Downfolding of the Epiglottis During Intubation

Postoperative sore throat – know where your airway is positioned

“…White et al conclude that we should reduce the intrathecal dose of bupivacaine 0.5% "towards 1.5 ml" [1]. This is consistent with the findings of Wood and White's earlier findings [2] and the recommendations of ASAP1 [3]. However, it is possible that we can go a lot lower than this volume.…”

“…If we want to compare apples with apples, we need to be absolutely sure that the airway device is positioned correctly in the trachea (TT) or the hypopharynx (SAD). Down-folding of the epiglottis can occur during laryngoscopy and tracheal intubation, which can go unnoticed by the laryngoscopist/ intubator [2,3].…”

“…I use 1.0-1.2 ml of isobaric levobupivacaine 0.5% (5-6 mg), plus 20 lg of fentanyl, made up to a total volume of 3.0 ml with saline, using a double-check procedure previously described [7]. Intrathecal injection is in the lateral position, with the operated side uppermost, contrary to the ASAP1 recommendations [3]. This is more comfortable for positioning the patient than having the operated side downwards, to facilitate a hyperbaric technique.…”

Epidural Lysis of Adhesions and Percutaneous Neuroplasty

“…The therapy is supported by observational studies and case series along with randomized-control trials. The recommendation was also made that this therapy could apply to most patients with post laminectomy syndrome or failed back syn-drome in many circumstances with informed consent [4]. Additionally, current procedural terminology (CPT) codes have been assigned to the two different kinds of adhesiolysis: CPT 62263 for the three-times injections over 2 to 3 days, which has recently changed to 3 injections 6-8 hours apart within 24 hours, usually done in an inpatient hospital setting, and CPT 62264 for the one-time injection series surgery-center model that may need to be repeated 3 to 3.5 times in a 12-month period.…”

Epidural Lysis of Adhesions and Percutaneous Neuroplasty

“…The recommendation was also made that this therapy could apply to most patients with post laminectomy syndrome or failed back syndrome in many circumstances with informed consent. 4 Additionally, current procedural terminology (CPT) codes have been assigned to the two different kinds of adhesiolysis: CPT 62263 for the three-times injections over 2 to 3 days, usually done in an inpatient hospital setting, and CPT 62264 for the one-time injection series surgery-center model that may need to be repeated 3 to 3.5 times in a 12-month period.…”