[Spinal anesthesia in the application of forceps; prophylaxis of shock].
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ICU patients, mainly those who need prolonged ventilatory support, may require tracheostomy, which once was done in the operating room, nowadays is performed in the ICU, as percutaneous dilatational tracheostomy (PDT). Forty two patients 18-72 yrs of age (mean 44 yrs), with varying indications for tracheostomy, had undergone PDT in the ICU under the standard protocol for this procedure. The mean time for completion of the procedure was 10 min. Advantages and complications are reviewed. The difficulties encountered were mainly the anatomical landmarks (10%), difficulties in dilatation (5%) and peristomal oozing (1%). It is concluded that percutaneous dilatational tracheostomy is an easy, cost effective, practical when done at bedside in the ICU, and spares transferring the patient to the operating theater.
Intraoperative air leaks are often treated by a sutureless patch technique using a fibrin tissue-adhesive collagen fleece or synthetic materials with fibrin sealant. Intraoperatively, the technique of using these materials has been troublesome, therefore air leaks fail to close. Akicette has been applied as an easy sutureless patch technique for air leaks. Seven air leaks (5 were lung cancers, 2 were spontaneous pneumothorax) were treated with Akicette. Akicette is simple to operate with, and can easily carry sheet materials. Using Akicette, the sheet materials tightly adhered onto surrounding the pleural defect without any sliding on the wet lung surface. Akicette is feasible tool for a sutureless patch technique and is useful to easily place the sheet materials.