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Biomedical subjects

Jonathan L Benumof

Publications and source records attributed to Jonathan L Benumof.

13 recordsLinked to original sources
PubMed2002

Obstructive sleep apnea in the adult obese patient: implications for airway management.

Adult obese patients with suspected or sleep test confirmed OSA present a formidable challenge throughout the perioperative period. Life-threatening problems can arise with respect to tracheal intubation, tracheal extubation, and providing satisfactory postoperative analgesia. Tracheal intubation and extubation decisions in obese patients with either a presumptive and/or sleep study diagnosis of OSA must be made within the context that there may be excess pharyngeal tissue that cannot be visualized by routine examination, and the literature indicates an increased risk of intubation difficulty. Regional anesthesia for postoperative pain control is desirable (although such management is not necessary or possible for many of these patients). If opioids are used for the extubated postoperative patient, then one must keep in mind an increased risk of pharyngeal collapse and consider the need for continuous visual and electronic monitoring. The exact management of each sleep apnea patient with regard to intubation, extubation, and pain control requires judgment and is a function of many anesthesia, medical, and surgical considerations.

Anesthesia↗
PubMed2002

Current status of the Combitube: a review of the literature.

The Combitube (Tyco-Healthcare-Kendall-Sheridan, Mansfield, MA) is an easily inserted and highly efficacious device to be used as an alternative airway whenever conventional ventilation fails. The Combitube allows ventilation and oxygenation whether the device locates in the esophagus (very common) or the trachea (rare). In this report, we review studies that suggest the Combitube is a valuable and effective airway in the emergency and prehospital settings, in cardiopulmonary resuscitation, in elective surgery, and in critically ill patients in the intensive care unit. Also reviewed are studies that demonstrate the superiority of the Combitube over other supraglottic ventilatory devices in resuscitation with respect to success rates with insertion and ventilation. Contrary to the Laryngeal Mask Airway, the Combitube may help in patients with limited mouth opening. The Combitube may be of special benefit in patients with massive bleeding or regurgitation, and it minimizes the risk of aspiration.

Emergencies↗
PubMed2002

Tongue piercing and obstetric anesthesia: is there cause for concern?

The practice of oral tissue piercing, until recently, has been limited mainly to various native tribes in Africa. However, in recent years, body piercing (including oral tissue piercing), has become increasingly popular in the United States and Europe. We present a case of an obstetric patient who presented for emergency postpartum surgery with fixated tongue jewelry in situ, which resulted in trauma to the tongue and difficult airway management. The difficult airway management consisted of tongue bleeding at the time of laryngoscopy and tongue edema at extubation. We consider these two events to be near misses of "cannot intubate" and "cannot ventilate" situations, respectively. Because the popularity of body piercing is increasing in our society, it is reasonable to expect that the incidence of oral jewelry interference with airway management will also increase. Based on this experience, we advise laboring patients with oral jewelry to remove the hardware before receiving anesthesia for safety reasons.

Adult↗
PubMed2002

Near tracheal extubation because of edema of the face and tongue.

IMPLICATIONS: Edema of the face and tongue can cause migration of the endotracheal tube out of the trachea. The present case illustrates the importance of preventing this potentially disastrous complication because reintubation might be impossible when the edema is severe.

Edema↗