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At least 91 records · Page 5Linked to original sources
PubMed2000

Traumatic pharyngo-oesophageal perforation in the newborn: a condition mimicking oesophageal atresia.

Two newborn infants with traumatic perforation of the pharyngo-oesophageal region are presented. This injury was induced by pharyngeal suction catheters and/or vigorous attempts at nasogastric or tracheal intubation during resuscitation of the newborn. The true nature of this condition remained unrecognized and the babies were thus referred with a tentative diagnosis of oesophageal atresia. The perforation itself could be treated successfully without surgery, despite a severe complication in one infant resulting from inadvertent use of barium sulphate contrast medium. Raising awareness of the possibility of this injury should help in avoiding this complication by gentle and skilful action during newborn resuscitation, particularly in the premature infant.

Barium Sulfate↗
PubMed2001

Oesophageal perforation presenting as oesophageal atresia in a premature neonate following difficult intubation.

Iatrogenic oesophageal perforation in neonates is well recognized in the medical and surgical literature with intubation injury listed as a possible contributing mechanism besides nasogastric tube placement and suctioning. Diagnosis can be difficult and sometimes confused with other entities. With early diagnosis, nonsurgical management often leads to complete resolution in neonates. We report the case of a 1-day-old premature neonate who was brought to the operating room with the preliminary diagnosis of proximal oesophageal atresia with stump perforation and distal tracheo-esophageal fistula. His intubation for respiratory distress at birth had been difficult due to Pierre-Robin sequence with micrognathia. Oesophagoscopy in the operating room revealed a patent oesophagus but perforations in the pharynx and in the proximal oesophagus with the nasogastric tube entering the pharyngeal perforation. Oesophageal perforation and the limitations of the difficult airway algorithm in small neonates are discussed.

Diagnosis, Differential↗
PubMed2002

[The importance of the esophageal-tracheal-double lumen tube for clinical use and emergencies].

Difficult intubation can unexpectedly occur in clinical practice and emergencies. Oxygenation must be maintained with resumed artificial ventilation. Besides tracheal intubation with an ETT as the "gold standard" of airway management, the esophageal-tracheal Combitube(R) (ETC; Tyco-Healthcare, Neustadt/Donau, Germany; www.combitube.org) is another interesting device that has been used satisfactorily in a variety of circumstances, specially for management of the difficult airway. The ETC has been used during prehospital and hospital emergencies. Now, anesthesiologists have managed the ETC successfully in clinical practice also. The anesthesiological management does not differ from the management in other difficult airway situations. The use of the Combitube needs an appropriate teaching and continuous clinical practice.

Anesthesia, Inhalation↗
PubMed1983

Bacterial endocarditis after Hurst bougienage in a patient with a benign oesophageal stricture.

A case of bacterial endocarditis which proved fatal in a 65-year-old edentulous male Caucasian with rheumatic valvular heart disease is reported. This occurred following dilatation of a benign oesophageal stricture with a Hurst mercury bougie. Transient low grade bacteraemia following upper gastrointestinal intubation is well documented but we are not aware of any published reports on bacterial endocarditis following this procedure and the possible implications of this case are discussed.

Aged↗
PubMed1986

Fever following abdominal surgery. Unusual infectious causes.

Identification of the cause and subsequent specific therapy are indicated for those prolonged or relapsing fevers that follow abdominal surgery. On rare occasions, these fevers can be attributed to potentially life-threatening occult infections, including maxillary sinusitis, acute cholecystitis, antibiotic-related pseudomembranous colitis, toxic shock syndrome, systemic candidiasis, and transfusion-related cytomegalovirus disease, malaria, and babesiosis. Early recognition and appropriate treatment of these infections relieve anxiety, reduce hospital costs, and increase patient survival rates.

Abdomen↗
PubMed1985

Behavioral effects of early lead exposure and subsequent toxocariasis in mice.

Mice were maintained under standard conditions, or treated with lead from birth, until they were approximately 40 d of age. At that time the lead solution was replaced with tap water and all animals were gastrointestinally intubated with either the parasite Toxocara canis or normal saline. At 2-5 wk following intubation the behavioral effects of T. canis in combination with the prior history of lead ingestion were compared to those produced by administration of either T. canis or lead alone or a single saline intubation. Differential group activity scores (cage crosses and standups) in response to changes in the home-cage environment during testing sessions were observed. While the addition of a second tier to the home cage during testing resulted in increased activity scores for all groups, changing the home-cage bedding produced increased activity only in the T. canis alone or prior lead ingestion alone groups. However, there were no differences in the number of parasite larvae found in fresh brain tissue preparations in either the T. canis alone or T. canis plus lead-history combination groups.

Animals↗
PubMed1985

Effect of increased amounts of pectin on a solid-liquid meal digestion in healthy man.

The effect of three concentrations of high-methoxy apple pectin (5, 10, and 15 g), on solid-liquid meal digestion was studied in 12 healthy men by the gastrointestinal intubation technique. The gastric emptying of water and carbohydrates is significantly reduced only after 10 and 15 g pectin. The changes in gastric pH are similar for pectin-free and pectin-containing meals. Cumulative lipase and trypsin outputs are not significantly different with and without pectin. When gastric uronic acid concentration is above 6 g/l, the duodenal absorption of carbohydrates is significantly reduced (p less than 0.001). The mean blood glucose levels with 10 and 15 g pectin are significantly higher than the control values at 180 min (p less than 0.05). Pectin does not modify serum concentrations of secretin, cholecystokinin (CCK), vasoactive intestinal polypeptide (VIP), gastric inhibitory polypeptide (GIP), and somatostatin but serum motilin and gastrin levels are below the control values after high fiber meal.

Adult↗
PubMed2004

Size 2 ProSeal laryngeal mask airway: a randomized, crossover investigation with the standard laryngeal mask airway in paediatric patients.

BACKGROUND: One of the main concerns with the use of the standard laryngeal mask airway (SLMA) in small infants is that its low-pressure seal might be inadequate for positive pressure ventilation so that there is a risk of gas leakage into the stomach with the subsequent risk of regurgitation. The new ProSeal LMA (PLMA) has been shown to form a more effective seal than the SLMA and to facilitate gastric tube placement in adults. The first paediatric size PLMA became available recently. METHODS: Thirty anaesthetized, non-paralysed children aged 46 (19) months, weighing 16 (10-21) kg, were studied. The SLMA and PLMA were inserted in random order into each patient. Airway leak pressure and maximum tidal volume were measured. Ease of insertion, quality of initial airway and fibreoptic position were also determined. Gastric tube placement was assessed for the PLMA. RESULTS: The airway leak pressure and maximum tidal volume were significantly higher for the PLMA (P=0.001). Ease of insertion and quality of initial airway were similar for both devices. Air entry into the stomach occurred more frequently with the SLMA (P=0.005). Gastric tube placement was possible in all patients. CONCLUSIONS: The size 2 PLMA offered some advantages over the same size of SLMA in this crossover investigation. The high reliability of gastric tube placement and the significantly increased airway leak pressure might have important implications for use of this device for positive pressure ventilation in infants.

Air Pressure↗
PubMed2005

A randomized non-crossover study comparing the ProSeal and Classic laryngeal mask airway in anaesthetized children.

BACKGROUND: We tested the hypothesis that ease of insertion, oropharyngeal leak pressure, fibreoptic position, gastric insufflation, and the frequency of mucosal trauma differ between the ProSeal laryngeal mask airway (PLMA) and the classic laryngeal mask airway (cLMA) in anaesthetized children. For the PLMA, we also assessed the ease of gastric tube placement via the PLMA drain tube and measure residual gastric volume. METHODS: 240 consecutive ASA I-III children aged 1-16 yr were randomized for airway management with the ProSeal or cLMA. RESULTS: The time taken to provide an effective airway, the number of insertion attempts, fibreoptic position of the airway tube and frequency of mucosal trauma were similar, but oropharyngeal leak pressure was higher (33 vs 26 cm H(2)O, P<0.0001) and gastric insufflation less common (0 vs 6%, P<0.01) for the PLMA. Gastric tube insertion was successful at the first attempt in 106 of 120, and at the second attempt in 14 of 120. The mean (sd; range) value for residual gastric volume was 2.2 (5.9; 0-30) ml. There were no differences in performance among sizes for the PLMA and the cLMA. CONCLUSIONS: We conclude that ease of insertion, fibreoptic position, and frequency of mucosal trauma are similar for the PLMA and cLMA in children, but oropharyngeal leak pressure is higher and gastric insufflation less common for the PLMA. Gastric tube insertion has a high success rate, provided the PLMA is correctly positioned.

Adolescent↗
PubMed1996

Gastroesophageal reflux and tracheobronchial contamination after cardiac surgery: should a nasogastric tube be routine?

Nasogastric (NG) tubes are routinely used in patients undergoing cardiac surgery. This randomized study was designed to assess gastroesophageal reflux (GER) without a NG tube (control) compared with a NG tube managed either by gravity drainage (gravity) or continuous low-grade suction (suction). Antimony pH probes were placed in the lower esophagus and trachea after induction of anesthesia in 51 patients, and pH was recorded every 5 s until the time of tracheal extubation. GER was defined as reversible decrease in esophageal pH to less than 4.0. No significant difference was found between groups in age, weight, gender, duration of postoperative ventilation, morphine use, or antiemetic use. All indicators of GER were seen more frequently in the gravity group compared with the two other groups (P < 0.001). One episode of sudden decrease in tracheal pH was observed in a patient in the gravity group, indicating tracheal aspiration, which was associated with delayed extubation and postoperative pneumonia. The absence of a NG tube is not associated with reflux, probably since the gastroesophageal sphincter remains competent. NG tubes are not routinely necessary for cardiac surgery in patients without risk factors for GER, and increase reflux risk if managed without low-grade suction.

Aged↗