinostomy surgery with bicanalicular silicon tube intubation was more successful than the other method of surgery. Consequently, the application of silicone tube intubation in transcanalicular diode laser dacryocystorhinostomy surgery is recommended.

  5. [Difficult Ventilation Requiring Emergency Endotracheal Intubation during Awake Craniotomy Managed by Laryngeal Mask Airway].

    Science.gov (United States)

    Matsuda, Asako; Mizota, Toshiyuki; Tanaka, Tomoharu; Segawa, Hajime; Fukuda, Kazuhiko

    2016-04-01

    We report a case of difficult ventilation requiring emergency endotracheal intubation during awake craniotomy managed by laryngeal mask airway (LMA). A 45-year-old woman was scheduled to receive awake craniotomy for brain tumor in the frontal lobe. After anesthetic induction, airway was secured using ProSeal LMA and patient was mechanically ventilated in pressure-control mode. Patient's head was fixed with head-pins at anteflex position, and the operation started. About one hour after the start of the operation, tidal volume suddenly decreased. We immediately started manual ventilation, but the airway resistance was extremely high and we could not adequately ventilate the patient. We administered muscle relaxant for suspected laryngospasm, but ventilatory status did not improve; so we decided to conduct emergency endotracheal intubation. We tried to intubate using Airwayscope or LMA-Fastrach, but they were not effective in our case. Finally trachea was intubated using transnasal fiberoptic bronchoscopy. We discuss airway management during awake craniotomy, focusing on emergency endotracheal intubation during surgery.

  6. Prehospital Intubation and Outcome in Traumatic Brain Injury—Assessing Intervention Efficacy in a Modern Trauma Cohort

    Directory of Open Access Journals (Sweden)

    Rebecka Rubenson Wahlin

    2018-04-01

    Full Text Available BackgroundPrehospital intubation in traumatic brain injury (TBI focuses on limiting the effects of secondary insults such as hypoxia, but no indisputable evidence has been presented that it is beneficial for outcome. The aim of this study was to explore the characteristics of patients who undergo prehospital intubation and, in turn, if these parameters affect outcome.Material and methodsPatients ≥15 years admitted to the Department of Neurosurgery, Stockholm, Sweden with TBI from 2008 through 2014 were included. Data were extracted from prehospital and hospital charts, including prospectively collected Glasgow Outcome Score (GOS after 12 months. Univariate and multivariable logistic regression models were employed to examine parameters independently correlated to prehospital intubation and outcome.ResultsA total of 458 patients were included (n = 178 unconscious, among them, n = 61 intubated. Multivariable analyses indicated that high energy trauma, prehospital hypotension, pupil unresponsiveness, mode of transportation, and distance to the hospital were independently correlated with intubation, and among them, only pupil responsiveness was independently associated with outcome. Prehospital intubation did not add independent information in a step-up model versus GOS (p = 0.154. Prehospital reports revealed that hypoxia was not the primary cause of prehospital intubation, and that the procedure did not improve oxygen saturation during transport, while an increasing distance from the hospital increased the intubation frequency.ConclusionIn this modern trauma cohort, prehospital intubation was not independently associated with outcome; however, hypoxia was not a common reason for prehospital intubation. Prospective trials to assess efficacy of prehospital airway intubation will be difficult due to logistical and ethical considerations.

  7. A randomized controlled study to evaluate and compare Truview blade with Macintosh blade for laryngoscopy and intubation under general anesthesia.

    Science.gov (United States)

    Timanaykar, Ramesh T; Anand, Lakesh K; Palta, Sanjeev

    2011-04-01

    The Truview EVO2™ laryngoscope is a recently introduced device with a unique blade that provides a magnified laryngeal view at 42° anterior reflected view. It facilitates visualization of the glottis without alignment of oral, pharyngeal, and tracheal axes. We compared the view obtained at laryngoscopy, intubating conditions and hemodynamic parameters of Truview with Macintosh blade. In prospective, randomized and controlled manner, 200 patients of ASA I and II of either sex (20-50 years), presenting for surgery requiring tracheal intubation, were assigned to undergo intubation using a Truview or Macintosh laryngoscope. Visualization of the vocal cord, ease of intubation, time taken for intubation, number of attempts, and hemodynamic parameters were evaluated. Truview provided better results for the laryngeal view using Cormack and Lehane grading, particularly in patients with higher airway Mallampati grading (P < 0.05). The time taken for intubation (33.06±5.6 vs. 23.11±57 seconds) was more with Truview than with Macintosh blade (P < 0.01). The Percentage of Glottic Opening (POGO) score was significantly higher (97.26±8) in Truview as that observed with Macintosh blade (83.70±21.5). Hemodynamic parameters increased after tracheal intubation from pre-intubation value (P < 0.05) in both the groups, but they were comparable amongst the groups. No postoperative adverse events were noted. Tracheal intubation using Truview blade provided consistently improved laryngeal view as compared to Macintosh blade without the need to align the oral, pharyngeal and tracheal axes, with equal attempts for successful intubation and similar changes in hemodynamics. However, the time taken for intubation was more with Truview.

  8. A randomized controlled study to evaluate and compare Truview blade with Macintosh blade for laryngoscopy and intubation under general anesthesia

    Directory of Open Access Journals (Sweden)

    Ramesh T Timanaykar

    2011-01-01

    Full Text Available Background: The Truview EVO2 TM laryngoscope is a recently introduced device with a unique blade that provides a magnified laryngeal view at 42° anterior reflected view. It facilitates visualization of the glottis without alignment of oral, pharyngeal, and tracheal axes. We compared the view obtained at laryngoscopy, intubating conditions and hemodynamic parameters of Truview with Macintosh blade. Materials and Methods: In prospective, randomized and controlled manner, 200 patients of ASA I and II of either sex (20-50 years, presenting for surgery requiring tracheal intubation, were assigned to undergo intubation using a Truview or Macintosh laryngoscope. Visualization of the vocal cord, ease of intubation, time taken for intubation, number of attempts, and hemodynamic parameters were evaluated. Results: Truview provided better results for the laryngeal view using Cormack and Lehane grading, particularly in patients with higher airway Mallampati grading (P < 0.05. The time taken for intubation (33.06±5.6 vs. 23.11±57 seconds was more with Truview than with Macintosh blade (P < 0.01. The Percentage of Glottic Opening (POGO score was significantly higher (97.26±8 in Truview as that observed with Macintosh blade (83.70±21.5. Hemodynamic parameters increased after tracheal intubation from pre-intubation value (P < 0.05 in both the groups, but they were comparable amongst the groups. No postoperative adverse events were noted. Conclusion: Tracheal intubation using Truview blade provided consistently improved laryngeal view as compared to Macintosh blade without the need to align the oral, pharyngeal and tracheal axes, with equal attempts for successful intubation and similar changes in hemodynamics. However, the time taken for intubation was more with Truview.

  9. Preanesthetic assessment data do not influence the time for tracheal intubation with Airtraq(tm video laryngoscope in obese patients

    Directory of Open Access Journals (Sweden)

    Dante Ranieri Jr.

    2014-06-01

    Full Text Available Purpose: this study investigated the influence of anatomical predictors on difficult laryngoscopy and orotracheal intubation in obese patients by comparing Macintosh and Airtraq(tm laryngoscopes. Methods: from 132 bariatric surgery patients (body mass index = 35 kg m-1, cervical perimeter, sternomental distance, interincisor distance, and Mallampati score were recorded. The patients were randomized into two groups according to whether a Macintosh (n = 64 or an Airtraq(tm (n = 68 laryngoscope was used for tracheal intubation. Time required for intubation was the first outcome. Cormack-Lehane score, number of intubation attempts, the Macintosh blade used, any need for external tracheal compression or the use of gum elastic bougie were recorded. Intubation failure and strategies adopted were also registered. Results: intubation failed in two patients in the Macintosh laryngoscope group, and these patients were included as worst cases scenario. The intubation times were 36.9 + 22.8 s and 13.7 + 3.1 s for the Macintosh and Airtraq(tm laryngoscope groups (p < 0.01, respectively. Cormack-Lehane scores were also lower for the Airtraq(tm group. One patient in the Macintosh group with intubation failure was quickly intubated with the Airtraq(tm. Cervical circumference (p < 0.01 and interincisor distance (p < 0.05 influenced the time required for intubation in the Macintosh group but not in the Airtraq(tm group. Conclusion: in obese patients despite increased neck circumference and limited mouth opening, the Airtraq(tm laryngoscope affords faster tracheal intubation than the Macintosh laryngoscope, and it may serve as an alternative when conventional laryngoscopy fails.

  10. Lingual traction to facilitate fiber-optic intubation of difficult airways: a single-anesthesiologist randomized trial.

    Science.gov (United States)

    Ching, Yiu-Hei; Karlnoski, Rachel A; Chen, Henian; Camporesi, Enrico M; Shah, Vimal V; Padhya, Tapan A; Mangar, Devanand

    2015-04-01

    Flexible fiber-optic bronchoscope-guided orotracheal intubation is a valuable technique with demonstrated benefits in the management of difficult airways. Despite its popularity with anesthesia providers, the technique is not fail-safe and airway-related complications secondary to failed intubation attempts remain an important problem. We sought to determine the effect of incorporating lingual traction on the success rate of fiber-optic bronchoscope-guided intubation in patients with anticipated difficult airways. In this prospective, randomized, cohort study, we enrolled 91 adult patients with anticipated difficult airways scheduled for elective surgery to undergo fiber-optic bronchoscope-guided orotracheal intubation alone or with lingual traction by an individual anesthesiologist after induction of general anesthesia and neuromuscular blockade. A total of 78 patients were randomized: 39 patients to the fiber-optic bronchoscope-guided intubation with lingual traction group and 39 patients to the fiber-optic bronchoscope-guided intubation alone group. The primary endpoint was the rate of successful first attempt intubations. The secondary outcome was sore throat grade on post-operative day 1. Fiber-optic intubation with lingual traction compared to fiber-optic intubation alone resulted in a higher success rate (92.3 vs. 74.4 %, χ (2) = 4.523, p = 0.033) and greater odds for successful first attempt intubation (OR 4.138, 95 % CI 1.041-16.444, p = 0.044). Sore throat severity on post-operative day 1 was not significantly different but trended towards worsening grades with lingual traction. In this study, lingual traction was shown to be a valuable maneuver for facilitating fiber-optic bronchoscope-guided intubation in the management of patients with anticipated difficult airways.

  11. Routine antibiotic cover for newborns intubated for aspirating meconium: is it necessary?

    Science.gov (United States)

    Krishnan, L; Nasruddin; Prabhakar, P; Bhaskaranand, N

    1995-05-01

    A retrospective analysis was performed on 215 babies to evaluate the incidence of septicemia in babies intubated at birth for aspirating meconium from the trachea. Only term, appropriate for gestational age babies were included. Babies with any known perinatal risk factor for infection were excluded from the study and none of the babies had been put on "prophylactic antibiotics." There were 88 babies in the intubated group in a one year period from January 1991 to December 1991. One hundred and twenty seven babies were taken as controls. There was no significant difference in the incidence of early septicemia in the two groups. There were no deaths in either group. It is concluded that well term babies who are intubated for aspirating meconium need not be put on routine antibiotic cover.

  12. Gastrointestinal nuclear medicine

    International Nuclear Information System (INIS)

    Koblik, P.D.; Hornof, W.J.

    1985-01-01

    General localization of gastrointestinal bleeding through the use of labeled red blood cells may be performed in children, or (99m)Tc-pertechnetate may be used if a Meckel's diverticulum is suspected. As in adults, cholecystitis and biliary leak may be assessed in children via (99m)Tc-IDA derivatives. Gastroesophageal reflux can be evaluated by oral consumption of the child's usual diet labeled with (99m)Tc sulfur colloid. For the scintigraphic determination of pulmonary aspiration, a relatively high concentration of tracer within a drop of liquid is placed beneath the child's tongue followed by dynamic imaging of the respiratory tract. Colonic transit scintigraphy can aid in the identification and therapeutic decision-making in patients with functional fecal retention, the most common cause of chronic constipation in children. (18)F-DOPA positron emission tomography is useful for classifying pancreatic involvement in infantile hyperinsulinism as focal or diffuse, thereby differentiating between patients who should receive curative focal pancreatic resection versus those who should receive medical management. Assessment of protein-losing enteropathy can be conducted scintigraphically and, compared with fecal alpha-1 antitrypsin collection, the scintigraphic method can detect esophageal and gastric protein loss. Also, scintigraphic quantification of protein loss can be performed without the requirement for fecal collection. Intestinal inflammation in children with inflammatory bowel disease can be evaluated using (99m)Tc white blood cells. The scintigraphic method is safe, accurate, well-tolerated by children and complementary to endoscopy in most patients

  13. Gastrointestinal scanning agent

    International Nuclear Information System (INIS)

    Francis, M.D.

    1980-01-01

    An easily prepared radiolabeled gastrointestinal scanning agent is described. Technetium-99m has ideal characteristics for imaging the upper and lower GI tract and determining stomach emptying and intestinal transit time when used with an insoluble particulate material. For example, crystalline and amorphous calcium phosphate particles can be effectively labeled in a one-step process using sup(99m)TcO 4 and SnCl 2 . These labeled particles have insignificant mass and when administered orally pass through the GI tract unchanged, without affecting the handling and density of the intestinal contents. Visualization of the esophageal entry into the stomach, the greater and lesser curvatures of the stomach, ejection into the duodenum, and rates of passage through the upper and lower GI tract are obtained. The slurry of sup(99m)TC particulate can be given rectally by enema. Good images of the cecum and the ascending, transverse, and descending colon are obtained. Mucosal folds and the splenic and hepatic flexures are visualized. The resilience of the large intestine is also readily visualized by pneumocolonographic techniques. (author)

  14. Intubation of prehospital patients with curved laryngoscope blade is more successful than with straight blade.

    Science.gov (United States)

    Alter, Scott M; Haim, Eithan D; Sullivan, Alex H; Clayton, Lisa M

    2018-02-17

    Direct laryngoscopy can be performed using curved or straight blades, and providers usually choose the blade they are most comfortable with. However, curved blades are anecdotally thought of as easier to use than straight blades. We seek to compare intubation success rates of paramedics using curved versus straight blades. Design: retrospective chart review. hospital-based suburban ALS service with 20,000 annual calls. prehospital patients with any direct laryngoscopy intubation attempt over almost 9years. First attempt and overall success rates were calculated for attempts with curved and straight blades. Differences between the groups were calculated. 2299 patients were intubated by direct laryngoscopy. 1865 had attempts with a curved blade, 367 had attempts with a straight blade, and 67 had attempts with both. Baseline characteristics were similar between groups. First attempt success was 86% with a curved blade and 73% with a straight blade: a difference of 13% (95% CI: 9-17). Overall success was 96% with a curved blade and 81% with a straight blade: a difference of 15% (95% CI: 12-18). There was an average of 1.11 intubation attempts per patient with a curved blade and 1.13 attempts per patient with a straight blade (2% difference, 95% CI: -3-7). Our study found a significant difference in intubation success rates between laryngoscope blade types. Curved blades had higher first attempt and overall success rates when compared to straight blades. Paramedics should consider selecting a curved blade as their tool of choice to potentially improve intubation success. Copyright © 2018 Elsevier Inc. All rights reserved.

  15. Risk factors for endotracheal intubation and mechanical ventilation in patients with opioids intoxication

    International Nuclear Information System (INIS)

    Mirmoghtadaee, P.; Mood, N.E.; Sabzghabaee, A.M.; Yaraghi, A.

    2012-01-01

    Objectives: Patients poisoned with opioids sometimes need endotracheal intubation with or without the use of mechanical ventilation. This study was done to determine the prognostic risk factors for of the need for endotracheal intubation and mechanical ventilation. Methodology: In this cross-sectional study which was performed in Isfahan (Iran), one hundred (n=100) opioid poisoned patients whom their overdoses were diagnosed by their full and reliable history, physical examination and positive response to naloxone; vital signs at the hospital admission, blood biochemistry, ABG details and also the type and estimated dosage of opioid, route of consumption, and their need to mechanical ventilation were evaluated. Results: Patients were mostly aged between 20-40 years old. Seventy nine patients were male and 26 cases (21 men) required endotracheal intubation and 15 cases (14 men) needed both intubation and mechanical ventilation. The most consumed opiates among the poisoned patients were opium (35%), heroin (16%), Tramadol (15%), Methadone (9%), crack (6%), Diphenoxylate (4%) and others (15%). There was a significant difference between the mean heart rates and respiratory rate of the patients who were connected to the ventilator and others (99.8 +- 21.8 and 87.3 +- 16.3; p=0.01). The lower level of consciousness [OR: 2.2 95% Confidence Interval (CI): 1.2-4.2], and lower admission level of hemoglobin (OR: 3.6; CI:1.2-10.8) were among the factors for predicting the need for intubation and ventilation. Conclusion: Determining the risk factors with prognostic value for the need to intubation or ventilation seems to be necessary for improving the standard of therapy in opioids poisoned patients. (author)

  16. Intubation following high-dose rocuronium in a cat with protracted laryngospasm

    Directory of Open Access Journals (Sweden)

    Graeme M Doodnaught

    2017-10-01

    Full Text Available Case summary An 11-year-old spayed female domestic shorthair cat with a history of laryngospasm at induction of general anesthesia presented for dental evaluation and treatment. The cat was premedicated with hydromorphone (0.05 mg/kg and alfaxalone (0.5 mg/kg intravenously, pre-oxygenated for 5 mins (3 l/min, face mask and anesthesia was induced with alfaxalone (to effect intravenously. Lidocaine (0.1 ml, 2% was applied topically to the arytenoid cartilages following loss of jaw tone. Laryngospasm was not noted during or immediately following lidocaine application. However, after waiting 60 s for the onset of effect of the topical lidocaine, laryngospasm was apparent. Orotracheal intubation by direct visualization was unsuccessful after four attempts by three anesthetists (with increasing levels of experience. At this point, a failed intubation was declared and the non-depolarising neuromuscular blocking agent rocuronium (1 mg/kg IV given, resulting in arytenoid abduction and appropriate conditions for intubation. Successful intubation occurred 9 mins after induction of anesthesia. Oxygen was continuously supplemented throughout and arterial hemoglobin saturation with oxygen was never <94%. Relevance and novel information To the authors’ knowledge, this is the first report of the use of high-dose rocuronium to successfully resolve prolonged laryngospasm at induction of general anesthesia in a cat. Despite laryngospasm and a delay in achieving orotracheal intubation, low values for arterial hemoglobin saturation with oxygen (indicative of hypoxemia were not observed, highlighting the benefits of pre-oxygenation and apneic oxygenation. The principles of the Difficult Airway Society 2015 guidelines were followed in managing this difficult intubation.

  17. Integration of point-of-care ultrasound during rapid sequence intubation in trauma resuscitation

    Directory of Open Access Journals (Sweden)

    Prakash Ranjan Mishra

    2018-01-01

    Full Text Available Introduction: Airway and breathing management play critical role in trauma resuscitation. Early identification of esophageal intubation and detection of fatal events is critical. Authors studied the utility of integration of point-of-care ultrasound (POCUS during different phases of rapid sequence intubation (RSI in trauma resuscitation. Methods: It was prospective, randomized single-centered study conducted at the Emergency Department of a level one trauma center. Patients were divided into ultrasonography (USG and clinical examination (CE arm. The objectives were to study the utility of POCUS in endotracheal tube placement and confirmations and identification of potentially fatal conditions as tracheal injury, midline vessels, paratracheal hematoma, vocal cord pathology, pneumothorax, and others during RSI. Patient >1 year of age were included. Time taken for procedure, number of incorrect intubations, and pathologies detected were noted. The data were collected in Microsoft Excel spread sheets and analyzed using Stata (version 11.2, Stata Corp, Texas, U. S. A software. Results: One hundred and six patients were recruited. The mean time for primary survey USG versus CE arm was (20 ± 10.01 vs. 18 ± 11.03 seconds. USG detected four pneumothorax, one tracheal injury, and one paratracheal hematoma. The mean procedure time USG versus CE arm was (37.3 ± 21.92 vs. 58 ± 32.04 seconds. Eight esophageal intubations were identified in USG arm by POCUS and two in CE arm by EtCO2 values. Conclusion: Integration of POCUS was useful in all three phases of RSI. It identified paratracheal hematoma, tracheal injury, and pneumothorax. It also identified esophageal intubation and confirmed main stem tracheal intubation in less time compared to five-point auscultation and capnography.

  18. A new composite measure of colonoscopy: the Performance Indicator of Colonic Intubation (PICI).

    Science.gov (United States)

    Valori, Roland M; Damery, Sarah; Gavin, Daniel R; Anderson, John T; Donnelly, Mark T; Williams, J Graham; Swarbrick, Edwin T

    2018-01-01

     Cecal intubation rate (CIR) is an established performance indicator of colonoscopy. In some patients, cecal intubation with acceptable tolerance is only achieved with additional sedation. This study proposes a composite Performance Indicator of Colonic Intubation (PICI), which combines CIR, comfort, and sedation. METHODS : Data from 20 085 colonoscopies reported in the 2011 UK national audit were analyzed. PICI was defined as the percentage of procedures achieving cecal intubation with median dose (2 mg) of midazolam or less, and nurse-assessed comfort score of 1 - 3/5. Multivariate logistic regression analysis evaluated possible associations between PICI and patient, unit, colonoscopist, and diagnostic factors. RESULTS : PICI was achieved in 54.1 % of procedures. PICI identified factors affecting performance more frequently than single measures such as CIR and polyp detection, or CIR + comfort alone. Older age, male sex, adequate bowel preparation, and a positive fecal occult blood test as indication were associated with a higher PICI. Unit accreditation, the presence of magnetic imagers in the unit, greater annual volume, fewer years' experience, and higher training/trainer status were associated with higher PICI rates. Procedures in which PICI was achieved were associated with significantly higher polyp detection rates than when PICI was not achieved. CONCLUSIONS : PICI provides a simpler picture of performance of colonoscopic intubation than separate measures of CIR, comfort, and sedation. It is associated with more factors that are amenable to change that might improve performance and with higher likelihood of polyp detection. It is proposed that PICI becomes the key performance indicator for intubation of the colon in colonoscopy quality improvement initiatives. © Georg Thieme Verlag KG Stuttgart · New York.

  19. Psychological traits influence autonomic nervous system recovery following esophageal intubation in health and functional chest pain.

    Science.gov (United States)

    Farmer, A D; Coen, S J; Kano, M; Worthen, S F; Rossiter, H E; Navqi, H; Scott, S M; Furlong, P L; Aziz, Q

    2013-12-01

    Esophageal intubation is a widely utilized technique for a diverse array of physiological studies, activating a complex physiological response mediated, in part, by the autonomic nervous system (ANS). In order to determine the optimal time period after intubation when physiological observations should be recorded, it is important to know the duration of, and factors that influence, this ANS response, in both health and disease. Fifty healthy subjects (27 males, median age 31.9 years, range 20-53 years) and 20 patients with Rome III defined functional chest pain (nine male, median age of 38.7 years, range 28-59 years) had personality traits and anxiety measured. Subjects had heart rate (HR), blood pressure (BP), sympathetic (cardiac sympathetic index, CSI), and parasympathetic nervous system (cardiac vagal tone, CVT) parameters measured at baseline and in response to per nasum intubation with an esophageal catheter. CSI/CVT recovery was measured following esophageal intubation. In all subjects, esophageal intubation caused an elevation in HR, BP, CSI, and skin conductance response (SCR; all p < 0.0001) but concomitant CVT and cardiac sensitivity to the baroreflex (CSB) withdrawal (all p < 0.04). Multiple linear regression analysis demonstrated that longer CVT recovery times were independently associated with higher neuroticism (p < 0.001). Patients had prolonged CSI and CVT recovery times in comparison to healthy subjects (112.5 s vs 46.5 s, p = 0.0001 and 549 s vs 223.5 s, p = 0.0001, respectively). Esophageal intubation activates a flight/flight ANS response. Future studies should allow for at least 10 min of recovery time. Consideration should be given to psychological traits and disease status as these can influence recovery. © 2013 John Wiley & Sons Ltd.

  20. Low-dose esmolol: hemodynamic response to endotracheal intubation in normotensive patients

    Directory of Open Access Journals (Sweden)

    Suresh Lakshmanappa

    2012-06-01

    Full Text Available Abstract Purpose: Endotracheal intubation is a frequently utilized and highly invasive component of anesthesia that is often accompanied by potentially harmful hemodynamic pressor responses. The purpose of this study was to investigate the efficiency of a single pre-induction 1 mg/kg bolus injection of esmolol for attenuating these hemodynamic responses to endotracheal intubation in normotensive patients. Material and methods: The study was composed of 100 randomly selected male and female patients between the ages of 18 and 60 that were scheduled for elective surgery and belonged to ASA grade I or II. Two minutes prior to intubation the control group received 10 mL of saline (n=50 and the experimental group received an injection of esmolol 1 mg/kg diluted to 10 mL (n=50. Heart rate (HR, systolic blood pressure (SBP, diastolic blood pressure (DBP, mean arterial pressure (MAP, and rate pressure product (RPP were compared to basal values before receiving medication (T-0, during pre-induction (T-1, induction (T-2, intubation (T-3, and post-intubation at 1 (T-4, 3 (T-6, 5 (T-8, and 10 (T-13 minutes. Results: Esmolol significantly attenuated the hemodynamic responses to endotracheal intubation at the majority of measured points. Attenuation of HR (10.8%, SBP (7.04%, DBP (3.99%, MAP (5%, and RPP (16.9% was observed in the esmolol group when compared to the control group values. Conclusions: A single pre-induction 1 mg/kg bolus injection of esmolol successfully attenuated the hemodynamic pressor response in normotensive patients. A significant attenuation of heart rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure was observed at the majority of measured time points in the esmolol administered group compared to the control group. [J Contemp Med 2012; 2(2.000: 69-76

  1. Scintigraphic evaluation of gastrointestinal bleeding

    International Nuclear Information System (INIS)

    Park, Yong Tai; Lee, Choon Keun; Lee, Sun Wha; Choi, Woo Suk; Yoon, Yup; Lim, Jae Hoon

    1988-01-01

    Gastrointestinal bleeding remains a major diagnostic problem. Although advances have been made in the medical and surgical methods of managing gastrointestinal bleeding, the commonly employed techniques of barium radiography, endoscopy, and angiography may not successfully localize the site and define the cause of gastrointestinal bleeding. Two widely available technetium-99m-labeled radiopharmaceuticals, sulfur colloid and red blood cells are currently used in the evaluation of patients who are bleeding from the gastrointestinal tract. Surgically confirmed 19 patients with use of 99m Tc-sulfur colloid (7 cases) and 99m Tc-RBC (12 cases) were retrospectively evaluated. The overall sensitivity of scintigraphy in detection of bleeding and localization of bleeding site was 68% and 84%, respectively. The authors conclude that bleeding scintigraphy is a safe, sensitive, and non-invasive method as an effective screening test before performing angiography or surgery.

  2. Sleep Dysfunction and Gastrointestinal Diseases.

    Science.gov (United States)

    Khanijow, Vikesh; Prakash, Pia; Emsellem, Helene A; Borum, Marie L; Doman, David B

    2015-12-01

    Sleep deprivation and impaired sleep quality have been associated with poor health outcomes. Many patients experience sleep disturbances, which can increase the risk of medical conditions such as hypertension, obesity, stroke, and heart disease as well as increase overall mortality. Recent studies have suggested that there is a strong association between sleep disturbances and gastrointestinal diseases. Proinflammatory cytokines, such as tumor necrosis factor, interleukin-1, and interleukin-6, have been associated with sleep dysfunction. Alterations in these cytokines have been seen in certain gastrointestinal diseases, such as gastroesophageal reflux disease, inflammatory bowel disease, liver disorders, and colorectal cancer. It is important for gastroenterologists to be aware of the relationship between sleep disorders and gastrointestinal illnesses to ensure good care for patients. This article reviews the current research on the interplay between sleep disorders, immune function, and gastrointestinal diseases.

  3. Radiological Atlas of Gastrointestinal Disease

    International Nuclear Information System (INIS)

    Nolan, D.J.

    1983-01-01

    This book is a reference to gastrointestinal disease and radiographic methods. It provides complete information for diagnosis and management and includes coverage of plain radiography, barium studies, water-soluble contrast studies, and more

  4. GASTROINTESTINAL INJURIES FROM BLUNT ABDOMINAL ...

    African Journals Online (AJOL)

    hi-tech

    2004-04-04

    Apr 4, 2004 ... Subjects: Twenty one children managed for gastrointestinal injuries from blunt trauma ... ileus, urinary tract infection and chest infection, respectively postoperatively. .... predictive value with CT scan, (9) the positive predictive.

  5. CT of acute gastrointestinal disease

    International Nuclear Information System (INIS)

    Wittenberg, J.

    1991-01-01

    The application of computerized tomography in gastrointestinal tract diseases are presented, including advantages in surgical belly that are: anatomic clarity, wide survey and rapid performance. (C.G.C.)

  6. Edward’s syndrome: A rare cause of difficult intubation-utility of left molar approach

    Directory of Open Access Journals (Sweden)

    Teena Bansal

    2016-04-01

    Full Text Available Edward’s syndrome (trisomy 18 is an autosomal abnormality with dysmorphic face, visceral deformities and delayed mental and motor development including congenital heart disease. Challenges may arise during mask ventilation, laryngoscopy and/or intubation of the trachea due to dysmorphic face. Difficult airway cart should be kept ready. Left molar approach using a standard Macintosh blade improves the laryngoscopic view in patients with difficult midline laryngoscopy. We hereby present a case report of a 2 year old male child with Edward’s syndrome posted for evacuation and drainage of brain abscess, intubated successfully using left molar approach.

  7. Retrograde Intubation in Temporomandibular Joint Ankylosis-A Double Guide Wire Technique

    Directory of Open Access Journals (Sweden)

    Vitha K Dhulkhed

    2008-01-01

    Full Text Available Intubating a patient with temporomandibular joint ankylosis is always a challenge particularly when fibreoptic laryngo-scope is not available. In a 20-year-old male patient we successfully carried out endotracheal intubation with 7 mm portex cuffed PVC tube with the help of two flexible J tipped guide wires. One guide wire was passed into the airway from cricothyroid puncture site and another from subcricoid site. Both were brought out through the nose. The first guide wire was used for retracting the epiglottis and the second as a guide for passing the endotracheal tube.

  8. Succinylcholine versus rocuronium for rapid sequence intubation in intensive care: a prospective, randomized controlled trial

    Science.gov (United States)

    2011-01-01

    Introduction Succinylcholine and rocuronium are widely used to facilitate rapid sequence induction (RSI) intubation in intensive care. Concerns relate to the side effects of succinylcholine and to slower onset and inferior intubation conditions associated with rocuronium. So far, succinylcholine and rocuronium have not been compared in an adequately powered randomized trial in intensive care. Accordingly, the aim of the present study was to compare the incidence of hypoxemia after rocuronium or succinylcholine in critically ill patients requiring an emergent RSI. Methods This was a prospective randomized controlled single-blind trial conducted from 2006 to 2010 at the University Hospital of Basel. Participants were 401 critically ill patients requiring emergent RSI. Patients were randomized to receive 1 mg/kg succinylcholine or 0.6 mg/kg rocuronium for neuromuscular blockade. The primary outcome was the incidence of oxygen desaturations defined as a decrease in oxygen saturation ≥ 5%, assessed by continuous pulse oxymetry, at any time between the start of the induction sequence and two minutes after the completion of the intubation. A severe oxygen desaturation was defined as a decrease in oxygen saturation ≥ 5% leading to a saturation value of ≤ 80%. Results There was no difference between succinylcholine and rocuronium regarding oxygen desaturations (succinylcholine 73/196; rocuronium 66/195; P = 0.67); severe oxygen desaturations (succinylcholine 20/196; rocuronium 20/195; P = 1.0); and extent of oxygen desaturations (succinylcholine -14 ± 12%; rocuronium -16 ± 13%; P = 0.77). The duration of the intubation sequence was shorter after succinycholine than after rocuronium (81 ± 38 sec versus 95 ± 48 sec; P = 0.002). Intubation conditions (succinylcholine 8.3 ± 0.8; rocuronium 8.2 ± 0.9; P = 0.7) and failed first intubation attempts (succinylcholine 32/200; rocuronium 36/201; P = 1.0) did not differ between the groups. Conclusions In critically ill

  9. Evaluation of intubating conditions after rocuronium bromide in adults induced with propofol or thiopentone sodium

    Directory of Open Access Journals (Sweden)

    Moazzam Md Shahnawaz

    2011-01-01

    Full Text Available Aim: The aims of present study were to compare the propofol and rocuronium with thiopentone and rocuronium in terms of clinically satisfactory intubating conditions and to co-relate intubating conditions with degree of paralysis in adductor pollicis muscle using train of four ratio (TOFR. The intubating conditions were evaluated after rocuronium bromide 0.6 mg kg−1 at 60 s. Materials and Methods : 60 patients of ASA grades I-II of either sex, age 18-50 years, undergoing various elective surgical procedures were randomly divided into two groups, propofol rocuronium (PR group and thiopentone rocuronium (TR group of 30 patients in each. In the PR group, patients received propofol 2.5 mg kg−1 and rocuronium 0.6 mg kg−1 ; in TR group, patients received thiopentone 5 mg kg−1 and rocuronium 0.6 mg kg−1 . In all patients the intubating conditions were evaluated by the observer at 60 s. TOFR was measured at the time of intubation by an assistant. Results : In the PR group the number of the patients placed in intubating conditions grades I, II, III and IV were 40%, 36.67%, 13.33% and 10% and their mean TOFR were 31.8±17.9%, 61.8±;14.6%, 61.7±27.9%, and 78.3±5.7% respectively. While in theTR group the number of patients placed in intubating condition grade I, II, and III were 60%, 26.67%, and 13.33% and their mean TOFR , 41.2±28.3%, 68.0±10.9% and 78.7±6.8%, respectively. There was no patient in grade lV in theTR group. Conclusion : The clinical intubating conditions and degree of paralysis of adductor pollicis muscle after rocuronium 0.6 mg kg−1 at 60 s in adults induced with propofol or thiopentone sodium are comparable.

  10. A Prospective Observational Study of Technical Difficulty With GlideScope-Guided Tracheal Intubation in Children.

    Science.gov (United States)

    Zhang, Bin; Gurnaney, Harshad G; Stricker, Paul A; Galvez, Jorge A; Isserman, Rebecca S; Fiadjoe, John E

    2018-05-09

    The GlideScope Cobalt is one of the most commonly used videolaryngoscopes in pediatric anesthesia. Although visualization of the airway may be superior to direct laryngoscopy, users need to learn a new indirect way to insert the tracheal tube. Learning this indirect approach requires focused practice and instruction. Identifying the specific points during tube placement, during which clinicians struggle, would help with targeted education. We conducted this prospective observational study to determine the incidence and location of technical difficulties using the GlideScope, the success rates of various corrective maneuvers used, and the impact of technical difficulty on success rate. We conducted this observational study at our quaternary pediatric hospital between February 2014 and August 2014. We observed 200 GlideScope-guided intubations and documented key intubation-related outcomes. Inclusion criteria for patients were the number of advancement maneuvers required to intubate the trachea, the location where technical difficulty occurred, the types of maneuvers used to address difficulties, and the tracheal intubation success rate. We used a bias-corrected bootstrapping method with 300 replicates to determine the 95% confidence interval (CI) around the rate of difficulty with an intubation attempt. After excluding attempts by inexperienced clinicians, there were 225 attempts in 187 patients, 58% (131 of 225; bootstrap CI, 51.6%-64.6%]) of the attempts had technical difficulties. Technical difficulty was most likely to occur when inserting the tracheal tube between the plane of the arytenoid cartilages to just beyond the vocal cords: "zone 3." Clockwise rotation of the tube was the most common successful corrective maneuver in zone 3. The overall tracheal intubation success rate was 98% (CI, 95%-99%); however, the first attempt success rate was only 80% (CI, 74%-86%). Patients with technical difficulty had more attempts (median [interquartile range], 2 [1

  11. Drug therapy for gastrointestinal and liver diseases

    National Research Council Canada - National Science Library

    Ballinger, Anne; Farthing, M. J. G. (Michael J. G.)

    2001-01-01

    ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Gastrointestinal bleeding Matthew R Banks, Peter D Fairclough . . . . . . . . . . . . . . . . . . . . 63 Inflammatory bowel...

  12. Antioxidant supplements for preventing gastrointestinal cancers

    DEFF Research Database (Denmark)

    Bjelakovic, G; Nikolova, D; Simonetti, R G

    2004-01-01

    Oxidative stress may cause gastrointestinal cancers. The evidence on whether antioxidant supplements are effective in preventing gastrointestinal cancers is contradictory.......Oxidative stress may cause gastrointestinal cancers. The evidence on whether antioxidant supplements are effective in preventing gastrointestinal cancers is contradictory....

  13. Foreign bodies in gastrointestinal tract

    Directory of Open Access Journals (Sweden)

    Ayşe Kefeli

    2014-03-01

    Full Text Available Objective: Ingested foreign bodies in gastrointestinal tract are a common event which can cause serious morbidity and mortality in the children and adult population. For this reason, early diagnosis and treatment are crucial for preventing these life threatening complications. In this study, we aimed to analyze the characteristics of the patients with upper gastrointestinal foreign bodies that were treated in our department. Methods: Patients diagnosed with upper gastrointestinal foreign bodies who were admitted to our hospital between February 2010 and August2013 were evaluated retrospectively. The data regarding their age, gender, clinical profile, type and localization of the esophageal foreign body, performed endoscopic procedure and initial symptoms of the patients were noted and analyzed statistically. Results: Thirty-eight patients with a diagnosis of gastrointestinal foreign body were included in this study. Of these patients, 21 were male and 17 were female. The youngest patient was 17 years old and the oldest patient was 79 years old. Most of the foreign bodies (%55.3 detected in the stomach. Food waste and metallic objects in 21 and 16 patients respectively. The most common complaint was dysphagia (%50. After endoscopic intervention three of the patients were directed to surgery. Conclusion: Early recognition and treatment of gastrointestinal foreign bodies is important as their complications are life threatening. The best method of removal of foreign bodies is controversial. Early management with upper gastrointestinal endoscopy is the most efficient and safe treatment method in current conditions.

  14. Evaluation of Ambu® aScope™ 2 in awake nasotracheal intubation in anticipated difficult airway using conventional or facilitated technique: A randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Omyma Shehata Mohamed Khalifa

    2015-10-01

    Conclusion: The aScope 2 provided a high success rate in awake nasotracheal intubation in patients with anticipated difficult airway and the use of a facilitated technique shortened the time needed to perform successful videoscopic intubation.

  15. Oral to nasal tube exchange under fibroscopic view: a new technique for nasal intubation in a predicted difficult airway.

    Science.gov (United States)

    Monclus, Enric; Garcés, Antonio; Artés, David; Mabrock, Maged

    2008-07-01

    For a predicted difficult airway, oral intubation techniques are well established in pediatric anesthesia, but nasotracheal intubation remains a problem. There are many reports concerning this, but the risk of bleeding, added to the lack of cooperation make this procedure difficult and hazardous. We describe a modification of the nasal intubation technique in two stages. First an oral intubation and then exchanging the oral for a nasal tube, in the case of a 13-year-old boy affected by an advanced stage of cherubism. Oral intubation using a laryngeal mask technique has already been reported, but problems appear during the exchange procedure and even more when direct laryngoscopy is impossible. Fiberscopic control of the exchange, and the introduction of a Cook Exchange Catheter into the trachea through the oral tube before withdrawal, permits oxygenation of the patient and acts as a guide for oral tube reintroduction if required.

  16. A 12-month descriptive analysis of emergency intubations at Brooke Army Medical Center: a National Emergency Airway Registry study.

    Science.gov (United States)

    April, Michael D; Schauer, Steven G; Brown Rd, Calvin A; Ng, Patrick C; Fernandez, Jessie; Fantegrossi, Andrea E; Maddry, Joseph K; Summers, Shane; Sessions, Daniel J; Barnwell, Robert M; Antonacci, Mark

    2017-01-01

    Emergency airway management is a critical skill for military healthcare providers. Our goal was to describe the Emergency Department (ED) intubations at Brooke Army Medical Center (BAMC) over a 12-month period. Physicians performing endotracheal intubations in the BAMC ED complete data collection forms for each intubation event as part of the National Emergency Airway Registry, including patient demographics, intubation techniques, success and failure rates, adverse events, and patient disposition. We cross-referenced these forms against the numbers of intubation events reported in the ED nursing daily reports to ensure capture of all intubations. Providers completed forms for every intubation within 6 weeks of the procedure. We analyzed data from March 28, 2016, to March 27, 2017. During the study period, providers performed 259 intubations in the BAMC ED. Reasons for intubation were related to trauma for 184 patients (71.0%) and medical conditions for 75 patients (29.0%). Overall, first-attempt success was 83.0%. Emergency medicine residents performed a majority of first attempts (95.0%). Most common devices chosen on first attempt were a video laryngoscope for 143 patients (55.2%) and a direct laryngoscope for 115 patients (44.4%). One patient underwent cricothyrotomy. The 2 most common induction agents were ketamine (59.8%; 95% CI, 55.2%-67.4%) and etomidate (19.3%; 95% CI, 14.7%-24.7%). The most common neuromuscular blocking agents were rocuronium (62.9%; 95% CI, 56.7%-68.8%) and succinylcholine (18.9%; 95% CI, 14.3%-24.2%). In the BAMC ED, emergency intubation most commonly occurred for trauma indications using video laryngoscopy with a high first-pass success.

  17. Safe intubation in Morquio-Brailsford syndrome: A challenge for the anesthesiologist

    Directory of Open Access Journals (Sweden)

    Souvik Chaudhuri

    2013-01-01

    Full Text Available Morquio-Brailsford syndrome is a type of mucopolysaccharidoses. It is a rare disease with features of short stature, atlantoaxial instability with risk of cord damage, odontoid hypoplasia, pectus carinatum, spine deformities, hepatomegaly, and restrictive lung disease. Neck movements during intubation are associated with the risk of quadriparesis due to cervical instability. This, along with the distortion of the airway anatomy due to deposition of mucopolysaccharides makes airway management arduous. We present our experience in management of difficult airway in a 3-year-old girl with Morquio-Brailsford syndrome posted for magnetic resonance imaging and computerized tomography scan of a suspected unstable cervical spine. As utmost sagacity during intubation is required, the child was intubated inside operation theatre in the presence of experienced anesthesiologists and then shifted to the peripheral location. Intubation was done with an endotracheal tube railroaded over a pediatric fibreoptic bronchoscope passed through the lumen of a classic laryngeal mask airway, keeping head in neutral position.

  18. A Non-invasive Real-time Localization System for Enhanced Efficacy in Nasogastric Intubation.

    Science.gov (United States)

    Sun, Zhenglong; Foong, Shaohui; Maréchal, Luc; Tan, U-Xuan; Teo, Tee Hui; Shabbir, Asim

    2015-12-01

    Nasogastric (NG) intubation is one of the most commonly performed clinical procedures. Real-time localization and tracking of the NG tube passage at the larynx region into the esophagus is crucial for safety, but is lacking in current practice. In this paper, we present the design, analysis and evaluation of a non-invasive real-time localization system using passive magnetic tracking techniques to improve efficacy of the clinical NG intubation process. By embedding a small permanent magnet at the insertion tip of the NG tube, a wearable system containing embedded sensors around the neck can determine the absolute position of the NG tube inside the body in real-time to assist in insertion. In order to validate the feasibility of the proposed system in detecting erroneous tube placement, typical reference intubation trajectories are first analyzed using anatomically correct models and localization accuracy of the system are evaluated using a precise robotic platform. It is found that the root-mean-squared tracking accuracy is within 5.3 mm for both the esophagus and trachea intubation pathways. Experiments were also designed and performed to demonstrate that the system is capable of tracking the NG tube accurately in biological environments even in presence of stationary ferromagnetic objects (such as clinical instruments). With minimal physical modification to the NG tube and clinical process, this system allows accurate and efficient localization and confirmation of correct NG tube placement without supplemental radiographic methods which is considered the current clinical standard.

  19. Ketorolac Tromethamine Spray Prevents Postendotracheal-Intubation-Induced Sore Throat after General Anesthesia

    Directory of Open Access Journals (Sweden)

    H. L. Yang

    2016-01-01

    Full Text Available Background. Postoperative sore throat is one of the major complaints of general anesthesia in the postanesthesia care unit. This prospective study investigated the preventive effect of ketorolac tromethamine spray in postendotracheal-intubation-induced sore throat after general anesthesia. Methods. Surgical patients undergoing general anesthesia with endotracheal intubation were recruited from a medical center. Patients were randomly assigned to group K (treated with 5% ketorolac tromethamine spray or group D (treated with distilled water spray. Before intubation, each endotracheal tube was sprayed with the appropriate solution by physicians over the 20 cm length of the cuff. Each group comprised 95 patients fitting the inclusion and exclusion criteria for whom complete data sets were collected. The intensity of the sore throat was measured at 1, 3, 6, and 24 h after surgery, and data were compared. Results. The two groups had similar characteristics. Postoperative sore throat was significantly less frequent in group K than in group D (p<0.001 and the pain intensity was significantly lower in group K than in group D at each time point (all p<0.001. Conclusions. This study demonstrated that preanesthesia 5% ketorolac tromethamine spray could effectively decrease postendotracheal-intubation-induced sore throat in patients undergoing general anesthesia.

  20. Orotracheal intubation and dysphagia: comparison of patients with and without brain damage

    Directory of Open Access Journals (Sweden)

    Aline Rodrigues Padovani

    2008-09-01

    Full Text Available Objectives: To compare the swallowing and feeding abilities in extubated patients with and without brain injury. Methods: A retrospective study including 44 patients aged 20 to 50 years submitted to prolonged orotracheal intubation (> 48 hours. Two groups were analyzed: Group 1 composed of nontraumatic brain injury patients, and Group 2 composed of patients with traumatic brain injury. Two scales for characterization of functional swallowing and feeding abilities were used to compare both groups; the levels of alertness, awareness and patient collaboration were also assessed. Rresults: The groups were equal in age, number and time of orotracheal intubation and extubation on the date of the assessment. Regarding the speech and language diagnosis, Group 1 presented higher percentage of functional swallowing and mild dysphagia, while Group 2 showed higher rates of moderate to severe dysphagia and severe dysphagia. The Functional Oral Intake Scale average was higher in Group 1. In addition, the injured brain group was sleepier, less collaborative and had less contact in the first evaluation. Cconclusions: In this study, patients who underwent prolonged orotracheal intubation had dysphagia in different degrees, but the patients with brain injury presented more frequent and severe disorder. Thus, this study suggested that orotracheal intubation cannot be considered as the single factor causing dysphagia, especially in neurological patients. Moreover, some cognitive factors may influence the possibility of providing oral feeding.

  1. Modeling water vapor and heat transfer in the normal and the intubated airways.

    Science.gov (United States)

    Tawhai, Merryn H; Hunter, Peter J

    2004-04-01

    Intubation of the artificially ventilated patient with an endotracheal tube bypasses the usual conditioning regions of the nose and mouth. In this situation any deficit in heat or moisture in the air is compensated for by evaporation and thermal transfer from the pulmonary airway walls. To study the dynamics of heat and water transport in the intubated airway, a coupled system of nonlinear equations is solved in airway models with symmetric geometry and anatomically based geometry. Radial distribution of heat, water vapor, and velocity in the airway are described by power-law equations. Solution of the time-dependent system of equations yields dynamic airstream and mucosal temperatures and air humidity. Comparison of model results with two independent experimental studies in the normal and intubated airway shows a close correlation over a wide range of minute ventilation. Using the anatomically based model a range of spatially distributed temperature paths is demonstrated, which highlights the model's ability to predict thermal behavior in airway regions currently inaccessible to measurement. Accurate representation of conducting airway geometry is shown to be necessary for simulating mouth-breathing at rates between 15 and 100 l x min(-1), but symmetric geometry is adequate for the low minute ventilation and warm inspired air conditions that are generally supplied to the intubated patient.

  2. Survey of Accepted Practice following Failed Intubation for Emergency Caesarean Delivery

    Directory of Open Access Journals (Sweden)

    Daniel Soltanifar

    2015-01-01

    Full Text Available Background. There is no consensus on the optimum management of failed tracheal intubation in emergency cesarean delivery performed for fetal compromise. The decision making process on whether to wake the patient or continue anesthesia with a supraglottic airway device is an underexplored area. This survey explores perceptions and experiences of obstetric anesthetists managing failed intubation. Methods. Anesthetists attending the Group of Obstetric Anaesthetists London (GOAL Meeting in April 2014 were surveyed. Results. Ninety-three percent of anesthetists surveyed would not always wake the patient in the event of failed intubation for emergency cesarean delivery performed for fetal compromise. The median (interquartile range of perceived acceptability of continuing anesthesia with a well-fitting supraglottic airway device, assessed using a visual analogue scale (0–100; 0 completely unacceptable; 100 completely acceptable, was 90 [22.5]. Preoperative patient consent regarding the use of a supraglottic airway device for surgery in the event of failed intubation would affect the decision making of 40% of anaesthetists surveyed. Conclusion. These results demonstrate that a significant body of anesthetists with a subspecialty interest in obstetric anesthesia in the UK would not always wake up the patient and would continue with anesthesia and surgery with a supraglottic airway device in this setting.

  3. Incidence and endoscopic characteristics of acute laryngeal lesions in children undergoing endotracheal intubation

    Directory of Open Access Journals (Sweden)

    Eliandra da Silveira de Lima

    Full Text Available ABSTRACT INTRODUCTION: Acute laryngeal lesions after intubation appear to be precursors of chronic lesions. OBJECTIVE: To describe the incidence and type of acute laryngeal lesions after extubation in a pediatric intensive care unit (PICU. METHODS: A cohort study involving children from birth to <5 years, submitted to intubation for more than 24 h in the PICU of an university hospital. In the first eight hours after extubation, a flexible fiberoptic laryngoscopy (FFL was performed at the bedside. Those with moderate to severe abnormalities underwent a second examination seven to ten days later. RESULTS: 177 patients were included, with a median age of 2.46 months. The mean intubation time was 8.19 days. Seventy-three (41.2% patients had moderate or severe alterations at the FFL, with the remaining showing only minor alterations or normal results. During follow-up, 16 children from the group with moderate to severe lesions developed subglottic stenosis. One patient from the normal FFL group had subglottic stenosis, resulting in an incidence of 9.6% of chronic lesions. CONCLUSION: Most children in the study developed mild acute laryngeal lesions caused by endotracheal intubation, which improved in a few days after extubation.

  4. Non-intubated recovery from refractory cardiogenic shock on percutaneous VA-extracorporeal membrane oxygenation

    NARCIS (Netherlands)

    van Houte, J; Donker, D W; Wagenaar, L J; Slootweg, A P; Kirkels, J H; van Dijk, D

    We report on the use of percutaneous femoral veno-arterial extracorporeal membrane oxygenation (VA-ECMO) in a fully awake, non-intubated and spontaneously breathing patient suffering from acute, severe and refractory cardiogenic shock due to a (sub)acute anterior myocardial infarction. Intensified

  5. Nasal endotracheal intubation in a premature infant with a nasal encephalocele.

    Science.gov (United States)

    Bannister, C M; Kashab, M; Dagestani, H; Placzek, M

    1993-01-01

    After a difficult nasal intubation a premature infant leaked cerebrospinal fluid (CSF) from one nostril. After developing bacterial meningitis, the baby was referred for neurosurgical management of the CSF fistula. Transaxial computed tomograms demonstrated a nasal encephalocele, but coronal scans were needed to show the defect in the cribriform plate. Images PMID:8346963

  6. A systematic review and meta-regression analysis of mivacurium for tracheal intubation

    NARCIS (Netherlands)

    Vanlinthout, L.E.H.; Mesfin, S.H.; Hens, N.; Vanacker, B.F.; Robertson, E.N.; Booij, L.H.D.J.

    2014-01-01

    We systematically reviewed factors associated with intubation conditions in randomised controlled trials of mivacurium, using random-effects meta-regression analysis. We included 29 studies of 1050 healthy participants. Four factors explained 72.9% of the variation in the probability of excellent

  7. TIME-COURSE OF ACTION AND INTUBATING CONDITIONS FOLLOWING VECURONIUM, ROCURONIUM AND MIVACURIUM

    NARCIS (Netherlands)

    WIERDA, JMKH; HOMMES, FDM; NAP, HJA; VANDENBROEK, L

    The purpose of this study was to compare the time course of action and tracheal intubating conditions of vecuronium, rocuronium, and mivacurium in anaesthetised patients. Anaesthesia consisted of thiopentone, fentanyl, N2O/O-2 and isoflurane. After a 2 x ED(50) dose the first attempt at tracheal

  8. Cuff inflation to aid nasotracheal intubation using the C-mac ...

    African Journals Online (AJOL)

    The main thrust of the technique is that cuff inflation of the endotracheal tube is used to lift the endotracheal tube off the posterior pharyngeal wall and thus direct it towards the glottis. The technique was used successfully in 5 consecutive patients needing nasotracheal intubation. Indeed a couple of these patients might have ...

  9. A Continuous Quality Improvement Airway Program Results in Sustained Increases in Intubation Success.

    Science.gov (United States)

    Olvera, David J; Stuhlmiller, David F E; Wolfe, Allen; Swearingen, Charles F; Pennington, Troy; Davis, Daniel P

    2018-02-21

    Airway management is a critical skill for air medical providers, including the use of rapid sequence intubation (RSI) medications. Mediocre success rates and a high incidence of complications has challenged air medical providers to improve training and performance improvement efforts to improve clinical performance. The aim of this research was to describe the experience with a novel, integrated advanced airway management program across a large air medical company and explore the impact of the program on improvement in RSI success. The Helicopter Advanced Resuscitation Training (HeART) program was implemented across 160 bases in 2015. The HeART program includes a novel conceptual framework based on thorough understanding of physiology, critical thinking using a novel algorithm, difficult airway predictive tools, training in the optimal use of specific airway techniques and devices, and integrated performance improvement efforts to address opportunities for improvement. The C-MAC video/direct laryngoscope and high-fidelity human patient simulation laboratories were implemented during the study period. Chi-square test for trend was used to evaluate for improvements in airway management and RSI success (overall intubation success, first-attempt success, first-attempt success without desaturation) over the 25-month study period following HeART implementation. A total of 5,132 patients underwent RSI during the study period. Improvements in first-attempt intubation success (85% to 95%, p improving RSI intubation performance in a large air medical company.

  10. The Effect of Tracheal Intubation-Induced Autonomic Response on Photoplethysmography

    Directory of Open Access Journals (Sweden)

    Pekka Talke

    2017-01-01

    Full Text Available Introduction. Intraoperative stress responses and postoperative pain can be monitored using photoplethysmography (PPG. PPG signal has two components, AC and DC. Effects of noxious stimuli-induced stress responses have not been studied on the DC component of PPG. The aim of this study was to investigate the effect of a known noxious stimulus (endotracheal intubation on both the AC and DC components of PPG. Methods. 15 surgical patients having general anesthesia were enrolled into this clinical study. PPG was recorded electronically from a pulse oximeter. Maximum changes in the AC and DC components of the PPG and pulse rate were determined in response to endotracheal intubation from high frequency (62.5 Hz PPG recordings. Results. Endotracheal intubation-induced autonomic stress response resulted in a significant decrease in the AC component of the PPG and an increase in pulse rate in every subject (p<0.05 for all. The decrease in the AC component of the PPG was 50±12% (p<0.05 and the increase in pulse rate was 26±10 bpm (p<0.05. The response of the DC component was variable (p = NS. Conclusion. Endotracheal intubation-induced stress response resulted in a significant and consistent change in the AC, but not the DC component of the PPG. This trial is registered with ClinicalTrials.gov Identifier NCT03032939.

  11. Verification of endotracheal intubation in obese patients - temporal comparison of ultrasound vs. auscultation and capnography

    DEFF Research Database (Denmark)

    Pfeiffer, P; Bache, Stefan Holst; Isbye, D L

    2012-01-01

    Ultrasound (US) may have an emerging role as an adjunct in verification of endotracheal intubation. Obtaining optimal US images in obese patients is generally regarded more difficult than for other patients. This study compared the time consumption of bilateral lung US with auscultation and capno...

  12. Failed obstetric tracheal intubation and postoperative respiratory support with the ProSeal laryngeal mask airway

    NARCIS (Netherlands)

    Keller, Christian; Brimacombe, Joseph; Lirk, Philipp; Pühringer, Fritz

    2004-01-01

    The ProSeal laryngeal mask airway (ProSeal LMA) provides a better seal and probably better airway protection than the classic laryngeal mask airway (classic LMA). We report the use of the ProSeal LMA in a 26-yr-old female with HELLP syndrome for failed obstetric intubation and postoperative

  13. Diffuse idiopathic skeletal hyperostosis of cervical spine - An unusual cause of difficult flexible fiber optic intubation

    Directory of Open Access Journals (Sweden)

    Baxi Vaibhavi

    2010-01-01

    Full Text Available This is a report of anterior osteophytes on the cervical vertebra resulting in distortion of the airway and leading to difficulty during intubation. The osteophytes associated with the syndrome of diffuse idiopathic skeletal hyperostosis were at the C2-3 and C6-7, T1 level and resulted in anterior displacement of the pharynx and the trachea respectively.

  14. Small bowel enteroscopy and intraoperative enteroscopy for obscure gastrointestinal bleeding.

    Science.gov (United States)

    Lewis, B S; Wenger, J S; Waye, J D

    1991-02-01

    Intraoperative endoscopy (IOE) is accepted as the ultimate diagnostic procedure for completely evaluating the small bowel in patients with obscure gastrointestinal (GI) bleeding. Small bowel enteroscopy (SBE) has been reported useful in the nonsurgical evaluation of the small intestine in these patients, but findings may be limited because of incomplete small bowel intubation and a lack of tip deflection. Twenty-three patients underwent 25 SBE exams and subsequently had 25 IOE exams during surgical exploration for continued bleeding. Patients' bleeding histories averaged 2 yr, with an average transfusion requirement of 27 units. Findings on IOE were the same as with SBE in 17/22 (77%) of examinations. We conclude that SBE and IOE are comparable in depth of insertion and ability to detect small vascular ectasias. Both procedures missed pathology due to limited visibility and the evanescent nature of ectasias. Long-term success in abolishing bleeding with these combined techniques can be expected in 55% of these patients. SBE should precede surgery, since the finding of diffuse ectasias precludes any benefit from operative intervention.

  15. Verification of endotracheal intubation in obese patients - temporal comparison of ultrasound vs. auscultation and capnography.

    Science.gov (United States)

    Pfeiffer, P; Bache, S; Isbye, D L; Rudolph, S S; Rovsing, L; Børglum, J

    2012-05-01

    Ultrasound (US) may have an emerging role as an adjunct in verification of endotracheal intubation. Obtaining optimal US images in obese patients is generally regarded more difficult than for other patients. This study compared the time consumption of bilateral lung US with auscultation and capnography for verifying endotracheal intubation in obese patients. A prospective, paired and investigator-blinded study performed in the operating theatre. Twenty-four adult patients requiring endotracheal intubation for bariatric surgery were included. During post-intubation bag ventilation, bilateral lung US was performed for detection of lungsliding indicating lung ventilation simultaneous with capnography and auscultation of epigastrium and chest. Primary outcome measure was the time difference to confirmed endotracheal intubation between US and auscultation alone. The secondary outcome measure was time difference between US and auscultation combined with capnography. Both methods verified endotracheal tube placement in all patients. No significant difference was found between US compared with auscultation alone. Median time for verification by auscultation alone was 47.5 s [interquartile (IQR) 40-51 s], with a mean difference of -0.3 s in favor of US (95% confidence interval -3.5-2.9 s) P = 0.87. Comparing US with the combination of auscultation and capnography, there was a significant difference between the two methods. Median time for verification by US was 43 s (IQR 40-51 s) vs. 55 s (IQR 46-65 s), P auscultation alone and faster than the standard method of auscultation and capnography. © 2012 The Authors. Acta Anaesthesiologica Scandinavica © 2012 The Acta Anaesthesiologica Scandinavica Foundation.

  16. Middle finger length-based tracheal intubation depth improves the rate of appropriate tube placement in children.

    Science.gov (United States)

    Zhou, Qing-he; Xiao, Wang-pin; Zhou, Hong-mei

    2015-11-01

    It is challenging for anesthetists to determine the optimal tracheal intubation depth in children. We hypothesize that a measure three times the length of the middle finger can be used for predicting tracheal tube depth in children. Eighty-six children (4-14 years of age) were included in this study. After the children were anesthetized, a fiberoptic bronchoscope (FOB) was inserted into the trachea, the lengths from the upper incisor teeth to carina and vocal cords were measured, and a suitably sized cuffed tracheal tube was inserted into the trachea. Age-based and middle finger length-based formulas were used to determine the tracheal intubation depth. All 86 children enrolled were included in this study. Compared with the age-based intubation, the rate of appropriate tube placement was higher for middle finger length-based intubation (88.37% vs 66.28%, P = 0.001). The proximal intubation rate was lower in middle finger length-based intubation (4.65% vs 32.56%, P tube depth was larger than that between age and optimal tracheal tube depth (0.883 vs 0.845). Our data indicate that the appropriate tube placement rate can be improved by using three times the middle finger length as the tracheal intubation depth in children. © 2015 John Wiley & Sons Ltd.

  17. Comparison of the effects of remifentanil and remifentanil plus lidocaine on intubation conditions in intellectually disabled patients

    Directory of Open Access Journals (Sweden)

    Can Eyigor

    2014-07-01

    Full Text Available BACKGROUND AND OBJECTIVES: This is a prospective, randomized, single-blind study. We aimed to compare the tracheal intubation conditions and hemodynamic responses either remifentanil or a combination of remifentanil and lidocaine with sevoflurane induction in the absence of neuromuscular blocking agents. METHODS: Fifty intellectually disabled, American Society of Anesthesiologists I-II patients who underwent tooth extraction under outpatient general anesthesia were included in this study. Patients were randomized to receive either 2 μg kg-1 remifentanil (Group 1, n = 25 or a combination of 2 μg kg-1 remifentanil and 1 mg kg-1 lidocaine (Group 2, n = 25. To evaluate intubation conditions, Helbo-Hansen scoring system was used. In patients who scored 2 points or less in all scorings, intubation conditions were considered acceptable, however if any of the scores was greater than 2, intubation conditions were regarded unacceptable. Mean arterial pressure, heart rate and peripheral oxygen saturation (SpO2 were recorded at baseline, after opioid administration, before intubation, and at 1, 3, and 5 min after intubation. RESULTS: Acceptable intubation parameters were achieved in 24 patients in Group 1 (96% and in 23 patients in Group 2 (92%. In intra-group comparisons, the heart rate and mean arterial pressure values at all-time points in both groups showed a significant decrease compared to baseline values (p = 0.000 CONCLUSION: By the addition of 2 μg/kg remifentanil during sevoflurane induction, successful tracheal intubation can be accomplished without using muscle relaxants in intellectually disabled patients who undergo outpatient dental extraction. Also worth noting, the addition of 1 mg/kg lidocaine to 2 μg/kg remifentanil does not provide any additional improvement in the intubation parameters.

  18. Laryngoscope and a new tracheal tube assist lightwand intubation in difficult airways due to unstable cervical spine.

    Directory of Open Access Journals (Sweden)

    Cai-neng Wu

    Full Text Available The WEI Jet Endotracheal Tube (WEI JET is a new tracheal tube that facilitates both oxygenation and ventilation during the process of intubation and assists tracheal intubation in patients with difficult airway. We evaluated the effectiveness and usefulness of the WEI JET in combination with lightwand under direct laryngoscopy in difficult tracheal intubation due to unstable cervical spine.Ninety patients with unstable cervical spine disorders (ASA I-III with general anaesthesia were included and randomly assigned to three groups, based on the device used for intubation: lightwand only, lightwand under direct laryngoscopy, lightwand with WEI JET under direct laryngoscopy.No statistically significant differences were detected among three groups with respect to demographic characteristics and C/L grade. There were statistically significant differences between three groups for overall intubation success rate (p = 0.015 and first attempt success rate (p = 0.000. The intubation time was significantly longer in the WEI group (110.8±18.3 s than in the LW group (63.3±27.5 s, p = 0.000 and DL group (66.7±29.4 s, p = 0.000, but the lowest SpO2 in WEI group was significantly higher than other two groups (p<0.01. The WEI JET significantly reduced successful tracheal intubation attempts compared to the LW group (p = 0.043. The severity of sore throat was similar in three groups (p = 0.185.The combined use of WEI JET under direct laryngoscopy helps to assist tracheal intubation and improves oxygenation during intubation in patients with difficult airway secondary to unstable spine disorders.Chinese Clinical Trial Registry ChiCTR-TRC-14005141.

  19. A mannequin study of intubation with the AP advance and GlideScope Ranger videolaryngoscopes and the Macintosh laryngoscope.

    Science.gov (United States)

    Hodd, Jack A R; Doyle, D John; Gupta, Shipra; Dalton, Jarrod E; Cata, Juan P; Brewer, Edward J; James, Monyulona; Sessler, Daniel I

    2011-10-01

    The AP Advance (APA) is a videolaryngoscope with interchangeable blades: intubators can choose standard Macintosh blades or a difficult-airway blade with increased curvature and a channel to guide the tube to the larynx. The APA may therefore be comparably effective in both normal and difficult airways. We tested the hypotheses that intubation with the APA is no slower than Macintosh laryngoscopy for normal mannequin airways, and that it is no slower than videolaryngoscopy using a GlideScope Ranger in difficult mannequin airways. Medical professionals whose roles potentially include tracheal intubation were trained with each device. Participants intubated simulated (Laerdal SimMan) normal and difficult airways with the APA, GlideScope, and a conventional Macintosh blade. Speed of intubation was compared using Cox proportional hazards regression, with a hazard ratio >0.8 considered noninferior. We also compared laryngeal visualization, failures, and participant preferences. Unadjusted intubation times in the normal airway with the APA and Macintosh were virtually identical (median, 22 vs 23 seconds); after adjustment for effects of experience, order, and period, the hazard ratio (95% confidence interval) comparing APA with Macintosh laryngoscopy was 0.87 (0.65, 1.17), which was not significantly more than our predefined noninferiority boundary of 0.8 (P = 0.26). Intubation with the APA was faster than with the GlideScope in difficult airways (hazard ratio = 7.6 [5.0, 11.3], P APA, whereas 33% and 37% failed with the GlideScope and Macintosh, respectively. In the difficult airway, 99% of participants achieved a Cormack and Lehane grade I to II view with the APA, versus 85% and 33% with the GlideScope and Macintosh, respectively. When asked to choose 1 device overall, 82% chose the APA. Intubation times were similar with the APA and Macintosh laryngoscopes in mannequins with normal airways. However, intubation with the APA was significantly faster than with the Glide

  20. Intubation conditions in young infants after propofol and remifentanil induction with and without low-dose rocuronium.

    Science.gov (United States)

    Gelberg, J; Kongstad, L; Werner, O

    2014-08-01

    Bolus injections of intravenous propofol and remifentanil can be used in the tracheal intubation of infants and children, but relatively large doses are needed. We hypothesised that addition of a small bolus of rocuronium would ensure good intubation conditions when modest propofol and remifentanil doses were used. Seventy infants between 3 weeks and 4 months of age were randomised to receive either placebo or rocuronium. Anaesthesia was induced with IV propofol, 3 (3-5) mg/kg [median (range)]. Rocuronium (0.2 mg/kg) or placebo was then injected, followed 15 s later by 2 μg/kg remifentanil. One anaesthetist attempted tracheal intubation 1 min after the rocuronium/placebo injection and used the 'Copenhagen scoring system' to assess intubation conditions. The neuromuscular effect of 0.2 mg/kg rocuronium was recorded in another eight, already intubated, infants using thumb accelerometry during train-of-four stimulation of the ulnar nerve. Intubation conditions were classified as 'poor' in 14 of 34 (41%) patients given placebo and in 10 of 36 (28%) patients given rocuronium (P = 0.32). There were four failed first attempts at intubation in the placebo group and none in the rocuronium group (P = 0.051). Maximum neuromuscular depression occurred 4 (3-8) after injection of 0.2 mg/kg rocuronium. Intubation conditions were poor in almost one third of the patients receiving propofol-remifentanil. Adding a low-dose rocuronium did not significantly improve intubation conditions. © 2014 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

  1. Effects of Fentanyl-lidocaine-propofol and Dexmedetomidine-lidocaine-propofol on Tracheal Intubation Without Use of Muscle Relaxants

    Directory of Open Access Journals (Sweden)

    Volkan Hancı

    2010-05-01

    Full Text Available The aim of this study was to compare the effects of fentanyl or dexmedetomidine when used in combination with propofol and lidocaine for tracheal intubation without using muscle relaxants. Sixty patients with American Society of Anesthesiologists stage I risk were randomized to receive 1 mg/kg dexmedetomidine (Group D, n = 30 or 2 mg/kg fentanyl (Group F, n = 30, both in combination with 1.5 mg/kg lidocaine and 3 mg/kg propofol. The requirement for intubation was determined based on mask ventilation capability, jaw motility, position of the vocal cords and the patient's response to intubation and inflation of the endotracheal tube cuff. Systolic arterial pressure, mean arterial pressure, heart rate and peripheral oxygen saturation values were also recorded. Rate pressure products were calculated. Jaw relaxation, position of the vocal cords and patient's response to intubation and inflation of the endotracheal tube cuff were significantly better in Group D than in Group F (p < 0.05. The intubation conditions were significantly more satisfactory in Group D than in Group F (p = 0.01. Heart rate was significantly lower in Group D than in Group F after the administration of the study drugs and intubation (p < 0.05. Mean arterial pressure was significantly lower in Group F than in Group D after propofol injection and at 3 and 5 minutes after intubation (p < 0.05. After intubation, the rate pressure product values were significantly lower in Group D than in Group F (p < 0.05. We conclude that endotracheal intubation was better with the dexmedetomidine–lidocaine–propofol combination than with the fentanyl–lidocaine–propofol combination. However, side effects such as bradycardia should be considered when using dexmedetomidine.

  2. Midline submental intubation might be the preferred alternative to oral and nasal intubation in elective oral and craniomaxillofacial surgery when indicated.

    Science.gov (United States)

    Jin, Huijun; Patil, Pavan Manohar

    2015-01-01

    No consensus exists to date regarding the best method of controlling the airway for oral or craniomaxillofacial surgery when orotracheal and nasotracheal intubations are unsuccessful or contraindicated. The most commonly used method of tracheostomy has been associated with a high degree of morbidity. Therefore, the present study was conducted to determine the indications, safety, efficacy, time required, drawbacks, complications, and costs of the midline submental intubation (SMI) approach in elective oral and craniomaxillofacial surgical procedures. A retrospective case series study was used to evaluate the surgical, financial, and photographic records of all patients who had undergone oral or craniomaxillofacial operations at Sharda University School of Dental Sciences, Greater Noida, from April 2006 to March 2014. The indications, drawbacks, time required for the procedure, ability to provide a secure airway, intra- and postoperative complications, and additional costs associated with SMI were analyzed. Of the 2,823 patients treated, the present study included 120 patients (97 men and 23 women, aged 19 to 60 years). The average time required for SMI was 10 ± 2 minutes. No episode of intraoperative oxygen desaturation was noted. One intraoperative complication, an injury to the ventral surface of the tongue, was encountered. Two patients developed infection at the skin incision site. No significant additional cost was incurred with the use of SMI. SMI has been successfully used in elective oral and craniomaxillofacial surgical procedures for which oral and nasal intubations were either not indicated or not possible. The advantages include a quick procedure, insignificant complications, the ability to provide a stable airway, and no added costs, making SMI a quick, safe, efficient, and cost-effective alternative in such cases. Copyright © 2015 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  3. Optimizing oxygenation and intubation conditions during awake fibre-optic intubation using a high-flow nasal oxygen-delivery system.

    Science.gov (United States)

    Badiger, S; John, M; Fearnley, R A; Ahmad, I

    2015-10-01

    Awake fibre-optic intubation is a widely practised technique for anticipated difficult airway management. Despite the administration of supplemental oxygen during the procedure, patients are still at risk of hypoxia because of the effects of sedation, local anaesthesia, procedural complications, and the presence of co-morbidities. Traditionally used oxygen-delivery devices are low flow, and most do not have a sufficient reservoir or allow adequate fresh gas flow to meet the patient's peak inspiratory flow rate, nor provide an adequate fractional inspired oxygen concentration to prevent desaturation should complications arise. A prospective observational study was conducted using a high-flow humidified transnasal oxygen-delivery system during awake fibre-optic intubation in 50 patients with anticipated difficult airways. There were no episodes of desaturation or hypercapnia using the high-flow system, and in all patients the oxygen saturation improved above baseline values, despite one instance of apnoea resulting from over-sedation. All patients reported a comfortable experience using the device. The high-flow nasal oxygen-delivery system improves oxygenation saturation, decreases the risk of desaturation during the procedure, and potentially, optimizes conditions for awake fibre-optic intubation. The soft nasal cannulae uniquely allow continuous oxygenation and simultaneous passage of the fibrescope and tracheal tube. The safety of the procedure may be increased, because any obstruction, hypoventilation, or periods of apnoea that may arise may be tolerated for longer, allowing more time to achieve ventilation in an optimally oxygenated patient. © The Author 2015. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  4. Use of intubating laryngeal mask airway in a morbidly obese patient with chest trauma in an emergency setting

    Directory of Open Access Journals (Sweden)

    Tripat Bindra

    2011-01-01

    Full Text Available A morbidly obese male who sustained blunt trauma chest with bilateral pneumothorax was referred to the intensive care unit for management of his condition. Problems encountered in managing the patient were gradually increasing hypoxemia (chest trauma with multiple rib fractures with lung contusions and difficult mask ventilation and intubation (morbid obesity, heavy jaw, short and thick neck. We performed awake endotracheal intubation using an intubating laryngeal mask airway (ILMA size 4 and provided mechanical ventilation to the patient. This report suggests that ILMA can be very useful in the management of difficult airway outside the operating room and can help in preventing adverse events in an emergency setting.

  5. Comparison of rocuronium at two different doses and succinylcholine for endotracheal intubation in adult patients for elective surgeries.

    Science.gov (United States)

    Chavan, S G; Gangadharan, S; Gopakumar, A K

    2016-01-01

    The effects of rocuronium at two different doses, that is, 0.6 mg/kg (2 × ED95) and 0.9 mg/kg (3 × ED95), were compared with succinylcholine (2 mg/kg) when used for endotracheal intubation in adult patients for elective surgeries under general anesthesia. Ninety patients were divided into three groups of 30 each. Groups A, B received injection rocuronium at 0.6 mg/kg, 0.9 mg/kg respectively and Group C received succinylcholine at 2 mg/kg. Onset of action of relaxant, intubation conditions, time taken to intubate and duration of action were compared. To compare the statistical difference in the age, weight, height of the study subjects, onset of action of relaxant, intubation conditions, time taken to intubate, and duration of action analysis of variance and unpaired t -test were used. The onset time was considerably shorter with rocuronium 0.9 mg/kg than 0.6 mg/kg. The onset time of rocuronium 0.9 mg/kg was found to be significantly longer than succinylcholine 2 mg/kg. Time taken to intubate was shortest with succinylcholine 2 mg/kg. The time taken to intubate with the rocuronium 0.9 mg/kg was found to be comparable to that of rocuronium 0.6 mg/kg. Intubation score of rocuronium 0.9 mg/kg was the best (17.75), which was comparable with succinylcholine. However, the intubation score obtained with rocuronium 0.6 mg/kg was inferior. Duration of action was shortest with succinylcholine. The duration of action is prolonged when the dose of rocuronium is increased from 0.6 to 0.9 mg/kg. Rapid sequence induction of anesthesia with propofol and fentanyl, succinylcholine allowed a more rapid endotracheal intubation sequence and created superior intubation conditions than rocuronium. However, the technique of using a large dose of rocuronium to achieve perfect conditions for tracheal intubation may have application whenever succinylcholine is relatively contraindicated.

  6. Effect of rocuronium on the bispectral index under anesthesia and tracheal intubation.

    Science.gov (United States)

    Yue, Hui; Han, Jinyu; Liu, Ling; Wang, Kaiyuan; Li, Jincheng

    2016-12-01

    The aim of the present study was to investigate the effect of various doses of rocuronium on bispectral index (BIS) responses to propofol induction and tracheal intubation, as well as the role of the non-depolarization muscle relaxant rocuronium on the depth of sedation. A total of 72 patients (American Society of Anesthesiologists physical status I-II) were anaesthetized with propofol using a target-controlled infusion, and randomly divided into two sedation level groups (n=36). The patients were divided into 2 groups according to the BIS value: A normal sedation group (group 1), with a stable BIS value at 40-60, and a deep sedation group (group 2), with a BIS value rocuronium (0.3, 0.6, 0.9 and 1.2 mg/kg). Tracheal intubation was performed after 2 min of rocuronium administration. BIS, electromyography (EMG), heart rate (HR) and mean arterial pressure (MAP) were recorded continuously and averaged over 1 min during baseline (T1), steady state (T2), 2 min after rocuronium infusion (T3), and 0, 2 and 5 min after tracheal intubation. The results demonstrated that HR and MAP decreased significantly at T2 and T3 compared with T1. Following tracheal intubation (L0), HR and MAP significantly increased compared with T2 and T3, and returned to levels similar to those prior to intubation after 5 min. In group 1C and 1D, BIS was significantly decreased at T3 compared with T2; BIS was significantly increased at L0 compared with T3 in group 1A and 1B. EMG at earlier stages of anesthesia was significantly higher compared with other points, and was significantly increased at L0 compared with T3 in group 1A and 1B. These results demonstrated that BIS response may be associated with the dosage of rocuronium in the normal sedation group, although no association was observed with the deep sedation group. Tracheal intubation resulted in marked hemodynamic changes under both normal and deep sedation.

  7. Risk factors for SARS transmission from patients requiring intubation: a multicentre investigation in Toronto, Canada.

    Directory of Open Access Journals (Sweden)

    Janet Raboud

    Full Text Available BACKGROUND: In the 2003 Toronto SARS outbreak, SARS-CoV was transmitted in hospitals despite adherence to infection control procedures. Considerable controversy resulted regarding which procedures and behaviours were associated with the greatest risk of SARS-CoV transmission. METHODS: A retrospective cohort study was conducted to identify risk factors for transmission of SARS-CoV during intubation from laboratory confirmed SARS patients to HCWs involved in their care. All SARS patients requiring intubation during the Toronto outbreak were identified. All HCWs who provided care to intubated SARS patients during treatment or transportation and who entered a patient room or had direct patient contact from 24 hours before to 4 hours after intubation were eligible for this study. Data was collected on patients by chart review and on HCWs by interviewer-administered questionnaire. Generalized estimating equation (GEE logistic regression models and classification and regression trees (CART were used to identify risk factors for SARS transmission. RESULTS: 45 laboratory-confirmed intubated SARS patients were identified. Of the 697 HCWs involved in their care, 624 (90% participated in the study. SARS-CoV was transmitted to 26 HCWs from 7 patients; 21 HCWs were infected by 3 patients. In multivariate GEE logistic regression models, presence in the room during fiberoptic intubation (OR = 2.79, p = .004 or ECG (OR = 3.52, p = .002, unprotected eye contact with secretions (OR = 7.34, p = .001, patient APACHE II score > or = 20 (OR = 17.05, p = .009 and patient Pa0(2/Fi0(2 ratio < or = 59 (OR = 8.65, p = .001 were associated with increased risk of transmission of SARS-CoV. In CART analyses, the four covariates which explained the greatest amount of variation in SARS-CoV transmission were covariates representing individual patients. CONCLUSION: Close contact with the airway of severely ill patients and failure of infection control practices to prevent exposure

  8. Scintigraphic evaluation of gastrointestinal motility disorders

    Energy Technology Data Exchange (ETDEWEB)

    Choe, Jae Gol [College of Medicine, Korea Univ., Seoul (Korea, Republic of)

    2001-02-01

    Current scintigraphic tests of gastrointestinal motor function provides relevant pathophysiologic information, but their clinical utility is controversial. Many scintigraphic methods are developed to investigate gastrointestinal motility from oral cavity to colon. These are esophageal transit scintigraphy, oropharyngeal transit study, gastric emptying test, small bowel transit time measurement, colon transit study and gastroesopahgeal reflux scintigraphy. Scintigraphy of gastrointestinal tract is the most physiologic and noninvasive method to evaluate gastrointestinal motility disorders. Stomach emptying test is regarded as a gold standard in motility study. Gastrointestinal transit scintigraphy also has a certain role in assessment of drug effect to GI motility and changes after theraphy of motility disorders. Scintigraphy provides noninvasive and quantitative assessment of physiological transit throughout the gastrointestinal tract, and it is extremely useful for diagnosing gastrointestinal motor dysfunction. This article reviews the current procedures, indications, significance and guidelines for gastrointestinal motility measurements by scintigraphy.

  9. Scintigraphic evaluation of gastrointestinal motility disorders

    International Nuclear Information System (INIS)

    Choe, Jae Gol

    2001-01-01

    Current scintigraphic tests of gastrointestinal motor function provides relevant pathophysiologic information, but their clinical utility is controversial. Many scintigraphic methods are developed to investigate gastrointestinal motility from oral cavity to colon. These are esophageal transit scintigraphy, oropharyngeal transit study, gastric emptying test, small bowel transit time measurement, colon transit study and gastroesopahgeal reflux scintigraphy. Scintigraphy of gastrointestinal tract is the most physiologic and noninvasive method to evaluate gastrointestinal motility disorders. Stomach emptying test is regarded as a gold standard in motility study. Gastrointestinal transit scintigraphy also has a certain role in assessment of drug effect to GI motility and changes after theraphy of motility disorders. Scintigraphy provides noninvasive and quantitative assessment of physiological transit throughout the gastrointestinal tract, and it is extremely useful for diagnosing gastrointestinal motor dysfunction. This article reviews the current procedures, indications, significance and guidelines for gastrointestinal motility measurements by scintigraphy

  10. Gastrointestinal Carcinoid Tumors—Health Professional Version

    Science.gov (United States)

    Gastrointestinal carcinoid tumors are rare, slow-growing tumors that originate in the neuroendocrine cells in the GI tract. Find evidence-based information on gastrointestinal carcinoid tumors treatment and research.

  11. GASTROINTESTINAL FOOD ALLERGY IN CHILDREN

    Directory of Open Access Journals (Sweden)

    Svetlana G. Makarova

    2017-01-01

    Full Text Available In recent years, there has been a significant increase in the prevalence  of food allergies. Pathological conditions associated  with a food intolerance are becoming an increasingly urgent problem of pediatrics. According to different researchers, allergic lesions of the gastrointestinal tract occurs in 25–50% of patients with such common pathology as an allergy to cow's milk proteins. The severity of diseases  associated  with food allergies and their prognosis  depend largely on early diagnosis and adequate treatment. Difficulties and errors  in the diagnosis  of gastrointestinal  food allergies  are associated  with both subjective  and objective  reasons,  primarily due to the fact that gastrointestinal  reactions to food are often delayed and non-IgE-mediated. The article describes clinical forms of gastrointestinal food allergy according to the existing classification. Diagnostic algorithms and modern approaches  to differential diagnosis of disease based on evidence-based  medicine and corresponding to international consensus papers are given.

  12. GASTROINTESTINAL TRACT OF CLARIAS GARIEPINUS ...

    African Journals Online (AJOL)

    DR. AMINU

    one hundred and ninety nine (199) were infested fish samples from gills and gastrointestinal tract .... Body cavity of fish were dissected using a pair of scissors and different portion of the gut (Oesophagus, stomach, intestine and rectum) were isolated and kept in .... Arme, C. and Wakey, M. (1970): The physiology of fishes.

  13. Nutritional management of gastrointestinal malignancies ...

    African Journals Online (AJOL)

    The evidence connecting food and gastrointestinal cancers from epidemiological studies, case-control studies, and prospective observational studies, indicates that determining the independent effects of specific nutrients is extremely diffi cult, given the many potential environmental factors to consider. The nutritional ...

  14. Approach to upper gastrointestinal bleeding

    African Journals Online (AJOL)

    Upper gastrointestinal haemorrhage has a variety of causes (Table 1) and is the commonest complication of peptic ulceration and portal hypertension. Peptic ulceration in the duo- denum or stomach and oesophageal varices are the conditions most often responsible for patients who have the potential to present.

  15. Immunity to gastrointestinal nematode infections

    DEFF Research Database (Denmark)

    Sorobetea, D.; Svensson Frej, M.; Grencis, R.

    2018-01-01

    Numerous species of nematodes have evolved to inhabit the gastrointestinal tract of animals and humans, with over a billion of the world's population infected with at least one species. These large multicellular pathogens present a considerable and complex challenge to the host immune system give...

  16. Gastrointestinal Stromal Tumors: A Case Report

    OpenAIRE

    Sashidharan, Palankezhe; Matele, Apoorva; Matele, Usha; Al Felahi, Nowfel; Kassem, Khalid F.

    2014-01-01

    Advances in the identification of gastrointestinal stromal tumors, its molecular and immunohiostochemical basis, and its management have been a watershed in the treatment of gastrointestinal tumors. This paradigm shift occurred over the last two decades and gastrointestinal stromal tumors have now come to be understood as rare gastrointestinal tract tumors with predictable behavior and outcome, replacing the older terminologies like leiomyoma, schwannoma or leiomyosarcoma. This report present...

  17. Laryngeal mask airway versus bag-mask ventilation or endotracheal intubation for neonatal resuscitation.

    Science.gov (United States)

    Qureshi, Mosarrat J; Kumar, Manoj

    2018-03-15

    Providing effective positive pressure ventilation is considered to be the single most important component of successful neonatal resuscitation. Ventilation is frequently initiated manually with bag and face mask (BMV) followed by endotracheal intubation if respiratory depression continues. These techniques may be difficult to perform successfully resulting in prolonged resuscitation or neonatal asphyxia. The laryngeal mask airway (LMA) may achieve initial ventilation and successful resuscitation faster than a bag-mask device or endotracheal intubation. Among newborns requiring positive pressure ventilation for cardio-pulmonary resuscitation, is LMA more effective than BMV or endotracheal intubation for successful resuscitation? When BMV is either insufficient or ineffective, is effective positive pressure ventilation and successful resuscitation achieved faster with the LMA compared to endotracheal intubation? We used the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL 2017, Issue 1), MEDLINE via PubMed (1966 to 15 February 2017), Embase (1980 to 15 February 2017), and CINAHL (1982 to 15 February 2017). We also searched clinical trials registers, conference proceedings, and the reference lists of retrieved articles for randomised controlled trials and quasi-randomised trials. We included randomised and quasi-randomised controlled trials that compared LMA for neonatal resuscitation with either BMV or endotracheal intubation and reported on any outcomes related to neonatal resuscitation specified in this review. Two review authors independently evaluated studies for risk of bias assessments, and extracted data using Cochrane Neonatal criteria. Categorical treatment effects were described as relative risks and continuous treatment effects were described as the mean difference, with 95% confidence intervals (95% CI) of estimates. We included seven trials that involved a total of 794 infants. Five

  18. Alternative intubation techniques vs Macintosh laryngoscopy in patients with cervical spine immobilization: systematic review and meta-analysis of randomized controlled trials

    Science.gov (United States)

    Suppan, L.; Tramèr, M. R.; Niquille, M.; Grosgurin, O.; Marti, C.

    2016-01-01

    Background. Immobilization of the cervical spine worsens tracheal intubation conditions. Various intubation devices have been tested in this setting. Their relative usefulness remains unclear. Methods. We searched MEDLINE, EMBASE, and the Cochrane Library for randomized controlled trials comparing any intubation device with the Macintosh laryngoscope in human subjects with cervical spine immobilization. The primary outcome was the risk of tracheal intubation failure at the first attempt. Secondary outcomes were quality of glottis visualization, time until successful intubation, and risk of oropharyngeal complications. Results. Twenty-four trials (1866 patients) met inclusion criteria. With alternative intubation devices, the risk of intubation failure was lower compared with Macintosh laryngoscopy [risk ratio (RR) 0.53; 95% confidence interval (CI) 0.35–0.80]. Meta-analyses could be performed for five intubation devices (Airtraq, Airwayscope, C-Mac, Glidescope, and McGrath). The Airtraq was associated with a statistically significant reduction of the risk of intubation failure at the first attempt (RR 0.14; 95% CI 0.06–0.33), a higher rate of Cormack–Lehane grade 1 (RR 2.98; 95% CI 1.94–4.56), a reduction of time until successful intubation (weighted mean difference −10.1 s; 95% CI −3.2 to −17.0), and a reduction of oropharyngeal complications (RR 0.24; 95% CI 0.06–0.93). Other devices were associated with improved glottis visualization but no statistically significant differences in intubation failure or time to intubation compared with conventional laryngoscopy. Conclusions. In situations where the spine is immobilized, the Airtraq device reduces the risk of intubation failure. There is a lack of evidence for the usefulness of other intubation devices. PMID:26133898

  19. Tumor del estroma gastrointestinal Tumor of the gastrointestinal stroma

    Directory of Open Access Journals (Sweden)

    Jorge Felipe Montero León

    2012-03-01

    Full Text Available Los tumores del estroma gastrointestinal, conocidos según sus siglas en inglés como GIST (gastrointestinal stromal tumors, son tumores mesenquimales que aparecen en cualquier lugar a lo largo del tracto intestinal. Este trabajo tiene el propósito de presentar una paciente de 60 años de edad que asiste a la consulta de ginecología del Instituto Nacional de Oncología y Radiobiología, por presentar dolor en el epigastrio, que se irradia al flanco derecho, con un aumento de volumen en la fosa iliaca derecha, y por ultrasonografía se plantea un tumor de ovario derecho, que se proyecta hacia el epigastrio y a hipocondrio derecho. Se describe la intervención quirúrgica y los hallazgos encontrados en estudios macro y microscópicos, así como en estudios posteriores por inmunohistoquímica de la lesión. Se concluye con un diagnóstico de tumor del estroma gastrointestinal y los resultados de las intervenciones quirúrgicas y medicamentosas realizadas. Se recomienda valorar la importancia de una estrecha relación entre cirujanos generales y ginecólogos frente a enfermedades inesperadas, por su difícil diagnóstico preoperatorio, que conllevan a un tratamiento quirúrgico adecuado, y que por la complejidad que requieren, necesitan de la competencia de ambas especialidades quirúrgicas.The tumors of the gastrointestinal stroma, known in English language as GIST (gastrointestinal stromal tumors are mesenchymal tumors appearing in any place throughout the intestinal tract. The objective of present paper is to present the case of a female patient aged 60 came to Genecology consultation of the National Institute of Oncology and Radiobiology due pain in epigastrium irradiating to right flank with increase of volume in the right iliac fossa and by ultrasonography it is a tumor of right ovarium projecting to epigastrium and the right hypochondrium. The surgical intervention is described as well as the findings noted in macro- and microscopic studies

  20. Exercise and the gastro-intestinal tract

    African Journals Online (AJOL)

    on perfonnance and me value of cardiovascular training in improving performance in aerobic sports is well recognised. The role of me gastro-intestinal tracr, bom as a limiting and sustaining facror in aerobic exercises, is less well appreciared. Gastro-intestinal symptoms. The spectrum of gastro-intestinal effecrs of exercise ...

  1. Infrared Red Intubation System (IRRIS) guided flexile videoscope assisted difficult airway management

    DEFF Research Database (Denmark)

    Kristensen, M S; Fried, E; Biro, P

    2018-01-01

    BACKGROUND: Tracheal intubation with a flexible scope is a cornerstone technique in patients with severely difficult airways, but may fail. We report on a technique, Infrared Red Intubation System (IRRIS), that seems to facilitate the identification of the glottis. METHODS: The IRRIS is placed over...... the patient's cricothyroid membrane and emits blinking infrared light through the patient's skin into the subglottic space. When a flexible videoscope (one that does not filter infrared light) is introduced into the airway, it will display this as a blinking white light emerging from the glottis, retrograde...... transillumination, showing the pathway to the trachea. We have introduced this as an adjunct when managing our patients with difficult airways. We describe the technique and retrospectively report on the first ten patients where it was used. RESULTS: All ten patients had significant pathology in the airway...

  2. Sugammadex use in difficult intubation due to ankylosing spondylitis and severe restrictive respiratory disease

    Directory of Open Access Journals (Sweden)

    Yakup Tomak

    2012-09-01

    Full Text Available We describe anesthesia management of a 50-year-old man scheduled for thoracic spinal reconstruction, presenting with severe restrictive respiratory disease and difficult airway due to ankylosing spondilitis. The patient was unable to extend his head, had difficulty in breathing and sleeping in supine position due to thoracal deformities. The patient was intubated using intubating laryngeal mask airway to overcome the difficulties of limited mouth opening and head extension. He was extubated following administration of sugammadex to obtain optimal conditions in terms of respiratory muscle function and to prevent hypersecretion and bronchospasm. J Clin Exp Invest 2012; 3 (3: 398-400Key words: Restrictive lung disease, airway management, laryngeal masks, sugammadex, ankylosing spondylitis

  3. Condensate subcooling near tube exit during horizontal in-tube condensation

    International Nuclear Information System (INIS)

    Hashizume, K.; Abe, N.; Ozeki, T.

    1992-01-01

    In-tube condensation is encountered in various applications for heat exchangers, such as domestic air-conditioning equipment, industrial air-cooled condensers, and moisture separator reheaters (MSRs) for nuclear power pants. Numerous research work has been conducted to predict the condensation heat transfer coefficient, and we have now enough information for thermal design of heat exchangers with horizontal in-tube condensation. Most of the research is analytical and/or experimental work in the annular or stratified flow regime, or experimental work on bulk condensation, i.e., from saturated vapor to complete condensation. On the other hand, there exist few data about the heat transfer phenomena in the very lower-quality region near the tube exit. The purpose of this paper is to clarify the condensation heat transfer phenomena near the tube exit experimentally and analytically, and to predict the degree of condensate subcooling

  4. Novel use of laryngeal mask airway classic excel™ for bronchoscopy and tracheal intubation

    Directory of Open Access Journals (Sweden)

    Anusha Kannan

    2013-01-01

    Full Text Available The usage frequency and scope of supraglottic airway devices in anesthesia has expanded since the original laryngeal mask airway (LMA prototype was invented by Dr Archie Brain in the early 1980s. Today, anesthesiologists are spoilt-for-choice with more than thirty options. The LMA Classic Excel™ was introduced to anesthesia practice in 2009; designed with an epiglottic elevating bar and a removable airway connector to facilitate tracheal intubation using the LMA as a conduit. We present a case report of a women diagnosed with papillary carcinoma of thyroid, who underwent bronchoscopic assessment of the trachea and subsequent intubation for an en-bloc dissection and removal of thyroid gland through the LMA Classic Excel™.

  5. COMPARATIVE STUDY OF EFFECT OF INTRAVENOUS MAGNESIUM SULPHATE AND INTRAVENOUS FENTANYL IN ATTENUATING THE HAEMODYNAMIC RESPONSES TO LARYNGOSCOPY AND INTUBATION

    Directory of Open Access Journals (Sweden)

    Patta

    2016-07-01

    Full Text Available AIM To compare the haemodynamic response to laryngoscopy and intubation with intravenous MgSO4 and intravenous fentanyl. METHODS Fifty adult patients were divided into two groups randomly into group M and group F. Patients of group M received 30 mg/kg body weight of IV MgSO4 and group F received IV fentanyl 1.5 µg/kg 5 minutes before intubation. RESULTS IV Fentanyl showed greater degree of haemodynamic stability i.e. rise in heart rate, mean arterial pressure during laryngoscopy and intubation compared to IV MgSO4. IV fentanyl showed side effects like respiratory depression, nausea and vomiting. CONCLUSION IV fentanyl is a better drug in controlling haemodynamic response to laryngoscopy and intubation.

  6. Avoidance versus use of neuromuscular blocking agents for improving conditions during tracheal intubation or direct laryngoscopy in adults and adolescents

    DEFF Research Database (Denmark)

    Lundstrøm, Lars Hyldborg; Duez, Christophe Hv; Nørskov, Anders Kehlet

    2017-01-01

    ) for adults and adolescents allocated to tracheal intubation with direct laryngoscopy. To look at various outcomes, conduct subgroup and sensitivity analyses, examine the role of bias, and apply trial sequential analysis (TSA) to examine the level of available evidence for this intervention. SEARCH METHODS......: We searched CENTRAL, MEDLINE, Embase, BIOSIS, International Web of Science, LILACS, advanced Google, CINAHL, and the following trial registries: Current Controlled Trials; ClinicalTrials.gov; and www.centerwatch.com, up to January 2017. We checked the reference lists of included trials and reviews...... the best conditions for tracheal intubation and may reduce the risk of upper airway discomfort or injury following tracheal intubation. Study results were characterized by indirectness, heterogeneity, and high or uncertain risk of bias concerning our primary outcome describing difficult tracheal intubation...

  7. Late complications after percutaneous tracheostomy and oral intubation: Evaluation of 1,628 procedures.

    Science.gov (United States)

    Storm, Benjamin; Dybwik, Knut; Nielsen, Erik Waage

    2016-05-01

    In large international studies, upper airway-related stenosis, granulomas, malacias, and laryngeal nerve palsies following percutaneous tracheostomy have an estimated incidence of 6% to 31%. The incidence following prolonged oral intubation is estimated to be 10% to 22%. The purpose of this study was to assess the incidence of late complications in our unit. Retrospective search of a single-unit intensive care patient population. Patient records for a defined period were searched using a predefined search string, identifying those who received invasive mechanical ventilation and split in subgroups by orotracheal tube or tracheostomy tube. This search was cross-linked with the International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) codes associated with recognized complications (J38.0, J38.3,J38.6, J38.7, J39.8, J39.9, J95.0, J95.5, J95.8, J95.9, J99, R04.8,S27.5). During the period January 1, 1997 to December 31, 2013, 32,852 patients were admitted to the intensive care unit. Of these, 1,620 patients received invasive mechanical ventilation. Out of this group, 519 had a tracheostomy and 1,109 were orally intubated. Four tracheostomized and zero orotracheally intubated patients had ICD-10 codes related to complications. From the patient records it became clear that three of four patients with tracheostomy had airway symptoms before being tracheostomized, and the fourth patient had her tracheostomy following a postintubation airway stenosis. Spanning a 17-year period, our study did not show any long-term symptomatic upper airway complications following tracheostomy and only one following orotracheal intubation. This contrasts the internationally estimated incidence. 4 Laryngoscope, 126:1077-1082, 2016. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.

  8. Discomfort during bronchoscopy performed after endobronchial intubation with fentanyl and midazolam: a prospective study.

    Science.gov (United States)

    Minami, Daisuke; Takigawa, Nagio; Kano, Hirohisa; Ninomiya, Takashi; Kubo, Toshio; Ichihara, Eiki; Ohashi, Kadoaki; Sato, Akiko; Hotta, Katsuyuki; Tabata, Masahiro; Tanimoto, Mitsune; Kiura, Katsuyuki

    2017-05-01

    Although endobronchial intubation during a bronchoscopic examination is useful for invasive procedures, it is not routine practice in Japan. The present study evaluated discomfort due to endobronchial intubation using fentanyl and midazolam sedation during bronchoscopy. Thirty-nine patients were enrolled prospectively from November 2014 to September 2015 at Okayama University Hospital. Fentanyl (20 µg) was administered to the patients just before endobronchial intubation, and fentanyl (10 µg) and midazolam (1 mg) were added as needed during the procedure. A questionnaire survey was administered 2 h after the examination. In the questionnaire, patient satisfaction was scored using a visual analog scale as follows: excellent (1 point), good (2 points), normal (3 points), uncomfortable (4 points) and very uncomfortable (5 points). An additional question ('Do you remember the bronchoscopic examination?') was also asked. Predefined parameters (blood pressure, heart rate, oxygen saturation and complications) were recorded. The enrolled patients included 22 males and 17 females; their median age was 70 (range: 28-88) years. The patients received a mean dose of 47.9 µg of fentanyl (range: 30-90 µg) and 2.79 mg of midazolam (range: 1-7 mg). In total, 28 patients (71.7%) agreed to undergo a second bronchoscopic examination; the mean levels of discomfort and for the re-examination were 2.07 points each. About 41% of the patients remembered the bronchoscopic examination. No severe complications were reported. Endobronchial intubation using fentanyl and midazolam sedation during an invasive bronchoscopic procedure might be recommended. UMIN000015578 in the UMIN Clinical Trials Registry. © The Author 2017. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com

  9. Tunge- og stemmebåndsparese efter endotrakeal intubation for Legionella-pneumoni

    DEFF Research Database (Denmark)

    Sønnichsen, Rikke; Lauritsen, Anne Oberg

    2013-01-01

    Extracranial involvement of the hypoglossal nerve and recurrent laryngeal branch of the vagal nerve can be a complication of anaesthetic airway management (Tapia's syndrome) or focal involvement due to Legionella infection. We present a patient with bilateral hypoglossal and unilateral recurrent...... laryngeal nerves palsy after a complicated intubation and a Legionella infection. Clarithromycin therapy was started. Within months, tongue mobility and swallowing gradually improved. Two months after discharge persisting unilateral recurrent nerve palsy was observed....

  10. The effect of lidocaine on neutrophil respiratory burst during induction of general anaesthesia and tracheal intubation.

    LENUS (Irish Health Repository)

    Swanton, B J

    2012-02-03

    BACKGROUND AND OBJECTIVE: Respiratory burst is an essential component of the neutrophil\\'s biocidal function. In vitro, sodium thiopental, isoflurane and lidocaine each inhibit neutrophil respiratory burst. The objectives of this study were (a) to determine the effect of a standard clinical induction\\/tracheal intubation sequence on neutrophil respiratory burst and (b) to determine the effect of intravenous lidocaine administration during induction of anaesthesia on neutrophil respiratory burst. METHODS: Twenty ASA I and II patients, aged 18-60 years, undergoing elective surgery were studied. After induction of anaesthesia [fentanyl (2 microg kg-1), thiopental (4-6 mg kg-1), isoflurane (end-tidal concentration 0.5-1.5%) in nitrous oxide (66%) and oxygen], patients randomly received either lidocaine 1.5 mg kg-1 (group L) or 0.9% saline (group S) prior to tracheal intubation. Neutrophil respiratory burst was measured immediately prior to induction of anaesthesia, immediately before and 1 and 5 min after lidocaine\\/saline. RESULTS: Neutrophil respiratory burst decreased significantly after induction of anaesthesia in both groups [87.4 +\\/- 8.2% (group L) and 88.5 +\\/- 13.4% (group S) of preinduction level (P < 0.01 both groups)]. After intravenous lidocaine (but not saline) administration, neutrophil respiratory burst returned towards preinduction levels, both before (97.1 +\\/- 23.6%) and after (94.4 +\\/- 16.6%) tracheal intubation. CONCLUSION: Induction of anaesthesia and tracheal intubation using thiopentone and isoflurane, inhibit neutrophil respiratory burst. This effect may be diminished by the administration of lidocaine.

  11. Use of Adult Fibreoptic Bronchoscope for Difficult Paediatric Intubation: A Case Report

    Directory of Open Access Journals (Sweden)

    Kundan Sandugir Gosavi

    2015-06-01

    Full Text Available Difficult airway management in paediatric patients may require a technique different from the standard one. We report the use of an adult fibreoptic bronchoscope and J tipped guidewire to intubate a child having temporo-mandibular joint ankylosis. Spontaneous respiration was maintained and local anaesthesia was provided to the upper airway during the procedure and the successful use of this technique avoided the requirement of surgical airway.

  12. A Randomized Comparison of In-hospital Rescuer Positions for Endotracheal Intubation in a Difficult Airway

    OpenAIRE

    Le Parc, Joanna M.; Bischof, Jason J.; King, Andrew M.; Greenberger, Sarah; Way, David P.; Panchal, Ashish R.; Finnegan, Geoffrey I.; Terndrup, Thomas E.

    2018-01-01

    Introduction: Emergency endotracheal intubation (ETI) is a common and critical procedure performed in both prehospital and in-hospital settings. Studies of prehospital providers have demonstrated that rescuer position influences ETI outcomes. However, studies of in-hospital rescuer position for ETI are limited. While we adhere to strict standards for the administration of ETI, we posited that perhaps requiring in-hospital rescuers to stand for ETI is an obstacle to effectiveness. Our objectiv...

  13. Intubation is not a marker for coma after in-hospital cardiac arrest: A retrospective study.

    Science.gov (United States)

    Berg, Katherine M; Grossestreuer, Anne V; Uber, Amy; Patel, Parth V; Donnino, Michael W

    2017-10-01

    In-hospital cardiac arrest (IHCA) strikes over 200,000 people in the United States annually. Targeted temperature management (TTM) is considered beneficial in other settings, but there is no prospective data for IHCA. Recent work on TTM and IHCA found an association between TTM and worse outcome. However, the authors used intubation as a marker for coma to determine eligibility for TTM. The validity of this approach is unexplored. Retrospective, single center study of adult patients with IHCA occurring in an intensive care unit, intubated prior to or during the event, or immediately after ROSC. We evaluated the percentage of patients documented as comatose after arrest, defined as Glasgow Comas Score (GCS) <8 for the primary analysis. We also evaluated the difference in hospital survival in patients with GCS <8 versus ≥8. Two sensitivity analyses using different methods for defining coma using post-ROSC GCS were conducted. 29/102 (28%) intubated patients had a post-ROSC GCS≥8, and 22 (22%) were documented as following commands. Survival in patients with GCS≥8 vs.<8 was 62% (18/29) vs. 37% (27/73) in unadjusted analysis (p=0.02). The adjusted odds ratio for survival to hospital discharge was 3.81 (95%CI: 1.37-10.61, p=0.01). Results were similar in both sensitivity analyses. Intubation prior to or during IHCA was not a valid marker of coma after ROSC. Post-ROSC mental status was associated with hospital survival, and thus could be an important confounder when conducting observational studies on the association of TTM with outcomes in this patient population. Copyright © 2017 Elsevier B.V. All rights reserved.

  14. Early nCPAP versus intubation in very low birth weight infants

    Directory of Open Access Journals (Sweden)

    Pedro Neves Tavares

    2013-06-01

    Full Text Available For many years endotracheal intubation and mechanical ventilation have been the standard of care for very low birth weight infants but, in the last decade, nasal continuous positive airway pressure (nCPAP has been described in many studies as an option for the treatment of preterm infants with respiratory distress syndrome. In fact, recent studies have shown that early nCPAP is not associated with higher rates of morbidity and mortality and does not imply more days of ventilation support when compared to traditional ventilation techniques. The authors conducted a study to compare the outcomes (in terms of mortality, morbidity and need for medical support of very low birth weight infants treated with nCPAP or endotracheal intubation and mechanical ventilation. One hundred and four newborns were enrolled in this study, 44 (42.3% were treated with nCPAP and 60 (57.7% with endotracheal intubation followed by mechanical ventilation. A subgroup analysis of newborns with gestational age between 28 and 31 weeks was also performed. It included 57 newborns with similar demographic characteristics, 29 (50.9% treated with nCPAP and 28 (49.1% with endotracheal intubation followed by mechanical ventilation. No statistically significant differences were found in the frequency of death or bronchopulmonary dysplasia. Statistically significant differences were found in the prevalence of hyaline membrane disease (p = 0.033 and surfactant administration (p = 0.021 with lower rates in the nCPAP group. No other differences were found in the prevalence of other morbidities or in the need for medical support after birth. These results suggests that nCPAP might be chosen as primary ventilatory support choice in very low birth weight preterm, when there are no contraindications to its use.

  15. EFFECTS OF PREANESTHETIC SINGLE DOSE INTRAVENOUS DEXMEDETOMIDINE VERSUS FENTANYL ON HEMODYNAMIC RESPONSE TO ENDOTRACHEAL INTUBATION-A CLINICAL COMPARATIVE STUDY

    Directory of Open Access Journals (Sweden)

    Chandita

    2015-12-01

    Full Text Available INTRODUCTION Many pharmacological agents have been evaluated in regards to their efficacy of blunting the adverse cardiovascular response to laryngoscopy and tracheal intubation. The aim of this study was to evaluate the efficacy of dexmedetomidine compared to fentanyl in blunting the haemodynamic response to laryngoscopy and intubation. METHOD Sixty patients were randomly allocated into two groups (30 patients in each group. The group D received intravenously 1 µgm/kg dexmedetomidine infusion and group F received 2µgm/kg fentanyl infusion. The study drugs were prepared in an identical looking container and were infused fifteen minutes prior to induction of anaesthesia. The study drugs were infused over a period of ten minutes and all the patients underwent a similar anaesthetics technique. Heart rate (HR and blood pressure (systolic, diastolic and mean blood pressure were noted at baseline, at the end of infusion of the study drugs, after induction of anaesthesia, immediately after laryngoscopy and intubation and at 1, 3, 5, 7 and 10 minutes after laryngoscopy and intubation. RESULTS HR significantly decreased in the group D when compared to group F immediately after study drug infusion and there was statistically significant reduction in heart rate for up to 5 min after intubation in both the groups. Although HR increased after intubation in both the groups, the magnitude was lower in the group D. In both the groups, laryngoscopy and intubation led to an increase in systolic, diastolic and mean arterial pressure; the magnitude was lower in the group D. CONCLUSION Dexmeditomidine (1µ/kg attenuates these untoward responses of laryngoscopy and intubation more effectively than fentanyl (2 µ/kg when administered as bolus dose in the pre-induction period of general anaesthesia.

  16. Effectiveness and safety of the Levitan FPS Scope™ for tracheal intubation under general anesthesia with a simulated difficult airway.

    Science.gov (United States)

    Kok, Tracy; George, Ronald B; McKeen, Dolores; Vakharia, Narendra; Pink, Aaron

    2012-08-01

    Studies show that the Levitan FPS (first pass success) Scope™ (LFS) is analogous to a bougie in simulated difficult airways with comparable tracheal intubation success rates. In this study, the efficacy and safety of tracheal intubation with the LFS was compared with that of the Macintosh laryngoscope utilizing manual in-line stabilization (MILS) to simulate difficult airways. Ninety-four subjects successfully completed the trial. Manual in-line stabilization of the cervical spine was applied and the initial laryngoscopy was performed using either the Macintosh or the LFS in conjunction with the Macintosh. Following the initial grading, a second laryngoscopy was repeated using the second randomized technique. Cormack-Lehane grades, percentage of glottic opening (POGO) scores, time to intubate, number of intubation attempts, and the use of alternate techniques were recorded. The anesthesiologist rated the subjective difficulty in using each technique with a numeric rating scale and a visual rating scale. There was no significant difference in the primary outcome "good laryngoscopic views" (Cormack-Lehane grade 1 and 2) compared with "poor laryngoscopic views" (Cormack-Lehane grade 3 and 4) between the LFS and the Macintosh. There were higher POGO scores with the LFS compared with the Macintosh (80% vs 20%, respectively; P < 0.0001), but this did not translate to easier intubations, as documented by the need for an alternate intubation technique or time to intubate (< 30 and < 60 sec, respectively). The incidence of mucosal trauma, sore throat, and hemodynamic responses did not differ significantly between the two techniques. The LFS in conjunction with the Macintosh laryngoscope does not improve the efficacy or safety of tracheal intubation in a simulated difficult airway.

  17. Comparison of plastic single-use and metal reusable laryngoscope blades for orotracheal intubation during rapid sequence induction of anesthesia.

    Science.gov (United States)

    Amour, Julien; Marmion, Frédéric; Birenbaum, Aurélie; Nicolas-Robin, Armelle; Coriat, Pierre; Riou, Bruno; Langeron, Olivier

    2006-01-01

    Plastic single-use laryngoscope blades are inexpensive and carry a lower risk of infection compared with metal reusable blades, but their efficiency during rapid sequence induction remains a matter of debate. The authors therefore compared plastic and metal blades during rapid sequence induction in a prospective randomized trial. Two hundred eighty-four adult patients undergoing general anesthesia requiring rapid sequence induction were randomly assigned on a weekly basis to either plastic single-use or reusable metal blades (cluster randomization). After induction, a 60-s period was allowed to complete intubation. In the case of failed intubation, a second attempt was performed using metal blade. The primary endpoint of the study was the rate of failed intubations, and the secondary endpoint was the incidence of complications (oxygen desaturation, lung aspiration, and oropharynx trauma). Both groups were similar in their main characteristics, including risk factors for difficult intubation. On the first attempt, the rate of failed intubation was significantly increased in plastic blade group (17 vs. 3%; P < 0.01). In metal blade group, 50% of failed intubations were still difficult after the second attempt. In plastic blade group, all initial failed intubations were successfully intubated using metal blade, with an improvement in Cormack and Lehane grade. There was a significant increase in the complication rate in plastic group (15 vs. 6%; P < 0.05). In rapid sequence induction of anesthesia, the plastic laryngoscope blade is less efficient than a metal blade and thus should not be recommended for use in this clinical setting.

  18. Rail roading technique for intubation of the canaliculi with sutupak in cases of common canalicular duct obstruction.

    Science.gov (United States)

    Sahdev, S; Motwane, S

    1991-01-01

    A variety of methods and materials have been used for the treatment of the problems relating to the canalicular system. An insight into the rail roading technique for intubation of the canaliculi with sutupak in cases of common canalicular duct obstruction is presented here. About 30 patients with block at the common canalicular duct, which was detected by dacryocystography were operated for dacryocystorhinostomy with intubation of both the canaliculi with sutupak No. 0 by rail roading technique with good results.

  19. Rail roading technique for intubation of the canaliculi with sutupak in cases of common canalicular duct obstruction

    Directory of Open Access Journals (Sweden)

    Sahdev Saroj

    1991-01-01

    Full Text Available A variety of methods and materials have been used for the treatment of the problems relating to the canalicular system. An insight into the rail roading technique for intubation of the canaliculi with sutupak in cases of common canalicular duct obstruction is presented here. About 30 patients with block at the common canalicular duct, which was detected by dacryocystography were operated for dacryocystorhinostomy with intubation of both the canaliculi with sutupak No. 0 by rail roading technique with good results.

  20. [Comparison between VAMA(®) and Berman(®) cannulas for fibroscopic orotracheal intubation in anaesthetised patients].

    Science.gov (United States)

    Castañeda Pascual, M; Batllori Gastón, M; Unzué Rico, P; Murillo Jaso, E; Dorronsoro Auzmendi, M; Martín Vizcaíno, M P

    2013-03-01

    In fibroscopic intubation, the fact of achieving a direct view in real time does not guarantee the correct advance of the endotracheal tube (ET) to its intratracheal position. The use of oral cannulas helps in achieving a free airway in order to pass the fibroscope and the ET. This study compares the VAMA(®) (V) and Berman(®) (B) cannulas as regards the time required for the intubation, fibroscopic view, and the ease in positioning the ET. 90 patients with no signs of difficult airway were randomised into 2 groups, Berman(®) (B) and VAMA(®) (V), depending on the type of cannula employed. After inducing general anaesthesia, they were intubated using a flexible fibroscope. The fibroscope and intubation times were recorded, as well as the quality of the fibroscopic view, and the level of difficulty in positioning the ET. No statistically significant differences were observed between the cannulas, although the intubation time (P=.292) and the difficulty found in positioning the ET were slightly less (P=.447) in the VAMA(®) group compared to the Berman(®) group. The vision quality was good with both devices, with only some degree of obstruction being encountered in only 22% of the patients. In no case was there complete obstruction, thus all the patients could be intubated correctly. The VAMA(®) cannula is an effective alternative to the classic cannulas for fibreoptic assisted intubation. Furthermore, the novel design provides advantages for the correct orientation of the fiberscope and the withdrawal of the cannula after intubation. Copyright © 2011 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Published by Elsevier España. All rights reserved.

  1. Apneic oxygenation for elimination of respiratory motion artefact in an intubated patient undergoing helical chest computed tomography angiography.

    Directory of Open Access Journals (Sweden)

    Ioannis Pneumatikos

    2008-10-01

    Full Text Available Respiratory motion artifact in intubated and mechanically ventilated patients often reduces the quality of helical computed tomography pulmonary angiography (CTPA. Apneic oxygenation is a well established intra-operative technique that allows adequate oxygenation for short periods (up to 10 min in sedated and paralyzed patients. We describe the use of the apneic oxygenation for elimination of respiratory motion artefact in an intubated patient undergoing helical chest computed tomography angiography.

  2. Quality of Vision in Eyes With Epiphora Undergoing Lacrimal Passage Intubation.

    Science.gov (United States)

    Koh, Shizuka; Inoue, Yasushi; Ochi, Shintaro; Takai, Yoshihiro; Maeda, Naoyuki; Nishida, Kohji

    2017-09-01

    To investigate visual function and optical quality in eyes with epiphora undergoing lacrimal passage intubation. Prospective case series. Thirty-four eyes of 30 patients with lacrimal passage obstruction were enrolled. Before and 1 month after lacrimal passage intubation, functional visual acuity (FVA), higher-order aberrations (HOAs), lower tear meniscus, and tear clearance were assessed. An FVA measurement system was used to examine changes in continuous visual acuity (VA) over time, and visual function parameters such as FVA, visual maintenance ratio, and blink frequency were obtained. Sequential ocular HOAs were measured for 10 seconds after the blink using a wavefront sensor. Aberration data were analyzed in the central 4 mm for coma-like, spherical-like, and total HOAs. Fluctuation and stability indices of the total HOAs over time were calculated. Lower tear meniscus was assessed by anterior segment optical coherence tomography. After lacrimal passage intubation, visual function significantly improved, as indicated by improved FVA (P = .003) and visual maintenance ratio (P function and optical quality via patency of the lacrimal passage. Copyright © 2017 Elsevier Inc. All rights reserved.

  3. Non-intubated uniportal left-lower lobe upper segmentectomy (S6).

    Science.gov (United States)

    Galvez, Carlos; Navarro-Martinez, Jose; Bolufer, Sergio; Sesma, Julio; Lirio, Francisco; Galiana, Maria; Rivera, Maria Jesus

    2017-01-01

    Worldwide accepted indications of anatomical segmentectomies are mainly early stage primary adenocarcinomas, pulmonary metastasis and benign conditions. Their performance through uniportal VATS has become more and more popular due to the less invasiveness of the whole procedure under this approach. Recently, many efforts have focused on non-intubated spontaneously breathing management of lobectomies and anatomical segmentectomies, although specific selection criteria and main advantages are not completely standardized. In a 62-year-old thin man with two pulmonary residual metastasis from sigma adenocarcinoma, after chemotherapy plus antiangiogenic treatment, we indicated a single-incision video-assisted left-lower lobe (LLL) upper segmentectomy (S6) under spontaneous breathing and intercostal blockade. Total operation time was 240 minutes. Chest tube was removed at 24 hours and the patient was discharge on postoperative day 2 without any complication. Non-intubated uniportal VATS is a safe and reasonable approach for lung-sparing resections in selected patients, although more evidence is required for selecting which patients can benefit more over standard intubated procedures.

  4. Endotracheal Intubation Using the Macintosh Laryngoscope or KingVision Video Laryngoscope during Uninterrupted Chest Compression

    Directory of Open Access Journals (Sweden)

    Ewelina Gaszynska

    2014-01-01

    Full Text Available Objective. Advanced airway management, endotracheal intubation (ETI, during CPR is more difficult than, for example, during anesthesia. However, new devices such as video laryngoscopes should help in such circumstances. The aim of this study was to assess the performance of the KingVision video laryngoscopes in a manikin cardiopulmonary resuscitation (CPR scenario. Methods. Thirty students enrolled in the third year of paramedic school took part in the study. The simulated CPR scenario was ETI using the standard laryngoscope with a Macintosh blade (MCL and ETI using the KingVision video laryngoscope performed during uninterrupted chest compressions. The primary endpoints were the time needed for ETI and the success ratio. Results. The mean time required for intubation was similar for both laryngoscopes: 16.6 (SD 5.11, median 15.64, range 7.9–27.9 seconds versus 17.91 (SD 5.6, median 16.28, range 10.6–28.6 seconds for the MCL and KingVision, respectively (P=0.1888. On the first attempt at ETI, the success rate during CPR was comparable between the evaluated laryngoscopes: P=0.9032. Conclusion. The KingVision video laryngoscope proves to be less superior when used for endotracheal intubation during CPR compared to the standard laryngoscope with a Mackintosh blade. This proves true in terms of shortening the time needed for ETI and increasing the success ratio.

  5. "Awake" ECCO2R superseded intubation in a near-fatal asthma attack.

    Science.gov (United States)

    Schneider, Thomas-Michael; Bence, Tibor; Brettner, Franz

    2017-01-01

    Near-fatal asthma attacks are life threatening events that often require mechanical ventilation. Extracorporeal carbon dioxide removal (ECCO 2 R) is, beside extracorporeal membrane oxygenation (ECMO), a well-established rescue option whenever ventilation gets to its limits. But there seems to be very rare experience with those techniques in avoiding mechanical ventilation in severe asthma attacks. A 67-year-old man with a near-fatal asthma attack deteriorated under non-invasive ventilation conditions. Beside pharmacological treatment, the intensivists decided to use an extracorporeal carbon dioxide removal system (ECCO 2 R) to avoid sedation and intubation. Within only a few hours, there was a breakthrough and the patient's status improved continuously. One and a half days later, weaning from ECCO 2 R was already completed. The discussion deals with several advantages of extracorporeal lung support in acute asthma, the potential of avoiding intubation and sedation, as well as the benefits of a conscious and spontaneously breathing patient. Extracorporeal membrane oxygenation (ECMO) in general and ECCO 2 R in particular is a highly effective method for the treatment of an acute near-fatal asthma attack. Pathophysiological aspects favor the "awake" approach, without sedation, intubation, and mechanical ventilation. Therefore, experienced clinicians might consider "awake" ECCO 2 R in similar cases.

  6. Respiratory care practitioners as primary providers of neonatal intubation in a community hospital: an analysis.

    Science.gov (United States)

    Noblett, K E; Meibalane, R

    1995-10-01

    Respiratory care practitioners (RCPs) serve as the primary providers of neonatal endotracheal intubation (ETI) in our institution. ETIs are performed by registered respiratory therapists who have completed Pediatric Advanced Life Support and Neonatal Advanced Life Support training and have successfully completed 3 intubations under the direct supervision of a senior therapist. The purpose of this study was to (1) ascertain whether RCPs can successfully provide this type of service with acceptable complications rates and (2) survey the economic impact of this practice on patient charges in our hospital. An analysis of each intubation event in which an RCP participated was collected and compiled over a 5-month period (9-94 to 2-95). Calculations were made of the success rate and complications. A total of 38 ETIs were performed by the RCPs. Of these, 37 (97.4%) were performed with neonatal ETI at a Level-II nursery in a community hospital, and this practice may result in a cost reduction.

  7. Outcomes of revision external dacryocystorhinostomy and nasal intubation by bicanalicular silicone tubing under endonasal endoscopic guidance.

    Science.gov (United States)

    Ari, Seyhmus; Kürşat Cingü, Abdullah; Sahin, Alparslan; Gün, Ramazan; Kiniş, Vefa; Caça, Ihsan

    2012-01-01

    To evaluate the long-term treatment outcomes in patients who underwent revision of external dacryocystorhinostomy (DCR) and nasal intubation by bicanalicular silicone tubing (BSTI) under endonasal endoscopic guidance. Data from 28 patients with recurrent dacryocystitis were retrospectively reviewed. Revision external DCR and bicanalicular nasal intubation by silicone tubing under endonasal endoscopic guidance was performed in 28 eyes of 28 patients. The patients were evaluated with respect to the reason of recurrence, time to recurrence, time to revision, duration of follow-up and surgical success. Endoscopic endonasal examination detected an osteotomy-side obstruction by the excessive granulation tissue in 24 patients (86%), nasal septal deviation in three patients (10%) and nasal polyp in one patient (4%). Recurrence occurred after a mean duration of 5.3±3.7 months following the first operation. The mean time between the first DCR operation and the revision DCR was 11.5 ± 9.3 months. After a mean follow-up of 14.9±7.8 months, the rate of anatomic success alone was 85% (24/28); the rate of subjective success was 78% (22/28). Revision external DCR and bicanalicular nasal intubation by silicone tubing under endonasal endoscopic guidance can be recommended in patients with recurrent dacryocystitis as a surgical approach that achieves satisfactory objective and subjective success rates.

  8. Electrophoretic deposition of graphene oxide onto carbon fibers for in-tube solid-phase microextraction.

    Science.gov (United States)

    Feng, Juanjuan; Wang, Xiuqin; Tian, Yu; Bu, Yanan; Luo, Chuannan; Sun, Min

    2017-09-29

    Carbon fibers (CFs) were functionalized with graphene oxide (GO) by an electrophoretic deposition (EPD) method for in-tube solid-phase microextraction (SPME). GO-CFs were filled into a poly(ether ether ketone) (PEEK) tube to obtain a fibers-in-tube SPME device, which was connected with high performance liquid chromatography (HPLC) equipment to build online SPME-HPLC system. Compared with CFs, GO-CFs presented obviously better extraction performance, due to excellent adsorption property and large surface area of GO. Using ten polycyclic aromatic hydrocarbons (PAHs) as model analytes, the important extraction conditions were optimized, such as sample flow rate, extraction time, organic solvent content and desorption time. An online analysis method was established with wide linear range (0.01-50μgL -1 ) and low detection limits (0.001-0.004μgL -1 ). Good sensitivity resulted from high enrichment factors (1133-3840) of GO-CFs in-tube device towards PAHs. The analysis method was used to online determination of PAHs in wastewater samples. Some target analytes were detected and relative recoveries were in the range of 90.2-112%. It is obvious that the proposed GO-CFs in-tube device was an efficient extraction device, and EPD could be used to develop nanomaterials functionalized sorbents for sample preparation. Copyright © 2017 Elsevier B.V. All rights reserved.

  9. Impact of Rocuronium and Succinylcholine on Sedation Initiation After Rapid Sequence Intubation.

    Science.gov (United States)

    Johnson, Eric G; Meier, Alex; Shirakbari, Alicia; Weant, Kyle; Baker Justice, Stephanie

    2015-07-01

    Rapid sequence intubation (RSI) involves a rapidly acting sedative plus a neuromuscular blocking agent (NMBA) to facilitate endotracheal intubation. Rocuronium and succinylcholine are NMBAs commonly used in RSI with drastically different durations of action. Evaluate whether patients receiving RSI with a longer-acting NMBA had a greater delay in sedation or analgesia than patients that received a short-acting NMBA. This was a retrospective review of patients presenting to the emergency department requiring endotracheal intubation. Exclusions included age rocuronium or succinylcholine. Secondary endpoints included hospital length of stay (HLOS), intensive care unit length of stay (ICU LOS), and impact of an emergency medicine pharmacist (EPh). A total 106 patients met inclusion criteria, 76 patients receiving rocuronium and 30 receiving succinylcholine. Mean time to sedation or analgesia was longer in the rocuronium group when compared to the succinylcholine group at 34 ± 36 min vs. 16 ± 21 min (p = 0.002). In the presence of an EPh, the mean time to sedation or analgesia was 20 ± 21 min, vs. 49 ± 45 min (p rocuronium in RSI had a significantly longer time to sedation or analgesia when compared to patients receiving succinylcholine. The presence of an EPh significantly decreased the time to administration of sedation or analgesia after RSI. Copyright © 2015 Elsevier Inc. All rights reserved.

  10. The effect of nitroglycerin on response to tracheal intubation. Assessment by radionuclide angiography

    International Nuclear Information System (INIS)

    Hart, A.P.; Camporesi, E.M.; Sell, T.L.; Croughwell, N.; Silva, R.; Jones, R.H.; McIntyre, R.W.; Stanley, T.E.; Reves, J.G.

    1989-01-01

    The effect of intravenous (IV) nitroglycerin (NTG) on perioperative myocardial ischemia as detected by single pass radionuclide angiocardiography was studied in 20 patients scheduled for elective coronary artery bypass grafting (CABG). Ten patients, selected at random, received IV NTG 1 microgram.kg-1.min-1 (NTG group) and 10 others, IV saline (control group). Anesthetic induction consisted of midazolam 0.2 mg.kg-1, vecuronium 0.1 mg.kg-1, and 50% N 2 O in O 2 . ECG leads I, II, and V5 were monitored for ST segment changes. Single pass radionuclide angiocardiography (RNA) was performed at 5 times: prior to induction, prior to tracheal intubation, and at 1, 3.5, and 6 min following intubation. The presence of new regional wall motion abnormalities (RWMA) was determined from each RNA study as compared with the preinduction measurement. Apart from one patient in the control group who developed a new ''v'' wave after intubation, there was no evidence of ischemia by pulmonary capillary wedge pressure. No ECG evidence of ischemia was detected in any patient. Despite this, new regional wall motion abnormalities were observed in 3 patients in the control group and 1 patient in the NTG group. Blood pressure and heart rate responses of patients with new RWMA were not significantly different from other patients. The low incidence of ischemia in this population precludes a definitive statement regarding the efficacy of IV NTG, but the lower incidence of RWMA in the NTG group suggests a protective effect

  11. Hypercapnea and Acidemia despite Hyperventilation following Endotracheal Intubation in a Case of Unknown Severe Salicylate Poisoning

    Directory of Open Access Journals (Sweden)

    Shannon M. Fernando

    2017-01-01

    Full Text Available Salicylates are common substances for deliberate self-harm. Acute salicylate toxicity is classically associated with an initial respiratory alkalosis, followed by an anion gap metabolic acidosis. The respiratory alkalosis is achieved through hyperventilation, driven by direct stimulation on the respiratory centers in the medulla and considered as a compensatory mechanism to avoid acidemia. However, in later stages of severe salicylate toxicity, patients become increasingly obtunded, with subsequent loss of airway reflexes, and therefore intubation may be necessary. Mechanical ventilation has been recommended against in acute salicylate poisoning, as it is believed to take away the compensatory hyperpnea and tachypnea. Despite the intuitive physiological basis for this recommendation, there is a paucity of evidence to support it. We describe a case of a 59-year-old male presenting with decreased level of consciousness and no known history of ingestion. He was intubated and experienced profound hypercarbia and acidemia despite mechanical ventilation with high minute ventilation and tidal volumes. This case illustrates the deleterious effects of intubation in severe salicylate toxicity.

  12. Comparison of different tests to determine difficult intubation in pediatric patients

    Directory of Open Access Journals (Sweden)

    Mehmet Turan Inal

    2014-12-01

    Full Text Available Background: The difficulties with airway management is the main reason for pediatric anesthesia-related morbidity and mortality. Objective: To assess the value of modified Mallampati test, Upper-Lip-Bite test, thyromental distance and the ratio of height to thyromental distance to predict difficult intubation in pediatric patients. Design: Prospective analysis. Measurements and results: Data were collected from 5 to 11 years old 250 pediatric patients requiring tracheal intubation. The Cormack and Lehane classification was used to evaluate difficult laryngoscopy. Sensitivity, specificity, positive predictive value and AUC values for each test were measured. Results: The sensitivity and specificity of modified Mallampati test were 76.92% and 95.54%, while those for ULBT were 69.23% and 97.32%. The optimal cutoff point for the ratio of height to thyromental distance and thyromental distance for predicting difficult laryngoscopy was 23.5 (sensitivity, 57.69%; specificity, 86.61% and 5.5 cm (sensitivity, 61.54%; specificity, 99.11%. The modified Mallampati was the most sensitive of the tests. The ratio of height to thyromental distance was the least sensitive test. Conclusion: These results suggested that the modified Mallampati and Upper-Lip-Bite tests may be useful in pediatric patients for predicting difficult intubation.

  13. Gastrointestinal Stromal Tumors: A Case Report

    Directory of Open Access Journals (Sweden)

    Palankezhe Sashidharan

    2014-03-01

    Full Text Available Advances in the identification of gastrointestinal stromal tumors, its molecular and immunohiostochemical basis, and its management have been a watershed in the treatment of gastrointestinal tumors. This paradigm shift occurred over the last two decades and gastrointestinal stromal tumors have now come to be understood as rare gastrointestinal tract tumors with predictable behavior and outcome, replacing the older terminologies like leiomyoma, schwannoma or leiomyosarcoma. This report presents a case of gastric gastrointestinal stromal tumor operated recently in a 47-year-old female patient and the outcome, as well as literature review of the pathological identification, sites of origin, and factors predicting its behavior, prognosis and treatment.

  14. A comparison of tracheal intubation using the Airtraq or the Macintosh laryngoscope in routine airway management: A randomised, controlled clinical trial.

    LENUS (Irish Health Repository)

    Maharaj, C H

    2006-11-01

    The Airtraq laryngoscope is a novel single use tracheal intubation device. We compared the Airtraq with the Macintosh laryngoscope in patients deemed at low risk for difficult intubation in a randomised, controlled clinical trial. Sixty consenting patients presenting for surgery requiring tracheal intubation were randomly allocated to undergo intubation using a Macintosh (n = 30) or Airtraq (n = 30) laryngoscope. All patients were intubated by one of four anaesthetists experienced in the use of both laryngoscopes. No significant differences in demographic or airway variables were observed between the groups. All but one patient, in the Macintosh group, was successfully intubated on the first attempt. There was no difference between groups in the duration of intubation attempts. In comparison to the Macintosh laryngoscope, the Airtraq resulted in modest improvements in the intubation difficulty score, and in ease of use. Tracheal intubation with the Airtraq resulted in less alterations in heart rate. These findings demonstrate the utility of the Airtraq laryngoscope for tracheal intubation in low risk patients.

  15. Radiopharmaceuticals and the gastrointestinal tract

    Energy Technology Data Exchange (ETDEWEB)

    Frier, M. [Radiopharmacy Unit, Dept. of Medical Physics, Queens Medical Centre, Univ. Hospital Nottingham (United Kingdom); Perkins, A.C. [Radiopharmacy Unit, Dept. of Medical Physics, Queens Medical Centre, Univ. Hospital Nottingham (United Kingdom)

    1994-11-01

    A review is presented of the design of radiolabelled test meals for the evaluation of gastrointestinal function, including oesophageal transit, gastro-oesophageal reflux, gastric emptying, enterogastric reflux and transit through the whole bowel. Descriptions of different systems are presented, together with validations of the procedures used. Published methods for assessment of oesophageal transit show a marked degree of consistency, whereas gastric emptying studies employ a wide range of both liquid and solid test meals. Recommendations are made concerning the optimal system for investigation of each part of the gastrointestinal tract, but whichever system is adopted, it is important to employ some validation procedures, and to establish normal ranges in the population under study. (orig.)

  16. Gastrointestinal hormones and their targets

    DEFF Research Database (Denmark)

    Rehfeld, Jens F.

    2014-01-01

    Gastrointestinal hormones are peptides released from endocrine cells and neurons in the digestive tract. More than 30 hormone genes are currently known to be expressed in the gastrointestinal tract, which makes the gut the largest hormone producing organ in the body. Modern biology makes...... it feasible to conceive the hormones under five headings: The structural homology groups a majority of the hormones into nine families, each of which is assumed to originate from one ancestral gene. The individual hormone gene often has multiple phenotypes due to alternative splicing, tandem organization......, or differentiated maturation of the prohormone. By a combination of these mechanisms, more than 100 different hormonally active peptides are released from the gut. Gut hormone genes are also widely expressed in cells outside the gut, some only in extraintestinal endocrine cells and neurons but others also in other...

  17. A Comparison of Macintosh and Airtraq Laryngoscopes for Endotracheal Intubation in Adult Patients With Cervical Spine Immobilization Using Manual In Line Axial Stabilization: A Prospective Randomized Study.

    Science.gov (United States)

    Vijayakumar, Vinodhadevi; Rao, Shwethapriya; Shetty, Nanda

    2016-10-01

    During cervical spine immobilization using Manual In Line Axial Stabilization (MILS), it is difficult to visualize the larynx by aligning the oropharyngeolaryngeal axes using Macintosh laryngoscope. Theoretically, Airtraq an anatomically shaped blade with endotracheal tube guide channel offers advantage over Macintosh. We hypothesized that intubation would be easier and faster with Airtraq compared with Macintosh laryngoscope. Ninety anesthetized adult patients with normal airways were intubated by experienced anesthesiologists after cervical immobilization with MILS either with Macintosh or Airtraq. Primary outcomes compared were successful intubation, and degree of difficulty of intubation as assessed by Intubation Difficulty Scale (IDS) score. Secondary outcomes compared were duration of laryngoscopy and intubation, degree of difficulty of intubation as assessed by Numerical Rating Scale score, soft tissue, and dental trauma. All 90 patients were successfully intubated in the first attempt. Intubation as assessed by IDS score was easier in Airtraq (84.44%) in contrast to slight difficulty in the Macintosh (77.78%) group; Numerical Rating Scale score was easy in both the groups (Airtraq-91.12%; Macintosh-93.34%). The median (interquartile range [IQR]) time for laryngoscopy, (12 s [IQR, 8 to 17.5) vs. 8 s [IQR, 6 to 12]); total duration for intubation (25 s [IQR, 20-33] vs. 22 s [IQR, 18-27.5]) were prolonged in Airtraq group in comparison to Macintosh group. In anesthetized adult patients with MILS compared with Macintosh, Airtraq provides equal success rate of intubation, statistically significant (although clinically insignificant) longer duration for laryngoscopy and intubation. Intubation with Airtraq was significantly easier than Macintosh as assessed by the IDS score.

  18. Precision Medicine in Gastrointestinal Pathology.

    Science.gov (United States)

    Wang, David H; Park, Jason Y

    2016-05-01

    -Precision medicine is the promise of individualized therapy and management of patients based on their personal biology. There are now multiple global initiatives to perform whole-genome sequencing on millions of individuals. In the United States, an early program was the Million Veteran Program, and a more recent proposal in 2015 by the president of the United States is the Precision Medicine Initiative. To implement precision medicine in routine oncology care, genetic variants present in tumors need to be matched with effective clinical therapeutics. When we focus on the current state of precision medicine for gastrointestinal malignancies, it becomes apparent that there is a mixed history of success and failure. -To present the current state of precision medicine using gastrointestinal oncology as a model. We will present currently available targeted therapeutics, promising new findings in clinical genomic oncology, remaining quality issues in genomic testing, and emerging oncology clinical trial designs. -Review of the literature including clinical genomic studies on gastrointestinal malignancies, clinical oncology trials on therapeutics targeted to molecular alterations, and emerging clinical oncology study designs. -Translating our ability to sequence thousands of genes into meaningful improvements in patient survival will be the challenge for the next decade.

  19. A CLINICAL ASSESSMENT OF MACINTOSH BLADE, MILLER BLADE AND KING VISIONTM VIDEOLARYNGOSCOPE FOR LARYNGEAL EXPOSURE AND DIFFICULTY IN ENDOTRACHEAL INTUBATION

    Directory of Open Access Journals (Sweden)

    Apoorva Mahendera

    2016-03-01

    Full Text Available CONTEXT Previous studies suggest glottic view is better achieved with straight blades while tracheal intubation is easier with curved blades and videolaryngoscope is better than conventional laryngoscope. AIMS Comparison of conventional laryngoscope (Macintosh blade and Miller blade with channelled videolaryngoscope (King Vision TM with respect to laryngeal visualisation and difficulty in endotracheal intubation. SETTINGS AND DESIGN This prospective randomised comparative study was conducted at a tertiary care hospital (in ASA I and ASA II patients after approval from the Institutional Ethics Committee. METHODS We compared Macintosh, Miller, and the King VisionTM videolaryngoscope for glottic visualisation and ease of tracheal intubation. Patients undergoing elective surgeries under general anaesthesia requiring endotracheal intubation were randomly divided into three groups (N=180. After induction of anaesthesia, laryngoscopy was performed and trachea intubated. We recorded visualisation of glottis (Cormack-Lehane grade-CL, ease of intubation, number of attempts, need to change blade, and need for external laryngeal manipulation. STATISTICAL ANALYSIS Demographic data, Mandibular length, Mallampati classification were compared using ANOVA, Chi-square test, Kruskal-Wallis Test, where P value <0.005 is statically significant. RESULTS CL grade 1 was most often observed in King Vision -TM VL group (90% which is followed by Miller (28.33%, and Macintosh group (15%. We found intubation was to be easier (grade 1 with King Vision -TM VL group (73.33%, followed by Macintosh (38.33%, and Miller group (1.67%. External manipulation (BURP was needed more frequently in patients in Miller group (71.67%, followed by Macintosh (28.33% and in King Vision -TM VL group (6.67%. All (100% patients were intubated in the 1 st attempt with King Vision -TM VL group, followed by Macintosh group (90% and Miller group (58.33%. CONCLUSIONS In patients with normal airway

  20. The 30-second rule: the effects of prolonged intubation attempts on oxygen saturation and heart rate in preterm infants in the delivery room.

    Science.gov (United States)

    Wozniak, Madeline; Arnell, Kathy; Brown, Melissa; Gonzales, Sarah; Lazarus, Danielle; Rich, Wade; Katheria, Anup

    2018-04-01

    A duration of 30 seconds has been shown to improve the success rate of intubation attempts without any decompensation. There is limited data regarding the detrimental effects of prolonged intubation attempts in preterm infants. The aim was to determine the effect of prolonged intubation attempts on heart rate and oxygen saturation in preterm infants. We retrospectively reviewed videos and physiologic data collected during delivery room (DR) resuscitations. Infants who had a functioning pulse oximeter at the time of intubation in the delivery room were analyzed using video and analog recordings. The duration of the intubation attempt was defined as the time the laryngoscope blade was in the infant's mouth. Prolonged intubations were defined as intubations over 30 seconds. Baseline heart rate and saturations were defined as the heart rate and saturation immediately prior to the intubation attempt. Video recording was used to determine time laryngoscope was in the mouth, what other procedures were performed, and whether there was recovery between attempts. Analog data including heart rate, airway pressure and saturation was also recorded. There were 52 intubation attempts in 28 infants. The median (IQR) birth weight and gestational age were 795 (705, 972) grams and 25 (25, 27) weeks. The duration of an intubation attempt was 35 (27, 46) seconds with number of attempts 2 (1, 2). There were 34 intubation attempts greater than 30 seconds (prolonged group) and 18 attempts less than or equal to 30 seconds (short group). Longer attempts did not affect intubation success (successful 34 [25,37] seconds vs. unsuccessful 41[29, 53] seconds; P=0.05). Infants in the prolonged group had a greater decrease in oxygen saturation percentage from baseline (5±8 percent, short intubation group and 13±27 prolonged intubation group; P=0.004). There was also a significant decrease in heart rate beats per minute between the two groups (6±9 in the short intubation group and 23±29

  1. Evaluation of Truview evo2® Laryngoscope In Anticipated Difficult Intubation-A Comparison To Macintosh Laryngoscope

    Directory of Open Access Journals (Sweden)

    Ishwar Singh

    2009-01-01

    Full Text Available The aim of the study was to assess and compare laryngoscopic view of Truview evo2 laryngoscope with that of Macintosh laryngoscope in patients with one or more predictors of difficult intubation (PDI. Moreover ease of intubation with Truview evo2 in terms of absolute time requirement was also aimed at. Patients for elective surgery requiring endotracheal intubation were initially assessed for three PDI parameters - modified Mallampati test, thyro-mental distance& Atlanto-occipital (AO joint extension. Patients with cumulative PDI scores of 2 to 5 (in a scale of 0 to 8 were evaluated for Cormack& Lehane (CL grading by Macintosh blade after standard induction. Cases with CL grade of two or more were further evaluated by Truview evo2 laryngoscope and corresponding CL grades were assigned. Intubation attempted under Truview evo2 vision and time required for each successful tracheal intubation (i.e. tracheal intubation completed within one minute was noted. Total fifty cases were studied. The CL grades assigned by Macintosh blade correlated well with the cumulative PDI scores assigned preoperatively, confirming there predictability. Truview evo2 improved laryngeal view in 92 % cases by one or more CL grade. Intubation with Truview evo2 was possible in 88% cases within stipulated time of one minute and mean time of 28.6 seconds with SD of 11.23 was reasonably quick. No significant complication like oro- pharyngeal trauma or extreme pressor response to laryngoscopy was noticed. To conclude, Truview evo2 proved to be a better tool than conventional laryngoscope in anticipated difficult situations.

  2. Technical realization of a sensorized neonatal intubation skill trainer for operators' retraining and a pilot study for its validation.

    Science.gov (United States)

    Panizza, Davide; Scaramuzzo, Rosa T; Moscuzza, Francesca; Vannozzi, Ilaria; Ciantelli, Massimiliano; Gentile, Marzia; Baldoli, Ilaria; Tognarelli, Selene; Boldrini, Antonio; Cuttano, Armando

    2018-01-04

    In neonatal endotracheal intubation, excessive pressure on soft tissues during laryngoscopy can determine permanent injury. Low-fidelity skill trainers do not give valid feedback about this issue. This study describes the technical realization and validation of an active neonatal intubation skill trainer providing objective feedback. We studied expert health professionals' performances in neonatal intubation, underlining chance for procedure retraining. We identified the most critical points in epiglottis and dental arches and fixed commercial force sensors on chosen points on a ©Laerdal Neonatal Intubation Trainer. Our skill trainer was set up as a grade 3 on Cormack and Lehane's scale, i.e. a model of difficult intubation. An associated software provided real time sound feedback if pressure during laryngoscopy exceeded an established threshold. Pressure data were recorded in a database, for subsequent analysis with non-parametric statistical tests. We organized our study in two intubation sessions (5 attempts each one) for everyone of our participants, held 24 h apart. Between the two sessions, a debriefing phase took place. In addition, we gave our participants two interview, one at the beginning and one at the end of the study, to get information about our subjects and to have feedback about our design. We obtained statistical significant differences between consecutive attempts, with evidence of learning trends. Pressure on critical points was significantly lower during the second session (p < 0.0001). Epiglottis' sensor was the most stressed (p < 0.000001). We found a significant correlation between time spent for each attempt and pressures applied to the airways in the two sessions, more significant in the second one (shorter attempts with less pressure, r s  = 0.603). Our skill trainer represents a reliable model of difficult intubation. Our results show its potential to optimize procedures related to the control of trauma risk and to improve

  3. Effect of just-in-time simulation training on tracheal intubation procedure safety in the pediatric intensive care unit.

    Science.gov (United States)

    Nishisaki, Akira; Donoghue, Aaron J; Colborn, Shawn; Watson, Christine; Meyer, Andrew; Brown, Calvin A; Helfaer, Mark A; Walls, Ron M; Nadkarni, Vinay M

    2010-07-01

    Tracheal intubation-associated events (TIAEs) are common (20%) and life threatening (4%) in pediatric intensive care units. Physician trainees are required to learn tracheal intubation during intensive care unit rotations. The authors hypothesized that "just-in-time" simulation-based intubation refresher training would improve resident participation, success, and decrease TIAEs. For 14 months, one of two on-call residents, nurses, and respiratory therapists received 20-min multidisciplinary simulation-based tracheal intubation training and 10-min resident skill refresher training at the beginning of their on-call period in addition to routine residency education. The rate of first attempt and overall success between refresher-trained and concurrent non-refresher-trained residents (controls) during the intervention phase was compared. The incidence of TIAEs between preintervention and intervention phase was also compared. Four hundred one consecutive primary orotracheal intubations were evaluated: 220 preintervention and 181 intervention. During intervention phase, neither first-attempt success nor overall success rate differed between refresher-trained residents versus concurrent non-refresher-trained residents: 20 of 40 (50%) versus 15 of 24 (62.5%), P = 0.44 and 23 of 40 (57.5%) versus 18 of 24 (75.0%), P = 0.19, respectively. The resident's first attempt and overall success rate did not differ between preintervention and intervention phases. The incidence of TIAE during preintervention and intervention phases was similar: 22.0% preintervention versus 19.9% intervention, P = 0.62, whereas resident participation increased from 20.9% preintervention to 35.4% intervention, P = 0.002. Resident participation continued to be associated with TIAE even after adjusting for the phase and difficult airway condition: odds ratio 2.22 (95% CI 1.28-3.87, P = 0.005). Brief just-in-time multidisciplinary simulation-based intubation refresher training did not improve the resident

  4. Cecal intubation time between cap-assisted water exchange and water exchange colonoscopy: a randomized-controlled trial.

    Science.gov (United States)

    Tseng, Chih-Wei; Koo, Malcolm; Hsieh, Yu-Hsi

    2017-11-01

    The water exchange (WE) method can decrease the discomfort of the patients undergoing colonoscopy. It also provides salvage cleansing and improves adenoma detection, but a longer intubation time is required. Cap-assisted colonoscopy leads to a significant reduction in cecal intubation time compared with traditional colonoscopy with air insufflation. The aim of this study was to investigate whether combined cap-assisted colonoscopy and water exchange (CWE) could decrease the cecal intubation time compared with WE. A total of 120 patients undergoing fully sedated colonoscopy at a regional hospital in southern Taiwan were randomized to colonoscopy with either CWE (n=59) or WE (n=61). The primary endpoint was cecal intubation time. The mean cecal intubation time was significantly shorter in CWE (12.0 min) compared with WE (14.8 min) (P=0.004). The volume of infused water during insertion was lower in CWE (840 ml) compared with WE (1044 ml) (P=0.003). The adenoma detection rate was 50.8 and 47.5% for CWE and WE, respectively (P=0.472). The Boston Bowel Preparation Scale scores were comparable in the two groups. Results from the multiple linear regression analysis indicated that WE with a cap, a higher degree of endoscopist's experience, a higher Boston Bowel Preparation Scale score, and a lower volume of water infused during insertion, without abdominal compression, without change of position, and without chronic laxative use, were significantly associated with a shorter cecal intubation time. In comparison with WE, CWE could shorten the cecal intubation time and required lower volume of water infusion during insertion without compromising the cleansing effect of WE.

  5. Obstetric Anaesthetists' Association and Difficult Airway Society guidelines for the management of difficult and failed tracheal intubation in obstetrics.

    Science.gov (United States)

    Mushambi, M C; Kinsella, S M; Popat, M; Swales, H; Ramaswamy, K K; Winton, A L; Quinn, A C

    2015-11-01

    The Obstetric Anaesthetists' Association and Difficult Airway Society have developed the first national obstetric guidelines for the safe management of difficult and failed tracheal intubation during general anaesthesia. They comprise four algorithms and two tables. A master algorithm provides an overview. Algorithm 1 gives a framework on how to optimise a safe general anaesthetic technique in the obstetric patient, and emphasises: planning and multidisciplinary communication; how to prevent the rapid oxygen desaturation seen in pregnant women by advocating nasal oxygenation and mask ventilation immediately after induction; limiting intubation attempts to two; and consideration of early release of cricoid pressure if difficulties are encountered. Algorithm 2 summarises the management after declaring failed tracheal intubation with clear decision points, and encourages early insertion of a (preferably second-generation) supraglottic airway device if appropriate. Algorithm 3 covers the management of the 'can't intubate, can't oxygenate' situation and emergency front-of-neck airway access, including the necessity for timely perimortem caesarean section if maternal oxygenation cannot be achieved. Table 1 gives a structure for assessing the individual factors relevant in the decision to awaken or proceed should intubation fail, which include: urgency related to maternal or fetal factors; seniority of the anaesthetist; obesity of the patient; surgical complexity; aspiration risk; potential difficulty with provision of alternative anaesthesia; and post-induction airway device and airway patency. This decision should be considered by the team in advance of performing a general anaesthetic to make a provisional plan should failed intubation occur. The table is also intended to be used as a teaching tool to facilitate discussion and learning regarding the complex nature of decision-making when faced with a failed intubation. Table 2 gives practical considerations of how to

  6. Comparison of dexmedetomidine and sufentanil for conscious sedation in patients undergoing awake fibreoptic nasotracheal intubation: a prospective, randomised and controlled clinical trial.

    Science.gov (United States)

    Shen, She-Liang; Xie, Yi-hong; Wang, Wen-Yuan; Hu, Shuang-Fei; Zhang, Yun-Long

    2014-01-01

    Fibreoptic intubation is a valuable technique for difficult airway management in which conscious sedation is paramount. To investigate the efficacy and safety of dexmedetomidine (DEX) and sufentanil (SUF) for conscious sedation during awake nasotracheal intubation under vision by a fibreoptic bronchoscope. Forty patients with anticipated difficult airways of American Society of Anesthesiologists I-II scheduled for awake fibreoptic nasotracheal intubation were randomised into two groups each containing 20 subjects. DEX group received DEX at a dose of 1.0 μg/kg over 10 min followed by a continuous infusion of 0.5 μg/kg per hour, while SUF group received SUF target controlled infusion in which the target plasma concentration was 0.3 ng/mL. The nasotracheal intubation conditions and the tolerance to nasotracheal intubation were observed; the occurrence of adverse events including hypertension, bradycardia and respiratory depression during nasotracheal intubation and post-surgical throat pain and hoarseness, and post-surgical memory score were recorded. Better nasotracheal intubation conditions and higher tolerance to intubation were observed in DEX group than those in SUF group (P memory score for sedation during awake fibreoptic nasotracheal intubation. © 2013 John Wiley & Sons Ltd.

  7. Upper gastrointestinal bleeding in patients with CKD.

    Science.gov (United States)

    Liang, Chih-Chia; Wang, Su-Ming; Kuo, Huey-Liang; Chang, Chiz-Tzung; Liu, Jiung-Hsiun; Lin, Hsin-Hung; Wang, I-Kuan; Yang, Ya-Fei; Lu, Yueh-Ju; Chou, Che-Yi; Huang, Chiu-Ching

    2014-08-07

    Patients with CKD receiving maintenance dialysis are at risk for upper gastrointestinal bleeding. However, the risk of upper gastrointestinal bleeding in patients with early CKD who are not receiving dialysis is unknown. The hypothesis was that their risk of upper gastrointestinal bleeding is negatively linked to renal function. To test this hypothesis, the association between eGFR and risk of upper gastrointestinal bleeding in patients with stages 3-5 CKD who were not receiving dialysis was analyzed. Patients with stages 3-5 CKD in the CKD program from 2003 to 2009 were enrolled and prospectively followed until December of 2012 to monitor the development of upper gastrointestinal bleeding. The risk of upper gastrointestinal bleeding was analyzed using competing-risks regression with time-varying covariates. In total, 2968 patients with stages 3-5 CKD who were not receiving dialysis were followed for a median of 1.9 years. The incidence of upper gastrointestinal bleeding per 100 patient-years was 3.7 (95% confidence interval, 3.5 to 3.9) in patients with stage 3 CKD, 5.0 (95% confidence interval, 4.8 to 5.3) in patients with stage 4 CKD, and 13.9 (95% confidence interval, 13.1 to 14.8) in patients with stage 5 CKD. Higher eGFR was associated with a lower risk of upper gastrointestinal bleeding (P=0.03), with a subdistribution hazard ratio of 0.93 (95% confidence interval, 0.87 to 0.99) for every 5 ml/min per 1.73 m(2) higher eGFR. A history of upper gastrointestinal bleeding (Pupper gastrointestinal bleeding risk. In patients with CKD who are not receiving dialysis, lower renal function is associated with higher risk for upper gastrointestinal bleeding. The risk is higher in patients with previous upper gastrointestinal bleeding history and low serum albumin. Copyright © 2014 by the American Society of Nephrology.

  8. Gastrointestinal helminths in migratory Camel

    Directory of Open Access Journals (Sweden)

    S G Rewatkar

    Full Text Available Survey of gastrointestinal helminth parasites in camel migrated from U.P., M.P., and Rajasthan at Nagpur region was carried out in early summer, 2008. Total 28 samples (12 males and 16 females were collected from different places of Nagpur region. They revealed parasites as Trichuris sp.(50%, Strongyloides sp.(32.14%, Trichostrongylus sp.(10.71%, Nematodirus sp.(10.71%, Haemonchus sp.(14.28%, Eurytrema sp.(21.42% ,Eimeria sp.(25%, Entamoeba sp.(17.85% and Balantidium sp.(7.14%.All were found positive for mixed helminthic infection. [Vet World 2009; 2(7.000: 258-258

  9. Gastrointestinal obstruction in penguin chicks.

    Science.gov (United States)

    Perpiñán, David; Curro, Thomas G

    2009-12-01

    A 7-day-old gentoo penguin (Pygoscelis papua) was found dead and postmortem examination revealed impaction of the ventriculus with feathers. A review of mortality in gentoo penguin chicks from 1997 to 2007 at that institution revealed another case of feather impaction of the ventriculus in a 4-week-old chick, a sibling of the previous chick. A third case of gastrointestinal impaction occurred in a 24-day-old king penguin (Aptenodytes patagonicus) with omphallitis and enteritis. In this chick, a fibrin mat produced a complete obstruction of the intestine at the level of Meckel's diverticulum.

  10. Fraccionando la microbiota gastrointestinal humana

    OpenAIRE

    Peris Bondia, Francisco

    2012-01-01

    La microbiota gastrointestinal humana es una de las comunidades microbianas más diversa y compleja que se puede encontrar en la naturaleza. Las nuevas tecnologías de secuenciación permiten obtener una amplia visión de la diversidad microbiana, lo que ha revelado una gran cantidad de bacterias no cultivables. A pesar del potencial de estas tecnologías de alto rendimiento la metagenómica no muestra la imagen completa. La citometría de flujo es una metodología que permite describir y/o separa...

  11. The All India Difficult Airway Association 2016 guidelines for tracheal intubation in the Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Sheila Nainan Myatra

    2016-01-01

    Full Text Available Tracheal intubation (TI is a routine procedure in the Intensive Care Unit (ICU and is often life-saving. In contrast to the controlled conditions in the operating room, critically ill patients with respiratory failure and shock are physiologically unstable. These factors, along with a suboptimal evaluation of the airway and limited oxygen reserves despite adequate pre-oxygenation, are responsible for a high incidence of life-threatening complications such as severe hypoxaemia and cardiovascular collapse during TI in the ICU. The All India Difficult Airway Association (AIDAA proposes a stepwise plan for safe management of the airway in critically ill patients. These guidelines have been developed based on available evidence; wherever robust evidence was lacking, recommendations were arrived at by consensus opinion of airway experts, incorporating the responses to a questionnaire sent to members of the AIDAA and the Indian Society of Anaesthesiologists. Non-invasive positive pressure ventilation during pre-oxygenation improves oxygen stores in patients with respiratory pathology. Nasal insufflation of oxygen at 15 L/min can increase the duration of apnoea before the occurrence of hypoxaemia. High-flow nasal cannula oxygenation at 60-70 L/min may also increase safety during TI in critically ill patients. Stable haemodynamics and gas exchange must be maintained during rapid sequence induction. It is necessary to implement an intubation protocol during routine airway management in the ICU. Adherence to a plan for difficult airway management incorporating the use of intubation aids and airway rescue devices and strategies is useful.

  12. Online in-tube microextractor coupled with UV-Vis spectrophotometer for bisphenol A detection.

    Science.gov (United States)

    Poorahong, Sujittra; Thammakhet, Chongdee; Thavarungkul, Panote; Kanatharana, Proespichaya

    2013-01-01

    A simple and high extraction efficiency online in-tube microextractor (ITME) was developed for bisphenol A (BPA) detection in water samples. The ITME was fabricated by a stepwise electrodeposition of polyaniline, polyethylene glycol and polydimethylsiloxane composite (CPANI) inside a silico-steel tube. The obtained ITME coupled with UV-Vis detection at 278 nm was investigated. By this method, the extraction and pre-concentration of BPA in water were carried out in a single step. Under optimum conditions, the system provided a linear dynamic range of 0.1 to 100 μM with a limit of detection of 20 nM (S/N ≥3). A single in-tube microextractor had a good stability of more than 60 consecutive injections for 10.0 μM BPA with a relative standard deviation of less than 4%. Moreover, a good tube-to-tube reproducibility and precision were obtained. The system was applied to detect BPA in water samples from six brands of baby bottles and the results showed good agreement with those obtained from the conventional GC-MS method. Acceptable percentage recoveries from the spiked water samples were obtained, ranging from 83-102% for this new method compared with 73-107% for the GC-MS standard method. This new in-tube CPANI microextractor provided an excellent extraction efficiency and a good reproducibility. In addition, it can also be easily applied for the analysis of other polar organic compounds contaminated in water sample.

  13. Changes in Tracheostomy- and Intubation-Related Tracheal Stenosis: Implications for Surgery.

    Science.gov (United States)

    Kim, Samuel S; Khalpey, Zain; Hsu, Charles; Little, Alex G

    2017-09-01

    This study sought to identify the changing characteristic patterns and locations of stenosis after tracheostomy or intubation and to assess the risk factors associated with perioperative complication and restenosis after primary resection and reconstruction. A retrospective review was performed (January /2012 to March 2015) on patients treated at the University of Arizona Medical Center (Tucson, Arizona) who had symptomatic tracheal stenosis secondary to prolonged intubation or tracheostomy. Data on demographics, surgical approach, and outcome were obtained. Analysis was performed using the χ 2 test, Kaplan-Meier estimate of survival, Cox proportional hazards survival analysis, and univariate and multivariate logistic regression. Forty-eight patients were referred for surgical resection, and 36 patients underwent primary resection and reconstruction; 72% of patients had previous endobronchial treatments for stenosis. Fourteen patients had postintubation tracheal stenosis, and 22 had tracheostomy-related stenosis (16 percutaneous, 6 open tracheostomy). Among all patients, 52.8% had stenosis proximal to or involving the cricoid; 72.7% of patients with tracheostomy-related stenosis had stenosis at or proximal to the cricoid, whereas only 21.4% of the patients with intubation-related stenosis had a similar location. Nineteen patients underwent laryngotracheal resection, and 17 patients had tracheal resection. The mean length of resection was 3.6 cm. A body mass index greater than 35 was associated with increased perioperative complications (p = 0.012). In multivariate analysis, patients younger than 30 years of age at operation had an increased relative risk of recurrence. Recent advances in percutaneous tracheostomy have increased the numbers of patients presenting with proximal tracheal stenosis, thus necessitating more complex subglottic resection and reconstruction. The anastomotic and overall complication rate remains low despite these more complex operations

  14. Corrosion casting of the subglottis following endotracheal tube intubation injury: a pilot study in Yorkshire piglets

    Science.gov (United States)

    2013-01-01

    Purpose Subglottic stenosis can result from endotracheal tube injury. The mechanism by which this occurs, however, is not well understood. The purpose of this study was to examine the role of angiogenesis, hypoxia and ischemia in subglottic mucosal injury following endotracheal intubation. Methods Six Yorkshire piglets were randomized to either a control group (N=3, ventilated through laryngeal mask airway for corrosion casting) or accelerated subglottic injury group through intubation and induced hypoxia as per a previously described model (N=3). The vasculature of all animals was injected with liquid methyl methacrylate. After polymerization, the surrounding tissue was corroded with potassium hydroxide. The subglottic region was evaluated using scanning electron microscopy looking for angiogenic and hypoxic or degenerative features and groups were compared using Mann–Whitney tests and Friedman’s 2-way ANOVA. Results Animals in the accelerated subglottic injury group had less overall angiogenic features (P=.002) and more overall hypoxic/degenerative features (P=.000) compared with controls. Amongst angiogenic features, there was decreased budding (P=.000) and a trend toward decreased sprouting (P=.037) in the accelerated subglottic injury group with an increase in intussusception (P=.004), possibly representing early attempts at rapid revascularization. Amongst hypoxic/degenerative features, extravasation was the only feature that was significantly higher in the accelerated subglottic injury group (P=.000). Conclusions Subglottic injury due to intubation and hypoxia may lead to decreased angiogenesis and increased blood vessel damage resulting in extravasation of fluid and a decreased propensity toward wound healing in this animal model. PMID:24401165

  15. Development of a preliminary risk index to identify trauma patients at risk for an unplanned intubation.

    Science.gov (United States)

    Kim, Dennis; Kobayashi, Leslie; Chang, David; Fortlage, Dale; Coimbra, Raul

    2014-01-01

    The development of respiratory failure requiring an emergent unplanned intubation (UI) is a potentially preventable complication associated with increased morbidity and mortality. The objective of this study was to develop a clinical risk index for UI based on readily available clinical data to assist in the identification of trauma patients at risk for this complication. We also sought to determine the impact of UI on patient outcomes. This is a 3-year retrospective analysis of our Level 1 trauma center registry to identify all patients requiring a UI. Patients who required a UI were compared with patients who were never intubated. An additive risk index consisting of 10 clinical variables was created using the final significant variables from a stepwise logistic regression model. The sensitivity and specificity of every possible index score were calculated and added together to calculate the "gain in certainty" values. During the 3-year period, 7,552 patients were admitted, of whom 967 (12.8%) required intubation. Of these, 55 (5.7%) underwent a UI. The final risk index consisted of 10 variables as follows: age 55 years to 64 years, age 65 years or older, male sex, Glasgow Coma Scale (GCS) score of 9 to 13, seizures, chronic obstructive pulmonary disease, traumatic brain injury, four or more rib fractures, spine fractures, and long-bone fractures. Gain in certainty was maximized at an index score of 4, with the highest combined sensitivity and specificity of 86.0% and 74.9%, respectively. The probability of UI increased from 0.9% at a score of 1 to 2.9% at 4 and 43% at 9. UI was associated with increased overall complications, length of stay, and mortality (p the development of an additive risk index. Prospective validation of the risk index is potentially warranted. Diagnostic study, level III.

  16. External laryngeal manipulation done by the laryngoscopist makes the best laryngeal view for intubation

    Directory of Open Access Journals (Sweden)

    Mohamed Shaaban Ali

    2014-01-01

    Full Text Available Purpose: External laryngeal manipulation (ELM is used to get better laryngeal view during direct laryngoscopy. This study was designed to test the hypothesis that ELM done by the intubating anesthetist (laryngoscopist offers the best laryngeal view for tracheal intubation. Materials and method: A total of 160 patients underwent different surgical procedures were included in this study. Percentage of glottic opening (POGO score and Cormack and Lehane scale were used as outcome measures for comparison between different laryngoscopic views. Four views were described; basic laryngoscopic view and then views after ELM done by the assistant, by the laryngoscopist and finally by the assistant after the guidance from the laryngoscopist respectively. The last three views compared with the basic laryngoscopic view. Results: ELM done by the laryngoscopist or by the assistant after guidance from the laryngoscopist showed significant improvement of Cormack grades and POGO scores compared with basic laryngoscopic view. Number of patients with Cormack grade1 increased from 39 after direct laryngoscopy to 97 and 96 patients (P < 0.001 by Fisher′s exact test, after ELM done by the laryngoscopist and that done by the assistant after guidance from the anesthetist respectively. Furthermore, the number of patients with POGO scores of 100% increased from 39 after direct laryngoscopy to 78 and 61 (P < 0.01 patients after ELM done by the laryngoscopist and that done by the assistant after guidance from the anesthetist respectively. Conclusion: It appeared from this study that ELM done by the anesthetist makes the best laryngeal view for tracheal intubation.

  17. Assessment of horizontal in-tube condensation models using MARS code. Part I: Stratified flow condensation

    Energy Technology Data Exchange (ETDEWEB)

    Jeon, Seong-Su [Department of Engineering Project, FNC Technology Co., Ltd., Bldg. 135-308, Seoul National University, Gwanak-gu, Seoul 151-744 (Korea, Republic of); Department of Nuclear Engineering, Seoul National University, Gwanak-gu, Seoul 151-744 (Korea, Republic of); Hong, Soon-Joon, E-mail: sjhong90@fnctech.com [Department of Engineering Project, FNC Technology Co., Ltd., Bldg. 135-308, Seoul National University, Gwanak-gu, Seoul 151-744 (Korea, Republic of); Park, Ju-Yeop; Seul, Kwang-Won [Korea Institute of Nuclear Safety, 19 Kuseong-dong, Yuseong-gu, Daejon (Korea, Republic of); Park, Goon-Cherl [Department of Nuclear Engineering, Seoul National University, Gwanak-gu, Seoul 151-744 (Korea, Republic of)

    2013-01-15

    Highlights: Black-Right-Pointing-Pointer This study collected 11 horizontal in-tube condensation models for stratified flow. Black-Right-Pointing-Pointer This study assessed the predictive capability of the models for steam condensation. Black-Right-Pointing-Pointer Purdue-PCCS experiments were simulated using MARS code incorporated with models. Black-Right-Pointing-Pointer Cavallini et al. (2006) model predicts well the data for stratified flow condition. Black-Right-Pointing-Pointer Results of this study can be used to improve condensation model in RELAP5 or MARS. - Abstract: The accurate prediction of the horizontal in-tube condensation heat transfer is a primary concern in the optimum design and safety analysis of horizontal heat exchangers of passive safety systems such as the passive containment cooling system (PCCS), the emergency condenser system (ECS) and the passive auxiliary feed-water system (PAFS). It is essential to analyze and assess the predictive capability of the previous horizontal in-tube condensation models for each flow regime using various experimental data. This study assessed totally 11 condensation models for the stratified flow, one of the main flow regime encountered in the horizontal condenser, with the heat transfer data from the Purdue-PCCS experiment using the multi-dimensional analysis of reactor safety (MARS) code. From the assessments, it was found that the models by Akers and Rosson, Chato, Tandon et al., Sweeney and Chato, and Cavallini et al. (2002) under-predicted the data in the main condensation heat transfer region, on the contrary to this, the models by Rosson and Meyers, Jaster and Kosky, Fujii, Dobson and Chato, and Thome et al. similarly- or over-predicted the data, and especially, Cavallini et al. (2006) model shows good predictive capability for all test conditions. The results of this study can be used importantly to improve the condensation models in thermal hydraulic code, such as RELAP5 or MARS code.

  18. Intubations and airway management: An overview of Hassles through third millennium

    Directory of Open Access Journals (Sweden)

    Abdullah Alanazi

    2015-01-01

    Full Text Available Background: The placement of a tube into a patient′s trachea "the intubation" as we call is not as simple as it looks. It is a very tricky and tedious maneuver that entails skills to assess and perform. Nevertheless, often this is left to the chores of inefficient hands due to a paucity of the availability of experts. They seldom are able to complete the task and often wind up calling the attention of the unit. The present review is an attempt to describe the need to undertake intubation, the procedures and techniques, the complications, including morbidity and mortality and airway management. This overview includes explicit descriptions of the difficult airway which represents multifaceted interface amid patient factors, clinical setting, and skills of the practitioner. Materials and Methods: To accomplish the target, peer-reviewed English language articles published during third millennium up to 2013 were selected from Pub Med, Pub Med Central, Science Direct, Up-to-date, Med Line, comprehensive databases, Cochrane library, and the Internet (Google, Yahoo. Review of Literature: The review constituted a systematic search of literature on the requirements that necessitate the practice of intubation, different techniques that facilitate easy conduct of procedure, the complications, including, morbidity and mortality, and the airway management. Conclusion: Recording every single detail has been beyond the scope of this review, however; some aspects have been wrapped up in nutshell. Some areas of the review are too basic which the medics are well aware of and knowledgeable. Nevertheless, these are difficult to be dispensed with in consideration of their source to the awareness of a common man and a great majority of the patients.

  19. Comparison of blind intubation through the I-gel and ILMA Fastrach by nurses during cardiopulmonary resuscitation: a manikin study.

    Science.gov (United States)

    Melissopoulou, Theodora; Stroumpoulis, Konstantinos; Sampanis, Michail A; Vrachnis, Nikolaos; Papadopoulos, Georgios; Chalkias, Athanasios; Xanthos, Theodoros

    2014-01-01

    To investigate whether nursing staff can successfully use the I-gel and the intubating laryngeal mask Fastrach (ILMA) during cardiopulmonary resuscitation. Although tracheal intubation is considered to be the optimal method for securing the airway during cardiopulmonary resuscitation, laryngoscopy requires a high level of skill. Forty five nurses inserted the I-gel and the ILMA in a manikin, with continuous and without chest compressions. Mean intubation times for the ILMA and I-gel without chest compressions were 20.60 ± 3.27 and 18.40 ± 3.26 s, respectively (p < 0.0005). ILMA proved more successful than the I-gel regardless of compressions. Continuation of compressions caused a prolongation in intubation times for both the I-gel (p < 0.0005) and the ILMA (p < 0.0005). In this mannequin study, nursing staff can successfully intubate using the I-gel and the ILMA as conduits with comparable success rates, regardless of whether chest compressions are interrupted or not. Copyright © 2014 Elsevier Inc. All rights reserved.

  20. Preventing pressure sores of the nasal ala after nasotracheal tube intubation: from animal model to clinical application.

    Science.gov (United States)

    Huang, Tze-Ta; Tseng, Chih-En; Lee, Tsan-Mu; Yeh, Jen-Ying; Lai, Yu-Yung

    2009-03-01

    Nasal-ala pressure sores induced by nasotracheal intubation are common complications of oral and maxillofacial surgery, but are easily ignored. To determine whether such sores could be prevented, we studied the effects of a combination of cushioning material in an animal model, and then analyzed the efficacy of this combination clinically. Four pigs received nasotracheal intubation. Each pig received intubation for 4, 8, 12, or 16 hours. Outcomes from pigs undergoing 500-gram-weight compression on each nostril were compared: one nostril received an application of cushioning materials, and the contralateral nostril did not. After the required study period, clinical assessment and further evaluation were performed by measuring pressure-sore dimensions and performing incisional biopsies. Clinical applications of this protective technique were then undertaken. Eight patients who underwent intubation without Soft Liner (GC Co, Tokyo, Japan) and DuoDERM CGF (ConvaTec, Inc, Princeton, NJ) protection, and 10 patients with Soft Liner and DuoDERM protection, were evaluated. The protective efficacy of the cushioning materials was significant in the animal model as well as in clinical practice. Pressure sores were avoided on the protected side, with severe tissue necrosis documented on the control side. We found that the combined use of Soft Liner and DuoDERM reduced the size and severity of nasal-ala pressure sores attributable to nasotracheal intubation during oral and maxillofacial surgery.

  1. I-gel Laryngeal Mask Airway Combined with Tracheal Intubation Attenuate Systemic Stress Response in Patients Undergoing Posterior Fossa Surgery

    Directory of Open Access Journals (Sweden)

    Chaoliang Tang

    2015-01-01

    patients. In this study, we proposed that I-gel combined with tracheal intubation could reduce the stress response of posterior fossa surgery patients. Methods. Sixty-six posterior fossa surgery patients were randomly allocated to receive either tracheal tube intubation (Group TT or I-gel facilitated endotracheal tube intubation (Group TI. Hemodynamic and respiratory variables, stress and inflammatory response, oxidative stress, anesthesia recovery parameters, and adverse events during emergence were compared. Results. Mean arterial pressure and heart rate were lower in Group TI during intubation and extubation (P<0.05 versus Group TT. Respiratory variables including peak airway pressure and end-tidal carbon dioxide tension were similar intraoperative, while plasma β-endorphin, cortisol, interleukin-6, tumor necrosis factor-alpha, malondialdehyde concentrations, and blood glucose were significantly lower in Group TI during emergence relative to Group TT. Postoperative bucking and serious hypertensions were seen in Group TT but not in Group TI. Conclusion. Utilization of I-gel combined with endotracheal tube in posterior fossa surgery patients is safe which can yield more stable hemodynamic profile during intubation and emergence and lower inflammatory and oxidative response, leading to uneventful recovery.

  2. To compare the accuracy of Prayer's sign and Mallampatti test in predicting difficult intubation in Diabetic patients

    International Nuclear Information System (INIS)

    Baig, M. M. A.; Khan, F. H.

    2014-01-01

    Objective: To determine the accuracy of Prayer's sign and Mallampatti test in predicting difficult endotracheal intubation in diabetic patients. Methods: The cross-sectional study was performed at Aga Khan University Hospital, Karachi, over a period from January 2009 to April 2010, and comprised 357 patients who required endotracheal intubation for elective surgical procedures. Prayer's sign and Mallampatti tests were performed for the assessment of airway by trained observers. Ease or difficulty of laryngoscopy after the patient was fully anaesthetised with standard technique were observed and laryngoscopic view of first attempt was rated according to Cormack-Lehan grade of intubation. SPSS 15 was used for statistical analysis. Results: Of the 357 patients, 125(35%) were classified as difficult to intubate. Prayer's sign showed significantly lower accuracy, positive and negative predictive values than Mallampatti test. The sensitivity of Prayer's sign was lower 29.6 (95% Confidence Interval, 21.9-38.5) than Mallampatti test 79.3 (95% confidence interval, 70.8-85.7) while specificity of both the tests was not found to be significantly different. Conclusion: Prayer's sign is not acceptable as a single best bedside test for prediction of difficult intubation. (author)

  3. Betel quid, chewing habits and difficult intubation: A case report and critical appraisal of evidence for practice.

    Science.gov (United States)

    Narendra, P L; Hegde, Harihar V; Vijaykumar, T K; Nallamilli, Samson

    2015-01-01

    Betel quid is used by 10-20% of world of population. Oral submucus fibrosis (OSF) is a chronic premalignant disease common in South Asian countries where betel quid is chewed. It is characterized by juxtaepithelial fibrosis of oral cavity and limited mouth opening, which can cause difficult intubation. A recent study in Taiwan has revealed long-term betel nut chewing is not predictor of difficult intubation. We describe two cases of OSF and critically analyze this study and its implications for clinical practice. OSF is now seen in Saudi Arabia and western countries with use of commercial betel quid substitutes. Although betel quid without tobacco is used in Taiwan, available evidence suggests rapid and early development of OSF where commercial chewing products like Pan Masala are used in India. Effects of betel quid may vary depending on the composition of quid and chewing habits. Studies where personal habits are involved must be analyzed carefully for external validity. Even though, Taiwan study is controlled, its validity outside Taiwan is highly questionable. Since OSF can cause unanticipated difficult intubation, thus during preanesthetic assessment, history of betel quid chewing, more importantly use of commercial chewing products is more likely to give clues to severity of OSF and possible difficult intubation. Further controlled trails in populations where commercial chewing products are used is necessary to detect association of chewing habits and difficult intubation.

  4. Rescue ventilation: resolving a "cannot mask ventilate, cannot intubate" situation during exchange of a Combitube for a definitive airway.

    Science.gov (United States)

    Rich, James M; Mason, Andrew M; Tillmann, H A; Foreman, Michael

    2009-10-01

    Our anesthesia care team was called to care for a patient who was admitted to the emergency department with the esophageal-tracheal double-lumen airway device (Combitube, Tyco Healthcare, Nellcor, Pleasanton, California) in place, which needed to be exchanged for a definitive airway because the patient required an extended period of mechanical ventilation. Several techniques were attempted to exchange the esophageal-tracheal Combitube (ETC) without success. First, we attempted direct laryngoscopy with the ETC in place after deflation of the No. 1 proximal cuff and sweeping the ETC to the left. We were prepared to use bougie-assisted intubation but could not identify any airway anatomy. After removal of the ETC, we unsuccessfully attempted ventilation/intubation with a laryngeal mask airway (LMA Fastrach, LMA North America, San Diego, California). Our third attempt was insertion of another laryngeal mask airway (LMA Unique, LMA North America) with marginal ventilation, but we again experienced unsuccessful intubation using a fiberscope. The ETC was reinserted after each intubation attempt because mask ventilation was impossible. Before proceeding with cricothyrotomy, we repeated direct laryngoscopy but without the ETC in place. We identified the tip of the epiglottis, which allowed for bougie-assisted intubation. This obviated the need for emergency cricothyrotomy.

  5. Intubation af førstegangsfødende med Klippel-Feils syndrom

    DEFF Research Database (Denmark)

    Münter, Kristine; Johansen, Jakob; Atke, Anders

    2014-01-01

    We describe a case of a first time parturient with Klippel-Feil syndrome (KFS). KFS is defined by fusion of cervical vertebrae and the clinical triad of low posterior hairline, short wide neck and limited neck movement. KFS represents a complex challenging anaesthesiologic condition due to limite...... spine disorder that might need airway management....... movement of the neck and the risk of irreversible neurologic sequelae if manipulated, as well as unpredictable effect of neuroaxial anaesthesia. We recommend awake fiberoptic intubation for airway management in this rare disorder and stress the necessity of early anaesthesiologic assessment in any cervical...

  6. Reduced cerebral oxygen–carbohydrate index during endotracheal intubation in vascular surgical patients

    DEFF Research Database (Denmark)

    Fabricius-Bjerre, Andreas; Overgaard, Anders; Winther-Olesen, Marie

    2015-01-01

    Brain activation reduces balance between cerebral consumption of oxygen versus carbohydrate as expressed by the so-called cerebral oxygen-carbohydrate-index (OCI). We evaluated whether preparation for surgery, anaesthesia including tracheal intubation and surgery affect OCI. In patients undergoing...... aortic surgery, arterial to internal jugular venous (a-v) concentration differences for oxygen versus lactate and glucose were determined from before anaesthesia to when the patient left the recovery room. Intravenous anaesthesia was supplemented with thoracic epidural anaesthesia for open aortic surgery...

  7. Delayed Detection of Esophageal Intubation in Anesthesia Malpractice Claims: Brief Report of a Case Series.

    Science.gov (United States)

    Honardar, Marzieh R; Posner, Karen L; Domino, Karen B

    2017-12-01

    This retrospective case series analyzed 45 malpractice claims for delayed detection of esophageal intubation from the Anesthesia Closed Claims Project. Inclusion criteria were cases from 1995 to 2013, after adoption of identification of CO2 in expired gas to verify correct endotracheal tube position as a monitoring standard by the American Society of Anesthesiologists. Forty-nine percent (95% confidence interval 34%-64%) occurred in the operating room or other anesthesia location where CO2 detection equipment should have been available. The most common factors contributing to delayed detection were not using, ignoring, or misinterpreting CO2 readings. Misdiagnosis, as with bronchospasm, occurred in 33% (95% confidence interval 20%).

  8. Endotracheal Tube Cuff Pressures in Patients Intubated Prior to Helicopter EMS Transport

    Directory of Open Access Journals (Sweden)

    Joseph Tennyson

    2016-11-01

    Full Text Available Introduction Endotracheal intubation is a common intervention in critical care patients undergoing helicopter emergency medical services (HEMS transportation. Measurement of endotracheal tube (ETT cuff pressures is not common practice in patients referred to our service. Animal studies have demonstrated an association between the pressure of the ETT cuff on the tracheal mucosa and decreased blood flow leading to mucosal ischemia and scarring. Cuff pressures greater than 30 cmH2O impede mucosal capillary blood flow. Multiple prior studies have recommended 30 cmH2O as the maximum safe cuff inflation pressure. This study sought to evaluate the inflation pressures in ETT cuffs of patients presenting to HEMS. Methods We enrolled a convenience sample of patients presenting to UMass Memorial LifeFlight who were intubated by the sending facility or emergency medical services (EMS agency. Flight crews measured the ETT cuff pressures using a commercially available device. Those patients intubated by the flight crew were excluded from this analysis as the cuff was inflated with the manometer to a standardized pressure. Crews logged the results on a research form, and we analyzed the data using Microsoft Excel and an online statistical analysis tool. Results We analyzed data for 55 patients. There was a mean age of 57 years (range 18–90. The mean ETT cuff pressure was 70 (95% CI= [61–80] cmH2O. The mean lies 40 cmH2O above the maximum accepted value of 30 cmH2O (p120 cmH2O, the maximum pressure on the analog gauge. Conclusion Patients presenting to HEMS after intubation by the referral agency (EMS or hospital have ETT cuffs inflated to pressures that are, on average, more than double the recommended maximum. These patients are at risk for tracheal mucosal injury and scarring from decreased mucosal capillary blood flow. Hospital and EMS providers should use ETT cuff manometry to ensure that they inflate ETT cuffs to safe pressures.

  9. Ghrelin and gastrointestinal stromal tumors.

    Science.gov (United States)

    Zhu, Chang-Zhen; Liu, Dong; Kang, Wei-Ming; Yu, Jian-Chun; Ma, Zhi-Qiang; Ye, Xin; Li, Kang

    2017-03-14

    Ghrelin, as a kind of multifunctional protein polypeptide, is mainly produced in the fundus of the stomach and can promote occurrence and development of many tumors, including gastrointestinal tumors, which has been proved by the relevant researches. Most gastrointestinal stromal tumors (GISTs, about 80%), as the most common mesenchymal tumor, also develop in the fundus. Scientific research has confirmed that ghrelin, its receptors and mRNA respectively can be found in GISTs, which demonstrated the existence of a ghrelin autocrine/paracrine loop in GIST tissues. However, no reports to date have specified the mechanism whether ghrelin can promote the occurrence and development of GISTs. Studies of pulmonary artery endothelial cells in a low-oxygen environment and cardiac muscle cells in an ischemic environment have shown that ghrelin can activate the phosphatidylinositol 3-kinase/AKT/mammalian target of rapamycin (PI3K/AKT/mTOR) signaling pathway. Moreover, some studies of GISTs have confirmed that activation of the PI3K/AKT/mTOR pathway can indeed promote the growth and progression of GISTs. Whether ghrelin is involved in the development or progression of GISTs through certain pathways remains unknown. Can we find a new target for the treatment of GISTs? This review explores and summaries the relationship among ghrelin, the PI3K/AKT/mTOR pathway and the development of GISTs.

  10. Does Hypothyroidism Affect Gastrointestinal Motility?

    Directory of Open Access Journals (Sweden)

    Olga Yaylali

    2009-01-01

    Full Text Available Background. Gastrointestinal motility and serum thyroid hormone levels are closely related. Our aim was to analyze whether there is a disorder in esophagogastric motor functions as a result of hypothyroidism. Materials and Methods. The study group included 30 females (mean age ± SE 45.17 ± 2.07 years with primary hypothyroidism and 10 healthy females (mean age ± SE 39.40 ± 3.95 years. All cases underwent esophagogastric endoscopy and scintigraphy. For esophageal scintigraphy, dynamic imaging of esophagus motility protocol, and for gastric emptying scintigraphy, anterior static gastric images were acquired. Results. The mean esophageal transit time (52.56 ± 4.07 sec for patients; 24.30 ± 5.88 sec for controls; P=.02 and gastric emptying time (49.06 ± 4.29 min for the hypothyroid group; 30.4 ± 4.74 min for the control group; P=.01 were markedly increased in cases of hypothyroidism. Conclusion. Hypothyroidism prominently reduces esophageal and gastric motor activity and can cause gastrointestinal dysfunction.

  11. Radiological diagnosis of gastrointestinal bleeding

    International Nuclear Information System (INIS)

    Neufang, K.F.R.; Gross-Fengels, W.; Lorenz, R.

    1990-01-01

    In the diagnosis of acute gastrointestinal bleeding, endoscopy holds the first place today. Radiological investigations are indispensable whenever endoscopy cannot precisely localise the bleeding site, whenever a tumour is present or suspected, in all cases of lower gastrointestinal bleeding, and in haemobilia. A tailored radiological approach is recommended. The radiological basis programme should be at least a complete abdominal ultrasound study and plain abdominal radiograms. CT and ERCP scans may become necessary in selected cases. As a rule, angiographical localisation of the bleeding site will be successful only in the acute stage; selective visceral arteriograms have to be obtained, which may be executed in the digital subtraction technique in patients who are cooperating and clinically stable. Angiodysplasias and aneurysms, however, may be demonstrated angiographically in the interval as well. Upper and/or lower G.I. tract studies with barium or water-soluble contrast media may be indicated in the interval in order to demonstrate tumours, metastatic lesions, diverticula and gut malformations. (orig.) [de

  12. Endotracheal intubation

    Science.gov (United States)

    ... the esophagus or stomach. Risks include: Bleeding Infection Trauma to the voice box (larynx), thyroid gland, vocal cords and windpipe (trachea), or esophagus Puncture or tearing (perforation) of body parts in the chest cavity, leading to lung collapse

  13. C-MAC compared with direct laryngoscopy for intubation in patients with cervical spine immobilization: A manikin trial.

    Science.gov (United States)

    Smereka, Jacek; Ladny, Jerzy R; Naylor, Amanda; Ruetzler, Kurt; Szarpak, Lukasz

    2017-08-01

    The aim of this study was to compare C-MAC videolaryngoscopy with direct laryngoscopy for intubation in simulated cervical spine immobilization conditions. The study was designed as a prospective randomized crossover manikin trial. 70 paramedics with immobilization (Scenario A); manual inline cervical immobilization (Scenario B); cervical immobilization using cervical extraction collar (Scenario C). Scenario A: Nearly all participants performed successful intubations with both MAC and C-MAC on the first attempt (95.7% MAC vs. 100% C-MAC), with similar intubation times (16.5s MAC vs. 18s C-MAC). Scenario B: The results with C-MAC were significantly better than those with MAC (pimmobilization. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. Chloroform ingestion causing severe gastrointestinal injury, hepatotoxicity and dermatitis confirmed with plasma chloroform concentrations.

    Science.gov (United States)

    Jayaweera, Dushan; Islam, Shawkat; Gunja, Naren; Cowie, Chris; Broska, James; Poojara, Latesh; Roberts, Michael S; Isbister, Geoffrey K

    2017-02-01

    Poisoning due to chloroform ingestion is rare. The classic features of acute chloroform toxicity include central nervous system (CNS) and respiratory depression, and delayed hepatotoxicity. A 30-year-old female ingested 20-30 mL of 99% chloroform solution, which caused rapid loss of consciousness, transient hypotension and severe respiratory depression requiring endotracheal intubation and ventilation. She was alert by 12 h and extubated 16 h post-overdose. At 38-h post-ingestion, her liver function tests started to rise and she was commenced on intravenous acetylcysteine. Her alanine transaminase (1283 U/L), aspartate transaminase (734 U/L) and international normalized ratio (2.3) peaked 67- to 72-h post-ingestion. She also developed severe abdominal pain, vomiting and diarrhoea. An abdominal CT scan was consistent with severe enterocolitis, and an upper gastrointestinal endoscopy showed erosive oesophagitis, severe erosive gastritis and ulceration. She was treated with opioid analgesia, proton pump inhibitors, sucralfate and total parenteral nutrition. Secretions caused a contact dermatitis of her face and back. Nine days post-ingestion she was able to tolerate food. Her liver function tests normalized and the dermatitis resolved. Chloroform was measured using headspace gas chromatograph mass spectrometry, with a peak concentration of 2.00 μg/mL, 4 h 20 min post-ingestion. The concentration-time data fitted a 1-compartment model with elimination half-life 6.5 h. In addition to early CNS depression and delayed hepatotoxicity, we report severe gastrointestinal injury and dermatitis with chloroform ingestion. Recovery occurred with good supportive care, acetylcysteine and management of gastrointestinal complications.

  15. "Detachment of the carinal hook following endobronchial intubation with a double lumen tube"

    Directory of Open Access Journals (Sweden)

    Rocha Ana C

    2011-10-01

    Full Text Available Abstract Background Carinal hooks increases difficulty at endotracheal intubation. Amputation of the carinal hook during passage and malpositioning of the tube to the hook are some of the potential problems related with left-sided Carlens double lumen tube (DLT. This article reports an amputation of the hook during a difficult selective intubation and aimed at calling the attention to complications associated with DLTs and the importance of fiberoptic bronchoscopy. Case presentation A 68 year-old woman was scheduled for right-sided thoracotomy in whom blind DLT insertion was performed. Narrowed trachea causes difficulty in rotating the DLT 90° counter-clockwise. After carinal hook was noticed upon visual inspection of the DLT, fiberoptic bronchoscopy was used to remove the missing part (with the use of forceps from the right mainstem bronchus. Conclusion Insertion of DLTs with carinal hook is associated with technical problems and potentially life-threatening hazards have discouraged their use. Fiberoptic evaluation and repositioning solves most of the problems. Although amputation of the carinal hook has not been previously reported, clinicians should be alert. This case report emphasizes the utility of the fiberoptic bronchoscopy in the operating theatre for placement, positioning and inspection of the carinal hook DLT.

  16. Development of a colonoscopy add-on device for improvement of the intubation process

    Directory of Open Access Journals (Sweden)

    Litten JD

    2011-12-01

    Full Text Available Jonathan D Litten1, JungHun Choi2, David Drozek31Department of Mechanical Engineering; 2Department of Mechanical Engineering and Biomedical Engineering Program; 3College of Osteopathic Medicine, Department of Specialty Medicine, Ohio University, Athens, OH, USAAbstract: A colonoscopy add-on device has been developed to reduce intubation time without modification of the current colonoscope and peripheral devices. One of the main purposes of the system is to minimize trauma caused by the distal tip of the colonoscope. The detachable sensory fixture at the end of the distal tip measures the distance between the distal tip and the colon wall in three directions, and the actuation system attached at the base of the colonoscope controls the distal tip by rotating two dial knobs. The device controls the distal tip to minimize contact between the distal tip and the colon wall, and the distal tip ideally points out the next possible lumen. A compatibility test of the infrared sensory system was carried out, and the design of the actuation system was accomplished. The system is integrated and controlled by a microprocessor. The device was tested in a silicon colon and porcine intestine. The results showed that a colonoscopist successfully reached the cecum with the aid of the colonoscopy add-on device without significant contact between the colon wall and the distal tip. The colonoscopy aid device was very helpful for the novice colonoscopist.Keywords: colonoscope, infrared sensors, intubation, trauma, colonoscopy training model

  17. [Vocal cord paralysis associated with tracheal intubation: incidence, risk analysis, and classification of severity].

    Science.gov (United States)

    Kikura, Mutsuhito; Suzuki, Yuji; Itagaki, Taiga; Sato, Tsunehisa; Nishino, Junko

    2015-01-01

    Vocal cord paralysis after tracheal intubation is rare. It causes severe hoarseness and aspiration, and delays recovery and discharge. Arytenoid cartilage dislocation and recurrent nerve paralysis are main causes of vocal cord paralysis. Physical stimulation of the tracheal tube as well as patient and surgical characteristics also contribute. Vocal cord paralysis occurs in 1 (0.07%) of 1,500 general surgery patients and on the left side in 70% of cases. It is associated with surgery/anesthesia time (two-fold, 3-6 hours; 15-fold, over 6 hours), age (three-fold, over 50 years), and diabetes mellitus or hypertension (two-fold). Symptoms resolve in 2-3 months. In adult cardiovascular surgery, vocal cord paralysis occurs in 1 (0.7-2%) of 50-100 cardiac surgery patients and 1 (8.6-32%) of 3-10 thoracic aortic surgery patients. In pediatric cardiac surgery, vocal cord paralysis occurs in 1 (0.1-0.5%) of 200-1,000 patients. We classified the severity of vocal cord paralysis as I, severe hoarseness; II, aspiration or dysphagia; and III, bilateral vocal cord paralysis, aspiration pneumonia, or the need for tracheal re-intubation or tracheotomy. We discuss the importance of informed consent for the patient and family.

  18. Awake fi beroptic intubation of a patient with amyotrophic lateral sclerosis: case report

    Directory of Open Access Journals (Sweden)

    Elif Bakı

    2012-12-01

    Full Text Available Amyotrophic Lateral Sclerosis is a rapidly progressive disease from the fi fth to sixth decades of life causing degeneration and death of the upper and lower motor neurons and no effective treatment. The diagnosis isdependent on the clinical presentation and consistent electrodiagnostic studies. Progressive denervation affects the muscles, causing muscular weakness and atrophy, when the ventilation muscles are affected deathdue to respiratory failure occurs within a few years. We present the case of a 54 years old, 180 cm height and 94 kg weight male patient with amyotrophic lateral sclerosis who underwent surgical treatment of thyroidcancer. Fiberoptic intubation was orally performed providing spontaneus breathing. Propofol was applied after passing vocal cords. Anesthesia was maintained with sevofl orane (%2 and a mixture of oxygen and airunder volume controlled ventilation. Rocuronium was used 20 mg at the beginning of the surgery. At the end of surgery, he wasn’t extubated and transferred to anesthesia intensive care unit. He was extubated after tenhours and he was awaked perfectly. The patient was discharged from intensive care unit after 24 hours and from hospital after ten days. We reported that amyotrophic lateral sclerosis patient with limited mouth opening who underwent thyroid surgery, using awake intubation.

  19. Circumferential tracheal resection with primary anastomosis for post-intubation tracheal stenosis: study of 24 cases.

    Science.gov (United States)

    Negm, Hesham; Mosleh, Mohamed; Fathy, Hesham

    2013-09-01

    The objective of this study is to evaluate the results of circumferential tracheal and cricotracheal resection with primary anastomosis for the treatment of post-intubation tracheal and cricotracheal stenosis. This is a retrospective analytical study. A total number of 24 patients were included in this study. The relevant preoperative, operative and postoperative records were collected and analyzed. Twenty patients were finally symptom-free reflecting an anastomosis success rate of 83.3 %. Variable grades of anastomotic restenosis occurred in 11 (45.8 %) patients, three patients were symptom-free and eight had airway obstructive symptoms. Four out of the eight patients with symptomatic restenosis were symptom-free with endoscopic dilatation while the remaining four patients required a permanent airway appliance (T-tube, tracheostomy) for the relief of airway obstruction and this group was considered as anastomotic failure. Cricoid involvement, associated cricoid resection and the type of anastomosis were the variables that had statistical impact on the occurrence of restenosis (P = 0.017, 0.017, 0.05; respectively). Tracheal resection with primary anastomosis is a safe effective treatment method for post-intubation tracheal stenosis in carefully selected patients. Restenosis does not always mean failure of the procedure since it may be successfully managed with endoscopic dilatation.

  20. A modified technique of retrograde intubation dacryocystorhinostomy for proximal canalicular obstruction

    Directory of Open Access Journals (Sweden)

    Nikolaos Trakos

    2009-11-01

    Full Text Available Nikolaos Trakos, Emmanouil Mavrikakis, Kostas G Boboridis, Marselos Ralidis, George Dimitriadis, Ioannis MavrikakisOculoplastic Service, Metropolitan Hospital, Athens, GreecePurpose: To describe a modification of the retrograde intubation dacryocystorhinostomy (DCR in patients with proximal canalicular obstruction.Materials and methods: Interventional case report of a 43-year-old female with a nine-month history of left epiphora following a road traffic accident involving the proximal lower canaliculus. An external DCR approach was performed. Following the creation of a lower canalicular pseudopunctum, the O’Donoghue silicone stent was introduced through the common ostium, out through the pseudopunctum of the lower canaliculus, and returned through the punctum of the normal upper canaliculus down through the common ostium into the nose.Results: The patient experienced complete resolution of symptoms and on her last follow-up, two years later, her lower canaliculus was patent to syringing.Conclusion: This modification of the retrograde intubation DCR is an effective technique which decreases the intraoperative time needed to insert the tubes and minimises further trauma to the newly created punctal area.Keywords: retrograde dacryocystorhinostomy, proximal canalicular obstruction, midcanalicular obstruction, conjuctivodacryocystorhinostomy

  1. Undersedation is a risk factor for the development of subglottic stenosis in intubated children,

    Directory of Open Access Journals (Sweden)

    Cláudia Schweiger

    Full Text Available Abstract Objective: To analyze the level of sedation in intubated children as a risk factor for the development of subglottic stenosis. Methods: All patients between 30 days and 5 years of age who required endotracheal intubation in the pediatric intensive care unit between 2013 and 2014 were included in this prospective study. They were monitored daily and COMFORT-B scores were obtained. Flexible fiber-optic laryngoscopy was performed within eight hours of extubation, and repeated seven to ten days later if the first examination showed moderate to severe laryngeal injuries. If these lesions persisted and/or if the child developed symptoms in the follow-up period, microlaryngoscopy under general anesthesia was performed to evaluate for subglottic stenosis. Results: The study included 36 children. Incidence of subglottic stenosis was 11.1%. Children with subglottic stenosis had a higher percentage of COMFORT-B scores between 23 and 30 (undersedated than those who did not develop subglottic stenosis (15.8% vs. 3.65%, p = 0.004. Conclusion: Children who developed subglottic stenosis were less sedated than children who did not develop subglottic stenosis.

  2. Effects of premedication with oral gabapentin on intraocular pressure changes following tracheal intubation in clinically normal dogs.

    Science.gov (United States)

    Trbolova, Alexandra; Ghaffari, Masoud Selk; Capik, Igor

    2017-09-19

    Gabapentin is an antiepileptic drug widely approved as an add-on therapy for epilepsy treatment in human and dogs. There is a clinical impression that gabapentin is a suitable drug which attenuates the IOP elevation associated with tracheal intubation in humans. The present study performed to determine the effects of oral gabapentin on intraocular pressure (IOP) changes following tracheal intubation in dogs. Twenty adult healthy dogs were randomly assigned to treatment (n = 10) and control (n = 10) groups. Dogs in the treatment group received oral gabapentin (50 mg/kg) 2 h before induction of anesthesia and dogs in the control group received oral gelatin capsule placebo at the same time. The dogs were anesthetized with propofol 6 mg/kg, and anesthesia was maintained with a constant infusion of 0.2 mg/kg/min of propofol for 20 min. IOP were measured immediately before induction and then repeated immediately after induction, as well as 5 min, 10 min and 15 min following tracheal intubation in both groups. IOP was significantly higher immediately after induction, and 5 min after tracheal intubation when compared with IOP reading before induction in the control group. There was no statistically significant change in IOPs immediately after induction, and 5 min after tracheal intubation in comparison to the values before induction in the treatment group. Based on the findings of this study, preanesthetic oral administration of gabapentin significantly prevents an increase in the IOP associated with tracheal intubation in dogs anesthetized with propofol.

  3. A COMPARATIVE CLINICAL STUDY BETWEEN IV ESMOLOL AND IV FENTANYL ON ATTENUATION OF HAEMODYNAMIC RESPONSES TO LARYNGOSCOPY AND INTUBATION

    Directory of Open Access Journals (Sweden)

    Abu Lais Mustaque

    2016-04-01

    Full Text Available INTRODUCTION Laryngoscopy and intubation is an integral part for providing general anaesthesia to patients undergoing various types of surgery. It also plays an important role in critical care units viz. for providing mechanical ventilation. It is a very essential tool in the hands of anaesthesiologist in maintaining airway. The present study is undertaken to determine and compare the efficacy of single bolus dose of IV esmolol 1 mg/kg and IV fentanyl 2 mcg/kg in attenuating the haemodynamic responses to laryngoscopy and tracheal intubation and to ascertain the effectiveness of esmolol hydrochloride and fentanyl citrate in suppressing sympathetic responses. MATERIAL & METHODS The study was conducted under the Department of Anaesthesiology and Critical Care, Assam Medical College and Hospital, Dibrugarh, during the period July 2013 to June 2014. For this purpose, 150 patients of either sex between 20-50 years of ASA I & II physical status were selected after obtaining informed and written consent and were divided into two groups namely, Group E receiving IV esmolol (1 mg/kg and Group F receiving IV fentanyl (2 mcg/kg. RESULTS Inj. fentanyl 2 mcg/kg IV administered 5 minutes before laryngoscopy and intubation was able to prevent adverse haemodynamic changes better than Inj. esmolol 1 mg/kg IV administered 3 minutes prior to laryngoscopy and intubation during elective surgeries under general anaesthesia. CONCLUSION Hence, from the findings of this study we can conclude that IV bolus dose of fentanyl 2 mcg/kg administered 5 minutes before laryngoscopy and intubation can attenuate the sympathetic response to laryngoscopy and intubation without any side effects of the drug in healthy patients undergoing elective surgeries under general anaesthesia.

  4. INTUBATIONS CONDITIONS AND HOMODYNAMIC RESPONSES UNDER ANESTHESIA INDUCTION WITH THREE COMBINATION DRUGS: ALFENTANIL- MIDAZOLAM, ALFENTANIL- THIOPENTAL AND ALFENTANIL- KETAMINE

    Directory of Open Access Journals (Sweden)

    H SOLTANI NEZHAD

    2000-03-01

    Full Text Available Background. Administration of alfentanil followed by propofol intravenously (IV without neuromuscular blockage for induction of anesthesia provides adaquate conditions for tracheal intubation. Other hypnotic drugs have not been thoroughly investigated in this regard. The aim of the present study was comparison of intubation conditions and hemodynamic responses of anesthesia induction with alfentanil/midazolam, alfentanil/Na thiopental and alfentanil/ ketamine. Methods. In a clinical trial study one hundred and twenty children were randomly allocated to four groups. Medication in these groups were alfentanil 40 µg/kg+ midazolam 200 µg/kg,alfentanil 40 µg/kg+Na thiopental 6 µg/kg, alfentanil 40 µg/kg+ketamin 2 mg/kg & Na thipental 6 mg/kg+suxamethonium 2 mg/kg (as control group. In all patients the ease of ventilation via face mask, jaw mobility, degree of exposure and position of vocal cords, patient's response to tracheal intubation, duration of time was needed for intubation and hemodynamic changes after intubation were assessed and recorded. Findings. There are significant differences between first three groups (interventional groups for jaw mebility, ventilation, vocal cord visuality, vocal cord position, patient movement during laryngoscopy and mean laryngoscopy time, (P < 0.05. There is significant difference between all groups of nesdonal+alfentanil except for patient movement. There is significant difference between mean SBP and PR before and after intubation in first and third group. Conclusion. Results represent that the group of Alfentanil plus Nesdonal had a better quality of ventilation rather than two other groups. It is recommended that administration of alfentanil plus thiopental combination is preferred in cases that using muscle relaxant is contraindicated.

  5. Review article: video-laryngoscopy: another tool for difficult intubation or a new paradigm in airway management?

    Science.gov (United States)

    Paolini, Jean-Baptiste; Donati, François; Drolet, Pierre

    2013-02-01

    An adequate airway management plan is essential for patient safety. Recently, new tools have been developed as alternatives to direct laryngoscopy and intubation. Among these, video-laryngoscopy has enjoyed a rapid increase in popularity and is now considered by many as the first-line technique in airway management. This paradigm shift may have an impact on patient safety. Studies show that video-laryngoscopes are associated with better glottic visualization, a higher success rate for difficult airways, and a faster learning curve, resulting in a higher success rate for intubations by novice physicians. Thus, unanticipated difficult intubations may be less frequent if video-laryngoscopy is used as the first-line approach. In addition, on-screen viewing by the operator creates a new dynamic interaction during airway management. The entire operating room team can assess progress in real time, which enhances communication and improves teaching. However, if video-laryngoscopes become standard tools for tracheal intubation, these more costly devices will need to be widely available in all locations where airway management is conducted. Furthermore, algorithms for difficult intubation will require modification, and the question of selecting alternate devices will arise. If the incidence of difficult intubation decreases, the lack of motivation to teach and learn the use of alternative devices might adversely impact patient safety. The greater effectiveness of video-laryngoscopes associated with multi-person visualization could enhance overall patient safety during airway management. However, the routine use of video-laryngoscopy also introduces some issues that need to be addressed to avoid potentially dangerous pitfalls.

  6. Computed tomography of the gastrointestinal tract

    International Nuclear Information System (INIS)

    Fishman, E.K.; Jones, B.

    1988-01-01

    This book contains 11 chapters and five case studies. Some of the chapter titles are: CT of the Stomach; CT and Other Inflammatory Bowel Disease; Evaluation of Crohn's Disease; Periotoneal Metastasis; CT and MRI Correlation of the Gastrointestinal Tract; CT of Acute Gastrointestinal Abnormlities; and CT of Colorectal Cancer

  7. Possible Waardenburg syndrome with gastrointestinal anomalies.

    OpenAIRE

    Nutman, J; Steinherz, R; Sivan, Y; Goodman, R M

    1986-01-01

    We describe a patient with possible Waardenburg syndrome associated with anal atresia and oesophageal atresia with tracheooesophageal fistula. Three other published cases with atretic gastrointestinal anomalies associated with the Waardenburg syndrome are reviewed. We conclude that the association between atretic lesions of the gastrointestinal tract and the Waardenburg syndrome may be a significant one.

  8. Possible Waardenburg syndrome with gastrointestinal anomalies.

    Science.gov (United States)

    Nutman, J; Steinherz, R; Sivan, Y; Goodman, R M

    1986-01-01

    We describe a patient with possible Waardenburg syndrome associated with anal atresia and oesophageal atresia with tracheooesophageal fistula. Three other published cases with atretic gastrointestinal anomalies associated with the Waardenburg syndrome are reviewed. We conclude that the association between atretic lesions of the gastrointestinal tract and the Waardenburg syndrome may be a significant one. Images PMID:3712396

  9. Unsedated Flexible Upper Gastrointestinal Endoscopy: Need for ...

    African Journals Online (AJOL)

    Background: To determine the incidence of oxygen desaturation and whether routine oxygen monitoring is necessary during unsedated diagnostic flexible upper gastrointestinal endoscopy. Methods: A prospective study involving 54 consecutive in and out patients who had diagnostic upper gastrointestinal endoscopy at ...

  10. Peptide Hormones in the Gastrointestinal Tract

    DEFF Research Database (Denmark)

    Rehfeld, Jens F.

    2015-01-01

    Gastrointestinal hormones are peptides released from endocrine cells and neurons in the digestive tract. More than 30 hormone genes are currently known to be expressed in the gastrointestinal tract, which makes the gut the largest hormone-producing organ in the body. Modern biology makes it feasi...

  11. Mammalian gastrointestinal parasites in rainforest remnants

    Indian Academy of Sciences (India)

    Here, we studied the gastrointestinal parasites of nonhuman mammalian hosts living in 10 rainforest patches of the Anamalai Tiger Reserve, India. We examined 349 faecal samples of 17 mammalian species and successfully identified 24 gastroin-testinal parasite taxa including 1 protozoan, 2 trematode, 3 cestode and 18 ...

  12. Antidepressants and gastrointestinal symptoms in the general Dutch adult population

    NARCIS (Netherlands)

    Schurink, B.; Tielemans, M.M.; Aaldering, B.R.; Eikendal, T.; Jaspers Focks, J.; Laheij, R.J.F.; Jansen, J.B.M.J.; Rossum, L.G.M. van; Oijen, M.G.H. van

    2014-01-01

    BACKGROUND: Gastrointestinal symptoms are frequently reported adverse effects of antidepressants, but antidepressants are also a treatment modality in functional gastrointestinal disorders. We aimed to assess the association between antidepressant use and gastrointestinal symptoms in the general

  13. Wire-guided (Seldinger technique intubation through a face mask in urgent, difficult and grossly distorted airways

    Directory of Open Access Journals (Sweden)

    Jake M Heier

    2012-01-01

    Full Text Available We report two cases of successful urgent intubation using a Seldinger technique for airway management through an anesthesia facemask, while maintaining ventilation in patients with difficult airways and grossly distorted airway anatomy. In both cases, conventional airway management techniques were predicted to be difficult or impossible, and a high likelihood for a surgical airway was present. This technique was chosen as it allows tracheal tube placement through the nares during spontaneous ventilation with the airway stented open and oxygen delivery with either continuous positive airway pressure and/or pressure support ventilation. This unhurried technique may allow intubation when other techniques are unsuitable, while maintaining control of the airway.

  14. Tube introducer and modified Celestin tube for use in palliative intubation of oesophagogastric neoplasms at fibreoptic endoscopy.

    Science.gov (United States)

    Atkinson, M; Ferguson, R; Parker, G C

    1978-01-01

    A new method for palliative intubation of inoperable neoplasms at or near the cardia is described. A guidewire is passed through the stricture, which is dilated using Eder Puestow metal olive dilators. The tube to be inserted is mounted on an introducer, which grips its distal end from inside, and is slid into position along the wire under radiological control. Twenty-five patients have been intubated with one death directly resulting from the procedure. The method provides a simple and relatively safe means of relieving dysphagia and improving nutrition. Images Fig. 2 PMID:79517

  15. [Case report : usefulness of the airwayscope for difficult intubations in a pediatric patients with Coffin-Siris syndrome].

    Science.gov (United States)

    Sakugawa, Yoko; Kamizato, Kota; Miyata, Yuji; Kakinohana, Manabu; Sugahara, Kazuhiro

    2013-05-01

    We experienced management of general anesthesia in a patients with Coffin-Siris syndrome (CS syndrome) which is an autosomal dominant disorder characterized by mental retardation, growth failure, hypoplasia of the fifth finger's distal phalanx and limb, and syndrome-specific facial appearance. Anesthesia was induced by sevoflurane by mask. After obtaining muscle relaxation by rocuronium, laryngoscopy by Machintosh #2 failed to reveal the vocal cord. However, the vocal cord was revealed by AirwayScope (AWS) for the pediatrics and then tracheal intubation was successful. Surgical procedures and anes-thetic management were performed uneventfully. This case demonstrates usefulness of AWS in pediatric patients with difficult intubation.

  16. TO STUDY EFFECT OF GABAPENTIN ON ATTENUATION OF PRESSOR RESPONSE TO DIRECT LARYNGOSCOPY AND TRACHEAL INTUBATION AND ON PERIOPERATIVE PAIN

    Directory of Open Access Journals (Sweden)

    Sarita Chandapet

    2017-05-01

    Full Text Available BACKGROUND Endotracheal intubation was first described by Rowbotham and Magill in 1921. 1 In 1940 Reid and Brace first described hemodynamic response to Laryngoscopy and Intubation due to Noxious stimuli. 2 The circulatory responses to laryngeal and tracheal stimulation are due to sympathoadrenal stimulation. 3 Laryngoscopy and Tracheal Intubation induces changes in circulating Catecholamine levels significantly. Norepinephrine, Epinephrine and Dopamine levels rise, but the raise in Norepinephrine levels is consistently associated with elevation of Blood pressure and Heart rate. 4 Even though the elevation in Blood pressure and Heart rate due to Laryngoscopy and Intubation are brief, they may have detrimental effects in high risk patients including Myocardial Infarction, Cardiac failure, Intracranial haemorrhage and increases in Intracranial pressure. 5 Many strategies have been advocated to minimize these hemodynamic adverse responses and aimed at different levels of the reflex arc. 6 Block of the peripheral sensory receptors and afferent input is by topical application and infiltration of Local Anaesthetic to Superior laryngeal nerve. Block of central mechanism of integration and sensory input by drugs like Fentanyl, Morphine etc. Block of efferent pathway and effector sites IV Lignocaine, Beta blockers, Calcium channel blockers, Hydralazine etc. No single drug or technique is satisfactory. The aim of this study is to evaluate the efficacy of Gabapentin in attenuating hemodynamic response to laryngoscopy and intubation in a placebo controlled double blind study. MATERIALS AND METHODS A clinical comparative study of attenuation of sympathetic response to laryngoscopy and intubation was done in 150 patients posted for elective surgery divided into two groups and were randomly allocated Group 1 – placebo capsules with sugar and Group 2 – Gabapentin 300 mg capsules. Heart rate, systolic, diastolic blood pressure, mean arterial pressure were

  17. HIV-Associated Gastrointestinal Cancer.

    Science.gov (United States)

    Jensen, Björn E-O; Oette, Mark; Haes, Johannes; Häussinger, Dieter

    2017-01-01

    People living nowadays with HIV and AIDS may be treated effectively regarding virus replication and immunology. However, non-AIDS-defining cancer is of growing relevance due to high incidence and unfavorable outcome. The aim of this review is to summarize current knowledge on gastrointestinal (GI) carcinoma. Although literature on GI cancer is rare, an increased incidence of esophageal, gastric, pancreatic, hepatocellular, and colorectal carcinoma has been demonstrated. However, there are only few reports on therapy strategies and outcome, so that, despite increased occurrence of many GI carcinomas, only little is known about individualized treatment options and outcome in HIV-positive patients. More efforts have to be undertaken to close this gap. © 2017 S. Karger GmbH, Freiburg.

  18. Malignant tumors of gastrointestinal tract

    International Nuclear Information System (INIS)

    Anon.

    1989-01-01

    International histological classification and classification according to TNM systems, domestic clinical classification according to stages of carcinoma of stomach, large intestine and rectum are presented. Diagnosis of tumoral processes of the given localizations should be based on complex application of diagnostic methods: clinical, ultrasonic, radiological and others. Surgical method and variants of surgical method with preoperative radiotherapy play a leading role in treatment of mentioned tumors. Combined method of treatment-surgical intervention with postoperation intravenous injection of colloid 198 Au - is applied for preventing propagation of stomach cancer metastases. Advisability of combining operations with radiological and antitumoral medicamentous therapy is shown. Reliable results of treatment of malignant tumors of gastrointestinal tract are presented

  19. Evaluation of intubation using the Airtraq or Macintosh laryngoscope by anaesthetists in easy and simulated difficult laryngoscopy--a manikin study.

    LENUS (Irish Health Repository)

    Maharaj, C H

    2006-05-01

    The Airtraq Laryngoscope is a novel intubation device which allows visualisation of the vocal cords without alignment of the oral, pharyngeal and tracheal axes. We compared the Airtraq with the Macintosh laryngoscope in simulated easy and difficult laryngoscopy. Twenty-five anaesthetists were allowed up to three attempts to intubate the trachea in each of three laryngoscopy scenarios using a Laerdal Intubation Trainer followed by five scenarios using a Laerdal SimMan Manikin. Each anaesthetist then performed tracheal intubation of the normal airway a second time to characterise the learning curve. In the simulated easy laryngoscopy scenarios, there was no difference between the Airtraq and the Macintosh in success of tracheal intubation. The time taken to intubate at the end of the protocol was significantly lower using the Airtraq (9.5 (6.7) vs. 14.2 (7.4) s), demonstrating a rapid acquisition of skills. In the simulated difficult laryngoscopy scenarios, the Airtraq was more successful in achieving tracheal intubation, required less time to intubate successfully, caused less dental trauma, and was considered by the anaesthetists to be easier to use.

  20. The combined use of Skype and the STORZ CMAC video laryngoscope in field intubation training with the Nebraska National Air Guard.

    Science.gov (United States)

    Boedeker, Ben H; Bernhagen, Mary; Miller, David J; Miljkovic, Nikola; Kuper, Gail M; Murray, W Bosseau

    2011-01-01

    This study examined the feasibility of using Skype technology in basic manikin intubation instruction of Nebraska National Air Guard personnel at a Casualty Training Exercise. Results show that the Skype monitor provided clear sound and visualization of the airway view to the trainees and the combination of VoIP technology and videolaryngoscopy for intubation training was highly valued by study participants.

  1. Comparison of the Airtraq and Truview laryngoscopes to the Macintosh laryngoscope for use by Advanced Paramedics in easy and simulated difficult intubation in manikins.

    LENUS (Irish Health Repository)

    Nasim, Sajid

    2009-01-01

    Paramedics are frequently required to perform tracheal intubation, a potentially life-saving manoeuvre in severely ill patients, in the prehospital setting. However, direct laryngoscopy is often more difficult in this environment, and failed tracheal intubation constitutes an important cause of morbidity. Novel indirect laryngoscopes, such as the Airtraq and Truview laryngoscopes may reduce this risk.

  2. Reporting systems in gastrointestinal endoscopy: Requirements and standards facilitating quality improvement: European Society of Gastrointestinal Endoscopy position statement

    NARCIS (Netherlands)

    Bretthauer, Michael; Aabakken, Lars; Dekker, Evelien; Kaminski, Michal F.; Rösch, Thomas; Hultcrantz, Rolf; Suchanek, Stepan; Jover, Rodrigo; Kuipers, Ernst J.; Bisschops, Raf; Spada, Cristiano; Valori, Roland; Domagk, Dirk; Rees, Colin; Rutter, Matthew D.

    2016-01-01

    To develop standards for high quality of gastrointestinal endoscopy, the European Society of Gastrointestinal Endoscopy (ESGE) has established the ESGE Quality Improvement Committee. A prerequisite for quality assurance and improvement for all gastrointestinal endoscopy procedures is

  3. Dose of rocuronium for rapid tracheal intubation following remifentanil 2 μg kg-1 and propofol 2 mg kg-1.

    Science.gov (United States)

    Oh, Ah-Young; Cho, Suk-Ju; Seo, Kwang-Suk; Ryu, Jung-Hee; Han, Sung-Hee; Hwang, Jung-Won

    2013-09-01

    Full relaxation is not mandatory for successful tracheal intubation. We tried to find the dose of rocuronium that gave acceptable intubation conditions in a rapid sequence intubation with remifentanil and propofol. A dose-finding study of rocuronium using a modified Dixon's up-and-down method. A single tertiary care teaching hospital. Patients undergoing elective surgery under general anaesthesia. After premedication with midazolam and glycopyrrolate, anaesthesia was induced using remifentanil 2 μg kg and propofol 2 mg kg, and a predetermined dose of rocuronium was administered. The dose of rocuronium was determined by a modified Dixon's up-and-down method starting from 0.8 mg kg with an interval of 0.1 or 0.05 mg kg. Intubation was performed 60 s after the start of the rocuronium injection. Intubation conditions were graded as excellent, good or poor. Excellent or good were regarded as clinically acceptable. A dose of rocuronium needed for acceptable intubation condition in 50% of patients (ED50) during rapid tracheal intubation after induction of anaesthesia with remifentanil and propofol. Twenty-eight patients were enrolled to obtain six crossovers. The ED50 of rocuronium was 0.20 mg kg (95% confidence interval, CI 0.17 to 0.23 mg kg) by a modified Dixon's up-and-down method. After induction of anaesthesia with remifentanil 2 μg kg and propofol 2 mg kg, the ED50 of rocuronium for acceptable intubation condition was 0.20 mg kg (95% CI, 0.17 to 0.23 mg kg) for rapid sequence intubation. Thus, we recommend that the intubation dose should be 0.8 mg kg. Clinical trial registration KCT0000094.

  4. A Multicenter, Randomized Trial of Ramped Position vs Sniffing Position During Endotracheal Intubation of Critically Ill Adults.

    Science.gov (United States)

    Semler, Matthew W; Janz, David R; Russell, Derek W; Casey, Jonathan D; Lentz, Robert J; Zouk, Aline N; deBoisblanc, Bennett P; Santanilla, Jairo I; Khan, Yasin A; Joffe, Aaron M; Stigler, William S; Rice, Todd W

    2017-10-01

    Hypoxemia is the most common complication during endotracheal intubation of critically ill adults. Intubation in the ramped position has been hypothesized to prevent hypoxemia by increasing functional residual capacity and decreasing the duration of intubation, but has never been studied outside of the operating room. Multicenter, randomized trial comparing the ramped position (head of the bed elevated to 25°) with the sniffing position (torso supine, neck flexed, and head extended) among 260 adults undergoing endotracheal intubation by pulmonary and critical care medicine fellows in four ICUs between July 22, 2015, and July 19, 2016. The primary outcome was lowest arterial oxygen saturation between induction and 2 minutes after intubation. Secondary outcomes included Cormack-Lehane grade of glottic view, difficulty of intubation, and number of laryngoscopy attempts. The median lowest arterial oxygen saturation was 93% (interquartile range [IQR], 84%-99%) with the ramped position vs 92% (IQR, 79%-98%) with the sniffing position (P = .27). The ramped position appeared to increase the incidence of grade III or IV view (25.4% vs 11.5%, P = .01), increase the incidence of difficult intubation (12.3% vs 4.6%, P = .04), and decrease the rate of intubation on the first attempt (76.2% vs 85.4%, P = .02), respectively. In this multicenter trial, the ramped position did not improve oxygenation during endotracheal intubation of critically ill adults compared with the sniffing position. The ramped position may worsen glottic view and increase the number of laryngoscopy attempts required for successful intubation. ClinicalTrials.gov; No.: NCT02497729; URL: www.clinicaltrials.gov. Copyright © 2017 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

  5. Midline submental orotracheal intubation in maxillofacial injuries: A substitute to tracheostomy where postoperative mechanical ventilation is not required

    Directory of Open Access Journals (Sweden)

    Malti Agrawal

    2010-01-01

    Conclusion: There were no significant operative or postoperative complications. Postoperative submental scarring was acceptable [6] . We conclude that midline submental intubation is a simple and useful technique with low morbidity. It can be chosen in selected cases of maxillofacial trauma and is an excellent substitute to tracheostomy where postoperative mechanical ventilation is not required.

  6. A comparative study of efficacy of esmolol and fentanyl for pressure attenuation during laryngoscopy and endotracheal intubation

    Directory of Open Access Journals (Sweden)

    Shobhana Gupta

    2011-01-01

    Full Text Available Objective: To compare the effectiveness of single bolus dose of esmolol or fentanyl in attenuating the hemodynamic responses during laryngoscopy and endotracheal intubation. Methods: Ninety adult ASA I and ASA II patients were included in the study who underwent elective surgical procedures. Patients were divided into three groups. Group C (control receiving 10 ml normal saline, group E (esmolol receiving bolus dose of esmolol 2 mg/kg and group F (fentanyl receiving bolus dose of fentanyl 2 μg/kg intravenously slowly. Study drug was injected 3 min before induction of anesthesia. Heart rate, systemic arterial pressure and ECG were recorded as baseline and after administration of study drug at intubation and 15 min thereafter. Results: Reading of heart rate, blood pressure and rate pressure product were compared with baseline and among each group. The rise in heart rate was minimal in esmolol group and was highly significant. Also the rate pressure product at the time of intubation was minimal and was statistically significant rate 15 min thereafter in group E. Conclusion: Esmolol 2 mg/kg as a bolus done proved to be effective in attenuating rises in heart rate following laryngoscopy and intubation while the rise in blood pressure was suppressed but not abolished by bolus dose of esmolol.

  7. Tracheal intubation in patients with cervical spine immobilization: a comparison of the Airwayscope, LMA CTrach, and the Macintosh laryngoscopes.

    LENUS (Irish Health Repository)

    Malik, M A

    2009-05-01

    The purpose of this study was to evaluate the effectiveness of the Pentax AWS, and the LMA CTrach, in comparison with the Macintosh laryngoscope, when performing tracheal intubation in patients with neck immobilization using manual in-line axial cervical spine stabilization.

  8. Comparison of gabapentin, pregabalin and placebo as premedication for attenuation of hemodynamic response to laryngoscopy and endotracheal intubation

    Directory of Open Access Journals (Sweden)

    Alireza Mahoori

    2017-08-01

    Conclusion: Oral gabapentin premedication is effective for control of hemodynamic pressor response of laryngoscopy and tracheal intubation. The study data showed that the pregabalin have the same effect. Pregabalin and gabapentin are both useful and safe for control of hemodynamic pressor response as premedication.

  9. Tracheal intubation with a flexible fibreoptic scope or the McGrath videolaryngoscope in simulated difficult airway scenarios

    DEFF Research Database (Denmark)

    Jepsen, Cecilie H; Gätke, Mona R; Thøgersen, Bente

    2014-01-01

    Grath videolaryngoscope and FFE. The participants then performed tracheal intubation on a SimMan manikin once with the McGrath videolaryngoscope and once with the FFE in three difficult airway scenarios: (1) pharyngeal obstruction; (2) pharyngeal obstruction and cervical rigidity; (3) tongue oedema. MAIN OUTCOME MEASURES...

  10. Pressure applied by the healthcare staff on a cricoids cartilage simulator during Sellick's maneuver in rapid sequence intubation

    NARCIS (Netherlands)

    J.A. Calvache (Jose Andrés); L.C.B. Sandoval (Luz); W.A. Vargas (William Andres)

    2013-01-01

    textabstractBackground: Sellick's maneuver or cricoid pressure is a strategy used to prevent bronchoaspiration during the rapid intubation sequence. Several studies have described that the force required for an adequate maneuver is of 2.5-3.5 kg. The purpose of this paper was to determine the force

  11. Diagnostic evaluatuin of gastrointestinal tumors

    International Nuclear Information System (INIS)

    Linke, R.; Tatsch, K.

    1998-01-01

    Prior to surgery of gastrointestinal tumors exact information about tumor localization, extent and possible infiltration in adjacent structures are important. The task for radiological and scintigraphic methods is predominantly the preoperative tumor staging. The upper (esophagus, stomach, duodenum) and the lower (colon, rectum) gastrointestinal tract should be routinely investigated by endoscopy and endosonography. CT or MRI imaging may add information about tumor extent, infiltration in adjacent structures and pathologically enlarged lymph nodes. The latter may be detected with similar or higher sensitivity by PET as well. Furthermore, with PET it is possible to differentiate a tumor recurrence from postoperative scar tissue earlier than with conventional morphological imaging techniques, for example in colorectal cancer. Liver tumors should primarily be inspected sonographically followed by an MRI scan if dignity is uncertain. The receptor scintigraphy with radioactive ligands allows to further characterize a detected tumor. Benigne liver lesions can be distinguished from malignant tumors (metastasis, hepatocellular carcinoma [HCC]) by the neogalactoalbumin-(NGA-)scintigraphy, because NGA binds exclusively to the liver galactose receptors of normally functioning hepatocytes. For the differentiation between liver metastasis and HCC insulin scintigraphy can be used, since insulin binds significantly in HCC due to an overexpression of insulin receptors in these tumors. If a malignant process is suspected, additionally CT-arterioportography may be recommended, because this newer radiological technique is capable to visualize lesions smaller than 1 cm. In such cases PET is sensitive as well and due to increased glucose metabolism even small foci can be detected with comparably high sepcificity. The method of choice for the detection of a pancreatic tumor is endoscopic sonography. In most cases the dignity of the tumor can be verified by ERCP, but sometimes it is very

  12. QuantiFERON–TB Gold In-Tube test performance in Denmark

    DEFF Research Database (Denmark)

    Hermansen, Thomas; Lillebaek, Troels; Hansen, Ann-Brit E

    2014-01-01

    BACKGROUND: Little is known about the QuantiFERON-TB Gold In-Tube Test (QFT) in extreme age groups. The test performance has been reported to be impaired in children and elderly, but reports are diverging. The aim of this study was to evaluate QFT performance in patients with and without......, the overall QFT performance was good. The sensitivity in children (≥ 1) was high although few children were included, whereas sensitivity declined with increasing age. Indeterminate rates were higher in infants and elderly. In contrast to current guidelines, our data suggest that the QFT performs well...... in children ≥ 1 years in low endemic regions but that the test should be used with care among the elderly....

  13. Normative Values and Interrelationship of MDVP Voice Analysis Parameters Before and After Endotracheal Intubation

    DEFF Research Database (Denmark)

    Sørensen, Martin Kryspin; Durck, Tina Trier; Bork, Kristian

    2016-01-01

    normative values for adults and investigates the correlation between these MDVP parameters in relation to the "standardized" trauma of endotracheal intubation. METHODS: Preoperative and postoperative assessments of vocal fold pathology with flexible videolaryngoscopy and voice analysis with MDVP using...... the best-of-three standardized recording were performed in 121 patients with normal voices included consecutively in the RCT. The procedures of anesthesia were standardized. RESULTS: The normative MDVP values of this study are consistently lower compared with most normative values presented in other...... studies. The preoperative to postoperative differences in jitter values (jitter and relative average perturbation) were closely correlated to the shimmer values for patients with postoperative vocal fold edemas. In the patients with edema, the preoperative to postoperative differences in jitter had...

  14. Ventilator-associated pneumonia: the importance of oral care in intubated adults.

    Science.gov (United States)

    Stonecypher, Karen

    2010-01-01

    Ventilator-associated pneumonia (VAP) occurs within 24 hours of intubation and mechanical ventilation. Health care costs related to increased patient mortality, extended length of stay, and patient well-being make treatment of VAP a priority in all health care settings. The Institute for Healthcare Improvements has developed the Ventilator Bundle as a group of interventions linked to ventilator care with demonstrated outcome improvements; removal of subglottic secretions is one of these recommendations. Dental plaque and bacterial colonization of pathogens is directly related to microaspiration of bacteria into the lungs. A moist environment in the mouth maintains normal oropharyngeal bacteria, preventing overgrowth of pathogenic bacteria. Frequent oral care to include twice-a-day brushing of the teeth found a 69% reduction in respiratory tract infections.

  15. Modified single-port non-intubated video-assisted thoracoscopic decortication in high-risk parapneumonic empyema patients.

    Science.gov (United States)

    Hsiao, Chen-Hao; Chen, Ke-Cheng; Chen, Jin-Shing

    2017-04-01

    Parapneumonic empyema patients with coronary artery disease and reduced left ventricular ejection fraction are risky to receive surgical decortication under general anesthesia. Non-intubated video-assisted thoracoscopy surgery is successfully performed to avoid complications of general anesthesia. We performed single-port non-intubated video-assisted flexible thoracoscopy surgery in an endoscopic center. In this study, the possible role of our modified surgery to treat fibrinopurulent stage of parapneumonic empyema with high operative risks is investigated. We retrospectively reviewed fibrinopurulent stage of parapneumonic empyema patients between July 2011 and June 2014. Thirty-three patients with coronary artery disease and reduced left ventricular ejection fraction were included in this study. One group received tube thoracostomy, and the other group received single-port non-intubated video-assisted flexible thoracoscopy surgery decortication. Patient demographics, characteristics, laboratory findings, etiology, and treatment outcomes were compared. Mean age of 33 patients (24 males, 9 females) was 76.2 ± 9.7 years. Twelve patients received single-port non-intubated video-assisted flexible thoracoscopy surgery decortication, and 21 patients received tube thoracostomy. Visual analog scale scores on postoperative first hour and first day were not significantly different in two groups (p value = 0.5505 and 0.2750, respectively). Chest tube drainage days, postoperative fever subsided days, postoperative hospital days, and total length of stay were significantly short in single-port non-intubated video-assisted flexible thoracoscopy surgery decortication (p value = 0.0027, 0.0001, 0.0009, and 0.0065, respectively). Morbidities were low, and mortality was significantly low (p value = 0.0319) in single-port non-intubated video-assisted flexible thoracoscopy surgery decortication. Single-port non-intubated video-assisted flexible thoracoscopy surgery

  16. [A project to reduce the incidence of intubation care errors among foreign health aides].

    Science.gov (United States)

    Chen, Mei-Ju; Lu, Yu-Hua; Chen, Chiu-Chun; Li, Ai-Cheng

    2014-08-01

    Foreign health aides are the main providers of care for the elderly and the physically disabled in Taiwan. Correct care skills improve patient safety. In 2010, the incidence of mistakes among foreign health aides in our hospital unit was 58% for nasogastric tube care and 57% for tracheostomy tube care. A survey of foreign health aides and nurses in the unit identified the main causes of these mistakes as: communication difficulties, inaccurate instructions given to patients, and a lack of standard operating procedures given to the foreign health aides. This project was designed to reduce the rates of improper nasogastric tube care and improper tracheostomy tube care to 20%, respectively. This project implemented several appropriate measures. We produced patient instruction hand-outs in Bahasa Indonesia, established a dedicated file holder for Bahasa Indonesian tube care reference information, produced Bahasa Indonesian tube-care-related posters, produced a short film about tube care in Bahasa Indonesian, and established a standardized operating procedure for tube care in our unit. Between December 15th and 31st, 2011, we audited the performance of a total of 32 foreign health aides for proper execution of nasogastric tube care (21 aides) and of proper execution of tracheostomy tube care (11 aides). Patients with concurrent nasogastric and tracheostomy tubes were inspected separately for each care group. The incidence of improper care decreased from 58% to 18% nasogastric intubation and 57% to 18% for tracheostomy intubation. This project decreased significantly the incidence of improper tube care by the foreign health aides in our unit. Furthermore, the foreign health aides improved their tube nursing care skills. Therefore, this project improved the quality of patient care.

  17. Sugammadex for reversal of neuromuscular block after rapid sequence intubation: a systematic review and economic assessment†

    Science.gov (United States)

    Chambers, D.; Paulden, M.; Paton, F.; Heirs, M.; Duffy, S.; Hunter, J. M.; Sculpher, M.; Woolacott, N.

    2010-01-01

    Summary Sugammadex 16 mg kg−1 can be used for the immediate reversal of neuromuscular block 3 min after administration of rocuronium and could be used in place of succinylcholine for emergency intubation. We have systematically reviewed the efficacy and cost-effectiveness and made an economic assessment of sugammadex for immediate reversal. The economic assessment investigated whether sugammadex appears cost-effective under various assumptions about the value of any reduction in recovery time with sugammadex, the likelihood of a ‘can't intubate, can't ventilate’ (CICV) event, the age of the patient, and the length of the procedure. Three trials were included in the efficacy review. Sugammadex administered 3 or 5 min after rocuronium produced markedly faster recovery than placebo or spontaneous recovery from succinylcholine-induced block. No published economic evaluations were found. Our economic analyses showed that sugammadex appears more cost-effective, where the value of any reduction in recovery time is greater, where the reduction in mortality compared with succinylcholine is greater, and where the patient is younger, for lower probabilities of a CICV event and for long procedures which do not require profound block throughout. Because of the lack of evidence, the value of some parameters remains unknown, which makes it difficult to provide a definitive assessment of the cost-effectiveness of sugammadex in practice. The use of sugammadex in combination with high-dose rocuronium is efficacious. Further research is needed to clarify key parameters in the analysis and to allow a fuller economic assessment. PMID:20937718

  18. Apneic oxygenation reduces hypoxemia during endotracheal intubation in the pediatric emergency department.

    Science.gov (United States)

    Vukovic, Adam A; Hanson, Holly R; Murphy, Shelley L; Mercurio, Danielle; Sheedy, Craig A; Arnold, Donald H

    2018-04-18

    Apneic oxygenation (AO) has been evaluated in adult patients as a means of reducing hypoxemia during endotracheal intubation (ETI). While less studied in pediatric patients, its practice has been largely adopted. Determine association between AO and hypoxemia in pediatric patients undergoing ETI. Observational study at an urban, tertiary children's hospital emergency department. Pediatric patients undergoing ETI were examined during eras without (January 2011-June 2011) and with (August 2014-March 2017) apneic oxygenation. The primary outcome was hypoxemia, defined as pulse oximetry (SpO 2 ) < 90%. The χ 2 and Wilcoxon rank-sum tests examined differences between cohorts. Multivariable regression models examined adjusted associations between covariates and hypoxemia. 149 patients were included. Cohorts were similar except for greater incidence of altered mental status in those receiving AO (26% vs. 7%, p = 0.03). Nearly 50% of the pre-AO cohort experienced hypoxemia during ETI, versus <25% in the AO cohort. Median [IQR] lowest SpO 2 during ETI was 93 (69, 99) for pre-AO and 100 [95, 100] for the AO cohort (p < 0.001). In a multivariable logistic regression model, hypoxemia during ETI was associated with AO (aOR 0.3, 95% confidence interval [CI] 0.1-0.8), increased age (for 1 year, aOR 0.8, 95% CI 0.7-1.0), lowest SpO 2 before ETI (for 1% increase, aOR 0.9, 95% CI 0.8-1.0), and each additional intubation attempt (aOR 4.0, 95% CI 2.2-7.2). Apneic oxygenation is an easily-applied intervention associated with decreases in hypoxemia during pediatric ETI. Nearly 50% of children not receiving AO experienced hypoxemia. Copyright © 2018 Elsevier Inc. All rights reserved.

  19. "COMPARISON OF HEMODYNAMIC CHANGES AFTER INSERTION OF LARYNGEAL MASK AIRWAY, FACEMASK AND ENDOTRACHEAL INTUBATION"

    Directory of Open Access Journals (Sweden)

    K. Montazari

    2004-11-01

    Full Text Available Hemodynamic changes are major hazards of general anesthesia and are probably generated by direct laryngoscopy and endotracheal intubation. We designed this prospective randomised study to assess the cardiovascular changes after either laryngeal mask airway (LMA, face mask (FM or endotracheal tube (ETT insertion in the airway management of adult patients anesthetised with nitrous oxide and halothane. A total of 195 healthy normotensive adult patients with normal airways were randomly assigned to one of the three groups according to their airway management (n= 65 each for transurethral lithotripsy procedures. Heart rate (HR, systolic blood pressure (SBP, diastolic blood pressure (DBP and mean arterial blood pressure (MAP values were recorded before the induction of anesthesia, and then every three minutes until 30 min thereafter. The mean maximum HR and MAP values obtained during 15 and 30 minutes after insertion of LMA were 81±13, 73±8 bpm and 82±14, 79 ±11 mmHg, respectively which were significantly smaller compared to those with FM (84±12, 80±6 bpm and 86±10, 83±13 mmHg and ETT (96±8, 88±7 bpm and 91±11, 82±9 mmHg (P< 0.05. Direct stimulation of the trachea appears to be a major cause of the hemodynamic changes associated with tracheal intubation during general anesthesia, but why hemodynamic changes in LMA were smaller than facemask needs further study. In healthy normotensive patients the use of LMA for the airway management during general anesthesia results in a smaller cardiovascular change than FM and ETT.

  20. Comparison of four techniques of nasogastric tube insertion in anaesthetised, intubated patients: A randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Mohan Chandra Mandal

    2014-01-01

    Full Text Available Background and Aims: Insertion of nasogastric tubes (NGTs in anaesthetised, intubated patients with a conventional method is sometimes difficult. Different techniques of NGT insertion have been tried with varying degree of success. The aim of this prospective, randomised, open-label study was to evaluate three modified techniques of NGT insertion comparing with the conventional method in respect of success rate, time taken for insertion and the adverse events. Methods: In the operation theatre of general surgery, the patients were randomly allocated into four groups: Group C (control group, n = 54, Group W (ureteral guide wire group, n = 54, Group F (neck flexion with lateral pressure, n = 54 and Group R (reverse Sellick′s manoeuvre, n = 54. The number of attempts for successful NGT insertion, time taken for insertion and adverse events were noted. Results: All the three modified techniques were found more successful than the conventional method on the first attempt. The least time taken for insertion was noted in the reverse Sellick′s method. However, on intergroup analysis, neck flexion and reverse Sellick′s methods were comparable but significantly faster than the other two methods with respect to time taken for insertion. Conclusion: Reverse Sellick′s manoeuver, neck flexion with lateral neck pressure and guide wire-assisted techniques are all better alternatives to the conventional method for successful, quick and reliable NGT insertion with permissible adverse events in anaesthetised, intubated adult patients. Further studies after eliminating major limitations of the present study are warranted to establish the superiority of any one of these modified techniques.

  1. COMPARISON OF UPPER LIP BITE TEST WITH MODIFIED MALLAMPATI TEST AND THYROMENTAL DISTANCE FOR PREDICTING DIFFICULTY IN ENDOTRACHEAL INTUBATION: A PROSPECTIVE STUDY

    Directory of Open Access Journals (Sweden)

    Prakash T. S. N

    2016-09-01

    Full Text Available BACKGROUND The significance of difficult or failed tracheal intubation was well recognised as a major cause of morbidity and mortality in anaesthetic practice as per ASA closed claim study. The need to predict potentially difficult tracheal intubation has received more importance, but with limited success. Unanticipated difficult intubation is a risk to patient’s life and a challenge to the skill of the anaesthesiologist. Many anatomical and pathological variables have been identified and have been suggested to be useful in anticipating a difficult airway. These factors have limitations because of wide variations in the incidence of difficult intubation, interobserver variability and inadequate statistical power of the currently measured variables. METHODS After obtaining institutional ethical committee clearance and written informed consent, the present study was conducted in 200 patients aged between 16 yrs. and 65 yrs. at King George Hospital, Andhra Medical College, Visakhapatnam, in the Department of Anaesthesiology. All the 200 patients undergoing elective surgical procedures under general anaesthesia were enrolled in the study. A thorough preanaesthetic evaluation was carried out in all the patients and the procedure was explained in detail to the patients. RESULTS Of the entire two hundred patients, a total of ten patients had difficult intubation, all of them had Cormack-Lehane class III on laryngoscopy. None of them had Cormack-Lehane class IV on laryngoscopy. The incidence of difficult intubation was 5% in the present study. There were no cases of failed intubation. One hundred and eighty seven patients predicted to be easy for intubation by ULBT (i.e. patients who had ULBT class I and II out of whom, however, we encountered difficult intubation in 5 patients. Out of the eight patients predicted to have difficult airway by ULBT III, only one patient had CL III difficult airway and subsequently difficult intubation. CONCLUSIONS MMT

  2. Phytotherapy in Functional Gastrointestinal Disorders.

    Science.gov (United States)

    Kelber, Olaf; Bauer, Rudolf; Kubelka, Wolfgang

    2017-01-01

    Phytotherapy is an important therapeutic option in functional gastrointestinal diseases (FGID). It has a large tradition, with different approaches in different regions of the world, some of which have made their way into modern evidence-based medicine (EBM). Taking into account the number of herbs in use, and also the cumulated scientific evidence on them, FGID are possibly the most important indication in phytotherapy. This does not only apply for European phytotherapy, but also for other regions, such as Asia. Within European phytotherapy, herbs active in FGID are usually classified according to their main active constituents and their activities. Typically, the herbs used in FGID are grouped into amara, aromatica, amara aromatica combining both properties, herbs stimulating gastric secretion, herbs containing spasmolytic and carminative essential oils or spasmolytic alkaloids, mucilaginosa soothing the mucosa, and flavonoid containing drugs with anti-inflammatory properties. In phytotherapy, different plants are frequently combined to maximize effectiveness and specificity of action. Very potent combination products can be developed when the mechanisms of action of the combination partners are complementary. This approach can be demonstrated by the example of STW 5. For this herbal combination product, therapeutic efficacy in FGID has been clinically proven according to the highest standards of EBM. This example also underlines that modern rational phytotherapy is definitely part of modern EBM. Key Messages: FGID is one of the most important indications in phytotherapy and rationally combined herbal preparations are established evidence-based therapeutic options. © 2018 The Author(s) Published by S. Karger AG, Basel.

  3. Microrobotics for future gastrointestinal endoscopy.

    Science.gov (United States)

    Menciassi, Arianna; Quirini, Marco; Dario, Paolo

    2007-01-01

    The impulse given by robotic technologies and imaging techniques to the development of a new way to conceive and perform surgery is clearly visible. Nowadays, minimally invasive surgical (MIS) procedures are often performed with the assistance of robots, such as the Da Vinci master-slave system, the AESOP robot with voice control, etc. In addition, mechatronic technologies are becoming the elective technologies for designing advanced hand-held surgical tools. The introduction of robotic technologies in endoscopy has been slower than in MIS, since the development of miniaturized robotic components for entering the small orifices of the human body is difficult. On the other hand, the large contribution that robotic technologies could bring to endoluminal techniques has been evident since the first development of instrumented catheters. In the 1990s, there was an increasing activity in the application of robotic technologies to improve endoscopic procedures in the gastrointestinal tract. The objective of robotic colonoscopy and gastroscopy was to obtain more effective diagnoses in terms of reduced pain for the patients, and to make uniform the diagnostic procedures, which too often depended on the manual abilities of the endoscopist. Currently, the availability of more reliable robotic technologies for miniaturization of size and integration of functions has allowed to conceive and develop robotic pills for the early screening of the digestive tract, with dramatic potential advantages for patients, endoscopists, and healthcare system.

  4. Probiotics: defenders of gastrointestinal habitats

    Directory of Open Access Journals (Sweden)

    Desh D. Singh

    2012-11-01

    Full Text Available Intestinal microbiota play an important role in maintaining normal gastrointestinal (GI function and ensuring that changes in the composition of the intestinal microbiota can promote GI function. The digestive tract is full of bacteria and many of these, including probiotics, are necessary for optimal digestive function. During bacterial gastroenteritis, harmful bacteria invade the digestive tract causing unpleasant symptoms and upsetting the balance between good and bad bacteria. Supplemental probiotics can help restore this balance. Studies have demonstrated that probiotics can often help reduce the severity of symptoms such as diarrhea and may help accelerate recovery. Probiotics are therapeutic preparations of live microorganisms administered in sufficient dosage to be beneficial to health. The therapeutic effects of these microorganisms appear to be strain specific. Primal Defense®, a unique, probiotic, bacterial compound, contains probiotics that support gut flora balance, promote consistent bowel function, control stomach acid levels to quickly eliminate burning sensation in the stomach and maintain immune system response. The probiotics in Primal Defense® maximize the benefits of a healthy diet by supporting normal absorption and assimilation of nutrients in the gut. Nearly 75% of our immune defenses are located in the digestive tract, so maintaining a favorable bacterial balance in the intestines (ideally 80% good or neutral bacteria to 20% bad or harmful bacteria is crucial to achieving and maintaining optimum health.

  5. Multicentric malignant gastrointestinal stromal tumor

    International Nuclear Information System (INIS)

    Shukla, Shailaja; Singh, Sanjeet K; Pujani, Mukta

    2009-01-01

    Malignant gastrointestinal stromal tumor (GIST) is a rare type of sarcoma that is found in the digestive system, most often in the wall of the stomach. Multiple GISTs are extremely rare and usually associated with type 1 neurofibromatosis and familial GIST. We report here a case of a 70-year-old woman who reported pain in the abdomen, loss of appetite, and weight loss for six months. Ultrasound examination showed a small bowel mass along with multiple peritoneal deposits and a mass within the liver. Barium studies were suggestive of a neoplastic pathology of the distal ileum. A differential diagnosis of adenocarcinoma/lymphoma with metastases was entertained. Perioperative findings showed two large growths arising from the jejunum and the distal ileum, along with multiple smaller nodules on the serosal surface and adjoining mesentery of the involved bowel segments. Segmental resection of the involved portions of the intestine was performed. Histopathological features were consistent with those of multicentric malignant GIST-not otherwise specified (GIST-NOS). Follow-up examination three months after surgery showed no evidence of recurrence. (author)

  6. Immunoscintigraphy of gastrointestinal tract carcinomas

    International Nuclear Information System (INIS)

    Mladenov, B.; Peshev, N.

    1995-01-01

    The results of labelled monoclonal antibodies (MoA) immunoscintigraphy in malignant tumors involving the gastrointestinal tract are presented. The obtained data have an essential practical bearing on the early diagnosis and radical treatment undertaken. Immunoscintigraphy is performed with Imacis-I ( 131 I, monoclonal antibody, 19-9 F(ab') 2 anti-CEA F(ab') 2 ) obtained from the CIS company, and Jodomab-R-2( 131 I, anti-CEA monoclonal antibody F(ab') 2 ) of the Sorin Biomedica Company, inserted at activity ranging from 11 to 185 MBq. Scanning by a planar gamma-camera is performed at 72 hours. A total of twenty-four patients are examined: 14 preoperatively (with gastric cancer - 2, pancreatic cancer - 1 and location of the neoplasm in different segments of the colon - 11), and ten postoperatively. Positive results are obtained in twenty-two (92 per cent) of the total number of patients under study. In twelve (86 per cent) of those examined preoperatively intensive accumulation of labelled autoantibodies in the cancer area is documented with a negative result recorded in two cases only. Metastases are found in two patients operated on, while in the remainder the results are negative and consistent with those of the other methods of examination. 13 refs., 4 figs. (author)

  7. [Functional and motor gastrointestinal disorders].

    Science.gov (United States)

    Mearin, Fermín; Rey, Enrique; Balboa, Agustín

    2015-09-01

    This article discusses the most interesting studies on functional and motor gastrointestinal disorders presented at Digestive Diseases Week (DDW), 2015. Researchers are still seeking biomarkers for irritable bowel syndrome and have presented new data. One study confirmed that the use of low-dose antidepressants has an antinociceptive effect without altering the psychological features of patients with functional dyspepsia. A contribution that could have immediate application is the use of transcutaneous electroacupuncture, which has demonstrated effectiveness in controlling nausea in patients with gastroparesis. New data have come to light on the importance of diet in irritable bowel syndrome, although the effectiveness of a low-FODMAP diet seems to be losing momentum with time. Multiple data were presented on the long-term efficacy of rifaximin therapy in patients with irritable bowel syndrome and diarrhoea. In addition, among other contributions, and more as a curiosity, a study evaluated the effect of histamine in the diet of patients with irritable bowel syndrome. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

  8. Gastrointestinal disturbances in marathon runners.

    Science.gov (United States)

    Riddoch, C; Trinick, T

    1988-06-01

    The purpose of this survey was to investigate the prevalence of running-induced gastrointestinal (GI) disturbances in marathon runners. A questionnaire was completed by 471 of the estimated 1,750 competitors in the 1986 Belfast City Marathon. Eighty-three per cent of respondents indicated that they occasionally or frequently suffered one or more GI disturbances during or immediately after running. The urge to have a bowel movement (53%) and diarrhoea (38%) were the most common symptoms, especially among female runners (74% and 68% respectively). Upper GI tract symptoms were experienced more by women than men (p less than 0.05) and more by younger runners than older runners (p less than 0.01). Women also suffered more lower GI tract symptoms than men (p less than 0.05) with younger runners showing a similar trend. Both upper and lower tract symptoms were more common during a "hard" run than an "easy" run (p less than 0.01) and were equally as common both during and after running. Of those runners who suffered GI disturbances, 72% thought that running was the cause and 29% believed their performance to be adversely affected. There was no consensus among sufferers as to the causes of symptoms and a wide variety of "remedies" were suggested. GI disturbances are common amongst long-distance runners and their aetiology is unknown. Medical practitioners should be aware of this when dealing with patients who run.

  9. To evaluate the effects of dexmedetomidine on intraocular pressure and haemodynamic changes in response to laryngoscopy and tracheal intubation

    Directory of Open Access Journals (Sweden)

    Tanuja

    2014-01-01

    Full Text Available Background: The most important prerequisites for neurosurgeries are brain relaxation, need of stable haemodynamics with less fluctuation in intracranial pressure and speedy recovery from anaesthesia. Endotracheal intubation is the major stressful stimuli that can elicit a marked pressor response. Various drugs have been used to attenuate these reflexes. Dexmedetomidine, a highly selective alpha 2-adrenoceptor agonist, have neuroprotective, cardioprotective, and sedative effects so it is potentially useful during neuroanaesthesia. This is a prospective randomised control trial carried out to see whether administration of Dexmedetomidine prior to intubation can attenuate the various haemodynamic responses, intraocular pressure (IOP and the requirement of induction dose of propofol in control and study group. Materials and Methods: Fifty patients (ASA grade 1, 2 scheduled for intracranial tumour surgeries were divided into two groups (25 each. Group D received Dexmedetomidine 0.8 μg/kg i.v. over 10 mins and group C received 20 ml saline. Anaesthesia induced with Propofol, dose adjusted using bispectral index monitor. The groups were compared with IOP, Heart rate (HR, Mean arterial pressure (MAP, and dose of Propofol required for induction. Results : Groups were well matched for their demographic data and pre-operative. IOP in both the eyes decreases significantly after premedication and remained below baseline even after 10 th min of intubation in group D while in Group C; it increased significantly after intubation and remained above baseline. The difference between groups was also statistically significant. HR and MAP decreased significantly in patients of group D compared to group C (P < 0.05. Patients were more haemodynamicaly stable at all time points after premedication in group D (P < 0.05. Propofol requirements for induction was lesser in group D (P < 0.05. Bradycardia and hypotension incidences were higher in group D. Conclusion

  10. All India Difficult Airway Association 2016 guidelines for the management of unanticipated difficult tracheal intubation in obstetrics

    Directory of Open Access Journals (Sweden)

    Venkateswaran Ramkumar

    2016-01-01

    Full Text Available The various physiological changes in pregnancy make the parturient vulnerable for early and rapid desaturation. Severe hypoxaemia during intubation can potentially compromise two lives (mother and foetus. Thus tracheal intubation in the pregnant patient poses unique challenges, and necessitates meticulous planning, ready availability of equipment and expertise to ensure maternal and foetal safety. The All India Difficult Airway Association (AIDAA proposes a stepwise plan for the safe management of the airway in obstetric patients. These guidelines have been developed based on available evidence; wherever robust evidence was lacking, recommendations were arrived at by consensus opinion of airway experts, incorporating the responses to a questionnaire sent to members of the AIDAA and the Indian Society of Anaesthesiologists (ISA. Modified rapid sequence induction using gentle intermittent positive pressure ventilation with pressure limited to ≤20 cm H 2 O is acceptable. Partial or complete release of cricoid pressure is recommended when face mask ventilation, placement of supraglottic airway device (SAD or tracheal intubation prove difficult. One should call for early expert assistance. Maternal SpO 2 should be maintained ≥95%. Apnoeic oxygenation with nasal insufflation of 15 L/min oxygen during apnoea should be performed in all patients. If tracheal intubation fails, a second- generation SAD should be inserted. The decision to continue anaesthesia and surgery via the SAD, or perform fibreoptic-guided intubation via the SAD or wake up the patient depends on the urgency of surgery, foeto-maternal status and availability of resources and expertise. Emergency cricothyroidotomy must be performed if complete ventilation failure occurs.

  11. A Comparison of Cormeck-Lehane and Mallampati Tests with Mandibular and Neck Measurements for Predicting Difficult Intubation

    Directory of Open Access Journals (Sweden)

    Niyazi Acer

    2011-06-01

    Full Text Available Objective: Various prediction tests were formulated to forecast difficult intubation. The Mallampati test, Wilson score, Cormack-Lehane test and thyromental distance are the most commonly used tests pre-operatively to assess the airway. The objective of the present study was to investigate whether a combination of the Mallampati and Cormack-Lehane’s classification to predict difficult intubation compared with sternomental and thyromental distances, mandibular length, width and neck length and circumference. Material and Methods: Two hundred twenty seven cases between 17 and 70 years old undergoing elective surgery were included in the study. Age, gender, body weight, body height and BMI were noted preoperatively. The pharyngeal structures were examined before the operation. At the time of intubation, laryngoscopic evaluation was performed according to the Cormack-Lehane’s laryngoscopic classification.Results: For analysis, Mallampati and Cormack-Lehane’s laryngoscopic classification were grouped as difficult (grades III and IV or easy (grades I and II. Whereas Mallampati scoring were class 1 and 2 (easy in 72.7% cases, Cormack-Lehane’s laryngoscopic scoring 90.7% of the cases were in class 1 and 2. The combination of the Cormeck-Lehane classification with neck circumference had the highest sensitivity (94.74%, but this combination decreased the positive predictive value. The combination of the Mallampati classification with neck length had the highest sensitivity (67.86%, but this combination decreased the positive predictive value.Conclusion: The findings suggest that the Mallampati and Cormeck-Lehane classification by itself is insufficient for predicting difficult intubation so should be used in conjunction with measurement of neck circumference and Cormeck-lehane test. Mallampati test with sternomental and thyromental distances in addition with neck length may be useful in routine test for preoperative prediction of difficult

  12. Effects of oral methylprednisolone and inhaled salbutamol in the decrease of wheezing in patients with asthma after tracheal intubation

    Directory of Open Access Journals (Sweden)

    2008-08-01

    Full Text Available Background: Airway instrumentation in patients with bronchial hyperreactivity, may evoke life-threatening asthma attack and a good strategy for the prevention of bronchospasm"nhas not been defined. In a randomized, prospective, placebo-controlled study, it was determined whether prophylaxis with either inhaled salbutamol-or combined inhaled salbutamol and oral methylprednisolone improves lung functions and prevents wheezing after intubation. Methods: Thirty one patients with partially reversible airway obstruction (airway resistance> 180%, forced expiratory volume in 1 second [FEV1] < 70% of predicted value, and FEV1 increase> 12% after two puffs of salbutamol were randomized to receive daily either 3-2 puffs (0.2 mg of salbutamol (n =16 or 3-2 puffs (0.2 mg of salbutamol and 40 mg of methylprednisolone (n = 15 orally for 5 days. In all patients lung function was evaluated daily and wheezing changes was assessed before and 5 minutes after tracheal intubation. Results: Both salbutamol and combined inhaled salbutamol and oral methylprednisolone treatment significantly improved airway resistance and FEV1 to a steady state, with no difference between groups. When a single-dose of salbutamol pre-induction or prolonged salbutamol treatment was employed, most patients (8 of 10 and 7 of 9 experienced wheezing after intubation. In contrast, only one patient of those who received both salbutamol and methylprednisolone experienced wheezing (P = 0.0058. Conclusions: Pretreatment with either salbutamol or combined inhaled salbutamol and oral methylprednisolone significantly improves lung function and decreases the incidence of wheezing after tracheal intubation. Methylprednisolone decreases incidence of wheezing more than salbutamol. Therefore, in patients with bronchial hyper reactivity, preoperative treatment with both methylprednisolone and salbutamol minimizes intubation-evoked broncho-constriction.

  13. Transcatheter Arterial Embolization for Gastrointestinal Bleeding Secondary to Gastrointestinal Lymphoma

    Energy Technology Data Exchange (ETDEWEB)

    Zheng, Lin [Henan Cancer Hospital, The Affiliated Cancer Hospital of Zhengzhou University, Department of Radiology (China); Shin, Ji Hoon, E-mail: jhshin@amc.seoul.kr; Han, Kichang; Tsauo, Jiaywei; Yoon, Hyun-Ki; Ko, Gi-Young [University of Ulsan, College of Medicine, Asan Medical Center, Department of Radiology and Research Institute of Radiology (Korea, Republic of); Shin, Jong-Soo [Kyunghee University, College of Medicine, Kangdong Kyunghee University Hospital, Department of Radiology (Korea, Republic of); Sung, Kyu-Bo [University of Ulsan, College of Medicine, Asan Medical Center, Department of Radiology and Research Institute of Radiology (Korea, Republic of)

    2016-11-15

    PurposeTo evaluate the effectiveness of transcatheter arterial embolization (TAE) for gastrointestinal (GI) bleeding caused by GI lymphoma.Materials and MethodsThe medical records of 11 patients who underwent TAE for GI bleeding caused by GI lymphoma between 2001 and 2015 were reviewed retrospectively.ResultsA total of 20 TAE procedures were performed. On angiography, contrast extravasation, and both contrast extravasation and tumor staining were seen in 95 % (19/20) and 5 % (1/20) of the procedures, respectively. The most frequently embolized arteries were jejunal (n = 13) and ileal (n = 5) branches. Technical and clinical success rates were 100 % (20/20) and 27 % (3/11), respectively. The causes of clinical failure in eight patients were rebleeding at new sites. In four patients who underwent repeat angiography, the bleeding focus was new each time. Three patients underwent small bowel resection due to rebleeding after one (n = 2) or four (n = 1) times of TAEs. Another two patients underwent small bowel resection due to small bowel ischemia/perforation after three or four times of TAEs. The 30-day mortality rate was 18 % due to hypovolemic shock (n = 1) and multiorgan failure (n = 1).ConclusionAngiogram with TAE shows limited therapeutic efficacy to manage GI lymphoma-related bleeding due to high rebleeding at new sites. Although TAE can be an initial hemostatic measure, surgery should be considered for rebleeding due to possible bowel ischemic complication after repeated TAE procedures.

  14. Drugs Approved for Gastrointestinal Stromal Tumors

    Science.gov (United States)

    This page lists cancer drugs approved by the Food and Drug Administration (FDA) for gastrointestinal stromal tumors (GIST). The list includes generic names and brand names. The drug names link to NCI's Cancer Drug Information summaries.

  15. Spontaneous neonatal gastrointestinal perforation: surgical or ...

    African Journals Online (AJOL)

    ... cases of spontaneous gastrointestinal perforation in neonates at the University of Benin Teaching Hospital, Benin City. The perinatal stress factors were caesarian delivery, prematurity and fetal distress due to prolonged obstructed labour.

  16. METHOD OF SUPPRESSING GASTROINTESTINAL UREASE ACTIVITY

    Science.gov (United States)

    Visek, W.J.

    1963-04-23

    This patent shows a method of increasing the growth rate of chicks. Certain diacyl substituted ureas such as alloxan, murexide, and barbituric acid are added to their feed, thereby suppressing gastrointestinal urease activity and thus promoting growth. (AEC)

  17. Gastro-intestinal phytobezoars in Zimbabwean Africans.

    Science.gov (United States)

    Stein, C M; Gelfand, M

    1985-01-01

    The clinical features of 10 African patients with gastro-intestinal phytobezoars are described. These were similar to those described with persimmon bezoars and we postulate that the fruit of locally found trees, also of the genus Diospyros, are responsible.

  18. International Foundation for Functional Gastrointestinal Disorders

    Science.gov (United States)

    ... Survey Corner News Medical and Treatment News Events Press Releases Commentary For Media ... IFFGD is your resource for reliable digestive health knowledge, support, and assistance about functional gastrointestinal (GI) and ...

  19. Gastrointestinal Epithelial Organoid Cultures from Postsurgical Tissues.

    Science.gov (United States)

    Hahn, Soojung; Yoo, Jongman

    2017-08-17

    An organoid is a cellular structure three-dimensionally (3D) cultured from self-organizing stem cells in vitro, which has a cell population, architectures, and organ specific functions like the originating organs. Recent advances in the 3D culture of isolated intestinal crypts or gastric glands have enabled the generation of human gastrointestinal epithelial organoids. Gastrointestinal organoids recapitulate the human in vivo physiology because of all the intestinal epithelial cell types that differentiated and proliferated from tissue resident stem cells. Thus far, gastrointestinal organoids have been extensively used for generating gastrointestinal disease models. This protocol describes the method of isolating a gland or crypt using stomach or colon tissue after surgery and establishing them into gastroids or colonoids.

  20. Prolonged parenteral nutrition after neonatal gastrointestinal surgery

    DEFF Research Database (Denmark)

    Estmann, Anne; Qvist, Niels; Husby, Steffen

    2002-01-01

    to diagnosis and clinical course. METHODOLOGY: This study reviews the clinical course of infants with gastrointestinal disease (gastroschisis, intestinal atresia, omphalocele, volvulus, Hirschsprung's disease and necrotizing enterocolitis) with a prolonged need for parenteral nutrition in the Western part...

  1. Comparative Molecular Analysis of Gastrointestinal Adenocarcinomas

    NARCIS (Netherlands)

    Liu, Yang; Sethi, Nilay S; Hinoue, Toshinori; Schneider, Barbara G; Cherniack, Andrew D; Sanchez-Vega, Francisco; Seoane, Jose A; Farshidfar, Farshad; Bowlby, Reanne; Islam, Mirazul; Kim, Jaegil; Chatila, Walid; Akbani, Rehan; Kanchi, Rupa S; Rabkin, Charles S; Willis, Joseph E; Wang, Kenneth K; McCall, Shannon J; Mishra, Lopa; Ojesina, Akinyemi I; Bullman, Susan; Pedamallu, Chandra Sekhar; Lazar, Alexander J; Sakai, Ryo; Thorsson, Vésteinn; Bass, Adam J; Laird, Peter W; de Krijger, RR

    2018-01-01

    We analyzed 921 adenocarcinomas of the esophagus, stomach, colon, and rectum to examine shared and distinguishing molecular characteristics of gastrointestinal tract adenocarcinomas (GIACs). Hypermutated tumors were distinct regardless of cancer type and comprised those enriched for

  2. Appropriateness of Referrals for Upper Gastrointestinal Endoscopy ...

    African Journals Online (AJOL)

    Appropriateness of Referrals for Upper Gastrointestinal Endoscopy. ... Accra between January and December, 2008 were interviewed and evaluated for this study. ... Presentations with bleeding and suspicion of malignancy showed statistical ...

  3. New techniques in gastrointestinal endoscopic surgery

    Directory of Open Access Journals (Sweden)

    Rafael Antonio Luengas Tello

    2012-09-01

    Full Text Available Gastrointestinal endoscopic surgery has been making great progress since the seventies in the management paradigms of conditions such as gastrointestinal bleeding, polyp resection and diagnostic and therapeutic management of the biliary tract. The current challenge is the development of techniques that allow endoscopic treatment of emerging diseases such as cancer, morbid obesity, gastro-esophageal reflux and achalasia. This article reports on new techniques and expectations for the future in the endoscopic management of these diseases.

  4. Rare upper gastrointestinal hemorrhage of cetuximab

    OpenAIRE

    Duan, Shi-Jie; Gao, Zi-Ming; Wang, Peng-Liang; Gong, Bao-Cheng; Huang, Han-Wei; Luo, Lei; Wang, Xin; Xing, Ya-Nan; Xu, Hui-Mian; Liu, Fu-Nan

    2017-01-01

    Abstract Rationale: cetuximab, an epidermal growth factor receptor inhibitor, is a targeted therapeutic regimen of colorectal cancers. Several common adverse effects have been found, such as cutaneous or gastrointestinal toxicity. However, according to the articles had been published, upper gastrointestinal bleeding (UGIB) is considered to be rare and its mechanism remains unclear. Patient concerns: In this report, we presented a 42-year-old male patient with advanced recto-sigmoid cancer. Af...

  5. Sedation-related complications in gastrointestinal endoscopy

    OpenAIRE

    Amornyotin, Somchai

    2013-01-01

    Sedation practices for gastrointestinal endoscopic (GIE) procedures vary widely in different countries depending on health system regulations and local circumstances. The goal of procedural sedation is the safe and effective control of pain and anxiety, as well as to provide an appropriate degree of memory loss or decreased awareness. Sedation-related complications in gastrointestinal endoscopy, once occurred, can lead to significant morbidity and occasional mortality in patients. The risk fa...

  6. Gastrointestinal Stromal Tumor of the Esophagus: Report of a Case

    OpenAIRE

    Mehmet Erol

    2014-01-01

    Gastrointestinal stromal tumors are rare neoplasms to be thought to arise from mesenchymal cells of the gastrointestinal tract. Gastrointestinal stromal tumors (GIST) of the esophagus are well documented but are very much rarer than gastrointestinal stromal tumors of the stomach and small bowel. We describe a case of GIST of the esophagus that was resected with wide surgical resection.

  7. Upper cervical spine movement during intubation: fluoroscopic comparison of the AirWay Scope, McCoy laryngoscope, and Macintosh laryngoscope.

    Science.gov (United States)

    Maruyama, K; Yamada, T; Kawakami, R; Kamata, T; Yokochi, M; Hara, K

    2008-01-01

    The AirWay Scope (AWS) is a new fibreoptic intubation device, which allows visualization of the glottic structures without alignment of the oral, pharyngeal, and tracheal axes, and thus may be useful in patients with limited cervical spine (C-spine) movement. We fluoroscopically evaluated upper C-spine movement during intubation with the AWS or Macintosh or McCoy laryngoscope. Forty-five patients, with normal C-spine, scheduled for elective surgery were randomly assigned to one of the three intubation devices. Movement of the upper C-spine was examined by measuring angles formed by adjacent vertebrae during intubation. Time to intubation was also recorded. Median cumulative upper C-spine movement was 22.3 degrees, 32.3 degrees, and 36.5 degrees with the AWS, Macintosh laryngoscope, and McCoy laryngoscope, respectively (Pmovement of the C-spine at C1/C2 in comparison with the Macintosh or McCoy laryngoscope (P=0.012), and at C3/C4 in comparison with the McCoy laryngoscope (P=0.019). Intubation time was significantly longer in the AWS group than in the Macintosh group (P=0.03). Compared with the Macintosh or McCoy laryngoscope, the AWS produced less movement of upper C-spine for intubation in patients with a normal C-spine.

  8. Use of a Flexible Intubating Scope in Combination with a Channeled Video Laryngoscope for Managing a Difficult Airway in the Emergency Department.

    Science.gov (United States)

    Sowers, Nicholas; Kovacs, George

    2016-02-01

    Difficulty with intubation is not uncommon in the emergency setting. Video laryngoscopes (VLs) are commonly used to manage the difficult airway in the emergency department (ED). Intubation using a flexible bronchoscope, while considered the gold standard for managing the anticipated difficult airway in the operating room, is not commonly used in the ED. We present a case describing VL-assisted flexible scope intubation performed in the ED as a novel feasible approach to managing the difficult airway. A 65-year-old male, post cardiac arrest, with multiple unsuccessful attempts at prehospital intubation had rapid sequence intubation (RSI) performed and, despite obtaining a view with a King Vision™ VL, the skilled operator was unable to advance the endotracheal tube (ETT). An Ambu™ aScope3 flexible intubating scope (FIS) was placed through the ETT loaded in the channel of the King Vision and advanced through the cords to a position proximal to the carina. The ETT was then advanced easily over the FIS and down the trachea. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Although video laryngoscopy is commonly used in the ED, intubation can prove difficult, despite having an adequate view of the glottis. Use of an FIS, however, through a channeled VL makes navigation of the ETT easier and facilitates tube advancement, which can be difficult with VL. Channeled VL-assisted use of an FIS is a viable option for managing the difficult airway. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. The effects of nicardipine or esmolol on the onset time of rocuronium and intubation conditions during rapid sequence induction: a randomized double-blind trial.

    Science.gov (United States)

    Lee, Ji Heui; Kim, Yunkwang; Lee, Kye Hyeok; Rim, Sung Kyu; Lee, Ji Yeon; Lee, Cheong

    2015-06-01

    The main aims of rapid sequence induction (RSI) are prompt and adequate muscle relaxation for tracheal intubation and hemodynamic stability during and after intubation. The purpose of the present study was to investigate the effects of nicardipine and esmolol on the action of rocuronium and intubation conditions during RSI. Adult patients (n = 82) were randomly allocated to one of three groups. One minute prior to the induction of sevoflurane-based general anesthesia, patients received 20 μg/kg of nicardipine (N group; n = 27) or 0.5 mg/kg of esmolol (E group; n = 27), or 5 ml of saline (C group; n = 28). Patients were assessed according to intubation conditions, the onset time of rocuronium, mean arterial pressure (MAP), and heart rate (HR) during RSI. The intubation conditions and score were significantly better in the C and N groups than in the E group (P rocuronium was shortened in the N group and prolonged in the E group when compared to the C group (P rocuronium and attenuated changes in MAP after intubation. Esmolol may disturb intubation conditions and the onset of action of rocuronium, despite being effective in alleviating responses of HR after RSI.

  10. Intravenous rocuronium 0.3 mg/kg improves the conditions for tracheal intubation in cats: a randomized, placebo-controlled trial.

    Science.gov (United States)

    Sakai, Daniel M; Zornow, Kailee Anne; Campoy, Luis; Cable, Christina; Appel, Leslie D; Putnam, Holly J; Martin-Flores, Manuel

    2018-01-01

    Objectives We evaluated the use of rocuronium 0.3 mg/kg intravenously (IV) to facilitate tracheal intubation in cats anesthetized for elective ovariohysterectomy. Methods Thirty female cats were randomly allocated to receive rocuronium 0.3 mg/kg IV or an equal volume of normal saline, following induction of anesthesia with ketamine and midazolam. Thirty seconds after induction, a single investigator, unaware of treatment allocation, attempted tracheal intubation. The number of attempts and the time to complete intubation were measured. Intubating conditions were assessed as acceptable or unacceptable based on a composite score consisting of five different components. Duration of apnea after induction was measured and cases of hemoglobin desaturation (SpO 2 rocuronium 12 s [range 8-75 s]; saline 60 s [range 9-120 s]) and with fewer attempts (rocuronium 1 [range 1-2]; saline 2 [range 1-3], both P = 0.006) in cats receiving rocuronium. Unacceptable intubating conditions on the first attempt occurred in 3/15 cats with rocuronium and in 10/15 with saline ( P = 0.01). Apnea lasted 4 ± 1.6 mins with rocuronium and 2.3 ± 0.5 mins with saline ( P = 0.0007). No cases of desaturation were observed. Conclusions and relevance Rocuronium 0.3 mg/kg IV improves intubating conditions compared with saline and reduces the time and number of attempts to intubate with only a short period of apnea in cats.

  11. Intubating conditions and side effects of propofol, remifentanil and sevoflurane compared with propofol, remifentanil and rocuronium: a randomised, prospective, clinical trial

    Science.gov (United States)

    2014-01-01

    Background Tracheal intubation without muscle relaxants is usually performed with remifentanil and propofol or sevoflurane. Remifentanil 1.0 to 4.0 μg·kg-1 and propofol 2.0-3.0 mg·kg-1 or sevoflurane up to 8.0 Vol% provide acceptable, i.e. excellent or good intubating conditions. We hypothesized that sevoflurane 1.0 MAC would provide acceptable intubating conditions when combined with propofol and remifentanil. Methods Eighty-three patients to be intubated were randomised to two groups. The SEVO group received propofol 1.5 mg kg-1, remifentanil 0.30 μg kg min-1 and sevoflurane 1.0 MAC; the MR group received the same doses of propofol and remifentanil plus rocuronium 0.45 mg kg-1. We evaluated intubation and extubation conditions, mean arterial pressure (MAP), heart rate (HR) and bispectral index (BIS). The vocal cords were examined for injury by videolaryngoscopy before and 24 hours after surgery. Results Acceptable intubating conditions were seen more frequently with rocuronium than with sevoflurane: 97% versus 82%; p = 0.03; the subscore for vocal cords was comparable: 100% versus 98%. MAP before intubation decreased significantly compared with the MAP at baseline to the same extent in both groups; ephedrine IV was given in 15 (SEVO) versus 16 (MR) patients; p = 0.93. BIS at tracheal intubation was 27 (13-65) in the SEVO group, 29 (14-62) in the MR group; p = 0.07. Vocal cord injuries (oedema, haematoma) were similar: 4 patients in each group. Conclusions Overall intubating conditions were better when rocuronium was used; the subscore for vocal cords was comparable. The incidence of side effects was the same in the two groups. Trial registration ClinicalTrials.Gov: NCT 01591031. PMID:24860256

  12. Deep Learning in Gastrointestinal Endoscopy.

    Science.gov (United States)

    Patel, Vivek; Armstrong, David; Ganguli, Malika; Roopra, Sandeep; Kantipudi, Neha; Albashir, Siwar; Kamath, Markad V

    2016-01-01

    Gastrointestinal (GI) endoscopy is used to inspect the lumen or interior of the GI tract for several purposes, including, (1) making a clinical diagnosis, in real time, based on the visual appearances; (2) taking targeted tissue samples for subsequent histopathological examination; and (3) in some cases, performing therapeutic interventions targeted at specific lesions. GI endoscopy is therefore predicated on the assumption that the operator-the endoscopist-is able to identify and characterize abnormalities or lesions accurately and reproducibly. However, as in other areas of clinical medicine, such as histopathology and radiology, many studies have documented marked interobserver and intraobserver variability in lesion recognition. Thus, there is a clear need and opportunity for techniques or methodologies that will enhance the quality of lesion recognition and diagnosis and improve the outcomes of GI endoscopy. Deep learning models provide a basis to make better clinical decisions in medical image analysis. Biomedical image segmentation, classification, and registration can be improved with deep learning. Recent evidence suggests that the application of deep learning methods to medical image analysis can contribute significantly to computer-aided diagnosis. Deep learning models are usually considered to be more flexible and provide reliable solutions for image analysis problems compared to conventional computer vision models. The use of fast computers offers the possibility of real-time support that is important for endoscopic diagnosis, which has to be made in real time. Advanced graphics processing units and cloud computing have also favored the use of machine learning, and more particularly, deep learning for patient care. This paper reviews the rapidly evolving literature on the feasibility of applying deep learning algorithms to endoscopic imaging.

  13. Molecular Testing for Gastrointestinal Cancer

    Directory of Open Access Journals (Sweden)

    Hye Seung Lee

    2017-03-01

    Full Text Available With recent advances in molecular diagnostic methods and targeted cancer therapies, several molecular tests have been recommended for gastric cancer (GC and colorectal cancer (CRC. Microsatellite instability analysis of gastrointestinal cancers is performed to screen for Lynch syndrome, predict favorable prognosis, and screen patients for immunotherapy. The epidermal growth factor receptor (EGFR tyrosine kinase inhibitor has been approved in metastatic CRCs with wildtype RAS (KRAS and NRAS exon 2–4. A BRAF mutation is required for predicting poor prognosis. Additionally, amplification of human epidermal growth factor receptor 2 (HER2 and MET is also associated with resistance to EGFR inhibitor in metastatic CRC patients. The BRAF V600E mutation is found in sporadic microsatellite unstable CRCs, and thus is helpful for ruling out Lynch syndrome. In addition, the KRAS mutation is a prognostic biomarker and the PIK3CA mutation is a molecular biomarker predicting response to phosphoinositide 3-kinase/AKT/mammalian target of rapamycin inhibitors and response to aspirin therapy in CRC patients. Additionally, HER2 testing should be performed in all recurrent or metastatic GCs. If the results of HER2 immunohistochemistry are equivocal, HER2 silver or fluorescence in situ hybridization testing are essential for confirmative determination of HER2 status. Epstein-Barr virus–positive GCs have distinct characteristics, including heavy lymphoid stroma, hypermethylation phenotype, and high expression of immune modulators. Recent advances in next-generation sequencing technologies enable us to examine various genetic alterations using a single test. Pathologists play a crucial role in ensuring reliable molecular testing and they should also take an integral role between molecular laboratories and clinicians.

  14. Gastrointestinal Bleeding Secondary to Calciphylaxis

    Science.gov (United States)

    Gupta, Nancy; Haq, Khwaja F.; Mahajan, Sugandhi; Nagpal, Prashant; Doshi, Bijal

    2015-01-01

    Patient: Female, 66 Final Diagnosis: Calciphylaxis Symptoms: Gastrointesinal haemorrhage Medication: None Clinical Procedure: Hemodialysis • blood transfusions Specialty: Gastroenterology and Hepatology Objective: Rare disease Background: Calciphylaxis is associated with a high mortality that approaches 80%. The diagnosis is usually made when obvious skin lesions (painful violaceous mottling of the skin) are present. However, visceral involvement is rare. We present a case of calciphylaxis leading to lower gastrointestinal (GI) bleeding and rectal ulceration of the GI mucosa. Case Report: A 66-year-old woman with past medical history of diabetes mellitus, hypertension, end-stage renal disease (ESRD), recently diagnosed ovarian cancer, and on hemodialysis (HD) presented with painful black necrotic eschar on both legs. The radiograph of the legs demonstrated extensive calcification of the lower extremity arteries. The hospital course was complicated with lower GI bleeding. A CT scan of the abdomen revealed severe circumferential calcification of the abdominal aorta, celiac artery, and superior and inferior mesenteric arteries and their branches. Colonoscopy revealed severe rectal necrosis. She was deemed to be a poor surgical candidate due to comorbidities and presence of extensive vascular calcifications. Recurrent episodes of profuse GI bleeding were managed conservatively with blood transfusion as needed. Following her diagnosis of calciphylaxis, supplementation with vitamin D and calcium containing phosphate binders was stopped. She was started on daily hemodialysis with low calcium dialysate bath as well as intravenous sodium thiosulphate. The clinical condition of the patient deteriorated. The patient died secondary to multiorgan failure. Conclusions: Calciphylaxis leading to intestinal ischemia/perforation should be considered in the differential diagnosis in ESRD on HD presenting with abdominal pain or GI bleeding. PMID:26572938

  15. [Case of awake intubation in semi-sitting position for a patient with myasthenia gravis combined with cervical disc hernia utilizing Pentax-AWS Airwayscope].

    Science.gov (United States)

    Komasawa, Nobuyasu; Ueki, Ryusuke; Tomita, Yukihiko; Kaminoh, Yoshiroh; Tashiro, Chikara

    2011-01-01

    We report a case of awake intubation utilizing Pentax-AWS Airwayscope in semi-sitting position. A 74-year-old man with myasthenia gravis and cervical disc hernia was scheduled for distal gastrectomy under general anesthesia. He could not move his head due to severe cervical disc hernia and also could not sufficiently breathe due to the fatigue of respiratory muscles by myasthenia gravis in supine position. With fentanyl bolus administration and lidocaine spray for laryngotracheal anesthesia, we performed awake intubation in semi-sitting position with AWS from cranial side. The patient did not buck during intubation and no hemodynamic change was observed.

  16. A randomized controlled trial comparing C Mac D Blade and Macintosh laryngoscope for nasotracheal intubation in patients undergoing surgeries for head and neck cancer.

    Science.gov (United States)

    Hazarika, Hrishikesh; Saxena, Anudeep; Meshram, Pradeep; Kumar Bhargava, Ajay

    2018-01-01

    Several devices are available to take care of difficult airway, but C-MAC D-Blade has scant evidence of its use in nasotracheal intubation in a difficult airway scenario. We compared the C-MAC D-Blade videolaryngoscope ™ , and the standard Macintosh laryngoscope for nasal intubation in patients with difficult airways selected by El-Ganzouri risk index using parameters of time and attempts required for intubation, glottic view in terms of Cormack-Lehane grade, ease of intubation, success rate, use of accessory maneuvers, incidence of complications, and hemodynamic changes. One hundred American Society of Anesthesiologists (ASA) I-III patients aged 20-70 years with EGRI score 1-≤7 scheduled for head and neck surgery requiring nasal intubation. ASA IV patients, patients with mouth opening <2.5 cm, patients difficult to mask ventilate, and patients with hyperkalemia and history of malignant hyperthermia were excluded from the study. Primary outcome was time taken to intubation, and secondary outcomes were a number of attempts, glottic view in terms of C/L grade, use of accessory maneuvers, success rate, incidence of trauma, ease of intubation, and hemodynamic changes before and after intubation. Time required for intubation was less (39.56 ± 15.65 s) in Group C than in Group M (50.34 ± 15.65 s). Cormack-Lehane Grade I and II view were more in C-MAC D-Blade group ( P < 0.05). Success rate and ease of intubation were found to be more in C-MAC D-Blade group than in Macintosh group ( P < 0.05). A number of attempts and incidence of complications such as trauma, bleeding, and failed intubation were greater in Macintosh group than in C-MAC D-Blade group. Hemodynamic changes were observed to be comparable in both the groups. C-MAC D-Blade videolaryngoscope ™ is a better tool in anesthetic management of difficult airway for nasal intubation compared to conventional Macintosh laryngoscope.

  17. Effects of using the simplified airway risk index vs usual airway assessment on unanticipated difficult tracheal intubation - a cluster randomized trial with 64,273 participants

    DEFF Research Database (Denmark)

    Nørskov, A K; Wetterslev, J; Rosenstock, C V

    2016-01-01

    departments vs 1.00% (302) in Non-SARI departments. Adjusted OR was 1.26 (0.68-2.34). CONCLUSIONS: Using the SARI compared with usual airway assessment we detected no statistical significant changes in unanticipated difficult- or easy intubations. CLINICAL TRIAL REGISTRATION: NCT01718561.......BACKGROUND: Unanticipated difficult intubation remains a challenge in anaesthesia. The Simplified Airway Risk Index (SARI) is a multivariable risk model consisting of seven independent risk factors for difficult intubation. Our aim was to compare preoperative airway assessment based on the SARI...

  18. Patient health communication mediating effects between gastrointestinal symptoms and gastrointestinal worry in pediatric inflammatory bowel disease

    Science.gov (United States)

    To investigate the effects of patient health communication regarding their inflammatory bowel disease (IBD) to their health care providers and significant others in their daily life as a mediator in the relationship between gastrointestinal symptoms and gastrointestinal worry in pediatric patients. ...

  19. European Society of Gastrointestinal Endoscopy - Establishing the key unanswered research questions within gastrointestinal endoscopy

    DEFF Research Database (Denmark)

    Rees, Colin J; Ngu, Wee Sing; Regula, Jaroslaw

    2016-01-01

    Background and study aim: Gastrointestinal endoscopy is a rapidly evolving research field. The European Society of Gastrointestinal Endoscopy (ESGE) plays a key role in shaping opinion and endoscopy activity throughout Europe and further afield. Establishing key unanswered questions within the fi...

  20. The importance of subjective facial appearance on the ability of anesthesiologists to predict difficult intubation.

    Science.gov (United States)

    Connor, Christopher W; Segal, Scott

    2014-02-01

    Previously we demonstrated that a computer algorithm based on bedside airway examinations and facial photographs accurately classified easy and difficult airways. The extent of the ability of anesthesiologists to perform the same task is unknown. We hypothesized that providing photographs would add to the predictive ability of anesthesiologists over that achieved when provided only with the Mallampati (MP) score and the thyromental distance (TMD). We further hypothesized that human observers would implicitly bias their predictions toward more sensitive determination of difficult airways, rather than more specific determination of easy airways. Residents, fellows, and attending anesthesiologists with varying levels of experience (N = 160) were presented with MP and TMD information from 80 Caucasian men subjects. The same subjects' data, accompanied by 3 facial photographs in head-on and right and left profiles, were also presented. Anesthesiologists classified the airways as easy or difficult according to specified criteria ("easy" defined as a single attempt with a Macintosh 3 blade resulting in a grade 1 laryngoscopic view; "difficult" defined as >1 attempt by an operator with at least 12 months anesthesia experience, grade 3 or 4 laryngoscopic view, need for a second operator, or nonelective use of an alternative airway device). Accuracy, sensitivity, and specificity were calculated for each anesthesiologist. We further developed a cost function to quantify a relative bias toward avoiding an unexpectedly difficult intubation versus overpreparing for an easy intubation. One hundred sixty respondents completed the study. Presenting photographs improved respondents' sensitivity and accuracy in classifying airways, though specificity decreased slightly. Overall accuracy when given photographs was 61.6% (95% confidence interval, 60.8%-62.4%), which was significantly lower than the computer's performance of 87.5% (t test, P interval, 4.9:1-8.4:1). Anesthesiologists can

  1. Monitoring and treatment of acute gastrointestinal bleeding.

    Science.gov (United States)

    Lenjani, Basri; Zeka, Sadik; Krasniqi, Salih; Bunjaku, Ilaz; Jakupi, Arianit; Elshani, Besni; Xhafa, Agim

    2012-01-01

    Acute gastrointestinal bleeding-massive acute bleeding from gastrointestinal section is one of the most frequent forms of acute abdomen. The mortality degree in emergency surgery is about 10%. It's very difficult to identify the place of bleeding and etiology. The important purpose of this research is to present the cases of acute gastrointestinal bleeding from the patients which were monitored and treated at The University Clinical Center of Kosova-Emergency Center in Pristina. These inquests included 137 patients with acute gastrointestinal bleeding who were treated in emergency center of The University Clinical Center in Pristina for the period from January 2005 until December 2006. From 137 patients with acute gastrointestinal bleeding 41% or 29% was female and 96% or 70.1% male. Following the sex we gained a high significant difference of statistics (p < 0.01). The gastrointestinal bleeding was two times more frequent in male than in female. Also in the age-group we had a high significant difference of statistics (p < 0.01) 63.5% of patients were over 55 years old. The mean age of patients with an acute gastrointestinal bleeding was 58.4 years SD 15.8 age. The mean age for female patients was 56.4 age SD 18.5 age. The patients with arterial systolic pressure under 100 mmHg have been classified as patients with hypovolemic shock. They participate with 17.5% in all prevalence of acute gastrointestinal bleeding. From the number of prevalence 2 {1.5%} patients have been diagnosed with peptic ulcer, 1 {0.7%} as gastric perforation and 1 {0.7%} with intestine ischemia. Abdominal Surgery and Intensive Care 2 or 1.5% died, 1 at intensive care unit and 1 at nephrology. As we know the severe condition of the patients with gastrointestinal bleeding and etiology it is very difficult to establish, we need to improve for the better conditions in our emergency center for treatment and initiation base of clinic criteria.

  2. Upper gastrointestinal symptoms in autoimmune gastritis

    Science.gov (United States)

    Carabotti, Marilia; Lahner, Edith; Esposito, Gianluca; Sacchi, Maria Carlotta; Severi, Carola; Annibale, Bruno

    2017-01-01

    Abstract Autoimmune gastritis is often suspected for its hematologic findings, and rarely the diagnosis is made for the presence of gastrointestinal symptoms. Aims of this cross-sectional study were to assess in a large cohort of patients affected by autoimmune gastritis the occurrence and the pattern of gastrointestinal symptoms and to evaluate whether symptomatic patients are characterized by specific clinical features. Gastrointestinal symptoms of 379 consecutive autoimmune gastritis patients were systematically assessed and classified following Rome III Criteria. Association between symptoms and anemia pattern, positivity to gastric autoantibodies, Helicobacter pylori infection, and concomitant autoimmune disease were evaluated. In total, 70.2% of patients were female, median age 55 years (range 17–83). Pernicious anemia (53.6%), iron deficiency anemia (34.8%), gastric autoantibodies (68.8%), and autoimmune disorders (41.7%) were present. However, 56.7% of patients complained of gastrointestinal symptoms, 69.8% of them had exclusively upper symptoms, 15.8% only lower and 14.4% concomitant upper and lower symptoms. Dyspepsia, subtype postprandial distress syndrome was the most represented, being present in 60.2% of symptomatic patients. Univariate and multivariate analyses showed that age gastritis is associated in almost 60% of cases with gastrointestinal symptoms, in particular dyspepsia. Dyspepsia is strictly related to younger age, no smoking, and absence of anemia. PMID:28072728

  3. Significantly reduced hypoxemic events in morbidly obese patients undergoing gastrointestinal endoscopy: Predictors and practice effect

    Directory of Open Access Journals (Sweden)

    Basavana Gouda Goudra

    2014-01-01

    Full Text Available Background: Providing anesthesia for gastrointestinal (GI endoscopy procedures in morbidly obese patients is a challenge for a variety of reasons. The negative impact of obesity on the respiratory system combined with a need to share the upper airway and necessity to preserve the spontaneous ventilation, together add to difficulties. Materials and Methods: This retrospective cohort study included patients with a body mass index (BMI >40 kg/m 2 that underwent out-patient GI endoscopy between September 2010 and February 2011. Patient data was analyzed for procedure, airway management technique as well as hypoxemic and cardiovascular events. Results: A total of 119 patients met the inclusion criteria. Our innovative airway management technique resulted in a lower rate of intraoperative hypoxemic events compared with any published data available. Frequency of desaturation episodes showed statistically significant relation to previous history of obstructive sleep apnea (OSA. These desaturation episodes were found to be statistically independent of increasing BMI of patients. Conclusion: Pre-operative history of OSA irrespective of associated BMI values can be potentially used as a predictor of intra-procedural desaturation. With suitable modification of anesthesia technique, it is possible to reduce the incidence of adverse respiratory events in morbidly obese patients undergoing GI endoscopy procedures, thereby avoiding the need for endotracheal intubation.

  4. Significantly reduced hypoxemic events in morbidly obese patients undergoing gastrointestinal endoscopy: Predictors and practice effect.

    Science.gov (United States)

    Goudra, Basavana Gouda; Singh, Preet Mohinder; Penugonda, Lakshmi C; Speck, Rebecca M; Sinha, Ashish C

    2014-01-01

    Providing anesthesia for gastrointestinal (GI) endoscopy procedures in morbidly obese patients is a challenge for a variety of reasons. The negative impact of obesity on the respiratory system combined with a need to share the upper airway and necessity to preserve the spontaneous ventilation, together add to difficulties. This retrospective cohort study included patients with a body mass index (BMI) >40 kg/m(2) that underwent out-patient GI endoscopy between September 2010 and February 2011. Patient data was analyzed for procedure, airway management technique as well as hypoxemic and cardiovascular events. A total of 119 patients met the inclusion criteria. Our innovative airway management technique resulted in a lower rate of intraoperative hypoxemic events compared with any published data available. Frequency of desaturation episodes showed statistically significant relation to previous history of obstructive sleep apnea (OSA). These desaturation episodes were found to be statistically independent of increasing BMI of patients. Pre-operative history of OSA irrespective of associated BMI values can be potentially used as a predictor of intra-procedural desaturation. With suitable modification of anesthesia technique, it is possible to reduce the incidence of adverse respiratory events in morbidly obese patients undergoing GI endoscopy procedures, thereby avoiding the need for endotracheal intubation.

  5. Causes of gastrointestinal colic at an equine referral hospital in South Africa (1998 - 2007

    Directory of Open Access Journals (Sweden)

    A. Voigt

    2009-05-01

    Full Text Available The most common causes of gastrointestinal colic at an equine referral hospital in South Africa were determined following retrieval of the medical records of horses admitted during a 10-year study period. The study included 935 horses of which 28 % were admitted after hours. Most horses were Thoroughbreds (54 %, male (57 %, with a mean age of 8.2 years and originated from the Gauteng Province (81 %. Heart rate (98 %, mucous membrane colour (95 % and auscultation of the abdomen (91 % were the clinical data commonly obtained at admission. Packed cell volume, total serum protein and white cell count were recorded in 78 %, 75 % and 44 % of horses respectively. Transrectal palpation (93 %, nasogastric intubation (84 %, intravenous catheterisation (74 % and abdominocentesis (53 % were the most frequently performed procedures. Medical intervention was performed in 558 horses (60 %. The common causes of medical colic were impactions (39 %, tympany (7 % and displacement of the large colon (6 %. An exploratory laparotomy was performed in 331 horses (36 %. The common causes of surgical colic were displacement (29 %, impaction (22 % and small intestinal strangulating lesions (18 %. Death occurred in 3 % of horses, while euthanasia before medical intervention was performed in 4 %. Overall, medical intervention was successful in 93 % of horses and 67 % in horses managed surgically. In conclusion, 55 % of all the equine admissions responded to medical intervention and the recovery rate for horses receiving both medical and surgical intervention was comparable to that reported in other studies.

  6. Colonoscopic findings and management of patients with outbreak typhoid fever presenting with lower gastrointestinal bleeding.

    Science.gov (United States)

    Shaikhani, Mohammad A R; Husein, Hiwa A B; Karbuli, Taha A; Mohamed, Mohamed Abdulrahman

    2013-09-01

    Lower gastrointestinal bleeding (LGIB) along with intestinal perforation is a well-known complication of typhoid fever. Reports of colonoscopic appearance and intervention of typhoid perforation involve only few cases. This series reports the colonoscopic findings and the role of colonoscopic hemostatic interventions in controlling the bleeding ileocolonic lesions. During the typhoid fever outbreak in Sulaymaniyah City in Iraqi Kurdistan Region, we received 52 patients with LGIB manifesting as fresh bleeding per rectum or melena. We performed total colonoscopy with ileal intubation for all cases. The findings were recorded and endoscopic hemostatic intervention with adrenaline-saline injection and argon plasma coagulation was applied to actively bleeding lesion. These patients were young, 11-30 years of age, with female preponderance. Blood culture was positive in 50 %. Colonoscopic findings were mostly located in the ileocecal region, although other areas of the colon were involved in many cases. Twenty-four percent of the cases required endoscopic hemostatic intervention by adrenaline injection with argon plasma coagulation which was effective in all patients except one who died in spite of surgical intervention in addition of endoscopic hemostasis. Dual endoscopic hemostatic intervention can be a safe and effective management option for patients with LGIB due to typhoid fever.

  7. Upper gastrointestinal bleeding following transcatheter aortic valve replacement: A retrospective analysis.

    Science.gov (United States)

    Stanger, Dylan E; Abdulla, Alym H; Wong, Frank T; Alipour, Sina; Bressler, Brian L; Wood, David A; Webb, John G

    2017-08-01

    The aim of this study was to identify the incidence of upper gastrointestinal bleeding (UGIB) in the postprocedural period following transcatheter aortic valve replacement (TAVR). As TAVR moves into intermediate- and low-risk patients, it has become increasingly important to understand its extracardiac complications. The patient population undergoing TAVR have clinical and demographic characteristics that place them at significant risk of UGIB. Practical aspects of TAVR, including use of antithrombotic therapy, further increase risk of UGIB. A retrospective single-center evaluation of 841 patients who underwent TAVR between January 2005 and August 2014 was performed in conjunction with analysis of referral patterns to the gastroenterology service for UGIB at the same site. The overall risk of UGIB following TAVR was found to be 2.0% (n = 17/841). Additionally, the risk of UGIB in patients receiving triple antithrombotic therapy was found to be 10-fold greater than patients not receiving triple antithrombotic therapy (11.8% vs 1.0%). Endoscopy findings demonstrated five high-risk esophageal lesions including erosive esophageal ulcers, visible vessels at the GE junction, erosions at distal esophagus, and an actively bleeding esophageal ring that had been intubated through by the transesophageal echocardiography (TEE) probe. This large cohort study demonstrates that TAVR is associated with a moderate risk of severe UGIB. The results of this study suggest that patients on triple antithrombotic therapy are at highest risk for severe UGIB. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  8. Removal of foreign bodies in the upper gastrointestinal tract in adults: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline.

    Science.gov (United States)

    Birk, Michael; Bauerfeind, Peter; Deprez, Pierre H; Häfner, Michael; Hartmann, Dirk; Hassan, Cesare; Hucl, Tomas; Lesur, Gilles; Aabakken, Lars; Meining, Alexander

    2016-05-01

    This Guideline is an official statement of the European Society of Gastrointestinal Endoscopy (ESGE). It addresses the removal of foreign bodies in the upper gastrointestinal tract in adults. Recommendations Nonendoscopic measures 1 ESGE recommends diagnostic evaluation based on the patient's history and symptoms. ESGE recommends a physical examination focused on the patient's general condition and to assess signs of any complications (strong recommendation, low quality evidence). 2 ESGE does not recommend radiological evaluation for patients with nonbony food bolus impaction without complications. We recommend plain radiography to assess the presence, location, size, configuration, and number of ingested foreign bodies if ingestion of radiopaque objects is suspected or type of object is unknown (strong recommendation, low quality evidence). 3 ESGE recommends computed tomography (CT) scan in all patients with suspected perforation or other complication that may require surgery (strong recommendation, low quality evidence). 4 ESGE does not recommend barium swallow, because of the risk of aspiration and worsening of the endoscopic visualization (strong recommendation, low quality evidence). 5 ESGE recommends clinical observation without the need for endoscopic removal for management of asymptomatic patients with ingestion of blunt and small objects (except batteries and magnets). If feasible, outpatient management is appropriate (strong recommendation, low quality evidence). 6 ESGE recommends close observation in asymptomatic individuals who have concealed packets of drugs by swallowing ("body packing"). We recommend against endoscopic retrieval. We recommend surgical referral in cases of suspected packet rupture, failure of packets to progress, or intestinal obstruction (strong recommendation, low quality evidence). Endoscopic measures 7 ESGE recommends emergent (preferably within 2 hours, but at the latest within 6 hours) therapeutic esophagogastroduodenoscopy for

  9. A case of pneumothorax following bougie-guided intubation in a patient undergoing excision of an intraventricular space occupying lesion

    Directory of Open Access Journals (Sweden)

    Ramanan Rajagopal

    2017-01-01

    Full Text Available A 46-year-old female with intraventricular space occupying lesion was posted for craniotomy and excision of the same. Immediately following routine induction of general anaesthesia and a bougie-guided intubation, she developed increased airway pressures and desaturation associated with a decreased air entry on the right side of the chest suggestive of a right-sided pneumothorax which was confirmed with radio imaging and following the placement of chest drain the saturation improved and airway pressures decreased. To be faced with a pneumothorax following an intubation could be surprising for a non-suspecting anaesthesiologist and it can have important implications especially in neurosurgical cases where a tight control of intracranial pressure is warranted. Hence, this case report emphasises the need for a high index of clinical suspicion for proper management and safe patient outcome.

  10. Neuronavigation-guided intubated wake-up craniotomy for a patient with a brain astrocytoma

    Directory of Open Access Journals (Sweden)

    Wen-Kuei Fang

    2013-08-01

    Full Text Available Computer-assisted neuronavigation (an image-guided technique that facilitates brain tumor surgery reduces the risk of neurological morbidity. Postoperative neurological dysfunction is also minimized by performing intraoperative neurological testing during awake craniotomy with proper surgical resection of a brain tumor. However, when the patient's airway is not secured, an awake craniotomy can be hazardous if emergent intubation is necessary. The present report describes a young man with a brain tumor who underwent neuronavigation-guided wake-up craniotomy and surgical resection of an astrocytoma. The patient was intubated throughout the course of the procedure, during which modified intraoperative neurological tests were performed for cortical mapping. The patient recovered well after the operation and without any neurological deficits.

  11. Association of apneic oxygenation with decreased desaturation rates during rapid sequence intubation by a Chinese emergency medicine service.

    Science.gov (United States)

    Mao, Yong; Qin, Zong-He

    2015-01-01

    Rapid and safe airway management has always been of paramount importance in successful management of critically ill and injured patients in the emergency department. The achievement rate of emergency medicine inhabitants in airway management improved enhanced essentially subsequent to finishing anaesthesiology turn. There was a slightly higher rate of quick sequence intubation in the postapneic oxygenation groups (preapneic oxygenation 6.4%; postapneic oxygenation 9.1%). The majority of patients intubated in both groups were men (preapneic oxygenation 72.3%; postapneic oxygenation 63.5%). A higher percentage of patients in the preapneic oxygenation group had a Cormack-Lehane grade III or worse view (23.2% versus 11.8%). Anaesthesiology turns should be considered as an essential component of emergency medicine training programs. A collateral curriculum of this nature should also focus on the acquisition of skills in airway management.

  12. Intubation conditions after rocuronium or succinylcholine for rapid sequence induction with alfentanil and propofol in the emergency patient

    DEFF Research Database (Denmark)

    Larsen, P B; Hansen, E G; Jacobsen, L S

    2005-01-01

    Background and objective: Previous studies mainly conducted on elective patients recommend doses of 0.9-1.2 mg kg[-1] rocuronium to obtain comparable intubation conditions with succinylcholine 1.0 mg kg[-1] after 60 s during a rapid-sequence induction. We decided to compare the overall intubating...... conditions of standard doses of rocuronium 0.6 mg kg[-1] and succinylcholine 1.0 mg kg[-1] during a strict rapid-sequence induction regimen including propofol and alfentanil. Methods: Male and female patients (ASA I-III) older than 17 yr scheduled for emergency abdominal or gynaecological surgery...... and with increased risk of pulmonary aspiration of gastric content were randomized to a rapid-sequence induction with succinylcholine 1.0 mg kg[-1] or rocuronium 0.6 mg kg[-1]. Patients with a predicted difficult airway were excluded. A senior anaesthesiologist 'blinded' for the randomization performed...

  13. The importance of neck circumference to thyromental distance ratio (NC/TM as a predictor of difficult intubation in obstructive sleep apnea (OSA patients

    Directory of Open Access Journals (Sweden)

    Hala Ezzat Abdel Naim

    2014-07-01

    Conclusion: Difficult intubation in OSA obese patients was independently associated with a Mallampati score of III or IV, and NC/TM ⩾5.15. Moreover, NC/TM yielded a high sensitivity, specificity and a negative predictive value.

  14. Evaluation of Carbon Nanotubes Functionalized Polydimethylsiloxane Based Coatings for In-Tube Solid Phase Microextraction Coupled to Capillary Liquid Chromatography

    OpenAIRE

    Neus Jornet-Martínez; Pascual Serra-Mora; Yolanda Moliner-Martínez; Rosa Herráez-Hernández; Pilar Campíns-Falcó

    2015-01-01

    In the present work, the performance of carbon nanotubes (c-CNTs) functionalized polydimethylsiloxane (PDMS) based coatings as extractive phases for in-tube solid phase microextraction (IT-SPME) coupled to Capillary LC (CapLC) has been evaluated. Carboxylic-single walled carbon nanotubes (c-SWNTs) and carboxylic-multi walled carbon nanotubes (c-MWNTs) have been immobilized on the activated surface of PDMS capillary columns. The effect of different percentages of diphenyl groups in the PDMS ex...

  15. Obstetric Anaesthetists' Association and Difficult Airway Society guidelines for the management of difficult and failed tracheal intubation in obstetrics*

    OpenAIRE

    Mushambi, M C; Kinsella, S M; Popat, M; Swales, H; Ramaswamy, K K; Winton, A L; Quinn, A C

    2015-01-01

    The Obstetric Anaesthetists' Association and Difficult Airway Society have developed the first national obstetric guidelines for the safe management of difficult and failed tracheal intubation during general anaesthesia. They comprise four algorithms and two tables. A master algorithm provides an overview. Algorithm 1 gives a framework on how to optimise a safe general anaesthetic technique in the obstetric patient, and emphasises: planning and multidisciplinary communication; how to prevent ...

  16. A simple method for accurate endotracheal placement of an intubation tube in Guinea pigs to assess lung injury following chemical exposure.

    Science.gov (United States)

    Nambiar, M P; Gordon, R K; Moran, T S; Richards, S M; Sciuto, A M

    2007-01-01

    ABSTRACT Guinea pigs are considered as the animal model of choice for toxicology and medical countermeasure studies against chemical warfare agents (CWAs) and toxic organophosphate pesticides because of the low levels of carboxylesterase compared to rats and mice. However, it is difficult to intubate guinea pigs without damaging the larynx to perform CWA inhalation experiments. We describe an easy technique of intubation of guinea pigs for accurate endotracheal placement of the intubation tube. The technique involves a speculum made by cutting the medium-size ear speculum in the midline leaving behind the intact circular connector to the otoscope. Guinea pigs were anesthetized with Telazol/meditomidine, the tongue was pulled using blunt forceps, and an otoscope attached with the specially prepared speculum was inserted gently. Insertion of the speculum raises the epiglottis and restrains the movements of vocal cord, which allows smooth insertion of the metal stylet-reinforced intubation tube. Accurate endotracheal placement of the intubation tube was achieved by measuring the length from the tracheal bifurcation to vocal cord and vocal cord to the upper front teeth. The average length of the trachea in guinea pigs (275 +/- 25 g) was 5.5 +/- 0.2 cm and the distance from the vocal cord to the front teeth was typically 3 cm. Coinciding an intubation tube marked at 6 cm with the upper front teeth accurately places the intubation tube 2.5 cm above the tracheal bifurcation. This simple method of intubation does not disturb the natural flora of the mouth and causes minimum laryngeal damage. It is rapid and reliable, and will be very valuable in inhalation exposure to chemical/biological warfare agents or toxic chemicals to assess respiratory toxicity and develop medical countermeasures.

  17. Predictive value of preoperative tests in estimating difficult intubation in patients who underwent direct laryngoscopy in ear, nose, and throat surgery

    Directory of Open Access Journals (Sweden)

    Osman Karakus

    2015-04-01

    Full Text Available BACKGROUND AND OBJECTIVES: Predictive value of preoperative tests in estimating difficult intubation may differ in the laryngeal pathologies. Patients who had undergone direct laryngoscopy (DL were reviewed, and predictive value of preoperative tests in estimating difficult intubation was investigated. METHODS: Preoperative, and intraoperative anesthesia record forms, and computerized system of the hospital were screened. RESULTS: A total of 2611 patients were assessed. In 7.4% of the patients, difficult intubations were detected. Difficult intubations were encountered in some of the patients with Mallampati scoring (MS system Class 4 (50%, Cormack-Lehane classification (CLS Grade 4 (95.7%, previous knowledge of difficult airway (86.2%, restricted neck movements (cervical ROM (75.8%, short thyromental distance (TMD (81.6%, vocal cord mass (49.5% as indicated in parentheses (p < 0.0001. MS had a low sensitivity, while restricted cervical ROM, presence of a vocal cord mass, short thyromental distance, and MS each had a relatively higher positive predictive value. Incidence of difficult intubations increased 6.159 and 1.736-fold with each level of increase in CLS grade and MS class, respectively. When all tests were considered in combination difficult intubation could be classified accurately in 96.3% of the cases. CONCLUSION: Test results predicting difficult intubations in cases with DL had observedly overlapped with the results provided in the literature for the patient populations in general. Differences in some test results when compared with those of the general population might stem from the concomitant underlying laryngeal pathological conditions in patient populations with difficult intubation.

  18. [Predictive value of preoperative tests in estimating difficult intubation in patients who underwent direct laryngoscopy in ear, nose, and throat surgery].

    Science.gov (United States)

    Karakus, Osman; Kaya, Cengiz; Ustun, Faik Emre; Koksal, Ersin; Ustun, Yasemin Burcu

    2015-01-01

    Predictive value of preoperative tests in estimating difficult intubation may differ in the laryngeal pathologies. Patients who had undergone direct laryngoscopy (DL) were reviewed, and predictive value of preoperative tests in estimating difficult intubation was investigated. Preoperative, and intraoperative anesthesia record forms, and computerized system of the hospital were screened. A total of 2611 patients were assessed. In 7.4% of the patients, difficult intubations were detected. Difficult intubations were encountered in some of the patients with Mallampati scoring (MS) system Class 4 (50%), Cormack-Lehane classification (CLS) Grade 4 (95.7%), previous knowledge of difficult airway (86.2%), restricted neck movements (cervical ROM) (75.8%), short thyromental distance (TMD) (81.6%), vocal cord mass (49.5%) as indicated in parentheses (p<0.0001). MS had a low sensitivity, while restricted cervical ROM, presence of a vocal cord mass, short thyromental distance, and MS each had a relatively higher positive predictive value. Incidence of difficult intubations increased 6.159 and 1.736-fold with each level of increase in CLS grade and MS class, respectively. When all tests were considered in combination difficult intubation could be classified accurately in 96.3% of the cases. Test results predicting difficult intubations in cases with DL had observedly overlapped with the results provided in the literature for the patient populations in general. Differences in some test results when compared with those of the general population might stem from the concomitant underlying laryngeal pathological conditions in patient populations with difficult intubation. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  19. New advances in gastrointestinal motility research

    CERN Document Server

    Pullan, A; Farrugia, G

    2013-01-01

    Research into gastrointestinal motility has received renewed interest in part due to recent advances in the techniques for measuring the structure and function of gastrointestinal cells, tissue and organs. The integration of this wealth of data into biophysically based computation models can aid in interpretation of experimental and clinical measurements and the refinement of measurement techniques. The contents of this book span multiple scales - from cell, tissue, organ, to whole body and is divided into four broad sections covering: i) gastrointestinal cellular activity and tissue structure; (ii) techniques for measuring, analyzing and visualizing high-resolution extra-cellular recordings; (iii) methods for sensing gastroelectrical activity using non-invasive bio-electro-magnetic fields and for modulating the underlying gastric electrical activity, and finally; (iv) methods for assessing manometric and videographic motility patterns and the application of these data for predicting the flow and mixing behav...

  20. The chronic gastrointestinal manifestations of Chagas disease

    Directory of Open Access Journals (Sweden)

    Nilce Mitiko Matsuda

    2009-01-01

    Full Text Available Chagas disease is an infectious disease caused by the protozoan Trypanosoma cruzi. The disease mainly affects the nervous system, digestive system and heart. The objective of this review is to revise the literature and summarize the main chronic gastrointestinal manifestations of Chagas disease. The chronic gastrointestinal manifestations of Chagas disease are mainly a result of enteric nervous system impairment caused by T. cruzi infection. The anatomical locations most commonly described to be affected by Chagas disease are salivary glands, esophagus, lower esophageal sphincter, stomach, small intestine, colon, gallbladder and biliary tree. Chagas disease has also been studied in association with Helicobacter pylori infection, interstitial cells of Cajal and the incidence of gastrointestinal cancer.

  1. Transfusion strategy for acute upper gastrointestinal bleeding.

    Science.gov (United States)

    Handel, James; Lang, Eddy

    2015-09-01

    Clinical question Does a hemoglobin transfusion threshold of 70 g/L yield better patient outcomes than a threshold of 90 g/L in patients with acute upper gastrointestinal bleeding? Article chosen Villanueva C, Colomo A, Bosch A, et al. Transfusion strategies for acute upper gastrointestinal bleeding. N Engl J Med 2013;368(1):11-21. Study objectives The authors of this study measured mortality, from any cause, within the first 45 days, in patients with acute upper gastrointestinal bleeding, who were managed with a hemoglobin threshold for red cell transfusion of either 70 g/L or 90 g/L. The secondary outcome measures included rate of further bleeding and rate of adverse events.

  2. Bayesian network modelling of upper gastrointestinal bleeding

    Science.gov (United States)

    Aisha, Nazziwa; Shohaimi, Shamarina; Adam, Mohd Bakri

    2013-09-01

    Bayesian networks are graphical probabilistic models that represent causal and other relationships between domain variables. In the context of medical decision making, these models have been explored to help in medical diagnosis and prognosis. In this paper, we discuss the Bayesian network formalism in building medical support systems and we learn a tree augmented naive Bayes Network (TAN) from gastrointestinal bleeding data. The accuracy of the TAN in classifying the source of gastrointestinal bleeding into upper or lower source is obtained. The TAN achieves a high classification accuracy of 86% and an area under curve of 92%. A sensitivity analysis of the model shows relatively high levels of entropy reduction for color of the stool, history of gastrointestinal bleeding, consistency and the ratio of blood urea nitrogen to creatinine. The TAN facilitates the identification of the source of GIB and requires further validation.

  3. Analysis of aldehydes in human exhaled breath condensates by in-tube SPME-HPLC.

    Science.gov (United States)

    Wang, ShuLing; Hu, Sheng; Xu, Hui

    2015-11-05

    In this paper, polypyrrole/graphene (PPy/G) composite coating was prepared by a facile electrochemical polymerization strategy on the inner surface of a stainless steel (SS) tube. Based on the coating tube, a novel online in-tube solid-phase microextraction -high performance liquid chromatography (IT-SPME-HPLC) was developed and applied for the extraction of aldehydes in the human exhaled breath condensates (EBC). The hybrid PPy/G nanocomposite exhibits remarkable chemical and mechanical stability, high selectivity, and satisfactory extraction performance toward aldehyde compounds. Moreover, the proposed online IT-SPME-HPLC method possesses numerous superiorities, such as time and cost saving, process simplicity, high precision and sensitivity. Some parameters related to extraction efficiency were optimized systematically. Under the optimal conditions, the recoveries of the aldehyde compounds at three spiked concentration levels varied in the range of 85%-117%. Good linearity was obtained with excellent correlation coefficients (R(2)) being larger than 0.994. The relative standard deviations (n = 5) of the method ranged from 1.8% to 11.3% and the limits of detection were between 2.3 and 3.3 nmol L(-1). The successful application of the proposed method in human EBC indicated that it is a promising approach for the determination of trace aldehyde metabolites in complex EBC samples. Copyright © 2015 Elsevier B.V. All rights reserved.

  4. Hemodynamic responses to dexmedetomidine in critically injured intubated pediatric burned patients: a preliminary study.

    Science.gov (United States)

    Shank, Erik S; Sheridan, Robert L; Ryan, Colleen M; Keaney, Timothy J; Martyn, J A Jeevendra

    2013-01-01

    Because of ineffectiveness and tolerance to benzodiazepines and opioids developing with time, drugs acting via other receptor systems (eg, α-2 agonists) have been advocated in burn patients to improve sedation and analgesia. This study in severely burned pediatric subjects examined the hemodynamic consequences of dexmedetomidine (Dex) administration. Eight intubated patients with ≥20 to 79% TBSA burns were studied between 7 and 35 days after injury. After baseline measurements of mean arterial blood pressure and heart rhythm were taken, each patient received a 1.0 µg/kg bolus of Dex followed by an ascending dose infusion protocol (0.7-2.5 µg/kg/hr), with each dose administered for 15 minutes. There was significant hypotension (27±7.5%, average drop in mean arterial pressure [MAP] ± SD), and a decrease in heart rate (HR; 19% ± 7, average drop in HR ± SD). The average HR decreased from 146 beats per minute to 120. No bradycardia (HR patients, the MAP decreased to patients, three patients completed the study receiving the highest infusion dose of Dex (2.5 µg/kg/hr), whereas in 2 patients the infusion part of the study was begun, but the study was stopped due to persistent hypotension (MAP burn patients.

  5. Experimental comparison and visualization of in-tube continuous and pulsating flow boiling

    DEFF Research Database (Denmark)

    Kærn, Martin Ryhl; Markussen, Wiebke Brix; Meyer, Knud Erik

    2018-01-01

    This experimental study investigated the application of fluid flow pulsations for in-tube flow boiling heat transfer enhancement in an 8 mm smooth round tube made of copper. The fluid flow pulsations were introduced by a flow modulating expansion device and were compared with continuous flow...... cycle time (7 s) reduced the time-averaged heat transfer coefficients by 1.8% and 2.3% for the low and high subcooling, respectively, due to significant dry-out when the flow-modulating expansion valve was closed. Furthermore, the flow pulsations were visualized by high-speed camera to assist...... generated by a stepper-motor expansion valve in terms of the time-averaged heat transfer coefficient. The cycle time ranged from 1 s to 7 s for the pulsations, the time-averaged refrigerant mass flux ranged from 50 kg m−2 s−1 to 194 kg m−2 s−1 and the time-averaged heat flux ranged from 1.1 kW m−2 to 30.6 k...

  6. Bronchial intubation could be detected by the visual stethoscope techniques in pediatric patients.

    Science.gov (United States)

    Kimura, Tetsuro; Suzuki, Akira; Mimuro, Soichiro; Makino, Hiroshi; Sato, Shigehito

    2012-12-01

    We created a system that allows the visualization of breath sounds (visual stethoscope). We compared the visual stethoscope technique with auscultation for the detection of bronchial intubation in pediatric patients. In the auscultation group, an anesthesiologist advanced the tracheal tube, while another anesthesiologist auscultated bilateral breath sounds to detect the change and/or disappearance of unilateral breath sounds. In the visualization group, the stethoscope was used to detect changes in breath sounds and/or disappearance of unilateral breath sounds. The distance from the edge of the mouth to the carina was measured using a fiberoptic bronchoscope. Forty pediatric patients were enrolled in the study. At the point at which irregular breath sounds were auscultated, the tracheal tube was located at 0.5 ± 0.8 cm on the bronchial side from the carina. When a detectable change of shape of the visualized breath sound was observed, the tracheal tube was located 0.1 ± 1.2 cm on the bronchial side (not significant). At the point at which unilateral breath sounds were auscultated or a unilateral shape of the visualized breath sound was observed, the tracheal tube was 1.5 ± 0.8 or 1.2 ± 1.0 cm on the bronchial side, respectively (not significant). The visual stethoscope allowed to display the left and the right lung sound simultaneously and detected changes of breath sounds and unilateral breath sound as a tracheal tube was advanced. © 2012 Blackwell Publishing Ltd.

  7. Anaesthesia care with and without tracheal intubation during emergency endoscopy for peptic ulcer bleeding

    DEFF Research Database (Denmark)

    Lohse, N; Lundstrøm, L H; Vestergaard, T R

    2015-01-01

    index score, BMI, age, sex, alcohol use, referral origin (home or in-hospital), Forrest classification, ulcer localization, and postoperative care. RESULTS: The study group comprised 3580 patients under anaesthesia care: 2101 (59%) for the TI group and 1479 (41%) for the MAC group. During the first 90...... with tracheal intubation (TI group) and without airway instrumentation (monitored anaesthesia care, MAC group) during emergency OGD. METHODS: This was a prospective, nationwide, population-based cohort study during 2006-13. Emergency OGDs performed under anaesthesia care were included. End points were 90 day...... days after OGD, 18.9% in the TI group and 18.4% in the MAC group died, crude odds ratio=1.03 [95% confidence interval (CI)=0.87-1.23, P=0.701], adjusted odds ratio=0.95 (95% CI=0.79-1.15, P=0.590). Patients in the TI group stayed slightly longer in hospital [mean 8.16 (95% CI=7.63-8.60) vs 7.63 days...

  8. Experimental research on in-tube condensation in the presence of air

    International Nuclear Information System (INIS)

    Tanrikut, A.; Yesin, O.

    2000-01-01

    In this research work, in-tube condensation in the presence of air is investigated experimentally for different operating conditions, and inhibiting effect of air is analyzed by comparing the experimental data of air/steam mixture with the data of corresponding pure steam cases, with respect to temperature, heat flux, and heat transfer coefficient. The test matrix covers the range of; P=2-6 bar, Re v =45000-94000, and X i =0%-52%. The inhibiting effect of air manifests itself as a remarkable decrease in centerline temperature (10 deg. C - 50 deg. C), depending on inlet air mass fraction. However, the measured centerline temperature is suppressed compared to the predicted one, from the Gibbs-Dalton Law, which indicates that the centerline temperature measurements are highly affected by inner wall thermal conditions, possibly due to narrow channel and high vapor Reynolds number. Even at the lowest air quality (10%) the reduction of the heat flux is 20% while it reaches up to 50% for the quality of 40%. Maximum percent decrease of the heat transfer coefficient was observed in runs with the system pressure of 2 bar; 45% and 65%, for the air mass fraction of 10% and 28%, respectively. (author)

  9. Non-intubated video-assisted thoracic surgery management of secondary spontaneous pneumothorax.

    Science.gov (United States)

    Galvez, Carlos; Bolufer, Sergio; Navarro-Martinez, Jose; Lirio, Francisco; Corcoles, Juan Manuel; Rodriguez-Paniagua, Jose Manuel

    2015-05-01

    Secondary spontaneous pneumothorax (SSP) is serious entity, usually due to underlying disease, mainly chronic obstructive pulmonary disease (COPD). Its morbidity and mortality is high due to the pulmonary compromised status of these patients, and the recurrence rate is almost 50%, increasing mortality with each episode. For persistent or recurrent SSP, surgery under general anesthesia (GA) and mechanical ventilation (MV) with lung isolation is the gold standard, but ventilator-induced damages and dependency, and postoperative pulmonary complications are frequent. In the last two decades, several groups have reported successful results with non-intubated video-assisted thoracic surgery (NI-VATS) with thoracic epidural anesthesia (TEA) and/or local anesthesia under spontaneous breathing. Main benefits reported are operative time, operation room time and hospital stay reduction, and postoperative respiratory complications decrease when comparing to GA, thus encouraging for further research in these moderate to high risk patients many times rejected for the standard regimen. There are also reports of special situations with satisfactory results, as in contralateral pneumonectomy and lung transplantation. The aim of this review is to collect, analyze and discuss all the available evidence, and seek for future lines of investigation.

  10. In-tube extraction for the determination of the main volatile compounds in Physalis peruviana L.

    Science.gov (United States)

    Kupska, Magdalena; Jeleń, Henryk H

    2017-01-01

    An analytical procedure based on in-tube extraction followed by gas chromatography with mass spectrometry has been developed for the analysis of 24 of the main volatile components in cape gooseberry (Physalis peruviana L.) samples. According to their chemical structure, the compounds were organized into different groups: one hydrocarbon, one aldehyde, four alcohols, four esters, and 14 monoterpenes. By single-factor experiments, incubation temperature, incubation time, extraction volume, extraction strokes, extraction speed, desorption temperature, and desorption speed were determined as 60°C, 20 min, 1000 μL, 20, 50:50 μL/s, 280°C, 100 μL/s, respectively. Quantitative analysis using authentic standards and external calibration curves was performed. The limit of detection and limit of quantification for the analytical procedure were calculated. Results shown the benzaldehyde, ethyl butanoate, 2-methyl-1-butanol, 1-hexanol, 1-butanol, α-terpineol, and terpinen-4-ol were the most abundant volatile compounds in analyzed fruits (68.6-585 μg/kg). The obtained data may contribute to qualify cape gooseberry to the group of superfruits and, therefore, increase its popularity. © 2016 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  11. Prevention of Dental Damage and Improvement of Difficult Intubation Using a Paraglossal Technique With a Straight Miller Blade

    Directory of Open Access Journals (Sweden)

    Yu-Feng Huang

    2010-10-01

    Full Text Available Patients with diseased teeth, or those who are difficult to intubate, have a higher risk of dental injury during laryngoscopy. We report 3 cases of smooth endotracheal intubation using a paraglossal technique with a straight Miller blade in patients with poor dentition. Three patients with poor dentition were scheduled to undergo surgery under general anesthesia. All patients presented with extremely loose upper central incisors and had lost the other right upper teeth, while micrognathia and prominent, loose upper incisors were noted in 1 case. We elected to use a straight Miller blade using a paraglossal approach. A nasopharyngeal airway was inserted after induction of general anesthesia to facilitate mask ventilation and prevent air leakage from the mask. The Miller blade was then inserted from the right corner of the mouth, avoiding contact with the vulnerable incisors, and advanced along the groove between the tongue and tonsil. The endotracheal tube was subsequently smoothly inserted after obtaining a grade 1 Cormack and Lehane view without dental trauma in all 3 cases. Direct laryngoscopy using the paraglossal straight blade technique avoids dental damage in patients with mobile upper incisors and no right maxillary molars. It is a practical alternative method that differs from the traditional Macintosh laryngoscope in patients with a high risk of dental injury during the procedure. This technique, which provides an improved view of the larynx, might also be helpful with patients in whom intubation is difficult.

  12. Apneic oxygenation reduces the incidence of hypoxemia during emergency intubation: A systematic review and meta-analysis.

    Science.gov (United States)

    Pavlov, Ivan; Medrano, Sofia; Weingart, Scott

    2017-08-01

    Apneic oxygenation has been advocated for the prevention of hypoxemia during emergency endotracheal intubation. Because of conflicting results from recent trials, the efficacy of apneic oxygenation remains unclear. We performed a systematic review and meta-analysis to investigate the effect of apneic oxygenation on the incidence of clinically significant hypoxemia during emergency endotracheal intubation. MEDLINE, EMBASE, and PubMed databases were searched without language and time restrictions for studies of apneic oxygenation performed in a critical care setting. Meta-analysis was conducted with a random-effect model, and according to intention-to-treat allocation wherever applicable. Subgroup analyses were performed to ensure the robustness of findings across various clinical outcomes. Eight studies (n=1953) were included in the meta-analysis. The pooled absolute risk of clinically significant hypoxemia was 27.6% in the usual care group and 19.1% in the apneic oxygenation group, without any heterogeneity across studies (I 2 =0%; p=0.42). Apneic oxygenation reduced the relative risk of hypoxemia by 30% (95% confidence interval 0.59 to 0.82). There was a trend toward lower mortality in the apneic oxygenation group (relative risk of death 0.77; 95% confidence interval 0.59 to 1.02). Apneic oxygenation significantly reduces the incidence of hypoxemia during emergency endotracheal intubation. These findings support the inclusion of apneic oxygenation in everyday clinical practice. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. The effect of laryngoscope handle size on possible endotracheal intubation success in university football, ice hockey, and soccer players.

    Science.gov (United States)

    Delaney, J Scott; Al-Kashmiri, Ammar; Baylis, Penny-Jane; Aljufaili, Mahmood; Correa, José A

    2012-07-01

    To assess the effectiveness of a standard long-handle laryngoscope and a short-handle laryngoscope on ease of possible intubation in football, ice hockey, and soccer players. Prospective crossover study. University Sport Medicine Clinic. Sixty-two university varsity football (62 males), 45 ice hockey (26 males and 19 females), and 39 soccer players (20 males, 19 females). Athletes were assessed for different airway and physical characteristics. Three different physicians then assessed the use of laryngoscopes of different handle sizes in supine athletes who were wearing protective equipment while in-line cervical spine immobilization was maintained. The ease of passage of a laryngoscope blade into the posterior oropharynx of a supine athlete was assessed using both a standard long-handle and a short-handle laryngoscope. Use of a short-handle laryngoscope was easier for all physicians in all sports as compared with a standard-sized laryngoscope. Passage of a laryngoscope blade into the posterior oropharynx of a supine athlete was easiest in soccer players and most difficult in football and ice hockey players for both sizes of laryngoscope. Interference from chest or shoulder pads was a common cause for difficulty in passing the laryngoscope blade into the posterior oropharynx for football and ice hockey players. In the rare instances that an endotracheal intubation is to be attempted on an unconscious athlete, a short-handle laryngoscope may provide the best chance for successful intubation.

  14. Comparison of the Glidescope and Pentax AWS laryngoscopes to the Macintosh laryngoscope for use by advanced paramedics in easy and simulated difficult intubation.

    LENUS (Irish Health Repository)

    Nasim, Sajid

    2009-01-01

    BACKGROUND: Intubation of the trachea in the pre-hospital setting may be lifesaving in severely ill and injured patients. However, tracheal intubation is frequently difficult to perform in this challenging environment, is associated with a lower success rate, and failed tracheal intubation constitutes an important cause of morbidity. Novel indirect laryngoscopes, such as the Glidescope and the AWS laryngoscopes may reduce this risk. METHODS: We compared the efficacy of these devices to the Macintosh laryngoscope when used by 25 Advanced Paramedics proficient in direct laryngoscopy, in a randomized, controlled, manikin study. Following brief didactic instruction with the Glidescope and the AWS laryngoscopes, each participant took turns performing laryngoscopy and intubation with each device, in an easy intubation scenario and following placement of a hard cervical collar, in a SimMan manikin. RESULTS: Both the Glidescope and the AWS performed better than the Macintosh, and demonstrate considerable promise in this context. The AWS had the least number of dental compressions in all three scenarios, and in the cervical spine immobilization scenario it required fewer maneuvers to optimize the view of the glottis. CONCLUSION: The Glidescope and AWS devices possess advantages over the conventional Macintosh laryngoscope when used by Advanced Paramedics in normal and simulated difficult intubation scenarios in this manikin study. Further studies are required to extend these findings to the clinical setting.

  15. Development of a running robot in super high speed tube. Aiming at realization of in-tube inspection for primary cooler and so forth of nuclear reactor

    International Nuclear Information System (INIS)

    Kato, Shigeo

    2000-01-01

    Authors have carried out a study on an in-tube running robot in living body on a base of laying stretching of bellows at a means of running by thinking application of in-tube inspection in living body such as large and small bowels. As a result, an in-tube running robot with about 20 mm in inner diameter capable of running in soft small bowel as well as in hard running tube was developed successfully. After an accident of the Tsuruga nuclear power plant, inspection of a large diameter tube with 76 mm in inner diameter was found to be much important, to begin development of an in-tube running robot for 50 mm class diameter tube. As a result, an in-tube running robot capable of enough holding a micro video camera with about 20 g in mass and showing 4.6 N in tension at more than ten times higher speed of 248 mm/s in no loading state, could be made in trial. Here was reported on a foothold realizable on an in-tube running robot for the 76 mm class large diameter tube to be investigated in future. (G.K.)

  16. Comparison of the Glidescope® and Pentax AWS® laryngoscopes to the Macintosh laryngoscope for use by Advanced Paramedics in easy and simulated difficult intubation

    Directory of Open Access Journals (Sweden)

    O' Donnell John

    2009-05-01

    Full Text Available Abstract Background Intubation of the trachea in the pre-hospital setting may be lifesaving in severely ill and injured patients. However, tracheal intubation is frequently difficult to perform in this challenging environment, is associated with a lower success rate, and failed tracheal intubation constitutes an important cause of morbidity. Novel indirect laryngoscopes, such as the Glidescope® and the AWS® laryngoscopes may reduce this risk. Methods We compared the efficacy of these devices to the Macintosh laryngoscope when used by 25 Advanced Paramedics proficient in direct laryngoscopy, in a randomized, controlled, manikin study. Following brief didactic instruction with the Glidescope® and the AWS® laryngoscopes, each participant took turns performing laryngoscopy and intubation with each device, in an easy intubation scenario and following placement of a hard cervical collar, in a SimMan® manikin. Results Both the Glidescope® and the AWS® performed better than the Macintosh, and demonstrate considerable promise in this context. The AWS® had the least number of dental compressions in all three scenarios, and in the cervical spine immobilization scenario it required fewer maneuvers to optimize the view of the glottis. Conclusion The Glidescope® and AWS® devices possess advantages over the conventional Macintosh laryngoscope when used by Advanced Paramedics in normal and simulated difficult intubation scenarios in this manikin study. Further studies are required to extend these findings to the clinical setting.

  17. Eastern Canadian Gastrointestinal Cancer Consensus Conference 2016.

    Science.gov (United States)

    Bossé, D; Ng, T; Ahmad, C; Alfakeeh, A; Alruzug, I; Biagi, J; Brierley, J; Chaudhury, P; Cleary, S; Colwell, B; Cripps, C; Dawson, L A; Dorreen, M; Ferland, E; Galiatsatos, P; Girard, S; Gray, S; Halwani, F; Kopek, N; Mahmud, A; Martel, G; Robillard, L; Samson, B; Seal, M; Siddiqui, J; Sideris, L; Snow, S; Thirwell, M; Vickers, M; Goodwin, R; Goel, R; Hsu, T; Tsvetkova, E; Ward, B; Asmis, T

    2016-12-01

    The annual Eastern Canadian Gastrointestinal Cancer Consensus Conference 2016 was held in Montreal, Quebec, 5-7 February. Experts in radiation oncology, medical oncology, surgical oncology, and infectious diseases involved in the management of patients with gastrointestinal malignancies participated in presentations and discussion sessions for the purpose of developing the recommendations presented here. This consensus statement addresses multiple topics: ■ Follow-up and survivorship of patients with resected colorectal cancer■ Indications for liver metastasectomy■ Treatment of oligometastases by stereotactic body radiation therapy■ Treatment of borderline resectable and unresectable pancreatic cancer■ Transarterial chemoembolization in hepatocellular carcinoma■ Infectious complications of antineoplastic agents.

  18. Congenital diaphragmatic hernia with gastrointestinal symptomatology

    International Nuclear Information System (INIS)

    Siroka, M.; Bilicky, J.; Hernesniemi, B.

    2014-01-01

    The authors report a case of 6-week-old baby boy with congenital diaphragmatic hernia(CDH). He presented with nonspecific gastrointestinal symptoms. CDH is commonly manifested by nonspecific respiratory problems. The symptoms of CDH in older infants are atypical and misleading. Children may have only gastrointestinal problems even the acute abdomen. In our case, the ultrasound examination of abdomen did not detect the exact cause of vomiting and intolerance of oral intake, but the explanation has brought classic chest X-ray. (author)

  19. Gastrointestinal complications of leukemia and its treatment

    International Nuclear Information System (INIS)

    Hunter, T.B.; Bjelland, J.C.

    1984-01-01

    Leukemia represents 4% of all cancer deaths and is the leading cause of death from malignancy for all patients under 30 years of age. Various rare, usually preterminal gastrointestinal complications of leukemia have been reported. These complications are becoming more common and no longer should be considered unusual. Their increasing incidence is the result of new, more aggressive treatment methods and increased patient lifespan. The authors describe the relative incidence and common radiographic presentations of leukemia-related gastrointestinal disease and emphasize that its prognosis is favorable with prompt diagnosis and treatment

  20. Effects of radiation upon gastrointestinal motility

    Institute of Scientific and Technical Information of China (English)

    Mary F Otterson

    2007-01-01

    Whether due to therapeutic or belligerent exposure, the gastrointestinal effects of irradiation produce symptoms dreaded by a majority of the population. Nausea, vomiting, diarrhea and abdominal cramping are hallmarks of the prodromal phase of radiation sickness, occurring hours to days following radiation exposure. The prodromal phase is distinct from acute radiation sickness in that the absorptive, secretory and anatomic changes associated with radiation damage are not easily identifiable. It is during this phase of radiation sickness that gastrointestinal motility significantly changes. In addition, there is evidence that motor activity of the gut contributes to some of the acute and chronic effects of radiation.

  1. Gastrointestinal hormone research - with a Scandinavian annotation

    DEFF Research Database (Denmark)

    Rehfeld, Jens F

    2015-01-01

    Gastrointestinal hormones are peptides released from neuroendocrine cells in the digestive tract. More than 30 hormone genes are currently known to be expressed in the gut, which makes it the largest hormone-producing organ in the body. Modern biology makes it feasible to conceive the hormones...... as a blood-borne hormone, a neurotransmitter, a local growth factor or a fertility factor. The targets of gastrointestinal hormones are specific G-protein-coupled receptors that are expressed in the cell membranes also outside the digestive tract. Thus, gut hormones not only regulate digestive functions...

  2. Diagnosis of liver, biliary tract and gastrointestine

    International Nuclear Information System (INIS)

    Aburano, Tamio

    1981-01-01

    The role of RI imaging in the diagnosis of lesions of the liver, biliary tracts and gastrointestinal tracts are reviewed, and representative cases are shown. Liver scintigraphy was of value for the diagnosis of lesions limitted to the liver such as primary and metastatic liver cancer and inflammatory liver diseases. However, RI methods were less useful in the diagnosis of lesions of the biliary tracts and stomach. RI scintigraphy was more sensitive than angiography in the detection of Meckel's deverticulum, Ballet's esophagus, and gastrointestinal hemorrhage. (Tsunoda, M.)

  3. Multiple Gastrointestinal Complications of Crack Cocaine Abuse

    Directory of Open Access Journals (Sweden)

    Neal Carlin

    2014-01-01

    Full Text Available Cocaine and its alkaloid free base “crack-cocaine” have long since been substances of abuse. Drug abuse of cocaine via oral, inhalation, intravenous, and intranasal intake has famously been associated with a number of medical complications. Intestinal ischemia and perforation remain the most common manifestations of cocaine associated gastrointestinal disease and have historically been associated with oral intake of cocaine. Here we find a rare case of two relatively uncommon gastrointestinal complications of hemorrhage and pancreatitis presenting within a single admission in a chronic crack cocaine abuser.

  4. Upper gastrointestinal bleeding - state of the art.

    Science.gov (United States)

    Szura, Mirosław; Pasternak, Artur

    2014-01-01

    Upper gastrointestinal (GI) bleeding is a condition requiring immediate medical intervention, with high associated mortality exceeding 10%. The most common cause of upper GI bleeding is peptic ulcer disease, which largely corresponds to the intake of NSAIDs and Helicobacter pylori infection. Endoscopy is the essential tool for the diagnosis and treatment of active upper GI hemorrhage. Endoscopic therapy together with proton pump inhibitors and eradication of Helicobacter pylori significantly reduces rebleeding rates, mortality and number of emergency surgical interventions. This paper presents contemporary data on the diagnosis and treatment of upper gastrointestinal bleeding.

  5. Scintigraphic demonstration of acute gastrointestinal bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Alavi, A.

    1980-01-01

    Acute gastrointestinal bleeding may be localized using noninvasive radionuclide methods. We have favored the use of technetium-99m sulfur colloid with sequential imaging because of the rapid clearance of background activity. Definition of the site of upper gastrointestinal bleeding, however, may be obscured by intense uptake of radioactivity by liver and spleen. The sensitivity of the method is such that the bleeding rates of 0.05-0.1 ml/min can be detected compared to a sensitivity of 0.5 ml/min for angiography.

  6. Wnt Signalling in Gastrointestinal Epithelial Stem Cells

    Directory of Open Access Journals (Sweden)

    Dustin J. Flanagan

    2018-03-01

    Full Text Available Wnt signalling regulates several cellular functions including proliferation, differentiation, apoptosis and migration, and is critical for embryonic development. Stem cells are defined by their ability for self-renewal and the ability to be able to give rise to differentiated progeny. Consequently, they are essential for the homeostasis of many organs including the gastrointestinal tract. This review will describe the huge advances in our understanding of how stem cell functions in the gastrointestinal tract are regulated by Wnt signalling, including how deregulated Wnt signalling can hijack these functions to transform cells and lead to cancer.

  7. Granular cells Tumor in the gastrointestinal tract

    International Nuclear Information System (INIS)

    Castano LL, Rodrigo; Gaitan B, Maria H; Juliao E, Fabian

    2005-01-01

    Granular cells tumors are ubiquitous lesions in the gastrointestinal tract, are rare and asymptomatic and they are generally an incidental discovery at gastroduodenoscopy or colonoscopy. In the gastrointestinal tract they are more frequently located in the esophagus, right colon and rectum, stomach, appendix, small intestine or biliopancreatic tract. This article describes three patients with four tumors of granular cells in rectum, esophagus (2 lesions) and appendix. It becomes special emphasis in their neural origin, their benign behavior that justifies the endoscopic resections or limited surgical excisions and the necessity of a pursuit for the possibility, although little, of malignant transformation

  8. Oral adverse effects of gastrointestinal drugs and considerations for dental management in patients with gastrointestinal disorders

    Directory of Open Access Journals (Sweden)

    Ramya Karthik

    2012-01-01

    Full Text Available Gastrointestinal disease is associated with alterations in the mouth or influence the course of the dental diseases, and the dental health care workers are expected to recognize, diagnose, and treat oral conditions associated with gastrointestinal diseases and also provide safe and appropriate dental care for afflicted individuals. Drugs used in the management of these diseases result in oral adverse effects and also are known to interact with those prescribed during dental care. Hence, this article has reviewed the drug considerations and guidelines for drug use during dental management of patients with gastrointestinal diseases.

  9. Endobronchial intubation detected by insertion depth of endotracheal tube, bilateral auscultation, or observation of chest movements: randomised trial.

    Science.gov (United States)

    Sitzwohl, Christian; Langheinrich, Angelika; Schober, Andreas; Krafft, Peter; Sessler, Daniel I; Herkner, Harald; Gonano, Christopher; Weinstabl, Christian; Kettner, Stephan C

    2010-11-09

    To determine which bedside method of detecting inadvertent endobronchial intubation in adults has the highest sensitivity and specificity. Prospective randomised blinded study. Department of anaesthesia in tertiary academic hospital. 160 consecutive patients (American Society of Anesthesiologists category I or II) aged 19-75 scheduled for elective gynaecological or urological surgery. Patients were randomly assigned to eight study groups. In four groups, an endotracheal tube was fibreoptically positioned 2.5-4.0 cm above the carina, whereas in the other four groups the tube was positioned in the right mainstem bronchus. The four groups differed in the bedside test used to verify the position of the endotracheal tube. To determine whether the tube was properly positioned in the trachea, in each patient first year residents and experienced anaesthetists were randomly assigned to independently perform bilateral auscultation of the chest (auscultation); observation and palpation of symmetrical chest movements (observation); estimation of the position of the tube by the insertion depth (tube depth); or a combination of all three (all three). Correct and incorrect judgments of endotracheal tube position. 160 patients underwent 320 observations by experienced and inexperienced anaesthetists. First year residents missed endobronchial intubation by auscultation in 55% of cases and performed significantly worse than experienced anaesthetists with this bedside test (odds ratio 10.0, 95% confidence interval 1.4 to 434). With a sensitivity of 88% (95% confidence interval 75% to 100%) and 100%, respectively, tube depth and the three tests combined were significantly more sensitive for detecting endobronchial intubation than auscultation (65%, 49% to 81%) or observation(43%, 25% to 60%) (Pauscultation to detect inadvertent endobronchial intubation. But even experienced physicians will benefit from inserting tubes to 20-21 cm in women and 22-23 cm in men, especially when high

  10. A rare cause of recurrent gastrointestinal bleeding: mesenteric hemangioma

    Directory of Open Access Journals (Sweden)

    Zeytunlu Murat

    2009-01-01

    Full Text Available Abstract Lower gastrointestinal hemorrhage accounts for approximately 20% of gastrointestinal hemorrhage. The most common causes of lower gastrointestinal hemorrhage in adults are diverticular disease, inflammatory bowel disease, benign anorectal diseases, intestinal neoplasias, coagulopathies and arterio-venous malformations. Hemangiomas of gastrointestinal tract are rare. Mesenteric hemangiomas are also extremely rare. We present a 25-year-old female who was admitted to the emergency room with recurrent lower gastrointestinal bleeding. An intraluminal bleeding mass inside the small intestinal segment was detected during explorative laparotomy as the cause of the recurrent lower gastrointestinal bleeding. After partial resection of small bowel segment, the histopathologic examination revealed a cavernous hemagioma of mesenteric origin. Although rare, gastrointestinal hemangioma should be thought in differential diagnosis as a cause of recurrent lower gastrointestinal bleeding.

  11. Gastro-Intestinal Parasites of Warthogs (Phacochoerus Africanus ...

    African Journals Online (AJOL)

    Gastro-Intestinal Parasites of Warthogs (Phacochoerus Africanus) from the Nazinga Game Ranch of Burkina Faso. ... the prevalence of gastrointestinal parasites in warthogs from the Nazinga Game Ranch of ... AJOL African Journals Online.

  12. Gastrointestinal estromal tumor: Presentation of a case

    International Nuclear Information System (INIS)

    Gil Gonzalez, Alexis; Hernandez Perez, Arnaldo; Gonzalez Rodriguez, Diana; Hernandez Fernandez, Diana M; Castanneda Munnoz, Angela

    2009-01-01

    Since the first descriptions made by Golden and Stout, this group of mesenchymal lesions is considered of muscular origin and they were named as leiomyoma, cellular leiomyoma, epithelioid leiomyoma, leiomyoblastoma, bizarre leiomyoma and leiomyosarcoma. But Mazur and Clark created the term estromal tumor only after they began to use the inmunohistochemistry and subsequently showed the absence of muscular markers, and the occasional presence of neural markers. Nowadays, gastrointestinal estromal tumors are called the primary mesenchymal CD117 positive, fusiform or epithelioid tumors of the gastrointestinal tract, epiplon, mesenterio, and retroperitoneum. The gastrointestinal estromal tumors appear at the wall of the digestive tube: stomach (50-60 %), small intestine (20-30 %), large intestine (10 %) and esophagus (5 %), and occasionally in epiplon, mesenterio, and retroperineum (5 %). In our work we present a 67 year-old patient, entered in our hospital for presenting high digestive bleeding. We studied the case, and found a 6 cm tumor of the gastric fundus. The tumor was operated and the definitive results of the pathologic anatomy showed a gastrointestinal estromal tumor

  13. Emergency readmission following acute upper gastrointestinal bleeding

    DEFF Research Database (Denmark)

    Strömdahl, Martin; Helgeson, Johan; Kalaitzakis, Evangelos

    2017-01-01

    OBJECTIVE: To assess the occurrence, clinical predictors, and associated mortality of all-cause emergency readmissions after acute upper gastrointestinal bleeding (AUGIB). PATIENTS AND METHODS: All patients with AUGIB from an area of 600 000 inhabitants in Sweden admitted in a single institution...

  14. Therapy for obesity based on gastrointestinal hormones

    DEFF Research Database (Denmark)

    Bagger, Jonatan I; Christensen, Mikkel; Knop, Filip K

    2011-01-01

    It has long been known that peptide hormones from the gastrointestinal tract have significant impact on the regulation of nutrient metabolism. Among these hormones, incretins have been found to increase insulin secretion, and thus incretin-based therapies have emerged as new modalities...

  15. Upper gastrointestinal endoscopic findings and prevalence of ...

    African Journals Online (AJOL)

    Upper gastrointestinal endoscopic findings and prevalence of Helicobacter pylori infection among adult patients with dyspepsia in northern Tanzania. ... Endoscopy (EGD) for initial work up. Study on antimicrobial susceptibility pattern of H. pylori is recommended to guide choices for evidence based treatment option.

  16. Nutrition in the prevention of gastrointestinal cancer

    NARCIS (Netherlands)

    Brandt, P.A. van den; Goldbohm, R.A.

    2006-01-01

    Diet has been hypothesized to play a role in the etiology of gastrointestinal cancer for a long time. Initially, strong evidence of such effects was found in retrospective epidemiological studies. Dietary habits, in particular those from the distant past, are difficult to measure, however. Results

  17. Sleep, immunity and inflammation in gastrointestinal disorders.

    Science.gov (United States)

    Ali, Tauseef; Choe, James; Awab, Ahmed; Wagener, Theodore L; Orr, William C

    2013-12-28

    Sleep disorders have become a global issue, and discovering their causes and consequences are the focus of many research endeavors. An estimated 70 million Americans suffer from some form of sleep disorder. Certain sleep disorders have been shown to cause neurocognitive impairment such as decreased cognitive ability, slower response times and performance detriments. Recent research suggests that individuals with sleep abnormalities are also at greater risk of serious adverse health, economic consequences, and most importantly increased all-cause mortality. Several research studies support the associations among sleep, immune function and inflammation. Here, we review the current research linking sleep, immune function, and gastrointestinal diseases and discuss the interdependent relationship between sleep and these gastrointestinal disorders. Different physiologic processes including immune system and inflammatory cytokines help regulate the sleep. The inflammatory cytokines such as tumor necrosis factor, interleukin-1 (IL-1), and IL-6 have been shown to be a significant contributor of sleep disturbances. On the other hand, sleep disturbances such as sleep deprivation have been shown to up regulate these inflammatory cytokines. Alterations in these cytokine levels have been demonstrated in certain gastrointestinal diseases such as inflammatory bowel disease, gastro-esophageal reflux, liver disorders and colorectal cancer. In turn, abnormal sleep brought on by these diseases is shown to contribute to the severity of these same gastrointestinal diseases. Knowledge of these relationships will allow gastroenterologists a great opportunity to enhance the care of their patients.

  18. [Biomorphology of gastrointestinal nematodes of small ruminants].

    Science.gov (United States)

    Giannetto, S

    2006-09-01

    Under the term gastrointestinal nematodes are included numerous parasites species of livestock belonging to the families Strongyloididae (Strongyloides), Strongylidae (Chabertia, Oesophagostomum) Trichostrongylidae (Trichostrongylus, Ostertagia, Teladorsagia, Cooperia, Marshallagia), Molineidae (Nematodirus), Ancylostomatidae (Bunostomum) and Trichuridae (Trichuris). This paper reviews the biomorphology aspects of these parasites as well as the controversy by the taxonomists in the classifications.

  19. Pattern of gastrointestinal opportunistic infections among HIV ...

    African Journals Online (AJOL)

    Twenty-two per cent (22%) of these had mixed parasitosis of cryptosporidium and hookworm. There was no significant association of CD4 cells count with intestinal parasitosis. x2 = 5.286 and p=0.259. However marital status was significantly associated with gastrointestinal opportunistic parasitosis with x2 of 12.693, ...

  20. [Fungal infections of the gastrointestinal tract].

    Science.gov (United States)

    Maragkoudakis, Emmanouil; Realdi, Giuseppe; Dore, Maria Pina

    2005-06-01

    In immunocompetent subjects fungal infections of the gastrointestinal tract are uncommon. Candida esophagitis remains the single most common fungal infection in immunocompromised hosts or in H. pylori- infected patients who receive antibiotic therapy. Enteric fungal infections are uncommon even in HIV-infected patients. Antifungal agents such as amphotericin B, ketoconazole, fluconazole, and the various formulations of itraconazole are effective for most cases.

  1. Gastrointestinal and Hepatic Disease in Sjogren Syndrome.

    Science.gov (United States)

    Popov, Yevgeniy; Salomon-Escoto, Karen

    2018-02-01

    Sjogren syndrome (SS) is a lymphocyte-mediated, infiltrative autoimmune disorder characterized by destruction of exocrine glands leading to secretory dysfunction. The typical manifestations include xerostomia and xerophthalmia; however, extensive gastrointestinal involvement is increasingly being recognized, emphasizing the variable and systemic nature of SS. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. Primary (AL) amyloidosis with gastrointestinal involvement

    DEFF Research Database (Denmark)

    Madsen, Lone Galmstrup; Gimsing, Peter; Schiødt, Frank V

    2009-01-01

    OBJECTIVE: Immunoglobulin light-chain (AL) amyloidosis is a rare disease that can affect several organs. The aim of this study was to characterize patients with gastrointestinal manifestations of AL amyloidosis, in terms of symptoms, biochemistry, and outcome. MATERIAL AND METHODS: Retrospectivel...

  3. Association between Khat Chewing and Gastrointestinal Disorders ...

    African Journals Online (AJOL)

    The prevalence of gastritis was 580 (57.7%); constipation 235 (23.4%); hemorrhoids 54 (5.4%) and that of dental problems (carries, decay, filling and extraction) was 225 (22.4%) of all study participants. Gastrointestinal disorders were found to be higher among khat chewers, where 64(36.2%) of them had dental problems; ...

  4. Gastrointestinal Injuries Following Blunt Abdominal Trauma In ...

    African Journals Online (AJOL)

    Treatment included segmental resection with end to end anastomosis, wedge resection with anastomosis, exteriorizations stomas, simple excision of the perforation and closure in two layers (gastric perforation). The total mortality was four (21.1%), two of them due to associated injuries. Conclusion: Gastrointestinal injuries ...

  5. Sensory testing of the human gastrointestinal tract.

    NARCIS (Netherlands)

    Brock, C.; Arendt-Nielsen, L.; Wilder-Smith, O.H.G.; Drewes, A.M.

    2009-01-01

    The objective of this appraisal is to shed light on the various approaches to screen sensory information in the human gut. Understanding and characterization of sensory symptoms in gastrointestinal disorders is poor. Experimental methods allowing the investigator to control stimulus intensity and

  6. Gastrointestinal immune responses in HIV infected subjects

    Directory of Open Access Journals (Sweden)

    LRR Castello-Branco

    1996-06-01

    Full Text Available The gut associated lymphoid tissue is responsible for specific responses to intestinal antigens. During HIV infection, mucosal immune deficiency may account for the gastrointestinal infections. In this review we describe the humoral and cellular mucosal immune responses in normal and HIV-infected subjects.

  7. Gastrointestinal diseases in HIV/AIDS

    African Journals Online (AJOL)

    an estimated 65 million people believed to be infected and an estimated. 14 000 new infections ... HIV is a staggering 10 - 20% of the population.1 Gastrointestinal (GI) diseases ... Oral fluconazole is a very successful treatment for ... candidiasis should be started on voriconazole.7 .... habits point to further investigation. An.

  8. Do statins protect against upper gastrointestinal bleeding?

    DEFF Research Database (Denmark)

    Gulmez, Sinem Ezgi; Lassen, Annmarie Touborg; Aalykke, Claus

    2009-01-01

    AIMS: Recently, an apparent protective effect of statins against upper gastrointestinal bleeding (UGB) was postulated in a post hoc analysis of a randomized trial. We aimed to evaluate the effect of statin use on acute nonvariceal UGB alone or in combinations with low-dose aspirin and other...

  9. Angiography and angiotherapy of gastrointestinal tract bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Soerensen, R.; Grassot, A.; Souchon, R.

    1982-03-01

    In selected patients with upper and lower gastrointestinal hemorrhage there is an indication for angiography. Vasoconstrictive drugs or embolization materials can be submitted through the catheter to stop the hemorrhage (angiotherapy). 81 patients were diagnosed by this method. Treatment through the angiographic catheter followed the diagnostic procedure in 41 cases. The hemorrhage was controlled in 36 patients.

  10. Gastrointestinal bleeding following NSAID ingestion in children

    African Journals Online (AJOL)

    Both presented with a history of fever and passage of bloody stools. There was a positive history of NSAID ingestion in both patients that was prescribed in the referring hospitals. ..... Bostwick HE, Halata MS, Feerick J, Newman LJ, Medow MS. Gastrointestinal bleeding in children following ingestion of low-dose. Ibuprofen.

  11. The Health Problems, Gastrointestinal and Blood Parasites ...

    African Journals Online (AJOL)

    The report on the disease conditions in donkeys in most West African countries is scanty in literature. This study was conducted to identify the health related problems including gastrointestinal and blood parasites of donkeys at the Bolgatanga livestock market in the Upper East region of Ghana from July to December, 2012.

  12. Gastrointestinal tract sonography in fetuses and children

    Energy Technology Data Exchange (ETDEWEB)

    Couture, Alain; Baud, Catherine; Ferran, Jean Louis; Saguintaah, Magali; Veyrac, Corinne [Hopital Arnaud de Villeneuve, 34 - Montpellier (France). Service de Radiologie Pediatrique

    2008-07-01

    Sonography of the gastrointestinal tract in fetuses, neonates and children entails no known biological risk, permits serial scanning and can provide information unobtainable with any other imaging modality. In experienced hands it can be used as the initial imaging technique in a number of gastrointestinal diseases and conditions. This book provides a comprehensive account of the current state of the art regarding sonography in this context. An introductory chapter compares the merits of sonography and magnetic resonance imaging of the fetal gastrointestinal tract. Subsequent chapters focus on the technique, pitfalls and findings in a wide variety of applications, including antropyloric diseases, bowel obstruction, bowel wall thickening, colitis, appendicitis, some types of intussusception, abdominal wall and umbilical abnormalities, intraperitoneal tumors, and trauma. In each case the sonographic morphology is considered in depth with the aid of high-quality illustrations. A concluding chapter comprises a quiz based on 15 case reports. Gastrointestinal Tract Sonography in Fetuses and Children will be of value to all with an interest in this field. (orig.)

  13. Gastrointestinal stromal tumour presenting as gastroduodenal intussusception.

    LENUS (Irish Health Repository)

    Wilson, Mark H

    2012-08-01

    Gastroduodenal intussusception secondary to gastrointestinal stromal tumour is a very rare cause for intestinal obstruction. The diagnosis of this condition can be challenging, as symptoms are often non-specific and intermittent. This article reports a case where the diagnosis was made preoperatively with abdominal imaging and was treated by a combination of endoscopic reduction and laparoscopic resection.

  14. Stem Cells in Repair of Gastrointestinal Epithelia

    NARCIS (Netherlands)

    Andersson-Rolf, Amanda; Zilbauer, Matthias; Koo, Bon-Kyoung; Clevers, Hans

    Among the endodermal tissues of adult mammals, the gastrointestinal (GI) epithelium exhibits the highest turnover rate. As the ingested food moves along the GI tract, gastric acid, digestive enzymes, and gut resident microbes aid digestion as well as nutrient and mineral absorption. Due to the harsh

  15. Comparison of tracheal intubation using the Airtraq® and Mc Coy laryngoscope in the presence of rigid cervical collar simulating cervical immobilisation for traumatic cervical spine injury

    Directory of Open Access Journals (Sweden)

    Padmaja Durga

    2012-01-01

    Full Text Available Background: It is difficult to visualise the larynx using conventional laryngoscopy in the presence of cervical spine immobilisation. Airtraq® provides for easy and successful intubation in the neutral neck position. Objective: To evaluate the effectiveness of Airtraq in comparison with the Mc Coy laryngoscope, when performing tracheal intubation in patients with neck immobilisation using hard cervical collar and manual in-line axial cervical spine stabilisation. Methods: A randomised, cross-over, open-labelled study was undertaken in 60 ASA I and II patients aged between 20 and 50 years, belonging to either gender, scheduled to undergo elective surgical procedures. Following induction and adequate muscle relaxation, they were intubated using either of the techniques first, followed by the other. Intubation time and Intubation Difficulty Score (IDS were noted using Mc Coy laryngoscope and Airtraq. The anaesthesiologist was asked to grade the ease of intubation on a Visual Analogue Scale (VAS of 1-10. Chi-square test was used for comparison of categorical data between the groups and paired sample t-test for comparison of continuous data. IDS score and VAS were compared using Wilcoxon Signed ranked test. Results: The mean intubation time was 33.27 sec (13.25 for laryngoscopy and 28.95 sec (18.53 for Airtraq (P=0.32. The median IDS values were 4 (interquartile range (IQR 1-6 and 0 (IQR 0-1 for laryngoscopy and Airtraq, respectively (P=0.007. The median Cormack Lehane glottic view grade was 3 (IQR 2-4 and 1 (IQR 1-1 for laryngoscopy and Airtraq, respectively (P=0.003. The ease of intubation on VAS was graded as 4 (IQR 3-5 for laryngoscopy and 2 (IQR 2-2 for Airtraq (P=0.033. There were two failures to intubate with the Airtraq. Conclusion: Airtraq improves the ease of intubation significantly when compared to Mc Coy blade in patients immobilised with cervical collar and manual in-line stabilisation simulating cervical spine injury.

  16. Gastrointestinal cancer after treatment of Hodgkin's disease

    International Nuclear Information System (INIS)

    Birdwell, Sandra H.; Hancock, Steven L.; Varghese, Anna; Cox, Richard S.; Hoppe, Richard T.

    1997-01-01

    Purpose: This study aimed to quantify the risk of gastrointestinal cancer following Hodgkin's disease treatment according to age at treatment, type of treatment, and anatomic sites. Methods and Materials: Cases were identified from the records of 2,441 patients treated for Hodgkin's disease between 1961 and 1994. Follow-up averaged 10.9 years, representing 26,590 person-years of observation. Relative risks (RR) for gastrointestinal cancer incidence and mortality were computed by comparison with expected annualized rates for a general population matched for age, sex, and race. Results: Gastrointestinal cancers developed in 25 patients. The incidence RR was 2.5 [95% confidence interval (CI), 1.5-3.5] and mortality RR was 3.8 (CI, 2.4-4.7). Sites associated with significantly increased risks included the stomach [RR 7.3 (CI, 3.4-13.8)], small intestine [RR 11.6 (CI, 1.9-38.3)], and pancreas [RR 3.5 (CI, 1.1-8.5)]. Risk was significantly elevated after combined modality therapy, RR 3.9 (CI, 2.2-5.6). The risk after radiotherapy alone was 2.0 (CI, 1.0-3.4), not a statistically significant elevation. The RR for gastrointestinal cancer was greatest after treatment at young age and decreased with advancing age. It was significantly elevated within 10 years after treatment [RR 2.0 (CI, 1.1-3.5)] and increased further after 20 years [RR 6.1 (CI, 2.5-12.7)]. Risk assessed by attained age paralleled risk according to age at treatment. Fifteen cases of gastrointestinal cancers arose within the irradiation fields. Conclusion: Patients treated for Hodgkin's disease are at modestly increased risk for secondary gastrointestinal cancer, especially after combined modality therapy and treatment at a young age. Risk was highest more than 20 years after treatment, but was significantly elevated within 10 years. Gastrointestinal sites with increased risk included the stomach, pancreas, and small intestine

  17. Gastrointestinal symptoms in children with acute neuroinfections

    Directory of Open Access Journals (Sweden)

    A.I. Markov

    2018-02-01

    Full Text Available Background. In cases of severe forms of infectious di­seases, in addition to local inflammation, secondary lesions of the gastrointestinal organs may occur. We aimed to study the semiotics and epidemiology of gastrointestinal symptoms in children with acute neuroinfection. Materials and methods. This observational, retrospective, case-control study. We analyzed cases of in-patient treatment of children aged 1 month to 18 years with acute neuroinfections (meningitis, encephalitis and encephalomyelopolyneuropathy. Results. The study included 117 patients with acute central nervous system infections. Clinical symptoms of gastrointestinal infection were observed in 83 (70.9 % children. Among revealed symptoms, disorders of intestinal moti­lity, such as constipation and diarrhea, were prevalent. Manifestations of hepatobiliary system dysfunction included increased transaminase level (alanine aminotransferase (ALT, alkaline phosphatase, gamma-glutamyltransferase (GGTF and/or ultrasound changes (enlargement, diffuse structural changes and were observed in 39.1 % of patients. Among the laboratory parameters, elevated ALT level was observed in 8.3 % of patients, bilirubin was elevated in only one child, alkaline phosphatase was above the age norm in 11.8 %, an increased GGTF above the age norm was observed in 31.3 % of patients. The level of intestinal fatty acid binding protein (I-FABP was elevated in 86.4 %, and L-type fatty acid binding protein (L-FABP — in all (100 % children. Clinical manifestations of gastrointestinal dysfunction (the presence of at least one of the gastrointestinal symptoms had an inverse relationship with the child’s age (rpb = –0.19, p = 0.033, correlated with staying in intensive care unit (odds ratio (OR = +5.25; 95% confidence interval (CI 1.62–16.97, artificial ventilation (OR = +4.5; 95% CI 1.00–21.69 and level of I-FABP (rpb = 0.34, p = 0.019. Conclusions. Among gastrointestinal symptoms in children with

  18. Undersedation is a risk factor for the development of subglottic stenosis in intubated children

    Directory of Open Access Journals (Sweden)

    Cláudia Schweiger

    2017-07-01

    Full Text Available Objective: To analyze the level of sedation in intubated children as a risk factor for the development of subglottic stenosis. Methods: All patients between 30 days and 5 years of age who required endotracheal intubation in the pediatric intensive care unit between 2013 and 2014 were included in this prospective study. They were monitored daily and COMFORT-B scores were obtained. Flexible fiber-optic laryngoscopy was performed within eight hours of extubation, and repeated seven to ten days later if the first examination showed moderate to severe laryngeal injuries. If these lesions persisted and/or if the child developed symptoms in the follow-up period, microlaryngoscopy under general anesthesia was performed to evaluate for subglottic stenosis. Results: The study included 36 children. Incidence of subglottic stenosis was 11.1%. Children with subglottic stenosis had a higher percentage of COMFORT-B scores between 23 and 30 (undersedated than those who did not develop subglottic stenosis (15.8% vs. 3.65%, p = 0.004. Conclusion: Children who developed subglottic stenosis were less sedated than children who did not develop subglottic stenosis. Resumo: Objetivo: Analisar o nível de sedação em crianças intubadas como um fator de risco para o desenvolvimento de estenose subglótica (ES. Métodos: Todos os pacientes entre 30 dias e 5 anos de idades que necessitaram de intubação endotraqueal na Unidade de Terapia Intensiva Pediátrica entre 2013 e 2014 foram incluídos neste estudo prospectivo. Eles foram monitorados diariamente e foram obtidos os escores da escala COMFORT-B. Foi feita laringoscopia com tubo flexível de fibra óptica em 8 horas da extubação e repetida 7-10 dias depois, caso o primeiro exame tenha mostrado lesões laríngeas moderadas a graves. Caso essas lesões tenham persistido e/ou caso a criança tenha desenvolvido sintomas no período de acompanhamento, foi feita microlaringoscopia sob anestesia geral para avaliar a ES

  19. Computed tomography in gastrointestinal stromal tumors

    International Nuclear Information System (INIS)

    Ghanem, Nadir; Altehoefer, Carsten; Winterer, Jan; Schaefer, Oliver; Springer, Oliver; Kotter, Elmar; Langer, Mathias; Furtwaengler, Alex

    2003-01-01

    The aim of this study was to define the imaging characteristics of primary and recurrent gastrointestinal stromal tumors (GIST) in computed tomography with respect to the tumor size. Computed tomography was performed in 35 patients with histologically confirmed gastrointestinal stromal tumors and analyzed retrospectively by two experienced and independent radiologist. The following morphologic tumor characteristics of primary (n=20) and (n=16) recurrent tumors were evaluated according to tumor size, shape, homogeneity, density compared with liver, contrast enhancement, presence of calcifications, ulcerations, fistula or distant metastases and the anatomical relationship to the intestinal wall, and the infiltration of adjacent visceral organs. Small GIST ( 5-10 cm) demonstrated an irregular shape, inhomogeneous density on unenhanced and contrast-enhanced images, a combined intra- and extraluminal tumor growth with aggressive findings, and infiltration of adjacent organs in 9 primary diagnosed and 2 recurrent tumors. Large GIST (>10 cm), which were observed in 8 primary tumors and 11 recurrent tumors, showed an irregular margin with inhomogeneous density and aggressive findings, and were characterized by signs of malignancy such as distant and peritoneal metastases. Small recurrent tumors had a similar appearance as compared with large primary tumors. Computed tomography gives additional information with respect to the relationship of gastrointestinal stromal tumor to the gastrointestinal wall and surrounding organs, and it detects distant metastasis. Primary and recurrent GIST demonstrate characteristic CT imaging features which are related to tumor size. Aggressive findings and signs of malignancy are found in larger tumors and in recurrent disease. Computed tomography is useful in detection and characterization of primary and recurrent tumors with regard to tumor growth pattern, tumor size, and varied appearances of gastrointestinal stromal tumors, and indirectly

  20. [Antithrombotic therapy and nonvariceal upper gastrointestinal bleeding].

    Science.gov (United States)

    Belanová, Veronika; Gřiva, Martin

    2015-12-01

    The incidence of acute upper gastrointestinal bleeding is about 85-108/100,000 inhabitants per year, nonvariceal bleeding accounts for 80-90%. Antiplatelet and anticoagulation treatment are the significant risk factors for upper gastrointestinal bleeding. To evaluate the occurrence of upper gastrointestinal bleeding in the general community of patients in a county hospital. And to compare the role played by antiplatelet and anticoagulation drugs and other risk medication. Retrospective analysis of patients over 18 years of age who underwent endoscopy for acute upper gastrointestinal bleeding or anaemia (haemoglobinupper gastrointestinal tract during a hospital stay in 2013 (from January to June). We included 111 patients of average age 69±15 years, men 60%. Nonvariceal bleeding accounted for 90% of the cases. None of the patients with variceal bleeding (10% of patients) took antiplatelet or anticoagulation therapy. There were 100 patients with nonvariceal bleeding of average age 70±15, 61% men. With the symptoms of acute bleeding (hematemesis, melena) presented in 73% of patients. The most frequent cause of bleeding was gastric and duodenal ulcer (54%). 32% of patients with nonvariceal bleeding had antiplatelets, 19% anticoagulants and 10% used nonsteroidal anti-inflammatory drugs, selective serotonin reuptake inhibitors or corticosteroids. 30-days mortality of patients with nonvariceal bleeding was 11%, annual mortality was 23%. There was no significant difference in mortality, blood transfusion requirements or surgical intervention between the patients with antithrombotic agents and without them. 25% of patients (8 patients) using acetylsalicylic acid did not fulfil the indication for this treatment. Among the patients examined by endoscopy for symptomatic nonvariceal bleeding and/or anaemia (haemoglobingastrointestinal bleeding. With regard to that, it is alarming, that there still exists a nonnegligible percentage of patients taking acetylsalicylic acid even