This document summarizes a study on using an airway exchange catheter (AEC) to facilitate reintubation in patients with difficult airways. The study found that:
1) 47 of 51 patients (92%) who were reintubated with an AEC in place were successfully reintubated on the first attempt, with 41 of 47 on the first pass (87% first pass success rate).
2) Complications were low, with only 7 patients experiencing mild hypoxemia during reintubation.
3) Maintaining airway access with an AEC improved reintubation success rates and decreased complications compared to patients who did not have an AEC in place.
1. This study compared general anesthesia (GA) and spinal anesthesia (SA) for 100 patients undergoing lumbar disk surgery through a randomized controlled trial.
2. Intraoperatively, mean blood loss was less with GA but not significantly. Surgeon satisfaction was higher with GA. No major complications occurred with either.
3. Postoperatively, hypertension was more common after GA, and nausea/vomiting were more frequent after SA.
4. Contrary to previous studies, the findings revealed SA had no advantages over GA, and GA may reduce risks and complications.
FUNCTION AFTER OPEN ABDOMINAL AORTIC POSOPERATIVE PULMONARY ANEURYSM REPAIR ...Felipe Posada
1) The study compared postoperative pulmonary function and pain control in COPD patients undergoing open abdominal aortic aneurysm repair with either epidural (Group I) or intravenous (Group II) analgesia.
2) Pulmonary function test (FEV1 and FVC) results were significantly better preserved in Group I patients on postoperative days 1 and 4.
3) Group I patients also had significantly less reported pain on postoperative days 1, 2, and 4 both at rest and during activity.
4) There were no differences in length of hospital stay, morbidity, or mortality between the groups.
This document provides a historical overview of the use of pulmonary artery catheters in anesthesia and critical care from 1970 to 2007, with an emphasis on studies from the past 6 years. It describes how the catheter was introduced in 1970 and how early studies suggested benefits to outcomes. However, over the past 6 years, several large, well-designed prospective trials and statistically sound retrospective studies have been published that show no benefit to outcomes from using pulmonary artery catheters and some even find potential increased morbidity with their use. The document focuses on randomized controlled trials in vascular surgery that failed to find improved outcomes from catheter use despite attempts at directed therapy based on catheter measurements.
This study investigated the clinical efficacy and safety of uniportal video-assisted thoracoscopic bronchial sleeve lobectomy (BSL) in 5 patients with central lung cancer. The results found that the BSL procedure was successfully completed in all 5 patients without severe complications. Key findings included an average operation time of 254 minutes, average blood loss of 116 ml, average hospital stay of 9.2 days, and no postoperative recurrence or metastasis during follow-up periods ranging from 3-19 months. The study concluded that uniportal video-assisted thoracoscopic BSL is a safe and minimally invasive treatment for central lung cancer.
This document reviews the use of open lung biopsy (OLB) in critically ill patients and those with respiratory failure. OLB is considered the gold standard for diagnosing parenchymal lung disease, but its use in intensive care unit patients is controversial due to risks. The document analyzes 22 studies on OLB outcomes in critically ill patients. It finds that OLB frequently results in specific diagnoses in over 50% of cases, sometimes 100%, and leads to significant changes in treatment in the majority of cases. However, OLB also carries risks of complications. More research is needed to determine the risks and benefits of OLB for critically ill respiratory failure patients.
- Chest tube (CT) placement is often used to treat pneumothorax, hemothorax, or pleural effusion following injury or surgery. However, the optimal management of CTs after placement is variable.
- Studies show CTs can safely be removed when drainage is ≤200ml/day or ≤2ml/kg/day, and that removal at end-inspiration or end-expiration carries similar risk of recurrence. Removal on suction is as safe as a brief trial of water seal.
- For non-ventilated patients, post-removal CXR may not be needed if stable. In ventilated patients, a CXR 1-3 hours post-removal is sufficient to
This article reviews strategies for prolonging chemotherapy treatment in patients with advanced non-small cell lung cancer (NSCLC) who have achieved stable disease after initial therapy. The strategies discussed include continuation of the initial regimen beyond 6 cycles, switching to a maintenance agent after completing initial therapy, and continuation of a lower-dose version of the initial regimen. The article finds no data supporting continuation beyond 6 cycles. Studies of switch-maintenance with erlotinib and pemetrexed showed improved overall survival. Continuation-maintenance improved progression-free survival without an overall survival benefit so far.
This study evaluated 52 patients who underwent cone reconstruction surgery for Ebstein's anomaly between 1993-2006. The surgery successfully repaired the tricuspid valve without need for replacement in any patients. Early postoperative results showed improved tricuspid regurgitation and right ventricular size and function. At long-term follow-up of 57 months on average, patients had significant improvement in heart failure symptoms. Reoperations were needed in 4 patients for tricuspid valve issues. The technique showed low mortality and effective long-term repair of the tricuspid valve and right ventricle.
1. This study compared general anesthesia (GA) and spinal anesthesia (SA) for 100 patients undergoing lumbar disk surgery through a randomized controlled trial.
2. Intraoperatively, mean blood loss was less with GA but not significantly. Surgeon satisfaction was higher with GA. No major complications occurred with either.
3. Postoperatively, hypertension was more common after GA, and nausea/vomiting were more frequent after SA.
4. Contrary to previous studies, the findings revealed SA had no advantages over GA, and GA may reduce risks and complications.
FUNCTION AFTER OPEN ABDOMINAL AORTIC POSOPERATIVE PULMONARY ANEURYSM REPAIR ...Felipe Posada
1) The study compared postoperative pulmonary function and pain control in COPD patients undergoing open abdominal aortic aneurysm repair with either epidural (Group I) or intravenous (Group II) analgesia.
2) Pulmonary function test (FEV1 and FVC) results were significantly better preserved in Group I patients on postoperative days 1 and 4.
3) Group I patients also had significantly less reported pain on postoperative days 1, 2, and 4 both at rest and during activity.
4) There were no differences in length of hospital stay, morbidity, or mortality between the groups.
This document provides a historical overview of the use of pulmonary artery catheters in anesthesia and critical care from 1970 to 2007, with an emphasis on studies from the past 6 years. It describes how the catheter was introduced in 1970 and how early studies suggested benefits to outcomes. However, over the past 6 years, several large, well-designed prospective trials and statistically sound retrospective studies have been published that show no benefit to outcomes from using pulmonary artery catheters and some even find potential increased morbidity with their use. The document focuses on randomized controlled trials in vascular surgery that failed to find improved outcomes from catheter use despite attempts at directed therapy based on catheter measurements.
This study investigated the clinical efficacy and safety of uniportal video-assisted thoracoscopic bronchial sleeve lobectomy (BSL) in 5 patients with central lung cancer. The results found that the BSL procedure was successfully completed in all 5 patients without severe complications. Key findings included an average operation time of 254 minutes, average blood loss of 116 ml, average hospital stay of 9.2 days, and no postoperative recurrence or metastasis during follow-up periods ranging from 3-19 months. The study concluded that uniportal video-assisted thoracoscopic BSL is a safe and minimally invasive treatment for central lung cancer.
This document reviews the use of open lung biopsy (OLB) in critically ill patients and those with respiratory failure. OLB is considered the gold standard for diagnosing parenchymal lung disease, but its use in intensive care unit patients is controversial due to risks. The document analyzes 22 studies on OLB outcomes in critically ill patients. It finds that OLB frequently results in specific diagnoses in over 50% of cases, sometimes 100%, and leads to significant changes in treatment in the majority of cases. However, OLB also carries risks of complications. More research is needed to determine the risks and benefits of OLB for critically ill respiratory failure patients.
- Chest tube (CT) placement is often used to treat pneumothorax, hemothorax, or pleural effusion following injury or surgery. However, the optimal management of CTs after placement is variable.
- Studies show CTs can safely be removed when drainage is ≤200ml/day or ≤2ml/kg/day, and that removal at end-inspiration or end-expiration carries similar risk of recurrence. Removal on suction is as safe as a brief trial of water seal.
- For non-ventilated patients, post-removal CXR may not be needed if stable. In ventilated patients, a CXR 1-3 hours post-removal is sufficient to
This article reviews strategies for prolonging chemotherapy treatment in patients with advanced non-small cell lung cancer (NSCLC) who have achieved stable disease after initial therapy. The strategies discussed include continuation of the initial regimen beyond 6 cycles, switching to a maintenance agent after completing initial therapy, and continuation of a lower-dose version of the initial regimen. The article finds no data supporting continuation beyond 6 cycles. Studies of switch-maintenance with erlotinib and pemetrexed showed improved overall survival. Continuation-maintenance improved progression-free survival without an overall survival benefit so far.
This study evaluated 52 patients who underwent cone reconstruction surgery for Ebstein's anomaly between 1993-2006. The surgery successfully repaired the tricuspid valve without need for replacement in any patients. Early postoperative results showed improved tricuspid regurgitation and right ventricular size and function. At long-term follow-up of 57 months on average, patients had significant improvement in heart failure symptoms. Reoperations were needed in 4 patients for tricuspid valve issues. The technique showed low mortality and effective long-term repair of the tricuspid valve and right ventricle.
1) FAST (Focused Assessment with Sonography for Trauma) is an ultrasound technique used to rapidly detect free fluid in the abdomen or chest as a marker of injury from blunt trauma. It can identify hemoperitoneum, hemothorax, or hemopericardium.
2) The standard FAST exam involves scanning four areas of the abdomen and chest to detect free fluid. Additional views of the liver, spleen, and other organs may also be included.
3) Accuracy of FAST depends on the experience and training of the provider. Studies show higher sensitivity when performed by radiologists compared to other clinicians. Maintaining skills through a sufficient case volume is important for competency.
This document reports a case study of a 64-year-old female patient who developed late onset tracheal stenosis after receiving an 125Iodine seed esophageal stent to treat advanced esophageal carcinoma. The patient experienced progressive stenosis of the lower trachea at 6, 26, and 47 days post-operatively. The causes of stenosis are believed to include direct pressure from the stent, tumor proliferation, pressure from the aortic arch, and complications from other therapies such as radiation treatment. Due to its short clinical use, 125Iodine seed stents may present some fatal complications, and more study is needed on their long-term efficacy.
This study examined 162 patients with cirrhosis who underwent endoscopic variceal band ligation to treat esophageal varices. The study aimed to determine the frequency and risk factors associated with the development of secondary gastric varices after eradicating esophageal varices. The results found that secondary gastric varices developed in 38 patients (23.5%) after eradicating their esophageal varices. Factors associated with an increased risk of developing secondary gastric varices included having more advanced liver disease (based on Child-Pugh class), larger esophageal varices at initial presentation, requiring more sessions of band ligation to eradicate the esophageal varices, and already having gastric varices present at initial presentation.
This document proposes a clinical algorithm for managing open abdomen with concomitant entero-atmospheric fistula (EAF), a surgical complication with high mortality. The algorithm aims to guide surgeons in choosing the best approach on a case-by-case basis. EAF is defined as an enteric fistula occurring within an open abdomen, lacking a tract and surrounding tissue. Current management techniques aim to divert fistula output, protect viscera, and allow bowel granulation. However, no single approach is ideal and significant heterogeneity exists. The document reviews various techniques and proposes a flowchart to help select the optimal individualized strategy. It also provides a detailed description of a "baby bottle nipple diversion" technique developed by the
A 54-year-old male patient presented with acute chest pain and dyspnea during a parathyroid gland biopsy. Physical examination revealed diminished breath sounds in the right lung. Chest X-ray showed a pneumothorax in the right lung. The patient underwent chest tube placement, through which air drainage ceased after two days. However, on the fourth day diminished breath sounds were still present, and a chest X-ray showed a lung expansion defect. The chest tube was subsequently removed and the patient was discharged after follow-up exams were normal. This case report presents a rare instance of an iatrogenic pneumothorax occurring during parathyroid gland biopsy, highlighting the importance of considering pneumothorax as a
Le degré de relâchement musculaire en chirurgie coelioscopique de la vésicule biliaire fait partie du quotidien des discussions entre anesthésistes et chirurgiens au bloc opératoire. Au fond tous sont convaincus de l'efficacité du curare : le chirurgien qui le demande et l'anesthésiste qui pense lui à sa décurarisation.
Cette étude teste curarisation profonde versus curarisation de routine dans la chirurgie coelioscopique de la vésicule biliaire. Avec comme première question "est-ce qu'une curarisation profonde permet de travaillert avec une pression abdominable moindre?", pression dont on sait qu'elle est pourvoyeuse de douleur post-opératoire.
La réponse est que le degré de curarisation participe de façon marginale au confort du chirurgien... et ne permet pas plus fréquemment de travailler à pression abdominale basse.
This case report describes a case of perinatal cardiomyopathy (PPCM) in a 40-week pregnant patient. The patient was diagnosed with PPCM based on echocardiography findings of left ventricular dilation and reduced ejection fraction of 34.8%. She underwent emergency cesarean section and received various supportive treatments including diuretics, cardiotonics, hemodialysis, and ventilator support. Her symptoms improved over 58 days of treatment and she was discharged, though follow-up echocardiography still showed some left ventricular dilation and reduced ejection fraction. The report emphasizes the importance of early PPCM diagnosis in pregnant women.
A C S0105 Postoperative Management Of The Hospitalized Patientmedbookonline
This document discusses postoperative management of surgical patients. It describes the different levels of postoperative care including same-day surgery, the surgical floor, telemetry ward, and intensive care unit. Factors determining a patient's disposition include their preoperative health, procedure performed, and postoperative clinical status. The document also discusses common postoperative orders related to tubes, drains, oxygen therapy, and wound care to guide nursing staff.
This study evaluated 52 cases of pediatric peritonitis treated via laparotomy over 5 years at a hospital in Nigeria. The most common cause of peritonitis was found to be typhoid intestinal perforation (48% of cases). Other common causes included ruptured appendix (17.3% of cases) and perforated intussusception (15.4% of cases). Post-operative complications occurred in 46.2% of patients, with surgical site infection being most common (23.1% of cases). The mortality rate was 13.5%. The study concludes that typhoid intestinal perforation is a major cause of peritonitis in children in this setting.
This research article studied preoperative predictive factors of occult and frank intrabiliary rupture of liver hydatid cysts. The study reviewed 56 patients with 82 liver hydatid cysts who underwent surgery. Cysts were divided into three groups: no rupture, occult rupture with bile in cyst but no passage into bile duct, and frank rupture with passage into bile duct. Multivariate analysis identified jaundice, cyst size >6.5cm, and symptoms >45 days as predictors of frank rupture. Predictors of occult rupture included cyst size >6.5cm, ≥3 recurrences, type II/III cyst, leukocytosis >9,000/mm3, and eosinophilia >5.5
This case report describes an unusual method for removing a plastic bead that had been aspirated into the tracheobronchial tree of a 9-year-old boy. Conventional bronchoscopic techniques using forceps were unsuccessful at removing the bead, which was located in the left lower lobar bronchus. A Fogarty embolectomy catheter was inserted through the bead's central hole and its balloon was inflated to grasp the bead. The catheter and bead were then removed together through the rigid bronchoscope, successfully retrieving the foreign body without requiring surgery. This creative use of a Fogarty catheter demonstrates how available tools can be adapted based on the shape and location of an aspirated foreign body.
This document describes a surgical procedure performed on a 17-year-old male patient who had previously undergone aortic valve replacement as a child and had since developed patient-prosthesis mismatch. The surgical team performed a Konno-Rastan procedure to enlarge the anterior aortic root as well as a Manougian technique to enlarge the posterior aortic root. A mechanical aortic valve was then implanted. The patient recovered well post-operatively with no significant transaortic gradient. Aortic root enlargement procedures can help address patient-prosthesis mismatch, especially in growing pediatric patients.
This document discusses the diagnosis and management of caustic esophageal strictures. It begins by outlining the clinical symptoms of dysphagia that result from caustic ingestion and lead to stricture formation. Diagnosis involves esophagogram or esophagoscopy at least 6 weeks after injury to identify strictures. Treatment involves endoscopic dilatation using wire-guided dilators, with multiple sessions often needed for complex strictures. Advanced endoscopic techniques have reduced the need for esophageal replacement surgery. The document concludes that caustic esophageal strictures can be successfully managed through endoscopic dilatation.
This collective review analyzed 20 studies on mesh-based repair of umbilical and epigastric hernias. The recurrence rate was found to be 2.0% with mesh repair. Polypropylene and ePTFE meshes had the lowest recurrence rates between 1.7-2.5%. An overall 12.4% complication rate was reported. Laparoscopic repair had a lower 1.0% recurrence rate compared to 2.6% for open repair, and was associated with less postoperative pain. However, the review did not conclusively establish laparoscopic repair's benefits due to potential bias in reported operation times and complications. Further research is needed to compare outcomes between the two approaches.
This study reviewed 86 patients who underwent pericardiectomy for chronic constrictive pericarditis (CCP) at a single center from 2010-2014. Preoperatively, most patients were in NYHA class II or III. Tuberculosis was the cause of CCP in 32.6% of patients. The overall mortality rate was 2.3%. Postoperatively, 90.6% of surviving patients were in NYHA class I or II. The results showed pericardiectomy to be an effective treatment for CCP, with tuberculosis remaining a common cause in India.
This study aimed to determine if preoperative hematological parameters and risk factors could predict in-hospital mortality for patients undergoing surgery to repair Type A aortic dissection. The study reviewed data from 78 patients who underwent deep hypothermic circulatory arrest surgery. Only preoperative creatinine levels were higher in patients who died. Total circulatory arrest time and cross-clamp time during surgery were found to be factors affecting mortality, with times over 44.5 minutes and 71 minutes respectively predicting higher risk of death. The study concluded that hematological biomarkers alone may be insufficient for estimating mortality risk, and intraoperative factors like longer circulatory arrest and clamp times impact outcomes for Type A aortic dissection surgery.
This document discusses penetrating injuries and management approaches. It provides information on:
1) Factors that determine energy transfer from penetrating weapons including weapon type, range, and tissue properties. Vital structures like brain and liver are more susceptible to injury.
2) Options for managing penetrating torso trauma have expanded from routinely operating to include selective non-operative approaches with monitoring.
3) Indications for emergency thoracotomy or laparotomy include hemodynamic instability, peritonitis on exam, or unexpected drops in vitals or hematocrit. Triple-contrast CT can help determine need for surgery.
1. asian cardiovascular and thoracic annals-2006-olcmen-363-6Gabriel Pacheco
This document summarizes a study examining the role and outcomes of surgery for pulmonary tuberculosis. The study retrospectively analyzed 57 patients who underwent 72 surgical procedures for pulmonary tuberculosis between 1993-2003 at a hospital in Turkey. The most common indications for surgery were trapped lung (31.6%), multidrug-resistant tuberculosis (17.5%), and aspergilloma (17.5%). The most common procedure was lobectomy (31.9%). Complications occurred in 18 patients (24.5% morbidity rate), most commonly prolonged air leak and residual pleural space issues. There was one postoperative death (1.8% mortality rate). The study concludes that surgery can be considered a safe and effective treatment for complications of pulmonary tuberculosis
This study examined whether hip involvement negatively impacts radiographic outcomes after lumbar pedicle subtraction osteotomy (PSO) in ankylosing spondylitis patients with thoracolumbar kyphosis. 44 patients underwent one-level lumbar PSO and were divided into two groups based on their hip involvement scores. Both groups had similar corrections of local kyphosis, but the group with hip involvement had significantly larger sagittal vertical axis and pelvic tilt postoperatively, indicating hip involvement can negatively impact radiographic outcomes after lumbar PSO. Additional osteotomies may be needed for patients with hip involvement to achieve satisfactory correction.
This document describes a study that evaluated using a single injection of diluted sodium bicarbonate while monitoring exhaled carbon dioxide levels to confirm correct placement of intravenous catheters before chemotherapy. The study involved injecting either sodium bicarbonate or saline through catheters in 67 oncology patients and monitoring exhaled CO2 levels. A rise in exhaled CO2 levels confirmed correct placement, identifying all 56 catheters deemed positively placed and 10 of 11 deemed questionable. This simple test could help prevent chemotherapy extravasation injuries by verifying catheter placement before treatment.
Pleurodese em derrames pleurais malignosFlávia Salame
- The study evaluated the effectiveness and safety of outpatient talc pleurodesis in patients with recurrent malignant pleural effusions and low performance status (KPS ≤70).
- 64 patients underwent pleural catheter placement, with 52 patients subsequently receiving talc pleurodesis. No complications occurred during catheter placement or pleurodesis.
- Pleurodesis resulted in complete or partial symptomatic improvement in nearly all patients. The recurrence rate 30 days after pleurodesis was 13.9%. Complications included catheter obstruction and empyema in a small number of patients.
The Use of Endotracheal Tubes in Prehospital Caremeducationdotnet
This document discusses the use of endotracheal tubes (ETTs) by paramedics in prehospital care. While ETTs are considered the gold standard for securing an airway, the document notes that paramedics receive limited training and experience with ETT intubation. Paramedics typically only perform 2-7 intubations per year after initial training. Other airway devices like laryngeal mask airways (LMAs) provide easier and less risky alternatives to ETTs. Studies have found LMA insertion is successful when ETT insertion fails. Guidelines recommend LMAs as a good alternative to ETTs for prehospital care given training limitations and risks of ETT intubation.
1) FAST (Focused Assessment with Sonography for Trauma) is an ultrasound technique used to rapidly detect free fluid in the abdomen or chest as a marker of injury from blunt trauma. It can identify hemoperitoneum, hemothorax, or hemopericardium.
2) The standard FAST exam involves scanning four areas of the abdomen and chest to detect free fluid. Additional views of the liver, spleen, and other organs may also be included.
3) Accuracy of FAST depends on the experience and training of the provider. Studies show higher sensitivity when performed by radiologists compared to other clinicians. Maintaining skills through a sufficient case volume is important for competency.
This document reports a case study of a 64-year-old female patient who developed late onset tracheal stenosis after receiving an 125Iodine seed esophageal stent to treat advanced esophageal carcinoma. The patient experienced progressive stenosis of the lower trachea at 6, 26, and 47 days post-operatively. The causes of stenosis are believed to include direct pressure from the stent, tumor proliferation, pressure from the aortic arch, and complications from other therapies such as radiation treatment. Due to its short clinical use, 125Iodine seed stents may present some fatal complications, and more study is needed on their long-term efficacy.
This study examined 162 patients with cirrhosis who underwent endoscopic variceal band ligation to treat esophageal varices. The study aimed to determine the frequency and risk factors associated with the development of secondary gastric varices after eradicating esophageal varices. The results found that secondary gastric varices developed in 38 patients (23.5%) after eradicating their esophageal varices. Factors associated with an increased risk of developing secondary gastric varices included having more advanced liver disease (based on Child-Pugh class), larger esophageal varices at initial presentation, requiring more sessions of band ligation to eradicate the esophageal varices, and already having gastric varices present at initial presentation.
This document proposes a clinical algorithm for managing open abdomen with concomitant entero-atmospheric fistula (EAF), a surgical complication with high mortality. The algorithm aims to guide surgeons in choosing the best approach on a case-by-case basis. EAF is defined as an enteric fistula occurring within an open abdomen, lacking a tract and surrounding tissue. Current management techniques aim to divert fistula output, protect viscera, and allow bowel granulation. However, no single approach is ideal and significant heterogeneity exists. The document reviews various techniques and proposes a flowchart to help select the optimal individualized strategy. It also provides a detailed description of a "baby bottle nipple diversion" technique developed by the
A 54-year-old male patient presented with acute chest pain and dyspnea during a parathyroid gland biopsy. Physical examination revealed diminished breath sounds in the right lung. Chest X-ray showed a pneumothorax in the right lung. The patient underwent chest tube placement, through which air drainage ceased after two days. However, on the fourth day diminished breath sounds were still present, and a chest X-ray showed a lung expansion defect. The chest tube was subsequently removed and the patient was discharged after follow-up exams were normal. This case report presents a rare instance of an iatrogenic pneumothorax occurring during parathyroid gland biopsy, highlighting the importance of considering pneumothorax as a
Le degré de relâchement musculaire en chirurgie coelioscopique de la vésicule biliaire fait partie du quotidien des discussions entre anesthésistes et chirurgiens au bloc opératoire. Au fond tous sont convaincus de l'efficacité du curare : le chirurgien qui le demande et l'anesthésiste qui pense lui à sa décurarisation.
Cette étude teste curarisation profonde versus curarisation de routine dans la chirurgie coelioscopique de la vésicule biliaire. Avec comme première question "est-ce qu'une curarisation profonde permet de travaillert avec une pression abdominable moindre?", pression dont on sait qu'elle est pourvoyeuse de douleur post-opératoire.
La réponse est que le degré de curarisation participe de façon marginale au confort du chirurgien... et ne permet pas plus fréquemment de travailler à pression abdominale basse.
This case report describes a case of perinatal cardiomyopathy (PPCM) in a 40-week pregnant patient. The patient was diagnosed with PPCM based on echocardiography findings of left ventricular dilation and reduced ejection fraction of 34.8%. She underwent emergency cesarean section and received various supportive treatments including diuretics, cardiotonics, hemodialysis, and ventilator support. Her symptoms improved over 58 days of treatment and she was discharged, though follow-up echocardiography still showed some left ventricular dilation and reduced ejection fraction. The report emphasizes the importance of early PPCM diagnosis in pregnant women.
A C S0105 Postoperative Management Of The Hospitalized Patientmedbookonline
This document discusses postoperative management of surgical patients. It describes the different levels of postoperative care including same-day surgery, the surgical floor, telemetry ward, and intensive care unit. Factors determining a patient's disposition include their preoperative health, procedure performed, and postoperative clinical status. The document also discusses common postoperative orders related to tubes, drains, oxygen therapy, and wound care to guide nursing staff.
This study evaluated 52 cases of pediatric peritonitis treated via laparotomy over 5 years at a hospital in Nigeria. The most common cause of peritonitis was found to be typhoid intestinal perforation (48% of cases). Other common causes included ruptured appendix (17.3% of cases) and perforated intussusception (15.4% of cases). Post-operative complications occurred in 46.2% of patients, with surgical site infection being most common (23.1% of cases). The mortality rate was 13.5%. The study concludes that typhoid intestinal perforation is a major cause of peritonitis in children in this setting.
This research article studied preoperative predictive factors of occult and frank intrabiliary rupture of liver hydatid cysts. The study reviewed 56 patients with 82 liver hydatid cysts who underwent surgery. Cysts were divided into three groups: no rupture, occult rupture with bile in cyst but no passage into bile duct, and frank rupture with passage into bile duct. Multivariate analysis identified jaundice, cyst size >6.5cm, and symptoms >45 days as predictors of frank rupture. Predictors of occult rupture included cyst size >6.5cm, ≥3 recurrences, type II/III cyst, leukocytosis >9,000/mm3, and eosinophilia >5.5
This case report describes an unusual method for removing a plastic bead that had been aspirated into the tracheobronchial tree of a 9-year-old boy. Conventional bronchoscopic techniques using forceps were unsuccessful at removing the bead, which was located in the left lower lobar bronchus. A Fogarty embolectomy catheter was inserted through the bead's central hole and its balloon was inflated to grasp the bead. The catheter and bead were then removed together through the rigid bronchoscope, successfully retrieving the foreign body without requiring surgery. This creative use of a Fogarty catheter demonstrates how available tools can be adapted based on the shape and location of an aspirated foreign body.
This document describes a surgical procedure performed on a 17-year-old male patient who had previously undergone aortic valve replacement as a child and had since developed patient-prosthesis mismatch. The surgical team performed a Konno-Rastan procedure to enlarge the anterior aortic root as well as a Manougian technique to enlarge the posterior aortic root. A mechanical aortic valve was then implanted. The patient recovered well post-operatively with no significant transaortic gradient. Aortic root enlargement procedures can help address patient-prosthesis mismatch, especially in growing pediatric patients.
This document discusses the diagnosis and management of caustic esophageal strictures. It begins by outlining the clinical symptoms of dysphagia that result from caustic ingestion and lead to stricture formation. Diagnosis involves esophagogram or esophagoscopy at least 6 weeks after injury to identify strictures. Treatment involves endoscopic dilatation using wire-guided dilators, with multiple sessions often needed for complex strictures. Advanced endoscopic techniques have reduced the need for esophageal replacement surgery. The document concludes that caustic esophageal strictures can be successfully managed through endoscopic dilatation.
This collective review analyzed 20 studies on mesh-based repair of umbilical and epigastric hernias. The recurrence rate was found to be 2.0% with mesh repair. Polypropylene and ePTFE meshes had the lowest recurrence rates between 1.7-2.5%. An overall 12.4% complication rate was reported. Laparoscopic repair had a lower 1.0% recurrence rate compared to 2.6% for open repair, and was associated with less postoperative pain. However, the review did not conclusively establish laparoscopic repair's benefits due to potential bias in reported operation times and complications. Further research is needed to compare outcomes between the two approaches.
This study reviewed 86 patients who underwent pericardiectomy for chronic constrictive pericarditis (CCP) at a single center from 2010-2014. Preoperatively, most patients were in NYHA class II or III. Tuberculosis was the cause of CCP in 32.6% of patients. The overall mortality rate was 2.3%. Postoperatively, 90.6% of surviving patients were in NYHA class I or II. The results showed pericardiectomy to be an effective treatment for CCP, with tuberculosis remaining a common cause in India.
This study aimed to determine if preoperative hematological parameters and risk factors could predict in-hospital mortality for patients undergoing surgery to repair Type A aortic dissection. The study reviewed data from 78 patients who underwent deep hypothermic circulatory arrest surgery. Only preoperative creatinine levels were higher in patients who died. Total circulatory arrest time and cross-clamp time during surgery were found to be factors affecting mortality, with times over 44.5 minutes and 71 minutes respectively predicting higher risk of death. The study concluded that hematological biomarkers alone may be insufficient for estimating mortality risk, and intraoperative factors like longer circulatory arrest and clamp times impact outcomes for Type A aortic dissection surgery.
This document discusses penetrating injuries and management approaches. It provides information on:
1) Factors that determine energy transfer from penetrating weapons including weapon type, range, and tissue properties. Vital structures like brain and liver are more susceptible to injury.
2) Options for managing penetrating torso trauma have expanded from routinely operating to include selective non-operative approaches with monitoring.
3) Indications for emergency thoracotomy or laparotomy include hemodynamic instability, peritonitis on exam, or unexpected drops in vitals or hematocrit. Triple-contrast CT can help determine need for surgery.
1. asian cardiovascular and thoracic annals-2006-olcmen-363-6Gabriel Pacheco
This document summarizes a study examining the role and outcomes of surgery for pulmonary tuberculosis. The study retrospectively analyzed 57 patients who underwent 72 surgical procedures for pulmonary tuberculosis between 1993-2003 at a hospital in Turkey. The most common indications for surgery were trapped lung (31.6%), multidrug-resistant tuberculosis (17.5%), and aspergilloma (17.5%). The most common procedure was lobectomy (31.9%). Complications occurred in 18 patients (24.5% morbidity rate), most commonly prolonged air leak and residual pleural space issues. There was one postoperative death (1.8% mortality rate). The study concludes that surgery can be considered a safe and effective treatment for complications of pulmonary tuberculosis
This study examined whether hip involvement negatively impacts radiographic outcomes after lumbar pedicle subtraction osteotomy (PSO) in ankylosing spondylitis patients with thoracolumbar kyphosis. 44 patients underwent one-level lumbar PSO and were divided into two groups based on their hip involvement scores. Both groups had similar corrections of local kyphosis, but the group with hip involvement had significantly larger sagittal vertical axis and pelvic tilt postoperatively, indicating hip involvement can negatively impact radiographic outcomes after lumbar PSO. Additional osteotomies may be needed for patients with hip involvement to achieve satisfactory correction.
This document describes a study that evaluated using a single injection of diluted sodium bicarbonate while monitoring exhaled carbon dioxide levels to confirm correct placement of intravenous catheters before chemotherapy. The study involved injecting either sodium bicarbonate or saline through catheters in 67 oncology patients and monitoring exhaled CO2 levels. A rise in exhaled CO2 levels confirmed correct placement, identifying all 56 catheters deemed positively placed and 10 of 11 deemed questionable. This simple test could help prevent chemotherapy extravasation injuries by verifying catheter placement before treatment.
Pleurodese em derrames pleurais malignosFlávia Salame
- The study evaluated the effectiveness and safety of outpatient talc pleurodesis in patients with recurrent malignant pleural effusions and low performance status (KPS ≤70).
- 64 patients underwent pleural catheter placement, with 52 patients subsequently receiving talc pleurodesis. No complications occurred during catheter placement or pleurodesis.
- Pleurodesis resulted in complete or partial symptomatic improvement in nearly all patients. The recurrence rate 30 days after pleurodesis was 13.9%. Complications included catheter obstruction and empyema in a small number of patients.
The Use of Endotracheal Tubes in Prehospital Caremeducationdotnet
This document discusses the use of endotracheal tubes (ETTs) by paramedics in prehospital care. While ETTs are considered the gold standard for securing an airway, the document notes that paramedics receive limited training and experience with ETT intubation. Paramedics typically only perform 2-7 intubations per year after initial training. Other airway devices like laryngeal mask airways (LMAs) provide easier and less risky alternatives to ETTs. Studies have found LMA insertion is successful when ETT insertion fails. Guidelines recommend LMAs as a good alternative to ETTs for prehospital care given training limitations and risks of ETT intubation.
This document discusses techniques for performing surgical tracheostomies. It begins by providing historical context and then covers indications and timing considerations. The optimal timing remains controversial but most agree conversion from an endotracheal tube to tracheostomy is indicated after 7-10 days of intubation if the patient is not likely to be extubated soon. The document then reviews tracheostomy anatomy and techniques including standard open surgical procedure which involves making a transverse incision above the suprasternal notch, retracting muscles to expose the trachea, and creating a vertical incision between tracheal rings to insert the tracheostomy tube. Post-procedure care and complications are also briefly mentioned.
Tracheostomy:When to perform and How to manage?Gamal Agmy
Tracheostomy is an ancient surgical procedure that can be traced back to Egyptian tablets from 3600 BC. It involves creating an opening in the trachea to allow direct access to the breathing tube. The document discusses the history, indications, techniques, management and outcomes of tracheostomy. It provides details on open surgical tracheostomy techniques as well as percutaneous dilational tracheostomy. Factors such as cannula choice, cuff management, replacement, humidification and weaning are reviewed for long-term tracheostomy care. Tracheostomy is indicated for patients requiring prolonged mechanical ventilation, inability to clear secretions or upper airway obstruction.
1) The authors reviewed outcomes of 104 consecutive minimally invasive esophagectomies (MIEs) performed between 1998-2007.
2) Surgical approaches included thoracoscopic/laparoscopic esophagectomy with cervical anastomosis (n=47), minimally invasive Ivor Lewis esophagectomy (n=51), and others.
3) Complications included anastomotic leak in 9.6% of patients and stricture in 26%. Mortality was 1.9% at 30 days and 2.9% in-hospital. Mean lymph nodes retrieved was 13.8.
STUDY OF eTEP FOR VENTRAL HERNIA REPAIR.pptxAnandaHegde1
This study aims to describe the technique of endoscopic eTEP Rives-Stoppa repair for ventral hernia repair. 41 patients undergoing eTEP ventral hernia repair were evaluated. The mean age was 57.1 years. Umbilical hernias were the most common based on EHS classification. The mean operative time was 3.7 hours. The mean hospital stay was 3.7 days. Post-operative complications included 1 recurrence and 1 seroma. The study concludes that eTEP is a cost-effective ventral hernia repair technique with low recurrence and morbidity rates.
1) The document describes a study of 40 patients with prolonged pulmonary air leaks treated with endobronchial valves.
2) Ninety-two percent of patients experienced resolution or reduction of their air leak after valve placement. Nearly half saw complete resolution.
3) On average, chest tubes were removed 21 days after valve placement and patients were discharged from the hospital 19 days after the procedure.
This study compared the effectiveness of four laryngoscope devices (Macintosh, Glidescope, Truview EVO2w, and Airwayscope) for tracheal intubation in patients with cervical spine immobilization. One hundred and twenty patients were randomly assigned to intubation with one of the four devices. The Glidescope, Airwayscope, and Truview EVO2w all improved the glottic view and reduced intubation difficulty compared with the Macintosh. However, the Glidescope and Airwayscope further reduced intubation difficulty and improved the glottic view more than the Truview EVO2w. While the Macintosh was faster, the Glidescope and Airwayscope provided
This study evaluated the incidence of ventilator-associated pneumonia (VAP) using the PneuX endotracheal tube system with or without elective endotracheal tube exchange. The study found no episodes of VAP while the PneuX system was in use in 53 patients over 48 hours of intubation and mechanical ventilation. On an intention-to-treat basis, the incidence of VAP was 1.8%. The study demonstrated that elective endotracheal tube exchange and intermittent subglottic secretion drainage can be performed reliably and safely using the PneuX system.
The document discusses airway management and difficult intubations. It notes that the efficacy of emergency intubation has not been rigorously studied. Various clinical tests to predict difficult airways have limited reliability. Videolaryngoscopy devices like the Glidescope provide better visualization of the vocal cords and easier intubation compared to traditional laryngoscopy, especially in simulated difficult airway scenarios. The skill of the operator is important in determining outcomes of intubation.
The document discusses several studies on the use of laparoscopic (TEP) and open preperitoneal (OPM) approaches for repairing recurrent inguinal hernias. The studies found that both approaches had low recurrence rates of around 2%, with the TEP approach having shorter operating times and hospital stays compared to OPM. Overall, the studies concluded that the preperitoneal approaches, whether open or laparoscopic, are good options for repairing recurrent inguinal hernias when performed by experienced surgeons.
1) The study compared the effects of an alveolar recruitment maneuver (ARM) plus high PEEP to standard ventilation on oxygenation during laparoscopic bariatric surgery in morbidly obese patients.
2) The ARM group had significantly higher intraoperative oxygen levels (Pao2) and respiratory system compliance compared to controls. However, the benefits disappeared after extubation.
3) The ARM group required more frequent use of vasopressors during surgery.
In 3 sentences, this summary highlights the key findings that the ARM improved intraoperative oxygenation and pulmonary mechanics but the benefits were transient, and it was associated with more vasopressor use during surgery.
This document discusses techniques for pulmonary resection surgery. It covers:
- Patient positioning in the lateral decubitus position to allow access for posterior thoracotomy incisions.
- Isolating the lung to be resected using a double-lumen endotracheal tube for single lung ventilation during hilar dissection.
- Completing systematic inspection and palpation of the lung before dividing structures and removing the specimen to check for abnormalities.
This study examined factors associated with the timing of death due to cancer recurrence after esophagectomy for adenocarcinoma. The study found:
- Of 351 patients who underwent esophagectomy, 191 (54%) died of cancer recurrence. The majority (97%) of these patients died within 5 years.
- Factors independently associated with earlier death due to recurrence included higher T-stage, lymph node ratio over 0.2, and presence of extracapsular lymph node involvement.
- Among patients who died of recurrence, earlier death was also associated with experiencing postoperative complications. This suggests complications may disturb the immune system and allow faster growth of residual cancer.
- The occurrence of complications was not directly
This document summarizes several studies on surgical repair of hiatal hernias. It discusses the use of mesh reinforcement to reduce recurrence rates for both laparoscopic fundoplications and large paraesophageal hernia repairs. The studies found mesh reinforcement was associated with fewer recurrences compared to primary suture repair, with no reported instances of mesh erosion. Longer follow-up is still needed but current data support the use of mesh for hiatal repairs.
This document discusses current concepts in managing the difficult airway. It summarizes several alternative airway devices and techniques including lighted stylets, video laryngoscopes, rigid and flexible fiber-optic laryngoscopes, supraglottic airway devices, awake intubation techniques using topical anesthesia, flexible fiber-optic intubation, retrograde intubation, transtracheal jet ventilation, cricothyrotomy, and tracheostomy. It provides tables describing many new airway devices and concludes that clinical experience is crucial for applying these techniques and devices to solve most airway problems.
This document discusses tracheostomy, including its history, indications, effects, techniques for insertion, care, and cautions. It provides guidance on timing of tracheostomy for prolonged ventilation cases. Key points include:
- Tracheostomy decreases anatomical dead space and work of breathing compared to endotracheal intubation.
- The TracMan study found no difference in mortality between early (1-4 days) and late (10+ days) tracheostomy for prolonged ventilation, though early tracheostomy resulted in less days of sedation.
- Percutaneous tracheostomy is usually performed under bronchoscopic guidance using commercial kits involving guidewire dilation of the tracheal stoma.
- Trache
Current concepts in the management of esophagueal perforationsFerstman Duran
This study analyzed 119 patients with esophageal perforations treated at a hospital in Canada between 1981-2007 to identify factors associated with mortality. The researchers found that malignant perforations, pre-operative respiratory failure requiring mechanical ventilation, higher comorbidity burdens, and sepsis were associated with significantly higher mortality based on multivariate analysis. However, time to treatment was not associated with increased mortality. Primary repair or resection with reanastomosis can be attempted even in patients treated after longer time periods from perforation.
This document discusses advanced airway management techniques for critically ill patients in the intensive care unit (ICU). It begins by noting that intubation in the ICU can be difficult due to patients' underlying illnesses and may differ from operating room intubations. Risk factors for difficult intubation and difficult mask ventilation are identified. Various airway devices and management strategies for difficult airways in the ICU are then discussed, including the need to recognize difficult airway risk factors to best prepare for securing the airway.
The document discusses breast anatomy, common benign breast diseases including cysts, fibroadenomas, mastalgia and nipple discharge. It describes approaches to evaluating breast problems through history, examination, diagnostic workup and managing various benign breast conditions through lifestyle modifications, medications or surgery. The goal of treatment is to alleviate symptoms while ruling out breast cancer.
The history of electrical impedance tomography (EIT) began in the 1980s but it took decades to develop EIT devices suitable for clinical use due to limitations in sensitivity, susceptibility to interference, and lack of user-friendly software. In the early 2000s, a collaboration between researchers and Dräger sought to address these issues and develop the first clinically viable EIT system, culminating in the PulmoVista 500, which enables continuous bedside monitoring of regional lung function without radiation. Validation studies demonstrated EIT's potential for guiding mechanical ventilation and optimizing settings for individual patients with acute lung injury.
The document provides 6 scenarios involving patients with various medical conditions and their arterial blood gas results. Each scenario includes 2 multiple choice questions testing interpretation of acid-base disturbances. The scenarios cover conditions such as opioid overdose, metabolic alkalosis, respiratory alkalosis, diabetic ketoacidosis, renal failure, and introduce acid-base nomograms for interpretation.
This document provides an overview of arterial blood gases (ABGs), including:
- What ABGs measure (oxygenation levels, acid-base disturbances, pH, pO2, pCO2, and other electrolytes)
- When ABGs are indicated (respiratory monitoring, unstable patients, post cardiac arrest, intra-operatively)
- How the body maintains acid-base balance through respiratory, renal, and chemical buffers that keep pH between 7.35-7.45.
- Common acid-base disturbances include respiratory or metabolic acidosis/alkalosis caused by changes in pCO2, bicarbonate, or other factors. Interpreting ABG values can help
This patient has an arterial blood gas showing:
1) Acidosis with a pH of 7.22
2) Elevated PaCO2 of 55 mm Hg, indicating a respiratory cause
3) Normal bicarbonate, supporting a diagnosis of respiratory acidosis likely due to her severe asthma attack.
The document discusses endotracheal intubation as the preferred method of airway management during respiratory failure or surgery requiring muscle relaxation. It is preferred because it provides a protected airway by preventing entry of foreign matter like gastric contents. Accurate placement requires skill as patients are usually rendered unconscious and paralyzed. The airway examination aims to identify patients where intubation may be difficult in order to prepare alternatives before medications induce apnea. Risk of aspiration can be reduced through techniques like rapid sequence induction, cricoid pressure during intubation, and administration of a non-particulate antacid or metoclopramide. Factors like Mallampati classification, obesity, limited mouth opening, and distances between anatomical landmarks can
This document is a reference guide for cardiopulmonary care published by Edwards Lifesciences. It provides concise summaries of anatomy, physiology, monitoring techniques, and central venous access. The guide is intended as an educational reference for medical personnel and disclaims any liability. It has been compiled from available literature and the editors cannot guarantee the correctness of the information.
Here are the key steps to analyze this mixed acid-base case:
1. Identify the primary disturbances:
- Respiratory alkalosis due to hyperventilation (PaCO2 28-30)
- Metabolic acidosis likely due to lasix use (daily high dose diuretic)
2. Determine the compensatory responses:
- Respiratory compensation for metabolic acidosis (lower than normal PaCO2)
- Renal compensation not yet fully compensated the metabolic acidosis
3. Analyze the ABG values in the context of the primary disturbances and degree of compensation.
- The ABG values reflect both an ongoing metabolic acidosis and respiratory alkalosis.
4.
The document discusses the top five post-extubation emergencies: laryngospasm, laryngeal stridor, acute hypoxemia, acute respiratory failure, and neurologic pathology. It provides definitions and discusses how to potentially predict and treat each emergency. Key points include that extubations should not be treated as routine, extensive assessment is important, and having difficult intubation supplies available is critical in case re-intubation is needed. The document emphasizes being prepared for potential post-extubation complications.
This letter describes a new technique for managing difficult extubation when the tracheal tube cuff fails to deflate. A patient required laryngoscopy after extubation was initially unsuccessful due to an inflated cuff. The resident made a small V-shaped cut in the tracheal tube wall just beyond the inflating lumen attachment. This allowed air to escape and the tracheal tube was then easily removed. The authors believe this is an easy, quick, and safer method compared to alternatives described in literature. However, one should confirm difficulty is solely due to cuff failure before using this technique.
This document provides information about pneumonia, including community-acquired pneumonia (CAP). It discusses the diagnosis and assessment of severity of CAP. Key points include:
1. CAP is a common infectious disease caused most frequently by Streptococcus pneumoniae. Diagnosis is based on clinical symptoms and chest imaging showing new infiltrates.
2. Chest radiographs are used to stage severity based on localization and number of involved lobes, and to detect complications like effusions or cavitation.
3. Severe CAP is defined by need for mechanical ventilation, septic shock, or combinations of minor criteria like low blood pressure, multilobar involvement, or low oxygen levels.
4. The severity of CAP is
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
2. extubation strategy involving reversible extubation complications encountered during reestablishment of
(14 –21). This is the first report to provide details, in a the airway. Hypoxemia was defined as a desaturation
relatively large cohort of difficult airway patients, on nadir of Spo2 Ͻ90% and severe hypoxemia as Spo2
the reintubation first-pass success rate, reasons for Ͻ70%. Reintubation of the patient’s trachea was indi-
reintubation failure, and any complications associated vidualized for each patient and at the discretion of the
with reestablishment of the airway after extubation. ICU and anesthesia teams. Typically, shortness of
Further, this is the first report describing extensive use breath, tachypnea, worsening oxygen saturations, stri-
of both the smaller adult 11F and the medium-sized dor, increased work of breathing, and failure of pul-
adult 14F AEC. monary toilet despite therapeutic assistance by the
nursing and respiratory therapy staff contributed to
the decision for reintubation.
METHODS Data were analyzed using SPSS 12 (SPSS Inc.,
In an observational analysis, a difficult airway Chicago, IL). The contingency 2 test was used for
quality improvement database was reviewed for pa- categorical variables in comparing complications be-
tients who were extubated over an AEC for a known tween patients with and without the AEC in place yet
or presumed difficult airway in the OR, the postanes- requiring reintubation of the trachea. Statistical sig-
thesia care unit (PACU), or the intensive care unit nificance was accepted at P Ͻ 0.05.
(ICU). Data were collected by the author prospectively
and entered into a Microsoft Excel spreadsheet
(1998 –2002); then, the database was transferred to and RESULTS
maintained in an SPSS statistical package data sheet In the review period, 354 patients with a known or
(2002–2006). Patients were cared for directly by the suspected difficult airway, based on previous airway
author or by members of the anesthesia airway team. encounters and current physical examination, had
If observation of postextubation patients extended access to their trachea maintained by an indwelling
beyond regular working hours (evening and night AEC after extubation. Other methods of staged extuba-
shifts), the author collected and verified data through tion (transition from ETT to laryngeal mask airway
ICU care team interviews and review of the medical [LMA] or bronchoscopic-assisted extubation) were rela-
records. The hospital’s IRB waived the need for in- tively few in the ICU setting and were not reviewed.
formed consent. After extubation over an AEC, each patient re-
Over a 9-yr period, 354 patients were extubated mained in a monitored environment (the ICU setting,
with a Cook AEC (3.7 mm E.D.-11F, 4.7 mm-14F or 6.3 the PACU, or transition from the OR to the PACU).
mm-19F, Cook Critical Care, Bloomington, IN) left in The AEC remained in place for a mean of 3.9 h (range,
the trachea for a potential reversible extubation as part 5 min to 72 h). All patients in the first group who
of a staged extubation strategy. The AEC remained in underwent an AEC-assisted reintubation did so
the trachea until reintubation was considered unlikely within 24 h after extubation. The second group did not
for each individual patient by the ICU and anesthesia have the AEC in position at the time of their reintu-
airway team. Reintubation of the trachea was man- bation. The AEC size used for the extubation varied:
aged by the anesthesia airway team (an anesthesia 11F (151 patients typically Ͻ5Ј5Љ tall, 46%), 14F (165
attending physician alone or an anesthesia resident patients typically taller than 5Ј5Љ, 50%) and 19F (13
[CA-2, CA-3] directly supervised by the attending patients taller than 5Ј10Љ, 4%). The location of
staff) at the patient’s bedside. The anesthesia team the patient at the time of tracheal extubation included
members’ experiences with reintubation over an in- the OR (17 postsurgical patients extubated at the
dwelling AEC varied, although they routinely per- conclusion of their anesthesia), the PACU (24 postsur-
formed tracheal intubation over a bougie airway catheter gical patients extubated after their transfer from the
or tracheal tube exchanges over an AEC. OR to the PACU for postanesthesia recovery), and the
Patient analysis was performed on the primary ICU (288 patients). Most of the ICU patients (75%) had
group, which included patients with an indwelling been intubated for Ͼ48 h, and many were in the
AEC, who required reintubation within 24 h and a recovery phase of resolving pneumonias, congestive
secondary group of patients who had initially had an heart failure, tracheobronchitis, neuro/mental status
indwelling AEC in the postextubation period but who alterations, and other maladies placing them at high
then underwent removal of the AEC based on the risk for potential extubation failure. Seventy-two per-
presumed tolerance of the extubated state. Patients in cent of the 354 patients had a known difficult airway
the secondary group subsequently required reintuba- based on a history of difficult airway management
tion within 7 days of tracheal extubation. These two requiring multiple conventional attempts (Ն3) or re-
groups were reviewed for the time from extubation to quiring an accessory airway device to secure the
reintubation, the number of attempts required to airway in the emergency room, the OR, or a remote
reintubate the trachea (with and without the AEC in location intubation during the current hospitalization.
place), the incidence of hypoxemia during reintuba- The remaining patients, 28%, had a suspected difficult
tion, the method used to resecure the airway, and any airway based on their current physical examination
1358 Extubation of the Difficult Airway ANESTHESIA & ANALGESIA
4. Table 3. Complications of the Reintubation Procedure
AEC present AEC absent
(n )15 ؍ (n )63 ؍ P
First-pass success rate for reintubation 87% 14% (5) Ͻ0.02
Hypoxemia during reintubation (Spo2 Ͻ90%) 8%b (4) 50% (18) Ͻ0.01
Severe hypoxemia during reintubation (Spo2 Ͻ70%) 6%a(3) 19% (7) 0.05
Bradycardia (heart rate Ͻ40) with hypotension 4% (2) 14% (5) Ͻ0.05
Multiple intubation attempts (Ն3) including the 10%b (5) 77% (28) Ͻ0.02
placement of an accessory airway device
Esophageal intubation 0 18% (6)
Rescue airway device/technique 6%a (3) 90% (32) Ͻ0.01
a
Includes the AEC failures due to inability to pass ETT into trachea (1 case) and proximal migration of the AEC out of the trachea (3 cases).
AEC ϭ airway exchange catheter; ETT ϭ endotracheal tube.
or suspected difficult airway,” since the vast majority the skills and preferences of the practitioner (1). Rein-
required multiple attempts to resecure the airway tubation of the trachea in the known or suspected
(three or more attempts with laryngoscopy plus the difficult airway patient appears fraught with compli-
accessory device/technique, 77%) when compared cations, as illustrated in this study by the group of
with only one patient with the indwelling AEC who patients who underwent extubation of their trachea
required three attempts. Table 2 illustrates the conven- over an AEC, had it subsequently removed when the
tional and accessory airway devices that were re- reintubation risk was presumed to be low, yet later
quired to assist the practitioner in resecuring the suffered extubation intolerance and were reintubated.
patients’ airways. Postextubation hypoventilation, airway compro-
The 14% first-pass reintubation success rate (first mise, ventilation-perfusion inequalities, and obstruc-
attempt with direct laryngoscopy or accessory device) tion due to fatigue may afflict the patient in the OR, in
in the non-AEC group was dwarfed by the AEC- the PACU, and in particular in the ICU (3,4). Continu-
assisted first-pass success rate of 87% (Table 3). Nearly ous access to the airway can be maintained via an AEC
all (90%) of the non-AEC group required an accessory with the proximal tip secured to the patient’s clothing
airway device or an advanced technique to success- or forehead (waterproof adhesive tape). This is well
fully reestablish the airway (Table 3). Of note, after tolerated by most patients (90%) and thus is a valuable
failure to intubate the trachea in four patients, despite option, considering a reintubation rate that varies
concerted attempts with accessory devices, a surgical from 0.4% to 25% in the various PACU and ICU
airway was required. Two of these four patients populations (3–7,14 –21).
received bag-mask ventilation during the establish- Currently, there are no evidence-based guidelines
ment of the surgical airway, and two patients had regarding the optimal period of time for maintaining
concurrent and successful ventilation and oxygen- airway access postextubation via an indwelling AEC.
ation via an LMA during placement of the surgical Experts have suggested at least 30 – 60 min or until the
airway. likelihood of reintubation is minimized (3,5,6,22–24).
Oxygen desaturation in the non-AEC group was Unfortunately, our database suggests that a minimum
common during the reintubation process, with the of 30 – 60 min would underestimate the need for a
nadir of Ͻ90% Spo2 occurring in 50% of the patients; reversible extubation in a significant number of these
40% of these suffered severe hypoxemia (Spo2 Ͻ70%, high-risk patients. Moreover, the potential for changes
Table 3). Esophageal intubation was more common in in the patient’s clinical status makes it difficult to
the non-AEC group (18% to 0%), as was hypoxemia- predict when the need for reintubation is minimized.
driven bradycardia with profound hemodynamic This may be particularly true in the ICU population,
deterioration. Table 3 compares the various complica- who may suffer acute alterations in their cardiopul-
tions of the reintubation procedure between those monary, metabolic, or neurological status, or other
reintubated with and without an indwelling AEC.
critical medical/surgical issues that may influence
their tolerance of extubation.
DISCUSSION If the intolerance of the extubated state is based
In the high-risk extubation patient with known or principally on the presence or potential accumulation
suspected airway management difficulties, develop- of periglottic edema, then the patient may benefit from
ment of a strategy to maintain access to the airway and extending the duration of the indwelling AEC to
to offer the safety of reversibility if the extubated state 60 –120 min. Periglottic edema contributing to airway
is not tolerated should be considered (1). This strategy compromise often occurs immediately upon extuba-
will depend, in part, on the surgical and medical tion or within 10 – 45 min of extubation, although it
conditions of the patient, on the previous airway has been noted that symptomatic laryngeal edema
procedures and current airway status, as well as on may develop as late as 8 h postextubation (14,15).
1360 Extubation of the Difficult Airway ANESTHESIA & ANALGESIA
6. 6. Loudermilk EP, Hartmanngruber M, Stoltfus DP, Langevin PB. 19. Hines R, Barash PG, Watrous G, O’Connor T. Complications
A prospective study of the safety of tracheal extubation using a occurring in the post-anesthesia care unit: a survey. Anesth
pediatric airway exchange catheter for patients with a known Analg 1992;74:503–9
difficult airway. Chest 1997;111:1660 –5 20. Biancofiore G, Bindi ML, Romanelli AM, Boldrini A, Bisa M,
7. Benumof JL. Airway exchange catheters: simple concept, poten- Esposito M, Urbani L, Catalano G, Mosca F, Filipponi F.
tially great danger. Anesthesiology 1999;91:342– 4 Immediate tracheal extubation following liver transplantation:
8. Baraka AS. Tension pneumothorax complicating jet ventilation fast track in liver transplantation: 5 years’ experience. Eur J
via Cook airway exchange catheter. Anesthesiology 1999; Anaesthesiol 2005;22:584 –90
91:557– 8 21. Epstein SK. Preventing post-extubation respiratory failure. Crit
Care Med 2006;34:1547– 8
9. DeLima L, Bishop M. Lung laceration after tracheal extubation
22. Hagberg C, ed. Handbook of difficult airway management.
over a plastic tube changer. Anesth Analg 1991;73:350 –1
Philadelphia: Churchill Livingstone, 2000. Chapter 16: Extuba-
10. Seitz PA, Gravenstein N. Endobronchial rupture from endotra- tion of the difficult airway
cheal reintubation with an endotracheal tube guide. J Clin 23. Miller K, Harkin C, Bailey PL. Postoperative tracheal extuba-
Anesth 1989;1:214 –7 tion. Anesth Analg 1995;80:149 –72
11. Benumof JL, Gaughan SD. Concerns regarding barotrauma 24. Topf AI, Eclayea A. Extubation of the difficult airway. Anesthe-
during jet ventilation. Anesthesiology 1992;76:1072–3 siology 1996;85:1213– 4
12. Fetterman D, Dubovoy A, Reay M. Unforeseen esophageal 25. Mort TC. Emergency tracheal intubation: complications associ-
misplacement of airway exchange catheter leading to gastric ated with repeated laryngoscopic attempts. Anesth Analg
perforation. Anesthesiology 2006;104:1111–2 2004;99:607–13
13. Bedger RC, Chang JL. A jet-stylet endotracheal catheter for 26. Rosenblatt WH. Preoperative planning of airway management
difficult airway management. Anesthesiology 1987;66:221–3 in critical care patients. Crit Care Med 2004;32:186 –92
14. Darmon J, Rauss A, Dreyfuss D, Bleichner G, Elkharrat D, 27. Mort TC. The incidence and risk factors for cardiac arrest during
Schlemmer B, Tenaillon A, Brun-Buisson C, Huet Y. Evaluation emergency tracheal intubation: A justification for incorporating
of risk factors for laryngeal edema after tracheal extubation in the ASA Guidelines in the remote location. J Clin Anesth
adults and its prevention by dexamethasone. Anesthesiology 2004;16:508 –16
1992;77:245–51 28. Le Tacan S, Wolter P, Rusterholtz T, Harlay M, Gayol S, Sauder
15. Ho L, Harn H, Lien T, Hu P, Wang J. Postextubation laryngeal P, Jaeger A. Complications of difficult tracheal intubations in a
critical care unit. Ann Fr Anesth Reanim 2000;19:719 –24
edema in adults. Intensive Care Med 1996;22:933– 6
29. Mort TC. The importance of a laryngoscopy strategy and
16. Epstein SK, Ciubotaru RL. Independent effects of etiology of
optimal conditions in emergency intubation. Anesth Analg
failure and time to reintubation on outcome for patients failing 2005;100:900 (author reply to letter)
extubation. Am J Respir Crit Care Med 1998;158:489 –93 30. Mort TC. Preoxygenation in critically ill patients requiring
17. Epstein SK. Decision to extubate. Intensive Care Med 2002; emergency tracheal intubation. Crit Care Med 2005;33:2672–5
28:535– 46 31. Dworkin R, Benumof JL, Benumof R, Karagianes TG. The
18. Esteban A, Frutos-Vivar F, Ferguson ND, Arabi Y, Apezteguia effective tracheal diameter that causes air trapping during jet
C, Gonzalez M, Epstein SK, Hill NS, Nava S, Soares MA, ventilation. J Cardiothorac Anesth 1990;4:731– 6
D’Empaire G, Alia I, Anzueto A. Noninvasive positive-pressure 32. Asai T, Shingu K. Difficulty in advancing a tracheal tube over a
ventilation for respiratory failure after extubation. N Engl J Med fiberoptic bronchoscope: incidence, causes and solutions. BJA
2004;350:2452– 60 2004;92:870 – 81
1362 Extubation of the Difficult Airway ANESTHESIA & ANALGESIA