PubMed Health⌕ Search

Biomedical subjects

E A Weymuller

Publications and source records attributed to E A Weymuller.

81 records · Page 5Linked to original sources
PubMedDate not supplied

Propofol versus isoflurane for endoscopic sinus surgery.

PURPOSE: A previous retrospective study reported that propofol anesthesia decreased bleeding during endoscopic sinus surgery compared with isoflurane. We performed a prospective study to compare the effects of propofol versus isoflurane on measured blood loss and the surgeon's subjective assessment of operating conditions during endoscopic sinus surgery. PATIENTS AND METHODS: After receiving institutional review board approval and written informed consent, 56 patients undergoing endoscopic sinus surgery were randomly assigned to receive propofol (n = 30) or isoflurane (n = 26) supplemented with nitrous oxide-oxygen and alfentanil. Blood loss was calculated from the hemoglobin concentration in suction canisters. One surgeon, who was blinded to the anesthetic agent, performed every procedure and assessed bleeding as follows: 1, no bleeding; 2, modest bleeding; 3, bleeding interfering with operating conditions and cause for an agent switch; and 4, intolerable bleeding requiring a change in surgical plan. Results were compared in the two anesthetic groups using chi-squared test, unpaired t-test, Mann-Whitney Utest, and a permutation test. A P of .05 was considered significant. RESULTS: Mean bleeding scores were less over time (P = .02) with propofol anesthesia, particularly in surgery in the ethmoid and sphenoid sinuses (P = .03), and the proportion of patients with a mean score >2 was less in the propofol group (30% v 54%; P = .033). Time until discharge to home or to a limited stay in a hospital bed was also less in the propofol group (183 v 243 minutes; P = .019). CONCLUSION: In our study, surgical blood loss was the same for both anesthetic agents overall, but propofol appeared to offer an advantage in terms of subjective improvement in operating conditions, particularly in the ethmoid and sphenoid sinuses.

Adult↗
PubMedDate not supplied

Cricothyroidotomy: the impact of antecedent endotracheal intubation.

In light of the current debate regarding cricothyroidotomy, we elected to study the procedure at our institution. Cricothyroidotomy was instituted whenever tracheotomy was necessary for airway management. After a fairly short period of time, some significant complications of cricothyroidotomy were apparent and the study was aborted prior to achieving statistically significant results. The report reviews 15 consecutive cricothyroidotomies. Five (33%) developed significant complications requiring surgical intervention. Of the five, two had life-threatening airway obstruction. The major underlying factor in patients who developed complications was prolonged intubation prior to the institution of cricothyroidotomy. The study suggests that cricothyroidotomy should not be performed after prolonged intubation. The issue of primary cricothyroidotomy for short-term airway control remains unanswered.

Airway Obstruction↗
PubMedDate not supplied

Quantification of intralaryngeal pressure exerted by endotracheal tubes.

Prolonged endotracheal intubation in critically ill patients has become an accepted routine. One notable consequence of this form of management is injury to the posterior aspect of the glottis, apparently an injury caused by the presence of an endotracheal tube. Utilizing two types of sensing devices, the pressure exerted by endotracheal tubes was measured in the canine larynx via a laryngofissure approach. Pressure in excess of 200 mm Hg was consistently noted in the region of the arytenoid cartilage. A variety of tubes were tested with similar results.

Animals↗
PubMedDate not supplied

Blindness and LeFort III fractures.

Injuries to the nasal frontal complex involve a moderately high degree of optic nerve trauma. This paper reviews opinions from notable experts in the field of maxillofacial trauma on appropriate management for acute facial fractures involving injury to the optic nerve and causing blindness in one eye. The opinions are mixed, but the overall attitude is one of conservatism. It is concluded that the weight of opinion supports a conservative approach consisting of external fixation without mobilization of the fractures, and a delayed cosmetic repair.

Blindness↗
PubMedDate not supplied

Management of difficult airway problems with percutaneous transtracheal ventilation.

Percutaneous transtracheal jet ventilation was used in the management of 13 cases of upper airway obstruction. Cases are subdivided according to the nature of the presenting airway problem. The first group had stable upper airway abnormalities; the second group presented as emergencies with rapidly evolving upper airway obstruction. This technique has two major advantages: 1) it provides rapid access to the airway during acute emergencies; and 2) it provides control of the airway where tissue distortion from head and neck trauma or tumor surgery makes standard anesthetic techniques difficult. Complications including catheter displacement, total expiratory obstruction, pneumothorax, and subcutaneous emphysema have been encountered. The authors conclude that percutaneous transtracheal jet ventilation is effective. However, potential problems exist and an in-depth understanding of the technique is necessary for its appropriate application and successful use.

Adult↗
PubMedDate not supplied

Endoscopic treatment of juvenile nasopharyngeal angiofibroma.

Traditional treatment of juvenile nasopharyngeal angiofibromas (JNAs) has included open surgical approaches for the majority of tumors. At the University of Washington Medical Center (UWMC), endoscopic techniques have been used for the removal of some small JNAs. This report describes the institutional experience in treating these tumors. The medical records of 15 patients at UWMC treated over a 15-year period for JNA were reviewed. Three patients were treated only by an endoscopic approach, and one patient had a combined endoscopic and open procedure. All three of the patients treated only by the endoscopic approach were disease free with a minimum of 24 months follow up. The one patient treated with a combined endoscopic and open approach had recurrence of disease. Endoscopic removal after embolization effectively treated three patients with early stage JNAs. Indications for this procedure are discussed.

Adolescent↗