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4 results

  • Chapter 25 - ENT surgery

  • from Section 3 - Specialties
  • Edited by Ian Calder, Adrian Pearce
  • Book:
    Core Topics in Airway Management
    Published online:
    10 January 2011
    Print publication:
    16 December 2010, pp 227-243

  • Summary

    An extubation plan should always be formulated. Extubation in a deep plane of anaesthesia is an advanced technique. One-third of aspiration events occur after extubation. Every extubation technique should ensure minimal interruption in the delivery of oxygen to the patient's lungs, and should extubation fail, ventilation should be achievable with the minimal difficulty or delay. The choice of extubation position reflects a balance between the risks of vomiting post-extubation, and subsequent inhalation and soiling of the lungs, and potential respiratory embarrassment and ease of assisting ventilation. The depth of anaesthesia at the time of extubation is highly important because of the risk of life-threatening laryngospasm. Peri-extubation insertion of a laryngeal mask airway (LMA) is a useful technique for airway maintenance in the recovery period with less airway obstruction and coughing, and higher saturations than either deep or awake extubation. An airway exchange catheter (AEC) is a useful aid.

  • Accuracy of clinical assessment of paediatric obstructive sleep apnoea in two English centres

  • E L Sproson, A M Hogan, C M Hill
  • Journal:
    The Journal of Laryngology & Otology / Volume 123 / Issue 9 / September 2009
    Published online by Cambridge University Press:
    22 May 2009, pp. 1002-1009
    Print publication:
    September 2009
  • Objectives:

    To ascertain the sensitivity and specificity of clinical diagnosis of obstructive sleep apnoea in children, and to determine if a published clinical algorithm identifies those at high risk of post-adenotonsillectomy complications.

    Method:

    Sixty-seven children aged three to eight years underwent clinical assessment and overnight polysomnography.

    Results:

    Polysomnography detected a significant apnoea–hypopnoea index (i.e. ≥5, indicating significant obstructive sleep apnoea) in 13 (43 per cent) children with a clinical diagnosis of obstructive sleep apnoea and in six (19 per cent) children with no such diagnosis. The sensitivity of clinical assessment was 68.4 per cent and the specificity 59.5 per cent. The post-operative risk algorithm failed to identify any high risk children, although in actuality seven had severe obstructive sleep apnoea confirmed by polysomnography.

    Conclusions:

    This study of two English centres confirms that the clinical diagnostic process for obstructive sleep apnoea is reasonably insensitive and has low specificity. The studied algorithm discriminated poorly between children with and without severe obstructive sleep apnoea. Realistic diagnostic screening guidelines for paediatric sleep apnoea are overdue in the UK, where access to polysomnography is limited.

  • 8 - Ovarian hyperstimulation syndrome

  • Edited by Paul Serhal, Caroline Overton
  • Book:
    Good Clinical Practice in Assisted Reproduction
    Published online:
    22 October 2009
    Print publication:
    01 July 2004, pp 146-166

  • Summary

    Ovarian hyperstimulation syndrome (OHSS) is characterized by ovarian enlargement and a shift of fluid from the intravascular to the extravascular space. OHSS is classified into mild OHSS, moderate OHSS, and severe OHSS. Vascular endothelial growth factor is a powerful mediator of vessel permeability. Angiogenin may play a role in neovascularization leading to the development of OHSS. The different complications of OHSS are vascular complications, liver dysfunction, renal complications, respiratory complications, and gastrointestinal complications. Current management of OHSS relies on the prediction and active prevention. Any patient undergoing ovarian stimulation is at risk of OHSS but it appears to be more frequent in younger women (aged less than 35 years) and women with polycystic ovarian syndrome (PCOS). This chapter discusses oestradiol monitoring of ovulation, ultrasonographic monitoring of OHSS, and prevention and treatment of OHS that includes basic treatment and surgical treatment.