We received 57 completed reports (100% response). The incidence using a unit-based estimation approach was one in 224 (95% confidence interval 179-281). Univariate analyses showed the index cases to be significantly older, heavier, with higher BMI, with Mallampati score recorded and score >1. Multivariate analyses showed that age, BMI, and a recorded Mallampati score were significant independent predictors of failed tracheal intubation. The classical laryngeal mask airway was the most commonly used rescue airway (39/57 cases). There was one emergency surgical airway but no deaths or hypoxic brain injuries. Gastric aspiration occurred in four (8%) index cases. Index cases were more likely to have maternal morbidities (P=0.026) and many babies in both groups were admitted to the neonatal intensive care unit: 21 (37%) vs 29 (27%) (NS). Three babies died--all in the control group.
INCIDENCEThirty cases occurred in males, while 70 were in females, giving a male-female ratio of 30:70= 1: 2-4. The average age of each patient was 69 years. The youngest sufferer was an 11-year-old girl who developed a stricture of the upper and lower thirds of the oesophagus following the ingestion of acetic acid. The youngest patient with a benign stricture of the oesophagus associated with hiatus hernia and reflux was a girl aged 16 years. It was noted that the disease was much more common in the elderly and that 85% of patients were over 60 years of age.
Of 4.52 patients suffering fLom malignancy of the thoracic oesophagus and cardia of the stomach, 381 were treated by oesophagogastrectomy.The need for early diagnosis is stressed in that palliation is all that can be achieoed hy this method of treatment in most cases, hut palliative resection appears to oger the patient a better chance of' survioal and u more satisfactory relief of his distressing symptoms than palliatiue intubation.The hospital mortality has been relatioely high. Howeoer, surgical experience, improved anaesthetic technique and the recent establishment of postoperative intensive cure facilities haue resulted in a marked decrease in this mortality, while still maintaining a high resection rate.The cmses of death and pathology encountered are also discussed.
During damage control laparotomy, surgery is abbreviated to allow for the correction of physiologic disturbances, with a plan to return to the operating theatre for definitive surgical repair. Re-entry into the abdomen is facilitated by temporary abdominal closure (TAC). Skin-only closure is one of the many techniques described for TAC Numerous sources advise against the use of this technique because of the risk of complications. This case report describes the use of skin-only closure during a damage control laparotomy. We reviewed the literature surrounding the various options for TAC to elucidate the potential role of skin-only closure after damage control laparotomy.
| 61 information. The one encouraging fact is that no women died in spite of what I consider less than optimal evaluation and management of the airway in pregnancy.
Comment by Jeffrey S. Lee, MDA fter cesarean section (CS), neuraxial opioids are often
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