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Uso de mascarilla laríngea para fibrobroncoscopía en lactantes durante ventilación mecánica
Revista chilena de enfermedades respiratorias , 2002, DOI: 10.4067/S0717-73482002000200005
Abstract: laryngeal mask (lm) has been used to manage airways during general anesthesia, in both children and adults, to avoid tracheal intubation. lately its use has been extended to perform flexible bronchoscopy (fb). in an infant under mechanical ventilation (mv), most of fb require an endotracheal tube # 4.5 because the smallest instrument with a suction channel has a 3.5 mm diameter. our objective was to evaluate the use of lm while performing fb in patients on mv. patients were sedated (atropine- midazolam and vecuronium), and monitored with transcutaneous oxygen saturation and cardiorespiratory monitor in an intensive care unit setup. lm was introduced, and its position was verified by clinical auscultation. fb olympus bf c-30, with 3.5 mm diameter was used. from december 1997 to october 1998 eleven procedures were done in 6 patients. their mean age was 6.2 months (range: 0.5-33), weight 4.9 kg (2.7-10.5). mv parameters were fio2 0.45 (0.4-1), mip 28.4 cm h2o (20-60) and peep 5,18 cm h2o (3-8). in all patients we used lm # 1.0, with an internal diameter 5.25 mm. indications for fb were: atelectasis (6), tracheobronchomalacia (2), hemoptisis (2) and subglotic stenosis (1). lm was introduced during the first attempt in 9 procedures, without complications. we maintained positive pressure ventilation without displacements of lm. after the fb, the patients were reintubated, with similar parameters compared to prior procedure. to sum up, we found that lm provides a safe artificial airway to ventilate patients who need fb during mechanical ventilation on small endotracheal tubes. this technique allows bronchial visualization, and aspiration and to perform bronchoalveolar lavage to carry out cell counting and cultures
The Diagnostic Yield of Navigational Bronchoscopy Performed with Propofol Deep Sedation  [PDF]
Uma Mohanasundaram,Lawrence A. Ho,Ware G. Kuschner,Rajinder K. Chitkara,James Canfield,Lourdes M. Canfield,Ganesh Krishna
ISRN Endoscopy , 2013, DOI: 10.5402/2013/824693
Abstract: Objective. To describe the diagnostic yield of electromagnetic navigation bronchoscopy (ENB) utilizing propofol for procedural deep sedation. Methods. We conducted a structured retrospective analysis of the medical records of patients who underwent ENB with propofol for the evaluation of pulmonary nodules and masses. We analyzed the relationships between lesion size and location, variance (CT-to-body divergence), and positron emission tomography findings on diagnostic yield. Diagnoses were established by histopathological evaluation and clinical-radiographic followup. Results. 41 patients underwent ENB during the study period. The overall diagnostic yield was 89% (42 of 47 target lesions). Among the 42 positive specimens, the diagnoses were squamous cell carcinoma , adenocarcinoma , small cell carcinoma , adenocarcinoma in situ , coccidioidomycosis , and inflammatory processes . Average lesion size was ?cm and variance ?mm. The diagnostic yield was greater when the lesion size was >4?cm (100%) and when variance was ≤4?mm (91% versus 87%, ). Conclusion. The diagnostic yield of ENB utilizing propofol for procedural deep sedation at our center was excellent. ENB with deep sedation may result in superior diagnostic yield compared with ENB performed with moderate sedation. 1. Introduction The diagnostic yield of flexible fiberoptic bronchoscopy is limited because of the inability to guide the biopsy needle directly to many pulmonary lesions. For lesions <2?cm in diameter, the diagnostic yield is 14% for lesions in the outer third of the chest and up to 31% in the proximal two-thirds [1]. Electromagnetic navigational bronchoscopy (ENB) is an emerging technology that improves the diagnostic yield of bronchoscopy for the assessment of peripheral pulmonary nodules. The diagnostic yield of ENB ranges from 59 to 74%, independent of lesion size and lobar distribution [2, 3]. It is designed to guide bronchoscopic biopsy tools to predetermined locations within the periphery of the bronchial tree. However, despite accurate navigation to within 10?mm of the target center in most cases, the ENB diagnostic failure rate remains clinically significant [4–6]. Respiratory variations causing larger than anticipated navigation errors [4] and dislodgement of biopsy instruments [6] may adversely affect diagnostic yield. Most reports of ENB performance have assessed outcomes among patients receiving procedural moderate sedation or general anesthesia. Our center is one of few in the United States to perform ENB with propofol deep sedation. The goals of our investigation were to
Preliminary report on surgical mask induced deoxygenation during major surgery Comunicación preliminar sobre desoxigenación inducida por la mascarilla quirúrgica durante la cirugía de larga duración  [cached]
A. Beder,U. Buyukkocak,H. Sabuncuoglu,Z.A. Keskil
Neurocirugía , 2008,
Abstract: Objectives. This study was undertaken to evaluate whether the surgeons' oxygen saturation of hemoglobin was affected by the surgical mask or not during major operations. Methods. Repeated measures, longitudinal and prospective observational study was performed on 53 surgeons using a pulse oximeter pre and postoperatively. Results. Our study revealed a decrease in the oxygen saturation of arterial pulsations (SpO2 ) and a slight increase in pulse rates compared to preoperative values in all surgeon groups. The decrease was more prominent in the surgeons aged over 35. Conclusions. Considering our findings, pulse rates of the surgeon's increase and SpO2 decrease after the first hour. This early change in SpO2 may be either due to the facial mask or the operational stress. Since a very small decrease in saturation at this level, reflects a large decrease in PaO2, our findings may have a clinical value for the health workers and the surgeons. Objetivos. Este estudio se realizó para determinar si la saturación de oxígeno del cirujano se afectaba por el uso de la mascarilla, durante intervenciones de larga duración. Métodos. Se hizo un estudio longitudinal y prospectivo en 53 cirujanos con medidas de la hemoglogina realizadas con un oxímetro para medir la saturación del pulso arterial. Se hicieron estudios antes y después de la operación. Resultados. Nuestro estudio puso de manifiesto una disminución de la saturación de oxígeno de las pulsaciones arteriales (SpO2 ) y un ligero aumento de las pulsaciones en comparación con el estado preoperatorio en todos los grupos de cirujanos. La disminución era mayor en el grupo de edad superior a los 35 a os. Conclusiones. Según nuestros hallazgos, el ritmo del pulso aumenta y la concentración de SpO2 disminuye después de la primera hora de la operación. Este cambio temprano de SpO2 puede deberse a la mascarilla o al estrés de la intervención. Puesto que un ligero descenso en la saturación a este nivel refleja una mayor disminución de la PaO2 , nuestros datos pueden tener un valor clínico para la salud del personal sanitario y para los cirujanos.
Anesthesia management of awake craniotomy performed under asleep-awake-asleep technique using laryngeal mask airway: Report of two cases
Vitthal Shrinivas,Sreedhar Rupa,Abraham Mathew
Neurology India , 2008,
Abstract: Asleep-awake-asleep technique of anesthesia is used during awake craniotomy with or without securing airway. We assessed this technique using laryngeal mask airway (LMA) in two patients. Patients underwent awake craniotomy for epilepsy surgery and the removal of a frontotemporal glioma. After anesthesia induction, airway was secured using LMA. Anesthesia was maintained using oxygen, nitrous oxide and sevoflurane, supplemented with an infusion of propofol and remifentanil. Twenty minutes before corticography, anesthesia was discontinued and LMA removed. Both patients were awake and cooperative during the neurological assessment and surgery on eloquent areas. The LMA was reinserted before the closure of the dura and remained in place until the end of surgery. Both patients had no recall of events under anesthesia, although experienced mild pain and discomfort during awake phase of surgery. Both expressed complete satisfaction over the anesthetic management. Asleep-awake-asleep technique using LMA offers airway protection. The painful aspect of surgery can be performed under anesthesia, hence minimizing the duration of stress and pain. Patients remained awake and cooperative throughout the time of neurological testing.
The Professional Medical Journal , 2009,
Abstract: Objectives: To demonstrate the usefulness of Bronchoscopy as a diagnostic tool in various pulmonary disorders. Design: Prospective study. Setting: Nawaz Medicare Hospital Faisalabad. Period: June 2004 to December 2007. Materials & Methods: This study was conducted on 52 patients, 37 were male & 15 were female. Their ages ranged from 26 to 85 years. These patients who under went Bronchoscopy were either suspected cases of bronchogenic carcinoma or had difficult to treat un-resolving pneumonias. Endobronchial biopsies and bronchial aspirates were obtained. Results: In the patients suspected of bronchogenic tumor 66.67% patients turned out to be positive on endobronchial biopsies. Bronchial aspirates were diagnostic in 73.32% cases of un-resolving pneumonias. The commonest symptoms in patients under going Bronchoscopy were haemoptysis and cough. Conclusion: Bronchoscopy is very useful in the diagnosis of suspected cases of bronchogenic carcinoma. Bronchial aspirates are helpful in the diagnosis of un-resolving pneumonias.
The Professional Medical Journal , 2006,
Abstract: One of the common indications for fibreoptic bronchoscopy in clinical practiceis patients presenting with radiological hilar and parahilar mass lesions. The study was aimed at better understandingof disease pattern on fibreoptic bronchoscopy in such patients. Objectives: To determine frequency of variousdiseases confirmed on fibreoptic bronchoscopies conducted for hilar and parahilar radiological opacities. Determine thefrequency of complications during fibreoptic bronchoscopy. Design: Descriptive study. Place and Duration of Study:This study was conducted at Military Hospital Rawalpindi from June 2002 to Dec 2002, which is a tertiary carehospital for armed forces. Materials & Methods: Sixty patients undergoing fibreoptic bronchoscopy for hilar andparahilar opacities were included in the study. Endobronchial biopsies, bronchial washing and brushing were performedfor histopathological and cytological analysis. Results: The most frequent finding on Bronchoscopy was anendobronchial mass lesion in 41 (68.3%) cases followed by inflammatory changes in 5(8.4%) and external compressionin 7(12%) cases. No endobronchial mass was seen in 7(12%) patients. Diagnostic yield was highest in patients in whoma mass lesion was seen on bronchoscopy, yielding a diagnosis in 97.5% of cases. Bronchogenic carcinoma was themost common diagnosis( 87.8%) in such cases with squamous cell carcinoma as the most frequent subtype 24 (58.5%).The diagnostic yield was low when either inflammatory changes, external compression or normal bronchial findings wereobserved on bronchoscopy. Overall Histopathological and cytological examination of the biopsies showed bronchogeniccarcinoma in 40(65%) cases, squamous cell in 28(70%) cases, small cell in 10 (25%) cases and adenocarcinoma in2(5%) cases, squamous metaplasia in 3(5%), non-specific inflammation in 7(10%), chronic non-caseatinggranulomatous inflammation in 2(3.3%) and caseating granuloma (tuberculosis) in 1(1.7%) case. No large cell orundifferentiated carcinoma was seen in this study. No histological diagnosis could be made in 8(14%) cases. Majorbleed occurred in one (1.6%) case who had a highly vascular tumor bleeding on biopsy. Minor bleed was seen in 3(5%)cases and marked fall in O2 saturation was noted in 2(3.3%) patients. No complications were observed in 54(90%)patients. Conclusion: Fibreoptic bronchoscopy is a high yield diagnostic procedure in hilar and parahilar lung shadowsand is completely safe and is highly recommended in all such cases as most will have malignant tumors requiringhistological diagnosis. Tuberculosis is an un
Comparative Study of Intraocular Pressure Changes with Laryngeal Mask Airway and Endotracheal Tube  [PDF]
Pandya Malti J, Agarwal Geeta
National Journal of Community Medicine , 2012,
Abstract: Aims: To evaluate the intraocular pressure changes subsequent to insertion and removal of laryngeal mask airway and endotracheal tube. Methods: The study was conducted in 60 adult patients. A standard general anaesthesia was administered to all patients, after induction of anaesthesia baseline measurements of intraocular pressure was taken, following which patients were divided into two groups. In group-I, airway secured with endotracheal tube and in group –II, with the laryngeal mask airway. Intraocular pressure measurements were done after induction and repeated immediately, three and six minutes after intubation with endotracheal tube or laryngeal mask airway insertion. At the end of surgery, intraocular pressure was measured again, immediately after reversal and three minutes after removal of endotracheal tube or laryngeal mask airway. The intraocular pressure measured after induction of anaesthesia was compared with intraocular pressure values in two groups at different intervals. Results: A statistically significant increase in intraocular pressure was seen in group-I (ETT) as compared to group- II (LMA) (p<0.001) immediately after securing airway and also at the end of surgery immediately after reversal and three minutes after removal of endotracheal tube or laryngeal mask airway. Conclusion: Use of laryngeal mask airway might offer advantages in patients where minimal changes in intraocular pressure are desirable.
Another Way to Use the Laryngeal Mask Airway (LMA)  [PDF]
James Smit, Dennis E. Feierman
Open Journal of Anesthesiology (OJAnes) , 2016, DOI: 10.4236/ojanes.2016.64011
Abstract: The laryngeal mask airway (LMA) has changed airway management. Besides its use as an airway conduit, it is also used to help obtain a secure airway, i.e., it is used to facilitate the placement of an endotracheal tube. We describe a new technique to use in potential difficult pediatric airway.
Progressive Dysphagia Post Laryngeal Mask Airway Intubation
U Noma, R Ali, R Kane, M Donnelly
Journal of Surgical Technique and Case Report , 2009,
Abstract: The laryngeal mask airway (LMA) is an important addition to the anaesthetic equipments; however its use may involve some important complications. We report an unusual and potentially serious complication arising from the use of this equipment. A 58 year old man underwent cataract surgery under general anaesthesia with a laryngeal mask airway. He woke up complaining of sore-throat which progressed to dysphagia and odynophagia over the next three days. The patient was found to have necrotic tissue and defects on the posterior pharyngeal wall which was managed conservatively.
Inferior alveolar nerve injury with laryngeal mask airway: a case report
Deepak Hanumanthaiah, Anil Ranganath
Journal of Medical Case Reports , 2011, DOI: 10.1186/1752-1947-5-560
Abstract: All abbreviations for laryngeal mask airway written as LMA should be written in full as laryngeal mask airway.Dr Sarmud Masud was a co-author on our article [1]. We have tried to contact Dr Sarmad Masud regarding the publication of this correction article, but have been unsuccessful. We no reason to believe that Dr Sarmad Masud would object to this publication.
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