Apneic anesthesia for improved endoscopic removal of laryngeal papillomata.

During a 2-year period at Indiana University Medical Center, nine patients underwent 51 endoscopic procedures employing the technique of apneic anesthesia for removal of papillomata involving the larynx. The apneic anesthesia technique affords improved visualization of the larynx and subglottis because the view is unencumbered by an endotracheal tube. This unencumbered view allows a more thorough removal of diseased tissue, especially in the posterior commissure and subglottis. In addition, the absence of an endotracheal tube reduces the risk of a fire occurring in the upper airway and eliminates the chance of physically disseminating papilloma particles into the lower tracheal-bronchial tree or toward the physician--a problem that is inherent in the intermittent jet ventilation technique. No significant complications related to the use of this technique have been encountered; however, the safety of apneic anesthesia is greatly enhanced by using a pulse oximeter and transcutaneous oxygen monitor to continuously monitor arterial oxygen saturation. Details of the apneic anesthesia technique are described, as are the relevant aspects of pulmonary physiology, which must be clearly understood to safely employ this method.

Impaired driving performance in shiftworkers: the role of the circadian system in a multifactorial model.

A substantial and growing percentage of the U.S. work force now works on a rotating shift schedule. The repeated changes in sleep-wake, meal and work times inherent in such schedules conflict with the dictates of the internal biological clock and have adverse consequences for the health of the shiftworker population. An important consequence of this conflict is impaired performance, both on and off the job, as indexed by the increased incidence of motor vehicle accidents in shift workers. In this paper we report the results of a survey administered to rotating shift and straight day workers at a manufacturing plant in the eastern U.S. This survey documents an increased incidence of motor vehicle accidents or "near misses" in which sleepiness was implicated as a cause by the respondent. Complaints of poor sleep and increased sleepiness were also significantly more common in shiftworkers than day workers. Last, shiftworkers reported higher caffeine and alcohol consumption, and were more likely to use alcohol as a sleep aid. Although causal links cannot be established using these associative observations alone, previously reported experience with alteration of shift schedules, improvement of levels of alertness, and reduction in adverse performance outcomes corroborate the possibility of a causal link and suggest potential interventions.