Airway management of patients undergoing oral cancer surgery: a retrospective study.

OBJECTIVE: This retrospective study aims to describe the airway management and benefits of nasotracheal intubation over tracheostomy in 260 patients with oral cancer undergoing surgery. METHODS AND RESULTS: The medical records of 260 patients undergoing surgery for oral cancer were reviewed for airway management during the perioperative period. Eighteen patients had previous surgery for oral cancer and were scheduled for flap reconstruction, recurrence or other complications. In 28 cases neck movement was restricted and decreased mouth opening was found in 50% of all patients because of a large growth or fixation of tissues of head and neck, oral cavity, pharynx or larynx by tumour, or radiation fibrosis. In 53 patients intubation was undertaken under spontaneous ventilation. In 20 cases the trachea was extubated in the immediate postoperative period. In 220 cases patients were extubated next morning in the intensive care unit. In none of the cases was elective tracheostomy under local anaesthesia performed before surgery for the maintenance of the airway for anaesthesia. Elective tracheostomies were done in 17 cases. Three patients remained intubated for 24-48 h because of a high suspicion of airway obstruction following extubation due to a large pectoralis major flap. These three patients received a tracheostomy because of increased oropharyngeal and laryngeal oedema. In three cases emergency tracheostomies were performed due to upper airway obstruction after extubation and in one case prolonged elective ventilation was required due to severe chest infection. CONCLUSION: Oral cancer patients have a potentially difficult airway but, if managed properly during perioperative period, morbidity and mortality can be reduced or avoided. Oral cancer patients can be managed safely without the routine use of a tracheostomy. Nasotracheal intubation is a safe alternative to tracheostomy in oral cancer patients except in some selected patients.

Rupture of left main bronchus associated with radiotherapy-induced bronchial injury and use of a double-lumen tube in oesophageal cancer surgery.

We report a case of rupture of the left main bronchus in a female patient with oesophageal carcinoma, who had received thoracic radiotherapy preoperatively. Endotracheal intubation was achieved with a left-sided double-lumen tube. After almost three hours of intubation and one and half hours of one-lung ventilation, bronchial injury was detected. Immediate surgical repair of the membranous part of the bronchus was undertaken, as well as completion of the oesophagectomy. Radiotherapy-induced damage to the bronchus was thought to have contributed to the rupture. The presentation, diagnosis and management of intraoperative bronchial rupture are discussed.

24 hour rhythm to the onset of preterm labour.

UNLABELLED: OBJECTIVE To describe the time of onset of contractions which result in preterm delivery to investigate if there is a diurnal influence. DESIGN: The admission register for the neonatal unit was used to identify admissions for prematurity over a three-year period. Obstetric case records were then reviewed to obtain the recorded time of onset of contractions when delivery was preceded by spontaneous labour. SETTING: A maternity hospital in the United Kingdom. MAIN OUTCOME MEASURES: The time of onset of spontaneous contractions which result in preterm labour and delivery. RESULTS: Four hundred and twenty-five women in preterm labour were studied. A significant diurnal rhythm in the timing of onset of contractions was noted with 42% of deliveries occurring in labour which commenced between midnight and 0600 hours. Subgroup analysis indicated that there was a significant rhythm in second trimester preterm labours, male and female babies and that this rhythm was present during both the winter and summer months. CONCLUSION: The periodicity of preterm labour onset demonstrates a rhythm which is similar to the rhythm in the onset of labour at term. Preterm labour most commonly begins between midnight and 0600 hours.

Maternal opiate use: pregnancy outcome in patients managed by a multidisciplinary approach.

The outcome of 39 pregnancies in 35 pregnant opiate users is reported. These women were managed by a multidisciplinary team resulting in 36 live births, one stillbirth. one spontaneous miscarriage and one induced abortion. The majority of patients were stabilised on methadone before the third trimester. The women were characterised by a high prevalence of previous obstetric and medical problems, 43.6% of the women were single and 87.2% unemployed The mean (SD) gestational age was 38.2 +/- 2.3 weeks, mean (SD) birth weight was 2980 +/- 543 g. There were eight cases of preterm deliveries, all occurred beyond 32 weeks' gestation. One preterm and two term babies had a birth weight below the 10th centile. Thirty-two (86.5%) women had a normal vaginal delivery, seven (10.8%) had caesarean section and one (2.7%) had forceps delivery. Comprehensive antenatal care in conjunction with methadone maintenance appears to result in a pregnancy outcome comparable with a general obstetric population.

Percutaneous transhepatic cholangiography using Chiba needle by blind method.

Percutaneous transhepatic cholangiography using Chiba needle by blind method was done on 25 patients with suspected obstructive jaundice. The overall success rate of the procedure was 96% and with few minor complications only.