1/16. A method for bronchoscopic evaluation of salivary aspiration in a disabled child.Chronic aspiration is a cause of life-threatening respiratory complications and repeated hospital admissions, particularly in children with neurological disabilities. Determining the source of aspiration is important for optimizing treatment. This report describes a simple technique to demonstrate salivary aspiration during fibreoptic bronchoscopy. A child with a history of recurrent pneumonia was given methylene blue orally 2 h prior to fibreoptic bronchoscopy. bronchoscopy was carried out through a laryngeal mask airway under inhalational anaesthesia. The stained saliva was seen to be pooling in the valleculae and then running down the trachea into the bronchi, confirming salivary aspiration.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/16. Complaints related to respiratory events in anaesthesia and intensive care medicine from 1994 to 1998 in denmark.BACKGROUND: In denmark, a National Board of patients' Complaints (NBPC) was founded in 1988. This study analyses anaesthetic complaints related to adverse respiratory events filed at the NBPC from 1994 to 1998 to point out directions for possible preventive measures. methods: All decisions made by the NBPC from 1994 to 1998 concerning personnel employed in the Danish health care system were scrutinized. Cases related to anaesthesia and intensive care medicine were reviewed. Adverse respiratory events were identified and classified by mechanism of the incident that had caused the complaint. Detailed information on anaesthetic technique, personnel involved, sequence of events, clinical manifestation of injury, and outcome was recorded. RESULTS: A total of 284 cases was identified. One-fifth (n=60) of the complaints were related to an adverse respiratory event. The overall mortality in these cases was 50% (n=30). In 19 complaints (32%), the treatment was considered substandard. CONCLUSION: Complaints related to respiratory events reveal that inadequate anaesthetic and intensive care medicine treatment leads to patient damage and death. Preventive strategies should be directed at the development of guidelines for handling the difficult airway, education in the management of the difficult airway, instruction in the correct use of anaesthetic equipment, improvement of interpersonnel communication routines, as well as implementation of simulator training.- - - - - - - - - - ranking = 5keywords = anaesthesia (Clic here for more details about this article) |
3/16. Triple-layer laryngeal closure for intractable aspiration.Impaired laryngeal protective function can result in intractable aspiration, which causes recurrent life-threatening pneumonia. Several surgical operations have been developed to treat intractable aspiration. In this case, we report a successful case of triple-layer laryngeal closure, which was performed in a patient with type II diabetes mellitus and nutritional failure due to intractable aspiration that had been caused by several stroke attacks. Triple-layer laryngeal closure is a unique modified technique that combines laryngotracheal separation and glottic closure operations. The method that we performed can be done more safely in patients who have higher post-operative and general anaesthesia risks.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
4/16. vomiting and aspiration pneumonitis with the laryngeal mask airway.We report a case of severe aspiration pneumonitis in the dependent lung of a 74-yr-old man following Austin-Moore arthroplasty. A laryngeal mask airway provided a clear airway until anaesthesia became too light during manipulation of the fractured femoral head. Active vomiting occurred and gastric contents were "reflected" back into the trachea. Tracheal intubation and suction were immediately performed but the patient required postoperative ventilatory and inotropic support for three days.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
5/16. Acute dilatation of the stomach during general anaesthesia. A case report.We describe a case of acute dilatation of the stomach which occurred during general anaesthesia for cataract extraction. This resulted in aspiration pneumonitis. We report the case because of its unexpected and sudden appearance. The presentation and management of this case is described, together with a review of the anaesthetic problems which may occur.- - - - - - - - - - ranking = 5keywords = anaesthesia (Clic here for more details about this article) |
6/16. Contac 400: a possible cause of aspiration under anaesthesia.patients often take proprietary medicines which they do not report to their anaesthetist. One such case is reported in which a self administered high dosage of such a medication can be linked with a potentially life threatening anaesthetic complication. Pre-anaesthetic assessment should include specific questioning on over-the-counter medication.- - - - - - - - - - ranking = 4keywords = anaesthesia (Clic here for more details about this article) |
7/16. Aspiration during induction of anaesthesia in patients with colon interposition.The risk of aspiration during induction of anaesthesia in patients with oesophageal disease is not well defined, and controversy exists with respect to patients who have undergone pharyngeal-gastric colon interposition. Excellent gastrooesophageal competence has been documented in many of these patients, and propulsive peristalsis has been demonstrated in interposed colonic segments, suggesting that aspiration risk is low. This report, however, describes recent anaesthetic experiences in two patients with colon interpositions and shows that these patients may have markedly redundant interposed segments that retain food or other particulate residue and, thus, present a significant risk of particulate aspiration. Awake intubation may be the best approach to avoid aspiration in these patients.- - - - - - - - - - ranking = 5keywords = anaesthesia (Clic here for more details about this article) |
8/16. Opitz-Frias syndrome. A case with potentially hazardous anaesthetic implications.The anaesthetic management is described of a nine-month-old male for surgical palliation of the the functional abnormalities associated with Opitz-Frias syndrome. Features of this syndrome of interest to anaesthetists include recurrent pulmonary aspiration of intestinal contents, achalasia of the oesophagus, subglottic stenosis, hypertelorism, micrognathia and a high arched palate. No previous reports of anaesthesia for patients with this condition have been identified.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
9/16. Anaesthetic implications of long term diabetic complications.A case history in which a patient suffering from long-term diabetes mellitus underwent vascular surgery of a lower extremity is presented. Anaesthesia was commenced with an epidural anaesthesia, but due to insufficient analgesia combined with a high thoracal block general anaesthesia was added. The course was complicated because of cardiomyopathy, autonomic neuropathy, difficult laryngoscopy, aspiration of gastric content, and acute renal failure. Anaesthetic implications of long-term diabetes mellitus are discussed.- - - - - - - - - - ranking = 2keywords = anaesthesia (Clic here for more details about this article) |
10/16. Effects of omeprazole, with and without metoclopramide, in elective obstetric anaesthesia.We report the results of a study comparing two dose regimens of the gastric antisecretory agent, omeprazole, used as prophylaxis against pulmonary aspiration of gastric contents during general anaesthesia for elective Caesarean section. Since antisecretory agents do not clear stomach contents already present at the start of treatment, two groups of patients who had received both omeprazole and a prokinetic drug, metoclopramide, were also studied. Thirty patients received oral omeprazole 40 mg on the evening before and on the morning of the operation (group 1), 33 received oral omeprazole 80 mg on the morning of the operation (group 2), and 15 (group 3) and 16 (group 4) patients respectively received the oral omeprazole doses stated above and in addition metoclopramide 10 mg given intramuscularly at least 20 min before induction of anaesthesia. Gastric aspirate pH and volume were measured at induction of anaesthesia and on completion of surgery. At induction of anaesthesia, treatment was judged successful (pH > or = 2.5 and volume < 25 ml) in 87%, 73%, 100% and 81% of patients in groups 1-4 respectively. The corresponding results on completion of surgery were 100%, 88%, 100% and 100%. While omeprazole is useful as prophylaxis against pulmonary aspiration during general anaesthesia for elective Caesarean section, the addition of a prokinetic agent seems to be necessary to maximise its effects.- - - - - - - - - - ranking = 9keywords = anaesthesia (Clic here for more details about this article) |
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