BACKGROUND It has been known that Dexmedetomidine pre-medication enhances the effects of volatile anesthetics, reduces the need of sevoflurane, and facilitates smooth extubation in anesthetized children. This present study was designed to determine the effects of different doses of intravenous dexmedetomidine pre-medication on minimum alveolar concentration of sevoflurane for smooth tracheal ex...

We would like to congratulate Gentile and Siobal on their review article concerning the recent advances in equipment for the treatment of ventilator-associated pneumonia,1 in which they reported different techniques to clear the subglottic secretions that accumulate during intubation. At the time of extubation, they described applying a positive pressure gradient just prior to cuff deflation. T...

Negative pressure pulmonary edema following tracheal extubation is an uncommon and life-threatening complication of patients undergoing endotracheal intubation and general anesthesia for surgical procedures. The common pattern in these cases is the occurrence of an episode of airway obstruction upon emergence from general anesthesia, usually caused by laryngospasm. Patients who are predisposed ...

BACKGROUND The efficacy of corticosteroids in reducing the incidence of postextubation laryngeal oedema is controversial. We aimed to test our hypothesis that methylprednisolone started 12 h before a planned extubation could prevent postextubation laryngeal oedema. METHODS We did a placebo-controlled, double-blind multicentre trial in 761 adults in intensive-care units. Patients who were vent...

Stridor is one of the most frequent causes of early extubation failure. The cuff-leak test may help to identify patients at risk to develop post-extubation laryngeal edema. However the discrimination power of the cuff-leak test is highly variable and can be use, at best, to detect patients at risk to develop edema but should not be used to postpone extubation as tracheal extubation can still be...

OBJECTIVE To describe the frequency and types of tracheal intubation complications and their main causes. METHODS Cross sectional study of patients who were submitted to tracheal intubation for more than 24 hours at the Pediatric ICU of Santa Casa de Misericórdia de São Paulo, between May 1998 and December 1999. Exclusion criteria were previous intubations, surgeries or traumas in the cervica...

Incorrect endotracheal placement of the tracheal tube can lead to serious complications, such as laryngeal nerve paralysis and accidental extubation [1]. In oral and maxillofacial surgery and dental procedure, the head of the patient was covered in drape, and an anesthesiologist cannot often see tracheal tube. In addition, surgeon (or dentist) may move the head of the patient. Flexion of the ne...

BACKGROUND The impact of delays in extubation on operating room (OR) workflow are challenging to assess because such delays may or may not be a bottleneck to the patient leaving the OR. We developed an observational measure that quantifies the influence of extubation times on OR workflow. METHODS The time from dressing on the patient (or its functional equivalent) to tracheal extubation was o...

Background Subglottic stenosis can lead to life-threatening difficult tracheal intubation during general anesthesia. We report a case of difficult tracheal intubation in an 11-month-old female who had unrecognized subglottic stenosis. Case presentation The patient was scheduled for elective correction of a right accessory auricle. She was suspected of having first and second branchial arch sy...