Simultaneous oral and nasal tracheal intubation utilizing a fiberoptic scope in a patient with facial trauma.

We report a case of an oral intubation in a facial trauma patient that required exchanging the oral tube to a nasal endotracheal tube. This was accomplished by utilizing the fiberoptic bronchoscope to introduce a nasal tracheal tube beside the oral tube prior to removal of the oral tube from the trachea. This allowed continuation of oxygenation and ventilation until the airway was subsequently secured with the nasal tracheal tube. This approach may help avoid the loss of the airway and subsequent intervention with a surgical airway under poor conditions.

Methylprednisolone does not influence endotoxin translocation during cardiopulmonary bypass.

This study investigated whether the prophylactic administration of methylprednisolone sodium succinate (MPSS) could prevent an increase in plasma endotoxin levels during cardiac surgery with cardiopulmonary bypass. MPSS (1 g/patient) or saline was given intravenously with induction in the steroid (n = 6) and control (n = 7) groups, respectively. Blood samples were collected preinduction and postinduction, during and after cardiopulmonary bypass, and 1 and 24 hours postoperatively. Plasma endotoxin was determined by a chromogenic Limulus amebocyte lysate assay. There was an intraoperative increase in the level of plasma endotoxin that occurred primarily after initiation of cardiopulmonary bypass and removal of the aortic cross-clamp. Endotoxin at 1 and 24 hours postoperatively was lower than the peak intraoperative levels and approached the preinduction level in both groups. The pump prime and other administered fluids contained low levels of endotoxin that were at or below the preinduction or postinduction level of the patients. MPSS did not prevent or attenuate the degree of endotoxemia during cardiopulmonary bypass. The loss of normal gut mucosal barrier function during cardiopulmonary bypass may result in endotoxemia and/or bacterial translocation, either of which could initiate or contribute to postoperative complications.