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2 results

  • Chapter 32 - The Bloody and Bleeding Airway

  • from Section 2 - Airway Management: Clinical Settings and Subspecialties
  • Edited by Tim Cook, Michael Seltz Kristensen
  • Book:
    Core Topics in Airway Management
    Published online:
    03 October 2020
    Print publication:
    03 December 2020, pp 282-289

  • Summary

    Bleeding in the upper airway is an important cause of airway-related death, even in young and otherwise healthy individuals. The estimated lifetime incidence of epistaxis is approximately 60%; post-tonsillectomy haemorrhage occurs in 6–15% of tonsillectomy cases; and bleeding following surgery for malignancy in the upper airway is one of the leading causes of requirement of an emergency front of neck airway. Pre-oxygenation may be difficult or impossible. Cornerstone techniques commonly employed to secure the airway, such as direct/videolaryngoscopy and flexible optical laryngoscopy, may be ineffective due to soiling of the hypopharynx – and the equipment – with blood. Supraglottic airway devices may be employed but are typically of limited efficacy due to the increased risk of aspiration and their potential interference with surgical access to the bleeding site in the hypopharynx, glottis and trachea. The clinician may thus be forced to use other, less familiar techniques and modify their approach to airway management, particularly if bleeding is profuse and/or conventional intubation and airway rescue techniques are predicted to be difficult. Cardiovascular compromise from blood loss may further complicate airway management and anaesthesia. We identify techniques and strategies that may be employed in this situation.

  • TREATMENT OF ENCOPRESIS BY PARENT-MEDIATED BIOFEEDBACK IN A CHILD WITH CORRECTED IMPERFORATE ANUS

  • Peter Griffiths, Harriet Livingstone
  • Journal:
    Behavioural and Cognitive Psychotherapy / Volume 26 / Issue 2 / April 1998
    Published online by Cambridge University Press:
    30 August 2019, pp. 143-152
    Print publication:
    April 1998

  • A six-year-old girl with surgically corrected imperforate anus and chronic faecal soiling was successfully treated by biofeedback. A portable biofeedback machine using an anorectal balloon was constructed and lent to the patient’s mother who administered the treatment at home following instruction in the clinic. Faecal incontinence was replaced by normal bowel evacuation habits after four weeks of the procedure. The effect was durable at least until follow-up at three months. Positive spin-offs were observed. The reversal of the child's encopresis suggested neuromuscular intactness of the anorectalregion despite the congenital malformation. Biofeedback probably compensated for an earlier learning fault. Domiciliary, parent-mediated biofeedback therapy is a cost-effective procedure and may be widely applicable to suitable patients within the population of children with primary expulsive and retentive bowel control disorders.