Even in the absence of formal Emergency Medical Services, improvements in the process of prehospital trauma care are possible by building on existing, although informal, patterns of prehospital transport.
Perioperative airway management in patients with oro-facial cancers who has undergone chemo/or radiotherapy poses a great challenge to the anaesthesiologist. These challenges are mainly due to either a mass in the oral cavity or a limited mouth opening making intubation difficult or a major facial defect making mask ventilation difficult. We present our first time experience in a 27-year-old man with a malignant lymphoma of the right cheek who had undergone chemotherapy and needed plastic surgery to restore the face.
Background: The main function of the endotracheal tube (ETT) cuff is to ensure a tight seal between the tracheal wall and the endotracheal tube to prevent stomach contents from entering the trachea during ventilation thus preventing aspiration. Whereas excessive inflation of the cuff is associated with complications as a result of impaired blood supply to the trachea mucosa, low inflation pressure puts the patient at risk of aspiration. This study sought to find the accuracy of correctly estimating the cuff pressure and whether experience has effect on the accuracy. Methods: After approval from the Ethics Committee, we observed 199 patients who had general anaesthesia and had been intubated at the Komfo Anokye Teaching Hospital, Kumasi Ghana. Anaesthesia practitioners were blinded to the study. The endotracheal cuff pressure was measured using a low pressure manometer. The experience of the Anaesthetist was also noted. Results: Only 26% of the cuff pressures measured were within the acceptable range of 20-30 cm H 2 O. 4.5% of the pressures measured were below the acceptable minimum value of 20 cm H 2 O hence exposing the patient to the risk of aspiration. 68% of the cuff pressures measured were above the maximum pressure of 30 cm H 2 O. Physician anaesthetists were likely to inflate the cuff correctly. They had average inflation pressures of 24 cm H 2 O with minimum and maximum inflation pressures of 15 cm H 2 O and 32 cm H 2 O respectively. Resident physician anaesthetists inflate the endotracheal pressures moderately high, an average of 41.64 cm H 2 O. Nurse anaesthetists and student nurse anaesthetists had a tendency to overinflate the endotracheal cuff above the recommended range of 20-30 cm H 2 O. Their mean inflating pressures were 64.7 and 68.54 respectively. Conclusion: ETT cuff pressures measured by the low pressure aneroid manometer in patients undergoing general anaesthesia in Komfo Anokye Teaching Hospital are routinely high and are significantly higher when inflated by nurse anaesthetists, student nurse anaesthetists and Anaesthesia residents.
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