The Experts below are selected from a list of 255 Experts worldwide ranked by ideXlab platform
A. Ladra - One of the best experts on this subject based on the ideXlab platform.
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intracranial placement of a Nasotracheal Tube after transnasal trans sphenoidal surgery
BJA: British Journal of Anaesthesia, 2003Co-Authors: Matthias Paul, Michael Dueck, Sandra Kampe, F. Petzke, A. LadraAbstract:Intracranial misplacement of a tracheal Tube during attempted Nasotracheal intubation is a rare, usually lethal complication. Such incidents are associated with fractures of the face and base of the skull. We report inadvertent intracranial placement of a Nasotracheal Tube in a patient who had 2 weeks previously undergone transnasal trans-sphenoidal surgery for a pituitary tumour. One should be aware that transnasal trans-sphenoidal surgery leaves a bony defect in the skull, which is susceptible to perforation by nasally introduced Tubes.
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Intracranial placement of a Nasotracheal Tube after transnasal trans‐sphenoidal surgery
British journal of anaesthesia, 2003Co-Authors: Matthias Paul, Michael Dueck, Sandra Kampe, F. Petzke, A. LadraAbstract:Intracranial misplacement of a tracheal Tube during attempted Nasotracheal intubation is a rare, usually lethal complication. Such incidents are associated with fractures of the face and base of the skull. We report inadvertent intracranial placement of a Nasotracheal Tube in a patient who had 2 weeks previously undergone transnasal trans-sphenoidal surgery for a pituitary tumour. One should be aware that transnasal trans-sphenoidal surgery leaves a bony defect in the skull, which is susceptible to perforation by nasally introduced Tubes.
Matthias Paul - One of the best experts on this subject based on the ideXlab platform.
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intracranial placement of a Nasotracheal Tube after transnasal trans sphenoidal surgery
BJA: British Journal of Anaesthesia, 2003Co-Authors: Matthias Paul, Michael Dueck, Sandra Kampe, F. Petzke, A. LadraAbstract:Intracranial misplacement of a tracheal Tube during attempted Nasotracheal intubation is a rare, usually lethal complication. Such incidents are associated with fractures of the face and base of the skull. We report inadvertent intracranial placement of a Nasotracheal Tube in a patient who had 2 weeks previously undergone transnasal trans-sphenoidal surgery for a pituitary tumour. One should be aware that transnasal trans-sphenoidal surgery leaves a bony defect in the skull, which is susceptible to perforation by nasally introduced Tubes.
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Intracranial placement of a Nasotracheal Tube after transnasal trans‐sphenoidal surgery
British journal of anaesthesia, 2003Co-Authors: Matthias Paul, Michael Dueck, Sandra Kampe, F. Petzke, A. LadraAbstract:Intracranial misplacement of a tracheal Tube during attempted Nasotracheal intubation is a rare, usually lethal complication. Such incidents are associated with fractures of the face and base of the skull. We report inadvertent intracranial placement of a Nasotracheal Tube in a patient who had 2 weeks previously undergone transnasal trans-sphenoidal surgery for a pituitary tumour. One should be aware that transnasal trans-sphenoidal surgery leaves a bony defect in the skull, which is susceptible to perforation by nasally introduced Tubes.
Takeshi Yokoyama - One of the best experts on this subject based on the ideXlab platform.
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Prediction of appropriate formula for Nasotracheal Tube size in developmental disability children
Clinical Oral Investigations, 2020Co-Authors: Masanori Tsukamoto, Shiori Taura, Hitoshi Yamanaka, Takashi Hitosugi, Takeshi YokoyamaAbstract:Objectives Developmental disability children have differences in growth. Therefore, Tube size selection is important for Nasotracheal intubation. In our previous study for healthy children undergoing dental surgery, height was the most suitable factor to predict Nasotracheal Tube size. The aim of this study was to find the most suitable formula for selection of Nasotracheal Tube size for them, retrospectively. Material and methods Developmental disability children aged 2 to 10 years were included in this study. They were intubated Nasotracheally from April 2012 until May 2017. Their actually intubated Tube sizes were checked. The predicted Tube sizes were calculated according to the formulas by the backgrounds: the diameter of the trachea at the 6th cervical (C6), 7th cervical (C7), and 2nd thoracic vertebrae (T2) in X-ray. The actually intubated Tube sizes were compared with predicted sizes. Data were analyzed using Spearman’s regression analysis. Results The Tube sizes with 5.0, 5.5, and 6.0 mm ID were intubated in 75 patients. The age-based formula was the most suitable; the correlation coefficients ( r ^2) were 0.9027 (vs age), 0.5434 (vs height), 0.3779 (vs weight), 0.0785 (vs C6), 0.2279 (vs C7), and 0.3065 (Th2) ( p < 0.01). However, 0.5-mm smaller size Tubes were more frequently intubated actually. Their correspondence rate to the predicted size was 48% (5.0 mm), 52% (5.5 mm), and 39% (6.0 mm), respectively. Conclusion The age-based formula could be the most suitable for predicting Nasotracheal Tube size in developmental disability children aged 2 to 10 years. One smaller size by the age formula was most suitable at first trial Tube. Clinical relevance The present data indicate that the selection of Nasotracheal Tube using one smaller size by the age formula (ID = 4 + age [years]/4) might be useful for developmental disability children.
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Predicting the appropriate size of the uncuffed Nasotracheal Tube for pediatric patients: a retrospective study
Clinical oral investigations, 2018Co-Authors: Masanori Tsukamoto, Hitoshi Yamanaka, Takeshi YokoyamaAbstract:Objectives The selection of an appropriate size of tracheal Tube is important for airway management. For Nasotracheal intubation, passing the nasal cavity should be taken into account for the selection of Tube size. The aim of this study was to investigate the selection of appropriate size of Nasotracheal Tube in pediatric patients retrospectively. Materials and methods The 1-12-year patients underwent dental procedures under general anesthesia intubated Nasotracheally. The correlation between height, age, weight, the tracheal diameters at C6, C7, Th2 on the chest X-ray, and actually performed Tube sizes were calculated. In addition, we compared the relationships between the predicted Tube size and actually the intubated Tube size. Results The Tube sizes intubated actually were between 4.0 and 6.0-mm ID. The formula by height could be most suitable for Tube size. The correspondence rates for the Tube with 4.5- and 5.0-mm ID were 78% and 53%. When they were predicted as 5.5- or 6.0-mm ID, 0.5 mm smaller size Tube were intubated actually; 56% and 70%. When the predicted Tube size was 4.0-mm ID, 0.5 mm larger size Tube was intubated actually; 66%. Conclusions The formula by height could be most suitable for the selection of size for pediatric Nasotracheal intubation. When the predicted Tube size was 5.5 or 6.0-mm ID, 0.5 mm smaller size should be chosen at first. In the case of 4.0-mm ID, 0.5 mm larger size should be chosen for first trial. Clinical relevance The present data indicate that the selection of Nasotracheal Tube using the formula by height might be useful.
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Changes in Nasotracheal Tube depth in response to head and neck movement in children
Acta anaesthesiologica Scandinavica, 2018Co-Authors: Hitoshi Yamanaka, Masanori Tsukamoto, Takashi Hitosugi, Takeshi YokoyamaAbstract:BACKGROUND A tracheal Tube is often inserted via the nasal cavity for dental surgery. The position of the Tube tip is important, given that the head position sometimes changes during surgery. Head movement induces changes in the length of the trachea (t-length) and/or the distance between the nare and the vocal cords (n-v-distance). In this study, we investigated the changes in t-length and n-v-distance in children undergoing Nasotracheal intubation. METHODS Eighty patients aged 2-8 year undergoing dental surgery were enrolled. After Nasotracheal intubation with an uncuffed Nasotracheal Tube (4.5-6.0 mm), the Tube was fixed at the patient's nares. The distance between the Tube tip and the first carina was measured using a fibrescope with the angle between the Frankfort plane and horizontal plane set at 110°. The location of the Tube in relation to the vocal cords was then checked. These measurements were repeated at angles of 80° (flexion) and 130° (extension). The t-length and n-v-distance were then calculated using these measurements. RESULTS On flexion, the t-length shortened significantly from 87.5 ± 10.4 mm to 82.9 ± 10.7 mm (P = 0.017) and the n-v-distance decreased from 128.1 ± 10.7 mm to 125.6 ± 10.4 mm (P = 0.294). On extension, the t-length increased significantly from 87.5 ± 10.4 mm to 92.7 ± 10.1 mm (P = 0.007) and the n-v-distance increased from 128.1 ± 10.7 mm to 129.4 ± 10.7 mm (P = 0.729). The change in t-length was significantly greater than that in the n-v-distance. CONCLUSION A change in the position of the tracheal Tube tip in the trachea depends mainly on changes in t-length during paediatric dental surgery.
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anesthetic management of a patient with chromosome 6p duplication a case report
Journal of Dental Anesthesia and Pain Medicine, 2017Co-Authors: Saori Morinaga, Masanori Tsukamoto, Takeshi YokoyamaAbstract:Chromosome 6p duplication is very rare and clinically characterized by short stature, mental retardation, and congenital heart diseases. Patients with mental retardation may present with poor oral health conditions. Dental treatment may need to be performed under general anesthesia in such patients. Our case report deals with induction of general anesthesia to a patient with chromosome 6p duplication, for dental treatment. The selection of a Nasotracheal Tube of an appropriate size, because of the patient's short stature, was especially important for airway management. In the present case, the patient with chromosome 6p duplication was intubated with a Nasotracheal Tube, which was not age-matched but adapted to the height and physique of the patient.
J E Smith - One of the best experts on this subject based on the ideXlab platform.
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Nasotracheal Tube placement over the fibreoptic laryngoscope
Anaesthesia, 1996Co-Authors: S Hughes, J E SmithAbstract:Summary We have assessed the effectiveness of three tracheal Tube rotational movements in assisting Nasotracheal Tube placement over the fibreoptic laryngoscope. Ninety ASA grade 1 or 2 oral surgery patients undergoing fibreoptic Nasotracheal intubation under general anaesthesia were studied. After the fibrescope had been positioned in the trachea, patients were randomly allocated to one of three groups. In group 1, no rotation was used and the Tube was advanced towards the trachea in the neutral position. In group 2, the Tube was rotated by 90° anticlockwise. In group 3, the Tube was rotated by 180° anticlockwise, then rotated back to 90° anticlockwise (overcorrected rotation). If resistance to the advance was encountered, up to two more attempts were allowed, after further rotational manoeuvres had been made, in accordance with a standard, graduated sequence. There were significantly more successful Tube placements at the first attempt in groups 2 and 3 (93% and 100% respectively) than in group I (63%). It is therefore recommended that 90° anticlockwise or overcorrected 90° anticlockwise Tube rotation is used to facilitate Nasotracheal Tube placement during fibreoptic intubation.
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Nasotracheal Tube placement over the fibreoptic laryngoscope.
Anaesthesia, 1996Co-Authors: S Hughes, J E SmithAbstract:We have assessed the effectiveness of three tracheal Tube rotational movements in assisting Nasotracheal Tube placement over the fibreoptic laryngoscope. Ninety ASA grade 1 or 2 oral surgery patients undergoing fibreoptic Nasotracheal intubation under general anaesthesia were studied. After the fibrescope had been positioned in the trachea, patients were randomly allocated to one of three groups. In group 1, no rotation was used and the Tube was advanced towards the trachea in the neutral position. In group 2, the Tube was rotated by 90 degrees anticlockwise. In group 3, the Tube was rotated by 180 degrees anticlockwise, then rotated back to 90 degrees anticlockwise (overcorrected rotation). If resistance to the advance was encountered, up to two more attempts were allowed, after further rotational manoeuvres had been made, in accordance with a standard, graduated sequence. There were significantly more successful Tube placements at the first attempt in groups 2 and 3 (93% and 100% respectively) than in group 1 (63%). It is therefore recommended that 90 degrees anticlockwise or overcorrected 90 degrees anticlockwise Tube rotation is used to facilitate Nasotracheal Tube placement during fibreoptic intubation.
Robert Cartotto - One of the best experts on this subject based on the ideXlab platform.
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Hypercapnic respiratory failure and partial upper airway obstruction during high frequency oscillatory ventilation in an adult burn patient
Canadian Journal of Anaesthesia, 2002Co-Authors: Andrew B. Cooper, Manuel Gomez, Avinash Islur, Gordon L. Goldenson, Robert CartottoAbstract:Purpose To present a case of severe hypercapnic respiratory failure in an adult burn patient and to describe our clinical problem solving approach during support with an unconventional mode of mechanical ventilation. Clinical features A 19-yr-old male with smoke inhalation and flame burns to 50% total body surface area was admitted to the Ross Tilley Burn Centre. High frequency oscillatory ventilation (HFOV) was initiated on day three for treatment of severe hypoxemia. By day four, the patient met consensus criteria for acute respiratory distress syndrome. On day nine, alveolar ventilation was severely compromised and was characterized by hypercapnea (PaC0_2 136 mmHg) and acidosis (pH 7.10). Attempts to improve CO_2 elimination by a decrease in the HFOV oscillatory frequency and an increase in the amplitude pressure failed. An intentional orotracheal Tube cuff leak was also ineffective. A 6.0-mm Nasotracheal Tube was inserted into the supraglottic hypopharynx to palliate presumed expiratory upper airway obstruction. After Nasotracheal Tube placement, an intentional cuff leak of the orotracheal Tube improved ventilation (PaCO_2 81 mmHg) and relieved the acidosis (pH 7.30). The improvement in ventilation (with normal oxygen saturation) was sustained until the patient’s death from multiple organ dysfunction four days later. Conclusion During HFOV in burn patients, postresuscitation edema of the supraglottic upper airway may cause expiratory upper airway obstruction. The insertion of a Nasotracheal Tube, combined with an intentional orotracheal cuff leak may improve alveolar ventilation during HFOV in such patients. Objectif Présenter un cas de défaillance respiratoire hypercapnique sévère chez un grand brûlé adulte et décrire la démarche clinique adoptée pendant l’établissement d’une ventilation mécanique non traditionnelle. Éléments cliniques Un homme de 19 ans exposé à des flammes et à l’inhalation de fumée a subi des brûlures sur 50 % de la surface corporelle et a été pris en charge au Ross Tilley Burn Centre. La ventilation oscillatoire à haute fréquence (VOHF) a été instaurée au troisième jour postopératoire pour traiter une hypoxémie sévère. Au quatrième jour, la condition du patient présentait tous les critères d’un syndrome de détresse respiratoire. Le neuvième jour, la ventilation alvéolaire était sérieusement compromise et caractérisée par de l’hypercapnie (PaC0_2 136 mmHg) et de l’acidose (pH 7,10). Les tentatives pour améliorer l’élimination du CO_2 en diminuant la fréquence oscillatoire de la VOHF et en augmentant la pression d’amplitude ont échoué. Une fuite provoquée volontairement dans le ballonnet du Tube orotrachéal a été aussi inefficace. Un Tube nasotrachéal de 6,0 mm a été inséré dans l’hypopharynx supraglottique pour pallier l’obstruction présumée des voies respiratoires supérieures. Après la mise en place du Tube nasotrachéal, une fuite intentionnelle du ballonnet du Tube orotrachéal a amélioré la ventilation (PaCO_2 81 mmHg) et fait disparaître l’acidose (pH 7,30). L’amélioration de la ventilation (avec une saturation normale en oxygène) a été maintenue jusqu’au décès du patient, quelques jours plus tard à la suite d’une défaillance multiviscérale. Conclusion Pendant la VOHF chez des grands brûlés, l’œdème des voies respiratoires supraglottiques en période postranimation peut causer une obstruction des voies respiratoires supérieures. L’insertion d’un Tube nasotrachéal, combinée à une fuite provoquée du ballonnet orotrachéal, peut améliorer la ventilation alvéolaire pendant la VOHF chez ces patients.
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Hypercapnic respiratory failure and partial upper airway obstruction during high frequency oscillatory ventilation in an adult burn patient.
Canadian journal of anaesthesia = Journal canadien d'anesthesie, 2002Co-Authors: Andrew B. Cooper, Manuel Gomez, Avinash Islur, Gordon L. Goldenson, Robert CartottoAbstract:To present a case of severe hypercapnic respiratory failure in an adult burn patient and to describe our clinical problem solving approach during support with an unconventional mode of mechanical ventilation. A 19-yr-old male with smoke inhalation and flame burns to 50% total body surface area was admitted to the Ross Tilley Burn Centre. High frequency oscillatory ventilation (HFOV) was initiated on day three for treatment of severe hypoxemia. By day four, the patient met consensus criteria for acute respiratory distress syndrome. On day nine, alveolar ventilation was severely compromised and was characterized by hypercapnea (PaC02 136 mmHg) and acidosis (pH 7.10). Attempts to improve CO2 elimination by a decrease in the HFOV oscillatory frequency and an increase in the amplitude pressure failed. An intentional orotracheal Tube cuff leak was also ineffective. A 6.0-mm Nasotracheal Tube was inserted into the supraglottic hypopharynx to palliate presumed expiratory upper airway obstruction. After Nasotracheal Tube placement, an intentional cuff leak of the orotracheal Tube improved ventilation (PaCO2 81 mmHg) and relieved the acidosis (pH 7.30). The improvement in ventilation (with normal oxygen saturation) was sustained until the patient’s death from multiple organ dysfunction four days later. During HFOV in burn patients, postresuscitation edema of the supraglottic upper airway may cause expiratory upper airway obstruction. The insertion of a Nasotracheal Tube, combined with an intentional orotracheal cuff leak may improve alveolar ventilation during HFOV in such patients.
