Application of lasers in equine upper respiratory surgery

The advantages and disadvantages of various surgical lasers are discussed. Included are aspects of laser safety, anesthesia and analgesia considerations for laser surgery, and diagnostic considerations. Horses with lesions such as ethmoid hematomas, nasal polyps, and lymphoid masses are ideal candidates for laser treatment. Other conditions that are suitably treated with lasers, such as dorsal displacement of the soft palate and entrapment of the epiglottis, are described.

Congenital defects of respiratory system among the children hospitalized in the clinic in years 1983-1989

Congenital defects of respiratory system in children constitute a small percentage of all innate defects. In 1983-1989 in the Clinic Pulmonology and Allergology Medical School in Warsaw hospitalized 2522 children. Authors recognized the congenital defects of respiratory system in 29 cases. The opinions of authors only a complex diagnostic examinations makes it possible in most of the cases to rapidly correct diagnosis and choose proper treatment.

Surgery of the upper respiratory tract in the racehorse

The authors discuss the surgical treatment of selected diseases of the upper airway of the racehorse. Although most of these conditions occur commonly and are easily diagnosed, their surgical management is often less straight-forward and may be surprisingly controversial. The authors' intent is to provide an overview of these problems and give some information regarding current treatment options.

Anesthetic management of laser airway surgery

This brief review of the anesthesiologist's role in the team effort necessary for the safe treatment of airway tumors by laser beam is provided to acquaint the referring physician or medical oncologist with some of the anesthesiologist's operating room concerns and how they are met. The necessity of bringing the patient to a level of maximum physiologic reserve prior to treatment becomes obvious with information gained by scanning this review. The referring physician or medical oncologist aids the patient and the anesthesiologist and surgeon by performing a thorough preoperative cardiopulmonary evaluation and therapeutic intervention, as indicated by patient need. The review includes a description of the actions of the carbon dioxide (CO2) and neodynium-yttrium aluminum garnet (YAG) lasers, "laser safety" for patients and personnel, monitoring, guarding the airway, ignition dangers, and comments on the use of jet and high frequency jet ventilation (HFJV).

[Diseases of the upper aerodigestive tract and neck--clinical aspects and challenges for the radiologist]

Based on the anatomy of the neck, some very characteristic inflammatory or tumorous diseases are demonstrated. The question is raised as to how far the radiologist can help the surgeon to estimate the extent e.g. of an abscess or a malignoma, so that the patient can receive the most adequate treatment.

[Anesthesiologic support of endoscopic laser surgery of the upper respiratory tract]

This paper discusses anesthesiological aspects of laser operations in the nasal cavity and pharynx, describes optimal anesthesiological procedures during endolaryngeal laser operations, and outlines anesthesiological methods during laser endoscopic interventions in the trachea and bronchi. In order to provide safety of anesthesiological support of laser operations of the upper respiratory tract, the present authors recommend to discontinue for no more than 1 to 1.5 min supply of the gas mixture or oxygen. On the basis of their own expertise and analysis of data in the literature, the authors assert that endolaryngeal laser operations, surgery of the trachea and bronchi of children as well as intervention using a rigid bronchoscope in adults should be performed with the help of general anesthesia. Laser operations using a fibrobronchoscope in adults as well as operations of the nasal cavity and pharynx can be carried out using local anesthesia.

Clinical uses of high frequency jet ventilation in anaesthesia

Since 1981, high frequency jet ventilation (HFJV) has been used in 300 patients undergoing surgery, most commonly during i.v. general anaesthesia for endoscopy and surgery of the airways: laryngoscopy, bronchoscopy, laryngeal microsurgery and laser surgery (more than 230 patients); repair of tracheal stenosis, tracheal sleeve pneumonectomy and tracheal sleeve lobectomy. HFJV was administered through a narrow injection catheter inserted in the airway, with a second rigid catheter positioned distally to the injector in the airway for gas sampling and measurement of airway pressure. In all subjects gas exchange was satisfactory, even during tracheoplasty and bronchoplasty.

[Clinical study on transfer into lung tissue and postoperative prophylactic effect of new cephamycin antibiotics, particularly cefotetan and cefbuperazone]

The following findings were obtained in our clinical study on the transfer of cefotetan (CTT) and cefbuperazone (CBPZ), new antibiotics of cephamycin series, into the lung tissue and on their postoperative prophylactic effect. 1. The mean serum concentration 30 minutes after the start of an intravenous drip infusion of 1 g of CTT over a period of 30 minutes was 99.4 micrograms/ml, and it decreased gradually thereafter with the half-life of 2.45 hours. After an intravenous drip infusion of 1 g of CTT over a period of 1 hour, the mean peak concentration of 104.1 micrograms/ml appeared 1 hour after the start of the infusion, and mean concentrations at 2, 4 and 6 hours after the infusion were 63.4, 34.3 and 27.0 micrograms/ml, respectively, with the half-life of 2.35 hours during phase beta. 2. Following 30 minutes of an intravenous drip infusion of CTT, the tissue CTT level in normal lung tissues was Tmax 1.82 hours and Cmax 19.8 micrograms/g. After 1 hour of an intravenous drip infusion the mean concentration in the tissues was at the peak of 39.7 micrograms/g in 2 hours after the start of an administration, while mean levels at 3, 4 and 6 hours after an administration were 32.2, 22.2 and 8.76 micrograms/g, respectively, with Tmax of 1.82 hours and Cmax of 30.5 micrograms/g. 3. Following an intravenous drip infusion of 1 g of CBPZ over a period of 1 hour, the mean serum drug concentration 1 hour after the start of infusion was at its peak, 83.3 micrograms/ml, while mean values at 2, 4 and 6 hours after the start of an administration were, respectively, 40.4, 19.8 and 9.62 micrograms/ml, with the beta-phase half-life of 2.03 hours. 4. By 1 hour after the start of intravenous drip infusion of CBPZ, the mean tissue level in normal lung tissues was at the peak of 31.6 micrograms/g, while mean levels at 3, 4 and 8 hours after an administration were 16.2, 11.0 and 4.56 micrograms/g, respectively, with Tmax of 1.67 hours and Cmax of 21.9 micrograms/g. 5. Infused CBPZ was transferred into bronchiole tissues. Drug concentrations in these tissues at 3 and 5 hours after the start of the infusion were 7.87 and 4.85 micrograms/g, respectively, with their ratios to the peak serum level were 9.4 and 5.8%, respectively.(ABSTRACT TRUNCATED AT 400 WORDS)

Permanent tracheostomy in Equidae: 47 cases (1981-1986)

Between 1981 and 1986, permanent tracheostomy was performed in 46 ponies and 1 adult Quarter Horse. Tracheostomies of 19 ponies and the horse were examined in June 1986 and evaluated for vertical length of stomal orifice (mean = 25.0 +/- 4.7 mm in the ponies and 55 mm in the horse), degree of tracheal obstruction (0/20), regrowth and apposition of epidermis (3/20), and whether or not stomal airflow occurred with nasal occlusion (20/20). In addition, the animals were evaluated to determine whether dyspnea developed during exercise. Records of 27 ponies were evaluated. Six of the 27 were not dyspneic with exercise at their last routine physical examination. Twenty-one ponies had died or had been euthanatized, but only 5 of these deaths were attributed to complications associated with the respiratory tract; 3 ponies had collapsing tracheas and 2 had chronic obstructive pulmonary disease. The permanent tracheostomy technique provided a functional and cosmetic airway and was associated with a low rate of complications.

Pneumonectomy for severe inflammatory lung disease. Results in 64 consecutive cases

Severe inflammatory lung disease resulting in severe unilateral pulmonary pathology necessitating pneumonectomy is still encountered in third world populations. A retrospective study of the last 64 patients undergoing pneumonectomy was performed. The underlying lung pathology was: destroyed lung due to tuberculosis in 33 patients; severe bronchiectasis in 25; necrotizing pneumonia in 4; lung abscess in 1 and hypoplastic lung in 1 patient. The perioperative management of these patients is outlined. Perioperative complications included respiratory failure in 4, secondary haemorrhage in 2 and post-pneumonectomy empyema in 5 patients. There were 2 mortalities (3.1%), both due to contralateral spillage with fulminant respiratory failure. Excellent results were achieved in 89% of the patients.

General anaesthetic management for laser resection of central airway lesions in 85 procedures

The perioperative course of 41 patients undergoing 85 endoscopic laser resections of central airway lesions under general anaesthesia was reviewed. The CO2 laser was used in 60 procedures and the Nd:YAG in 25. Intravenous anaesthesia and Venturi ventilation were utilized for 65 resections; 20 procedures involved predominantly inhalation anaesthesia via the ventilating bronchoscope. Significant intraoperative complications included arterial desaturation (SaO2 less than 90 per cent) in 26 per cent of procedures, and refractory hypertension requiring vasodilator therapy in 19 per cent. Intravenous anaesthesia was associated with a longer duration of recovery room care and a higher incidence of postoperative respiratory complications (delayed extubation, recovery room re-intubation and ventilation, and post-extubation stridor). Inhalation anaesthesia appeared to simplify the intraoperative management and decrease the incidence, duration and severity of immediate postoperative respiratory complications.

The thoracic surgical spectrum of acquired immune deficiency syndrome

The acquired immune deficiency syndrome has presented a complex and, as yet, unsolvable spectrum of pulmonary disease characterized by bizarre infections, pneumothoraces, respiratory distress, and death. Thirty-eight patients underwent 49 surgical procedures during 42 months. Ages of the patients ranged from 24 to 56 years. Surgical procedures included tracheostomy, closure of air leaks, mediastinoscopy, lobectomy, open lung biopsy, and esophagogastrectomy. Hospital mortality was 10 of 38 (24%); the 1 year survival rate was 13 of 38 (34%). Pulmonary infections included Pneumocystis carinii, cytomegalovirus, Microbacterium avium, toxoplasmosis, candidiasis, and Cryptococcus neoformans. Open lung biopsy and surgical closure of air leaks can be accomplished safely with low morbidity. Tracheostomy and ventilatory support should be avoided at present in the majority of patients with this syndrome, as the mortality has been 100% when that stage of the disease is reached.

[Temporary minimal esophagostomy in the surgical treatment of malignant esophago-respiratory fistulas]

Oesophago-bronchial and oesophago-pleural fistulae are serious complications of oesophageal cancers. They occur earlier than is generally believed and, if untreated, result in death caused by septic and respiratory complications. An original two-stage surgical method is reported and illustrated by 3 cases. The first stage consists of excluding the oesophagus at both ends and introducing, through a small oesophagostomy, a Foley's catheter to aspirate the secretions; the cardia is excluded by stapling; jejunostomy is performed by the catheter technique. The second stage consists of oesophageal reconstruction. The functional result is of such quality that the indications for palliative endoscopic intubation, perhaps used too routinely at present, should be revised.