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11/140. Airway ignition during CO2 laser laryngeal surgery and high frequency jet ventilation.

    We present a case of a patient submitted for extirpation of a neoplasm of the larynx, by means of carbon dioxide laser surgery. High frequency jet ventilation was applied by means of orotracheal intubation with two Teflon catheters, 2 mm in external diameter and 30 cm in length, attached with three equally placed strips of adhesive paper tape. One catheter was used to inject the jet volume and the other used to measure the airway pressure. The adhesive strips were moistened and FiO2 was lower than 50%. After 30 min using the laser, an airway fire was noticed. ventilation was interrupted and the catheters were removed. The patient was reintubated with an endotracheal tube of 6 mm ID and the surgical procedure was continued until the tumour was removed. Two factors contributed to the airway fire: the ignition of the lowest adhesive strip that had dried and the use of the laser in the mode of continuous pulsation.
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12/140. pneumoperitoneum secondary to endoscopic harvest of saphenous vein graft.

    Endoscopic harvest of saphenous vein graft for coronary artery bypass grafting decreases leg wound complications compared with traditional longitudinal incision. A case of pneumoperitoneum secondary to endoscopic harvest of saphenous vein using insufflation of carbon dioxide is reported. Hypercarbia, increased peak airway pressure, but no significant changes of hemodynamics, or myocardial ischemia were noted. The management of this rare complication is described.
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keywords = airway
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13/140. Unintentional ileostomy: a complication of the videolaparoscopic method? Report of the first case.

    jejunostomy is widely acknowledged in the literature as a means for enteral nutrition. Complication rates range from 16% to 46% for the classical open technique and from 11% to 70% for the several mini-invasive techniques currently in use, including the laparoscopic techniques. The most probable complications are abscess, intestinal obstruction, abdominal wall infection, intraperitoneal leakage, enterocutaneous fistula, and loss, elbowing, or even rupture of the enteral probe. The authors report the case of a patient with severe malnutrition concomitant with advanced gastric cancer who underwent jejunostomy because of an incapacity for normal oral feeding. Previous attempts to pass a nasal enteral probe were not successful, even with the aid of endoscopy. Videolaparoscopy was indicated for adequate staging of the neoplasm and for performance of video-assisted jejunostomy. During the procedure, an extensive carcinomatous process was observed that rendered comprehension of the abdominal anatomy extremely difficult. Consequently, while attempting jejunal catheterization, unintentional catheterization of the terminal ileum took place. The authors discuss this first reported case of unintentional ileostomy and review the literature.
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ranking = 0.23841576215115
keywords = obstruction
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14/140. Acute occlusion of left internal mammary artery graft during dual-chamber pacemaker implantation.

    A patient who had undergone bypass surgery 5 yr earlier, including left internal mammary artery (LIMA) grafting to the left anterior descending artery, underwent transvenous dual-chamber permanent pacemaker implantation for persistent advanced atrioventricular block. Intraoperative LIMA graft obstruction occurred, resulting in anterior myocardial infarction that was treated successfully by primary percutaneous transluminal coronary angioplasty and stenting. This is the first report of the occurrence of this complication during pacemaker implantation.
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ranking = 0.23841576215115
keywords = obstruction
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15/140. Upper airway complications in children after bone marrow transplantation.

    OBJECTIVE: To describe the upper and lower airway complications in children during bone marrow transplantation (BMT). STUDY DESIGN: review of medical records of patients requiring airway intervention during BMT over a 4-year period. RESULTS: During the 4-year period, 832 pediatric BMTs were performed. Of these, 87 patients (10.5%) required mechanical ventilation. patients had intubation for a mean of 79 days (range, -7-638 d) after BMT. patients received mechanical ventilation for a mean of 12 days (range, 1-85 d). Duration of ventilation was significantly longer in patients with difficult intubation; in these 54 patients there were 64 intubations. Of these intubations, 19 (30%) were difficult. These difficult intubations occurred in 16 (30%) patients. patients with Hurler syndrome and congenital immunodeficiencies had significantly more difficult intubations than children with leukemia. The incidence of complications causing difficult intubation were difficulty visualizing cords, because of the presence of blood (63%); difficulty visualizing cords, because of edema (19%); anatomically narrowed airway (13%); limited neck extension (13%); and limited jaw opening (6%). The resulting mortality rate was 82% in children requiring intubation. survivors were significantly younger than nonsurvivors. CONCLUSIONS: Pediatric BMT has become increasingly more common. airway management is rarely required during the engraftment phase, but when intervention is required, it is often difficult, particularly in the nonleukemic child, and may require the skills of an otolaryngologist. Representative cases are presented, and management is discussed.
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keywords = airway
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16/140. Gas extravasation complicating laparoscopic extraperitoneal inguinal hernia repair.

    carbon dioxide can extravasate from the abdominal cavity during insufflation and result in pneumomediastinum, pneumothorax, and subcutaneous emphysema. We report a case of unilateral pneumothorax with pneumomediastinum and subcutaneous emphysema after laparoscopic extraperitoneal bilateral inguinal hernia repair. Additionally, we discuss the pathophysiology, diagnostic work-up, and management of this malady. Because of the natural resolution of CO2 pneumothoraces, observation for asymptomatic patients is appropriate, whereas tube thoracostomy should be reserved for symptomatic patients. It is utmost importance to determine the etiology of gas extravastion and consider other complications such as airway or esophageal injury or pulmonary barotrauma.
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keywords = airway
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17/140. Lethal hemoptysis caused by biopsy injury of an abnormal bronchial artery.

    A 62-year-old man with a long history of lung disease developed atelectasis of the right middle lung lobe, caused by a protrusion in the wall of the middle lobe bronchus. A biopsy was performed in the suspicious region. This was immediately followed by massive arterial bleeding into the airways and complicated by cardiac arrest soon after. The bleeding could not be controlled by nonsurgical treatment; the patient died 24 h after the complication because of pulmonary insufficiency. autopsy revealed the bleeding to have been caused by a biopsy injury of a bronchial artery that had run superficially in the bronchial mucosa and had produced the intrabronchial protrusion. Several other abnormal intrabronchial arteries were found peripherally in this lung.
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ranking = 0.33333333333333
keywords = airway
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18/140. Airway fire due to diathermy during tracheostomy in an intensive care patient.

    We describe a case of airway fire in an 83-year-old, critically ill patient. The fire occurred during a surgical tracheostomy under general anaesthesia, following ignition of the tracheal tube by diathermy. After debridement of the burnt tissue and treatment with intravenous antibiotics and glucocorticoids, the patient's respiratory function worsened initially. The patient eventually recovered without long-term sequelae and was discharged from the intensive care unit. The circumstances of this and other similar incidents are reviewed, as are the suggested methods for preventing this frightening occurrence.
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ranking = 0.33333333333333
keywords = airway
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19/140. life-threatening pneumothorax of the ventilated lung during thoracoscopic pleurectomy.

    PURPOSE: To report the case of a patient who underwent right thoracoscopic pleurectomy with lung exclusion and developed contralateral (left) pneumothorax with resulting life-threatening alteration of the respiratory and cardiovascular functions. CLINICAL FEATURES: A 28-yr-old male was admitted to the intensive care unit for a well tolerated, second episode of spontaneous right pneumothorax and scheduled for right thoracoscopic pleurectomy. anesthesia was induced and maintained with sufentanil and propofol. A double lumen endotracheal tube (ETT) was inserted, its correct positioning checked clinically and by fiberoptic bronchoscopy and the patient was placed in the left decubitus position. Approximately one hour into the procedure, during the second period of right pulmonary exclusion, SpO2 values decreased within two minutes to 78%. End tidal capnography (EtCO2) values decreased to 6-8 mmHg within seconds and peak airway pressure increased to values between 50 and 60 cm H2O. Severe cyanosis, sinus bradycardia and arterial hypotension developed. The surgical procedure was stopped, propofol administration discontinued, bipulmonary ventilation reinstituted and the patient placed in the supine position which restored hemodynamic and respiratory function. Inspection and auscultation were consistent with tension left pneumothorax which was evacuated. CONCLUSION: pneumothorax of the ventilated lung during one lung ventilation for thoracoscopic procedures must be diagnosed quickly. Reinstitution of bipulmonary ventilation should probably be the first therapeutic attitude.
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keywords = airway
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20/140. Endotracheal tube fires during carbon dioxide laser surgery on the larynx--a case report.

    Endotracheal tube (ETT) fire is a catastrophic disaster that may occur during laser surgery of the upper airway. Several means are available for protection of polyvinyl chloride (PVC) tube from fire, but they are not perfect in prevention of fires caused by laser beam. The PVC tube is hazardous for carbon dioxide (CO2) laser surgery if it is not well wrapped with metallized foil tape. We report a case that a PVC ETT wrapped with aluminum foil ignited during CO2 laser surgery of the larynx. In this report, we emphasize the shaft of the PVC tube must be completely wrapped with aluminum foil to prevent exposure of any surface if it is used in CO2 laser surgery of the upper aero digestive tract.
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keywords = airway
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