Pack Placement Research Articles

Current Practices: Antibiotic Use Following Placement of Nasal Packing.

Current Practices: Antibiotic Use Following Placement of Nasal Packing.

Effective Gravel Pack Technique for Well Completion

Sand production occurs when oil and gas is produced alongside reservoir formations at some point in the productive lifecycle of a well, understanding why reservoir produces sand is a crucial step towards managing sand production, the objective of this research is to improve the quality of produced fluid (oil/gas) for easy separation, the study method of this research work was basically a laboratory based sieve analysis of formation sand of a well in consideration, this is designed to achieve the most effective gravel pack grain size to be used, from the result analyzed with careful interpretations as presented, the Niger Delta Well-X formation comprise grain sizes of 0.0788” – 0.0025” range as captured from the available set of sieves used, the concentration of percentage retain falls within grain size 0.0197” – 0.007 1” with 0.0197” having about 41.4% retain by weight with the total grain weight of 737grams to stand at 305grams, while grain size 0.0118” had a percentage retained of 25.5% having a weight of 188grams and 0.0071” had a percentage retain of 12.9% with a weight of 95% respectively, keeping all other size to be 20.1%, for the sorting, 9.4 was calculated from the analysis of this research which makes the gravel pack to be well sorted. Therefore, permeability and plugging challenges are not a problem. The range of gravel size recommended for the gravel pack was kept at a minimum of 0.0727” and a maximum of 0.1639”. A screen size of 55 gauges was calculated to enable effective gravel pack placement operation, which is practical solution to sand production for the well investigated if properly managed.

Mechanical Design and Tactical Placement Technique of Robust and Reliable Battery Pack for Electric Vehicle- A Review

The great sensitivity of lithium-ion battery packs to external factors such pressure, temperature, and dynamic mechanical stresses might result in a potential failure during thermal runaway in an electric car caused by shaking or collision with a car. Enormous electrification of the commercial and public transit industries is hampered, among other things, by concerns about battery pack safety and reliability. In order to solve these problems, this study covers mechanical design elements. Through examples, the paper shows how basic mechanical elements able to incorporated into the design of battery packing to reduce the likelihood of failure and lessen the previously listed safety issues. In addition, the essential elements of a durable The battery pack has been thoroughly examined, and the resources needed to create these elements and satisfy their operational specifications have been determined. A LEAF battery package design example is used to illustrate the strategic battery pack placement technique. Lastly, the fundamental technical design specifications for a durable and dependable battery packing methods are made public by contrasting the disclosed design choices presented in this article with battery pack design.

Comparison of grooved and conventional Macintosh laryngoscope blades for throat pack insertion: A randomized control trial.

Throat pack insertion is required for many otolaryngological surgeries under general anesthesia. To facilitate surgery, an oral Ring, Adair, and Elwyn (RAE) endotracheal tube is used. When the Macintosh blade is used to insert the pack, the tube often moves to the left as per its design. We designed a groove in the Macintosh laryngoscope blade to hold the endotracheal tube in place during pack placement. This study was done to compare the grooved and conventional Macintosh laryngoscope blades for throat pack insertion with respect to the intraoral movement of the tube, ease of packing, time taken, and associated hemodynamic changes in patients who have been intubated with a preformed oral endotracheal tube. This randomized control trial included 80 patients after approval from the institutional ethics committee and CTRI. Informed written consent was taken from all patients. Packing of cases was done with either grooved (group G) or conventional Macintosh laryngoscope blade (group C). Student's t-test, Chi-square test, and Mann-Whitney U test were used to analyze data. The tube remained in the center in 35/40 patients in group G as compared to 10/40 patients in group C (P < 0.0001). Packing the throat was significantly easier (P = 0.005), and time taken to pack the throat was shorter in group G as compared to group C (P = 0.0008). The endotracheal tube remains in the center more often during throat pack insertion using a grooved laryngoscope blade as compared to the conventional Macintosh laryngoscope blade. The grooved blade is easier to use and takes less time to insert the throat pack.

Diagnosis and management of complications following pelvic organ prolapse surgery using a synthetic mesh: French national guidelines for clinical practice

Diagnosis and management of complications following pelvic organ prolapse surgery using a synthetic mesh: French national guidelines for clinical practice

Tranexamic acid for the reduction of bleeding during functional endoscopic sinus surgery.

Tranexamic acid for the reduction of bleeding during functional endoscopic sinus surgery.

The Optimal Hemostasis Duration After Tooth Extraction: A Randomized Controlled Trial.

Background There is a lack of evidence-based practice regarding the duration of pressure pack placement following tooth extraction. This study aimed to compare the incidence of post-extraction bleeding following 60 minutes versus 10 minutes of pressure pack placement. Methodology A randomized controlled trial was conducted at a tertiary care hospital and included patients requiring intra-alveolar tooth extractions. Patients were randomly allocated into the experimental group or control group by a permuted block randomization method. A blinded observer noted the incidence of post-extraction bleeding. Categorical variables were summarized as frequency and percentage. The chi-square test was used for intergroup statistical analysis. P-values <0.05 were considered statistically significant. Results There were 528 participants, 264 of whom were allocated to each group. The incidence of post-extraction bleeding was 8% and 6.8% in the experimental and control groups, respectively. On bivariate analysis, there was no statistically significant difference between the two groups (p = 0.618; relative risk with 95% confidence interval = 1.0). Conclusions In the majority of cases, hemostasis was achieved in 10 minutes. Therefore, removing the pressure pack after 10 minutes may be advised to ensure hemostasis and, ultimately, save chairside time.

Comparative Study of Nutrient Release Pattern from Nutripellet Pack and Polycoat Paper Encapsulated Fertilizer Pack Placed in Soils

Nutripellet pack is a tubular assembly composed of fertilizer pellet, manure pellet and bioinoculants. A laboratory electrolyte release study was conducted to assess the extent of nutrient enrichment by nutrient release from encapsulated fertilizer pellet. Nutripellet pack and fertilizer pellet pack was placed in soil, within a closed container. Periodically the entire soil was removed for the estimation of soil reaction (pH), electrical conductivity (EC) and available forms of N, P and K up to 11 weeks after incubation (WAI). Before the analysis the residual encapsulated pellet was removed. The treatments comprising the sources of fertilizers (N for urea, P for DAP or SSP and K for MOP), levels of nutrient release pore (0, 25 micro pores) in fertilizer pellet and Nutripellet pack (fertilizer pellet + manure pellet) placement in sand, red soil and hill soil. High available N, P and K observed with Nutripellet pack with NP (DAP) K was registered in sand, red and hilly soils.

P-41981402-96 - How much time is sufficient to achieve hemostasis following dental extraction: Few minutes to many minutes- A randomized controlled trial

There is no consensus regarding the duration of pressure pack placement following tooth extraction. The duration varies from 5 minutes to 60 minutes. Standard duration of pressure pack placement following tooth extractions performed on healthy patients needs to be defined. The aim of the study was to determine the duration for which a pressure pack is required to achieve hemostasis following dental extraction. A randomized controlled trial of 192 patients undergoing intralaveolar extractions were recruited by consecutive random sampling and randomized using permuted block randomisation. Patients underwent extractions and pressure packs were placed for 10 or 60 minutes depending upon the group to which they belonged. Incidence of post-extraction bleeding, reactionary and secondary hemorrhage was compared in between groups. 192 participants were included in the study. The majority of the study participants belonged to the 18 to 45 years of age group (49%) and were female (60%). Hemostasis was achieved in the majority of the participants (91%) with the primary pack. 9.4% of participants in the 10 minutes group and 8.3% of participants in the 60 minutes group failed to achieve hemostasis with the primary pack. This difference was not statistically significant (p-value= 0.799). The additional pack requirement was statistically not different (p-value= 0.233) between the 10 minutes group (8.3%) and 60 minutes group (4.2%). Ten minutes is sufficient time to achieve hemostasis following tooth extraction and hence the pressure pack may be removed after ten minutes by the surgeon himself. There is no consensus regarding the duration of pressure pack placement following tooth extraction. The duration varies from 5 minutes to 60 minutes. Standard duration of pressure pack placement following tooth extractions performed on healthy patients needs to be defined. The aim of the study was to determine the duration for which a pressure pack is required to achieve hemostasis following dental extraction. A randomized controlled trial of 192 patients undergoing intralaveolar extractions were recruited by consecutive random sampling and randomized using permuted block randomisation. Patients underwent extractions and pressure packs were placed for 10 or 60 minutes depending upon the group to which they belonged. Incidence of post-extraction bleeding, reactionary and secondary hemorrhage was compared in between groups. 192 participants were included in the study. The majority of the study participants belonged to the 18 to 45 years of age group (49%) and were female (60%). Hemostasis was achieved in the majority of the participants (91%) with the primary pack. 9.4% of participants in the 10 minutes group and 8.3% of participants in the 60 minutes group failed to achieve hemostasis with the primary pack. This difference was not statistically significant (p-value= 0.799). The additional pack requirement was statistically not different (p-value= 0.233) between the 10 minutes group (8.3%) and 60 minutes group (4.2%). Ten minutes is sufficient time to achieve hemostasis following tooth extraction and hence the pressure pack may be removed after ten minutes by the surgeon himself.

Documenting the Impact Potential of a Menthol Cigarette Ban at Point-of-Sale: A Photograph-Based Analysis of the Presence and Placement of Menthol Versus Regular Cigarette Packs on the Shelves of Tobacco Retail Outlets in New York City.

To investigate the absolute and proportionate number of menthol versus regular cigarette packs displayed on the shelves inside tobacco retail outlets (TROs) across New York City (NYC). Photographic surveillance methods were used to capture the presence and proportionate amount of all visible cigarette packs on the shelves inside N = 160 TROs. Statistical analyses examined the absolute and proportionate number of menthol packs in each TRO as a function of NYC borough, the local TRO environment, population smoking rates derived from the NYC Community Health Survey, and other demographic indicators from the American Community Survey. The total number of cigarette packs on the shelves of each TRO and the proportion of menthol packs varied significantly across TROs, averaging about one-quarter of all packs displayed (M = 0.274; SD = .15). Modeling results indicate that the proportion of menthol packs displayed was significantly greater in areas with elevated population smoking rates (odds ratio [OR] = 1.03, CI: 1.01-1.06) and density of TROs per 1000 residents (OR = 1.23; CI: 1.01-1.49), although these associations varied in complex ways with the proportion living under the federal poverty level and the proportion under age 18 years residing within each zip-code. Results of this study demonstrate the utility of photograph-based TRO audit methods for objective, reliable documentation of the presence and proportionate amount of menthol versus other cigarette pack types on TRO shelves and highlight the need to account for sources of variation between small areas when examining the TRO product landscape and evaluating the effectiveness of regulatory actions against menthol. This study describes use of a "hands-free" surveillance technique that offers valuable advantages over traditional retailer surveillance techniques. Comprehensive photographic surveillance data collection allows for more objective measurements of, in this case, the retail outlet's tobacco power wall, as multiple coders can review the same images and interrater reliability can be empirically tested. The results of this analysis highlight the need to account for local variation between small areas when examining TRO product landscapes and the effects of policy changes at the retailer level.

Temperature Optimization Within 2 Uniquely Designed Courier Lockboxes During Extreme Summer Temperatures.

To determine optimal temperature profiles for 2 uniquely designed courier lockboxes (steel vs polymer) by standardizing daily ice (-20ºC) and cold (4-8ºC) pack placement. Paired courier lockboxes were placed outside in direct sunlight. Ambient outdoor and lockbox temperatures were monitored during 2 4-day cycles, and temperature mean and range were determined daily (time frame, 4:00-10:00 pm). Control lockboxes without packs were compared with experimental paired lockboxes with either 2 cold packs placed at 4:00 pm or 4 ice packs placed at 8:00 am and replaced with 4 cold packs at 4:00 pm daily. Cycle 1 mean temperatures within control steel and polymer lockboxes were 31.8ºC (range, 18.4-44.1ºC) and 37.2ºC (range, 27.1-46.7ºC), respectively. The addition of 2 cold packs at 4:00 pm reduced mean temperatures to 29.1ºC (range, 19.1-37.2ºC) and 25.3ºC (range, 20.0-31.6ºC) in steel and polymer boxes, respectively. Cycle 2 mean temperatures within control steel and polymer lockboxes were 28.3ºC (range, 22.4-40.8ºC) and 31.6ºC (range, 23.8-41.0ºC), respectively. The addition of 4 ice packs at 8:00 am and replacement with 4 cold packs at 4:00 pm reduced mean temperatures to 24.3ºC (range, 17.4-27.9ºC) and 13.4ºC (range, 6.6-18.1ºC) in steel and polymer boxes, respectively. Standardizing instructions for ice and cold packs can decrease internal courier lockbox temperatures.

Effect of Throat Pack Placement on the Incidence of Sore Throat and Postoperative Nausea and Vomiting in Septorhinoplasty Patients: A Randomized Controlled Trial.

Advances in surgical and anesthetic techniques have led to a growing interest in performing procedures at ambulatory surgery centers. However, procedures involving the oropharyngeal or nasopharyngeal region may lead to the ingestion of blood, which can lead to postoperative nausea and vomiting (PONV). To date, limited studies have largely failed to demonstrate the benefits of oropharyngeal throat packing. The authors aimed to investigate whether throat packing during elective septorhinoplasty increases the incidence of postoperative throat pain and assess its effects on PONV. A randomized, prospective, single-blinded study was performed on 101 patients undergoing elective septorhinoplasty who received oropharyngeal throat packing vs no packing to compare the incidence of PONV and throat pain in the immediate postoperative period in addition to postoperative day (POD) 1 and 2. The incidence and severity of postoperative throat pain were significantly greater in patients receiving throat packs in the immediate postoperative period and on POD 1. Significant differences in throat pain and incidence between the 2 groups diminished by POD 2. Patients having received throat packs also demonstrated a higher utilization of opioids in postanesthesia care unit. The incidence of PONV did not significantly differ between the 2 cohorts at any point of observations. The results of this study largely agree with previous data that throat packs may contribute to postoperative throat pain while not significantly altering the incidence of PONV. Considering these data, we do not recommend routine utilization of throat packing during elective septorhinoplasty.

Leveraging Novel Label Design to Improve Older Consumers' Use of Medications

Over-the-counter (OTC) medication is a convenient, affordable way for older adults to treat a variety of conditions; older consumers use more OTCs per capita than other people for varied reasons. As with any medication, OTCs carry risks. Because the labels of OTCs are frequently the only information accessed by consumers, labels designed to communicate safety information are paramount for these products. Yet, available studies suggest that consumers do not regularly access the comprehensive information in the Drug Facts Label (DFL) when making purchase or use decisions, tending to rely on information found on the front of the package. Herein, we evaluate how four OTC label formats (standard; standard/highlight; critical warnings on front/highlighted; critical warnings on front not highlighted) affect how aging participants attend to critical information. Sixty-eight participants (65+) engaged a computer-based task answering yes/no questions that required use of labeling information about the warnings or active ingredients (AI). Results indicate that AI information is found accurately and relatively quickly compared to warning information and highlighting and placement on the front of the package had little effect. By contrast, warning information was found slowly and with low accuracy with the standard label, and highlighting and front of pack placement both significantly improved performance. These results suggest that novel labelling strategies could result in more effective, safer use of OTC medicines among older consumers and provide insights that could be used by regulators as they work to improve policy focused on improving mandates for OTC labeling.

A DroneGo Disaster Relief Response System

&lt;p&gt;To support the Puerto Rico hurricane disaster scenario, we develop a DroneGo disaster response system by establishing the following models. First, we establish a location analysis model for ISO containers based on the coverage of video reconnaissance and the priority comparison between the two required missions–medical supply delivery and video reconnaissance. According to the locations of 11 harbors in Puerto Rico, we select three suitable harbors to position three cargo containers called CON 1, 2 and 3 to conduct the missions. Second, we build two packing configuration models to design the packing configuration for containers. In one model, we recommend a drone fleet for CON 1 and 3 according to reconnaissance conditions, and then put drones into containers in order. In another model for CON 2, we determine the type of drones according to the medical supply demands of hospitals. For both models, the number of drones of each type is determined by the enumeration method and the packing placement is determined by the greedy algorithm. The algorithms are coded in Visual C++ and MATLAB. The computational results show that the space utilizations for the three containers are all above 80.8%. Third, we design a drone flight plan model based on graph theory. According to the time and space constraints of drones, we devise flight plans as well as delivery routes and schedule. The computational results show that the coverage of video reconnaissance is up to 70.1%. Finally, we carry out the error and sensitivity analysis, discuss the strengths and weaknesses of our models, and design the future work. In addition, a two-page memo that summarizes our modeling results, conclusions, and recommendations is given at the end of the paper.&lt;/p&gt;

To Evaluate the Duration of Pressure Pack Placement Following Tooth Extraction to Achieve Haemostasis- a Randomised Controlled Clinical Trial

Tooth removal is one of the most common dental procedures done in routine dental practice. Often, dental surgeons are challenged with controlling inadvertent bleeding after a tooth removal. Placing a rolled bundle of moist gauze over the region and instructing the patient to apply bite pressure over the gauze pack is the most common manoeuvre to control bleeding that is routinely performed. Often, dentists advise patients to bite and hold the gauze for about an hour. There is no unanimity among practitioners regarding the ideal time duration for which the bite pressure needs to be applied. Primary control of bleeding occurs by contraction of blood vessels and platelet plug formation, which occludes the vessels lining the socket. This occurs in the first few minutes (4 to 9 minutes). The formation and stabilization of clot is an important but secondary aspect for control of bleeding which takes about an hour. This study aims at answering the question 'Does control of bleeding following tooth removal require the fibrin clot formation and stabilization or is platelet plug formation sufficient?‘ An awareness of the average time duration required for bleeding to stop after tooth removal is required in dental practice and control of bleeding is an essential skill in dentistry. This study aims at quantifying the average time required for control of bleeding from a tooth extraction socket. If bleeding stops within 5 to 10 minutes, it would be advisable for all patients who undergo tooth removal to have their sockets checked for bleeding before being sent home. The need to check for prolonged bleeding has become more necessary in recent times because more patients are on blood thinners. Sometimes they may be unaware themselves or they may misinform the dentist prior to the procedure. If the dentist could remove the pressure pack and ensure that the bleeding has stopped prior to sending the patient home, it could avoid the possible sequelae of persistent bleeding following pack removal at home. Informing the patient that the bleeding has stopped and instructing the patient of care of tooth extraction socket forms an important aspect of risk management.

Analyses of Fluids Used in Gravel Pack Placement in Sand Control Operations

Gravel pack fluids for proppant transport in sand control operations have been analyzed. The two fluids considered have been Xanthan and HEC. Laboratory experiment was conducted on the two fluids to determine their capabilities as carrier fluids. 30Lbs/Mgal and 40Lbs/Mgal of both fluids were considered using Trigonox A-W70 as breaker fluid. The result shows that Xanthan withstood more of the breaker fluid than HEC in terms of sand settling and breaker time. HEC broke at lesser time than Xanthan making Xanthan more capable to hold proppant at downhole conditions while transporting to target depth. The combined analyses of the breaking time, the sand settling capability, the plastic viscosity and pH makes Xanthan more preferable as a gravel pack fluid than Xanthan. However, HEC shows more ease of release of proppant once target depth is reached. Effect of proppant release and cost of proppant supports the choice of HEC as a gravel pack fluids. For optimized operation the combined use of HEC and Xanthan is recommended at calculated depth and downhole condition.

Internal Carotid Blood Flow Responses To The Diving Response In Humans

The immersion of the face in cold water evokes a powerful autonomic reflex known as the diving response. It is activated primarily by stimulation of the trigeminal nerve (TGS) that innervates the areas around the forehead and cheeks, but its physiological effects are also modulated by secondary mechanisms such as apnoea. The diving response is believed to act to preserve oxygen delivery to the heart and brain. We sought to determine the relative importance of the TGS and apnoea components of the diving response to the regulation of cerebral blood flow.In 8 young, healthy volunteers (aged 24 ± 3 yr; 2 women), middle cerebral artery velocity (MCAV; transcranial Doppler), arterial blood pressure (Finometer), heart rate (ECG) and the partial pressure of end‐tidal carbon dioxide (PETCO2) were recorded. In addition, internal carotid artery diameter and velocity were measured (ICAV) using duplex Doppler ultrasound, and internal carotid artery flow (ICAQ) calculated. Cerebral vascular conductance (CVC) was calculated as; MCAV or ICAQ/MAP. TGS was evoked by the placement of ice packs on the forehead and cheeks under two conditions; 1) while performing an end‐expiratory breath‐hold (+BH), and 2) while breathing spontaneously (‐BH). The second condition was always undertaken last and its duration was matched to that of the first condition. Data were averaged at baseline (3 min) and at the end of each manoeuvre (last 10 cardiac cycles) and are presented as mean ± SEM.The apnoea was held for 26 ± 3 s. During combined TGS+BH, mean blood pressure (88 ± 5 vs. 101 ± 4 mmHg), MCAV (67 ± 9 vs. 82 ± 8 cm s−1) and ICAQ (309 ± 42 vs. 386 ± 56 ml min−1) were increased (p&lt;0.05), while MCACVC (0.77 ± 0.11 vs 0.81± 0.08 cm s−1/mmHg) and ICACVC (3.49 ± 0.47 vs. 3.84 ± 0.60 ml min−1/mmHg) remained unchanged (P&lt;0.05), and heart rate tended to decline (71 ± 2 vs. 65 ± 3 bpm; P=0.072). In contrast, during TGS–BH, mean blood pressure increased (87 ± 2 vs. 91 ± 2 mmHg: P&lt;0.01), while MCAV (65 ± 7 vs. 66 ± 7 cm s−1), MCACVC (0.75 ± 0.08 vs. 0.73 ± 0.08 cm s−1/mmHg), ICAQ (304 ± 40 vs. 296 ± 41 ml min−1), ICACVC (3.38 ± 0.48 vs. 3.17 ± 0.47 ml min−1/mmHg) and heart rate (67 ± 4 vs. 66 ± 4 bpm) remained unchanged (P&gt;0.05).In summary, cerebral blood flow increased when TGS was coupled with an apnoea, but the independent activation of TGS did not elicit an increase in cerebral blood flow. These findings suggest that physiological factors associated with breath holding (e.g., pressor response, CO2 accumulation) make the predominate contribution to diving response mediated‐increases in cerebral blood flow in humans.This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

An Atypical Presentation of Hemifacial Spasm Secondary to Neurovascular Compression

We conducted a prospective, randomized, controlled study to investigate the influence of pharyngeal pack placement on postoperative nausea, vomiting, and throat pain after minor oral surgery. Our study group was made up of 80 patients-45 men and 35 women, aged 19 to 52 years (mean: 27.3)-who underwent a minor oral surgical procedure under general anesthesia. Patients were randomly assigned to one of three groups: 20 patients who received a pharyngeal pack under videolaryngoscopic guidance (video guidance group), 20 who had a pack placed blindly (blind insertion group), and 40 patients who received no pack at all (control group). Postoperative nausea occurred in only 4 patients (20%) in the blind insertion group (p < 0.007). No patient experienced postoperative vomiting. Postoperative throat pain occurred in all 20 video guidance patients (100%), in 17 of the blind insertion patients (85%), and in 20 of the controls (50%). The difference between the controls and each of the two pack groups was statistically significant (p < 0.006); the difference between the two pack groups was not significant.

The use of throat packs in pediatric cleft lip/palate surgery: a retrospective study

ObjectivesThroat packs are commonly used to prevent ingestion or aspiration of blood and other debris during cleft lip/palate surgery. However, dislodgement or (partial) retainment after extubation could have serious consequences. The aim of the present study was to investigate the effect of omitting pharyngeal packing during cleft lip/palate surgery on the incidence of early postoperative complications in children.Materials and methodsA retrospective study was performed on all children who underwent cleft lip/palate surgery at the Wilhelmina Children’s Hospital. This study compared the period January 2010 through December 2012 when pharyngeal packing was applied according to local protocol (group A) with the period January 2013 till December 2015 when pharyngeal packing was no longer applied after removal from the protocol (group B). Data were collected for sex, age at operation, cleft lip/palate type, type of repair, lateral incisions, length of hospital stay, and complications in the first 6 weeks after surgery. Early complications included wound dehiscence, postoperative bleeding, infection, fever, upper respiratory tract infection (URTI), and lower respiratory tract infection (LRTI).ResultsThis study included 489 cleft lip/palate operations (group A n = 246, group B n = 243). A total of 39 (15.9%) early complications were recorded in group A and a total of 40 (16.5%) in group B. There were no significant differences (P = 0.902) in complications between the two groups; however, there was a significant difference (P < 0.001) in length of hospital stay between the two groups (group A 3.6 days vs group B 3.2 days).ConclusionOmitting routine placement of throat packs in cleft lip/palate surgery was not associated with an increased early postoperative complication rate. Therefore, the traditional, routine placement of a throat pack during cleft lip/palate surgery can be questioned.Clinical relevanceThe traditional, routine placement of a throat pack during cleft lip/palate surgery can be questioned.

The Effects of Mouth Opening and Throat Pack Placement on Uncuffed Nasal Endotracheal Tube Leakage and Delivered Tidal Volumes in Mechanically Ventilated Pediatric Patients Undergoing Dental Procedures.

Intubation for pediatric patients is frequently performed with an uncuffed endotracheal tube (ETT), which may result in an incomplete tracheal seal, resulting in gas leakage (leak). The purpose of this study was to assess the effect of (1) mouth opening and (2) throat pack placement in sealing and/or minimizing this leak to an acceptable level while providing adequate tidal volumes in mechanically ventilated patients. This prospective study of 2- to 6-year-olds undergoing general anesthesia with nasal intubation for dental procedures in the New York University-Lutheran Medical Center operating room was conducted between March 2015 and October 2015. Three sequential tidal volume (VT) measurements were recorded: postintubation with the neck extended, with mouth opened, and after throat pack placement. Twenty-five subjects were included in the analyses. For subjects in whom no leak was detected, only throat pack placement statistically improved VT. This is in marked contrast to numerically large, statistically significant effects, relative to baseline, for mouth opening (±23.2 mL, p < .009, 21% increase from baseline) and throat pack placement (±46 mL, p < .009, 41% increase from baseline) when a leak was detected. In children 2-6 years of age, nasal intubation with uncuffed ETTs that have incomplete tracheal seal have improved VT with mouth opening and throat pack placement. This finding suggests that the intubation procedure is a process that extends through positioning, mouth opening, and throat pack placement.