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At least 1,189 records · Page 66Linked to original sources
PubMed1975

Cricopharyngeal myotomy: treatment of dysphagia.

Six patients are presented who underwent cricopharyngeus myotomy for dysphagia. The clinical history and cine studies appear to be the most useful assessments in defining patients with dysphagia who may improve after a myotomy. Etiological factors which may precipitate poor coordination of the swallowing mechanism and a relative cricopharyngeus muscle obstruction include neuromuscular disorders, radical oral surgery, central nervous disease, and idiopathic disorders, although the exact physiology of the cricopharyngeus muscle in health and disease is not as yet delineated, the muscle is being implicated in many problems as the inciting factor of upper esophageal dysphagia. The operation of cricopharyngeus myotomy is a relatively simple procedure and should be done with little morbidity and mortality in properly selected cases.

Adult↗
PubMed2001

Laryngotracheal anastomosis: primary and revised procedures.

OBJECTIVES: Acquired upper airway stenosis is usually associated with a complex of pathological conditions at the high tracheal and the subglottic levels. Reported reconstructive techniques include widening by incorporation of grafts, segmental resection, and anastomosis or combined procedures. The management of recurrent stenosis after reconstructive surgery is a major challenge and has rarely been discussed in the literature. The purposes of the present study are to compare the clinical course of primary versus revised reconstructive procedures and to analyze the effect of age, diabetes, chronic lung disease, grading of stenosis, extent of resection, and revised procedures on the operative rate of success. STUDY DESIGN: A cohort study in a tertiary referral medical center. METHODS: The clinical course of 23 consecutive patients undergoing laryngotracheal anastomosis was studied comparing a group of 13 primary with 10 revision procedures. Seventeen patients underwent cricotracheal and six patients thyrotracheal anastomoses. All patients but one were tracheotomized before the definitive reconstructive procedure. Suprahyoid release was routinely performed except for two cases, and only one patient required sternotomy. The Wilcoxon test was used to examine the relationship between preoperative clinical parameters and the postoperative success (i.e., airway patency). RESULTS: Twenty-two of 23 patients (95.6%) had successful decannulation. Four patients required a revision procedure because of repeat stenosis at the site of the anastomosis (2) or distal tracheal malacia (2). Residual airway stenosis of less than 50% was noted in six patients, although only three complained of dyspnea during daily-activity exertion. There was no associated mortality. Complications included subcutaneous emphysema (4), granulation tissue formation (3), pneumonia (2), cardiac arrhythmia (2), and one each of pneumomediastinum, neck hematoma, and urosepsis. Protracted aspirations were noted in one patient who had revision surgery. Age was the only parameter that correlated with postoperative airway patency (P <.07), whereas the presence of chronic obstructive lung disease and diabetes, grade of stenosis, type of surgery, and revision surgery were found to be insignificant. CONCLUSIONS: The clinical course of laryngotracheal anastomosis in primary and revised procedures was similar in our group of patients. The operation can be performed safely, with an expected high rate of success and acceptable morbidity.

Anastomosis, Surgical↗
PubMedDate not supplied

Thiopentone and suxamethonium crash induction. An assessment of the potential hazards.

A technique of 'crash induction' using thiopentone and suxamethonium with cricoid pressure was studied in 100 unselected patients at risk from vomiting or regurgitation. No episode of regurgitation occurred. There was difficulty with intubation due to poor relaxation in 7 patients and, in 61 cases, it was believed that there was some evidence of a potential hazard from raised intra-abdominal pressure other than due to fasciculation. Systolic blood pressure rose more than 20% in 19 patients, and fell more than 20% in 9 patients.

Adolescent↗
PubMed1990

An unusual complication of tracheal intubation.

We report a previously undescribed complication of tracheal intubation. The complication arose as a result of tracheal intubation performed as an emergency procedure in a patient with an abnormal anteriorly placed larynx. Subsequent corrective laryngeal surgery was required after a temporary tracheostomy had been performed.

Adult↗
PubMed1996

A survey of emergency airway management in the United Kingdom.

A postal questionnaire aiming to ascertain the availability of cricothyrotomy and transtracheal ventilation equipment, and experience of its use, was sent to all tutors of the Royal College of Anaesthetists in the United Kingdom and Ireland. The response rate was 74.9%. Almost half of the respondents had experience of cricothyrotomy. The 'Portex Minitrach' (58.6%) was the most commonly used preformed device, followed by the 'William-Cook' cannula (8.5%). The 14-G intravenous cannula (21.1%) was the most frequently improvised cricothyrotomy device. Seventy six percent of all theatres had equipment available for such emergency airway management. Sixty five percent of Portex-Minitrach insertions resulted in complications, more than half of which were serious (total failure to cannulate (17.1%), multiple attempts (20.7%), pneumothorax (8.5%) and severe bleeding (7.3%)). Major complication rates of the 'William-Cook' device and 14-G intravenous cannula were 27.3% and 22.2% respectively. Seventy five percent of patients reported had eventual successful airway management with full recovery, while 9.6% had partial recovery and 15.4% died. Formal training of emergency airway management was practised in 14.2% of anaesthetic departments, while 73.6% had informal training. Twelve percent of the departments did not specifically teach their trainees the skill of emergency airway management.

Airway Obstruction↗
PubMed2006

Needle vs surgical cricothyroidotomy: a short cut to effective ventilation.

Cricothyroidotomy can be performed using three techniques. This literature review seeks to determine which is more appropriate for use in prehospital can't intubate/can't ventilate scenarios where laryngeal mask airways prove ineffective. The common approach of inserting a 14-gauge cannula and using low-pressure ventilation via intermittent occlusion of an opening in oxygen tubing (15 l x min(-1) flow) results in ineffective ventilation within 60 s or less, depending on the degree of airway obstruction. In the absence of a high degree of upper airway obstruction, ventilation can be effective if the cannula is attached to a high pressure (45 psi) jet ventilator, but such devices are rare in UK prehospital practice. A self-inflating bag used with a cuffed tube inserted through a horizontal scalpel incision provides sustained adequate ventilation, has a relatively low complication rate compared to needle cricothyroidotomy and is a skill that can be easily taught to paramedics, nurses and doctors.

Airway Obstruction↗
PubMed1976

A morphometric study of the laryngeal saccule and sinus.

A morphometric study of 111 larynxs from both sexes was performed with the initial intention of assessing the incidence of asymptomatic laryngeal pouches. Certain basic measurements were made also to determine the dimensions of the laryngeal saccule and sinus relative to the height and width of the larynx in the two sexes. Asymptomatic pouches were found in 2 patients, one from each sex and there was no obvious difference in the height of the saccule relative to the height of the larynx in the two sexes. However, since the male larynx was deeper in the anteroposterior plane relative to its height, the male saccule tended to be relatively shallower than the female.

Adolescent↗