We describe our experience using the laryngeal mask airway (LMA) in children to facilitate diagnostic procedures in fiberoptic bronchoscopy (FOB). Two cases of stridor, two cases of protracted pneumonia, and one case of laryngotracheomalacia were studied. Intravenous atropine (0.02 mg/kg) was given, and induction was carried out by either inhalation of a mixture of halothane-nitrous oxide-oxygen (n = 3) or IV injection of propofol (n = 2). After an adequate depth of anesthesia was obtained, a LMA was introduced. A 2.7-mm-OD flexible fiberoptic bronchoscope was introduced through the LMA and the diagnostic procedure was performed. Ventilation and oxygenation were maintained, and no serious morbidity was associated with the procedure. We found the use of the LMA to facilitate FOB to be useful, easy to perform, and safe, avoiding nasal trauma and providing a patent airway.
Two patients with chest injuries, flail chest and respiratory failure were mechanically ventilated by a system composed of 2 Bennett respirators and an independent source of gas. This system provides high-frequency positive pressure ventilation (HFPPV), low-frequency conventional mechanical ventilation (LFCMV) and high inspiratory flow of fresh gas (HIF), through the independent source. This system made use of the advantages of HFPPV and also solved the problem of possible CO2 retention. Using this system we could ventilate the patients while they were fully conscious and cooperative, thus eliminating the need for sedatives and muscle relaxants. Time of mechanical ventilation was shortened since the internal pneumatic fixation was very good and made it possible for the fractured ribs to unite rapidly. Restoration of spontaneous breathing was immediate after disconnection from the ventilator. We suggest this method as another mode of ventilation for patients with flail chest and respiratory failure.
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