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Zeppelin Mail
Zeppelins carried a great deal of mail, mostly because zeppelin first flight covers and other philatelic covers were prized by stamp collectors and the postal revenue from these items financed much of the cost of operating the zeppelins.
For information about covers from specific ships, visit:
- Graf Zeppelin Mail (LZ-127)
- Hindenburg Mail (LZ-129)
- Graf Zeppelin Mail (LZ-130)
- USS Akron/Macon Mail
- Zeppelin Mail Forgeries
Zeppelins were the fastest way to send mail across the ocean in their day, and so some commercial mail also exists, especially on the South Atlantic route. LZ-127's service to South America cut mail time from weeks to days and was especially popular among businessmen.
Hindenburg's 2-1/2 day service was the fastest way to send mail between Europe and North America in 1936, when ocean liners took five days or more to cross the Atlantic. Hindenburg's irregular schedule made the service unappealing for most business uses, but no faster way to send mail existed until May, 1939, when Pan American Airways inaugurated airmail service across the North Atlantic in Boeing 314 Clipper flying boats.
Zeppelins did have mail competition across the South Atlantic beginning in 1934, when the German airline Deutsche Luft Hansa began a multi-leg airmail service between Europe and South America which crossed the Atlantic at its narrowest point, between Gambia in Africa and Natal in Brazil, offering a coordinated mail service between zeppelins and airplanes.
I welcome comments and emails, but please note that for various reasons I don't like to offer an opinion on the value or authenticity of zeppelin covers or other items of airship memorabilia.
{ 19 comments… read them below or add one }
- June 21, 2015 at 11:51 am
Have a German stamp dated 13.2.1930. Most of the franking shows…
"Amerikanische-……….. Within the circular franking are "Bremen- New York".
Doubt its a Zepplin, but what is it then…plane? V. doubtful. Possibly ship? Not had any luck yet on the web, but I'm not used to this sort of search, so can anyone advise, please?
Cheers, John Rollando
- July 20, 2015 at 5:10 pm
Full transcript probably reads "Deutsche-Amerikanishe Seepost – Bremen-New York". If it's a double circle most probably the Bremen or Columbus (Europa not commissioned at that date), if single circle could be any of the other NDL or Hapag steamers serving the North Atlantic route.
- April 9, 2015 at 5:46 am
How does one obtain information on particular flights. I am interested in tracing a route and information about how many passengers, the amount of mail carried on each leg, etc.
- April 21, 2013 at 11:07 am
My wife has a post card showing the Rauchsalon(sitting area) on the LZ 129 Hindenberg with two stamps one of which is the 50D with a picture of the Hindenberg on it.It was sent from the Hindenberg to her aunt and it is post marked LUFTSCIFF HINDENBERG,25.6.1936 .The post card descibes the senders view over Gatwick England,Amsterdam and down the Rhine to Frankfurt-I thought this might be of interest and obviously am questioning as to how unique it is-WMGoldberg
- October 22, 2012 at 3:28 pm
The latest English version of a Michel Zepplin catalog I can find is a 2003 copy. Has a newer edition been published and could you recommend a source?
Member APS
- August 1, 2012 at 11:07 am
I cannot find any information as to the postal rates for Zeppelin mail from the U.S. Why were there 65c, $1.30, $2.65 and 50c stamps? What rates did these pay?
- April 18, 2016 at 12:17 am
This is a hard topic to research, but as best I found out the 65c was for a postcard and $1.30 on one segment of the total flight, and $2.60 carried a letter all the way. $3.90 (and aren't we lucky they didn't issue another stamp for that?) would cover the round trip mailing of a letter. These were the 1930 rates. I see some covers with all 3 1930 stamps, but believe that was for philatelic reasons. As for the 1933 stamp, it carried a letter across the Atlantic for just 50c (it was, after all, deep in the Depression).
- November 21, 2010 at 1:50 pm
I have a zeppelin cover posted from Addis Abeba, Ethiopia. Did a zeppelin land in Addis? I can find no confirming info about this. Thanks.
- November 26, 2010 at 12:23 pm
Mail was often dispatched from places not served by zeppelins; the mail was sent by traditional means to a zeppelin departure point (such as Frankfurt), from which it was dispatched across the Atlantic by zeppelin and then continued its journey to the final destination by traditional means if necessary.
- September 18, 2009 at 11:48 am
Thanks for the information. I did not purchase the cover, and glad now that I did not. Sounds like questionable advertising. I appreciate your response.
- June 7, 2009 at 6:01 pm
I am considering the purchase of a postal cover whose cachet pictures a drawing of the "Hindenburg" and an unidentified single engine monoplane. Above the cachet are the words "Per Airship HINDENBURG", and beneath that the word, "Registered". The letter is franked with three 1936 Winter Olympic stamps and a Zeppelin stamp. The letter was postmarked on April 27, 1936, at Leipzig; and addressed to a person in Brooklyn, New York. One of the markings is a red, round stamp with the words printed in a circular
format with the words, " Deustsche Luftpost Europa Nordamerica." My question: With a postmark of April 27, 1936, is it reasonable to assume that the letter was carried on the Hindenburg on its first flight to America? Thank you for your assistance.
- June 10, 2009 at 8:34 am
For various reasons, I don't offer advice about the authenticity of value of particular items, and I could not comment on the authenticity of an item without seeing it personally. (I would also need information about the backstamps to even guess whether it was carried on a particular flight). I am sorry I cannot be of more assistance, but thank you for visiting the site and posting your comment.
- August 26, 2009 at 12:20 pm
April 27th 1936 is the wrong cancellation date for a letter mailed on the First
North American Flight . That flight ocurred on May 6 – 14 , 1936 and is the flight carried cover is listed
in the American Air Mail catalog as Z-404, worth only about $30.00.
Also something else is wrong. The German Olympic stamps were not issued
until July or August 1936 and appeared on the envelopes of the August 5 to 11th flight of the Hindenburg. AAMS Cat. # Z-416 .
- March 24, 2009 at 7:02 pm
Hi, I have a lot of old Zep covers and post cards from different countries (mostly Germany, Norway, Switzerland, US). The Sieger Zeppelin catalog that I have is pretty old ('92). Where can I get the most current covers and post cards catalog?
I' going to sell the whole collection (about 200 pcs. overall) and I want to find out the latest catalog prices for the stuff I have.
Thank you,
- March 25, 2009 at 7:16 am
@ Nick:
You can get a more recent catalog from Hermann E. Sieger GmbH, but while these catalogs are an invaluable historical resource, and I highly recommend them for that purpose, they are not an infallible source of information about pricing, since pricing is affected by so many market factors. The best use of the catalog for pricing information is to give you a general idea of which covers are more valuable than others, in relative terms, but you can't use the catalog to determine exactly how much a dealer or collector would pay for your collection.
- August 7, 2009 at 12:03 pm
There is another Sieger cataglog that was published in 2002, maybe
even another one. Although it is still dated it is still the best catalog
to use. Be sure and adjust your prices from the listed Euros to U.S. $$$.
Ford U. Ross member Zeppelin Collectors Club and the AAMS.
Does your collection include any flown U.S. NAVY or other BLIMP covers?
You may email me direct at firstname.lastname@example.com These are not
listed in any printed catalogs.
- August 26, 2009 at 11:37 am
You will have to check with a dealer for a copy the Latest Seiger, 2001.
There is a later catalog, 2005 issue by FROST, It has their latest
prices in it but some are high. firstname.lastname@example.com
Member AAMS; ZCC, etc.
Leave a Comment

subset: commoncrawl


text:
John Williams, a professional engineer, agrees to testify as an expert witness for the firm of Jones & Black in a court case. In return, the firm promises to pay Williams $1500 plus expenses for his services.
(a) Is this a lawful contract? State the reasons for your decision.
(b) Suppose Williams agrees to accept $2500 if Jones wins, but only expenses if Jones loses. Is this a lawful contract? State your reasons.


text:
Star Trek Into Darkness is now available on iTunes ($14.99 SD/19.99 HD) and you can, of course, watch it on your Apple TV. The movie hits iTunes three weeks before the DVD release (September 10th), and, as noticed by 9to5Mac, it's "the first major movie available on digital mediums like iTunes prior to DVD sales".
Apple seeded the third beta of the Apple TV 5.4, a couple of days back with a few minor bug fixes. Internet connection issues, iTunes Radio bugs, problems while switching between multiple accounts, playback issues and a huge number of AirPlay music bugs have been resolved
Update: Google released an iOS app that lets you set up and manage your Chromecast.
It may look like Apple TV has finally got its worthy opponent. After the disasters with Nexus Q and Google TV, Google finally thinks they've hit the spot with Chromecast. Released yesterday, Chromecast is a HDMI dongle that can stream online content directly to your TV, via an Android or even an iOS device (Windows, Mac OS and Chrome OS are supported too).
According to Digitimes, "rumors are circulating in the market" that Apple is in talks with LG to buy their 55- and 65-inch Ultra HD TV panels for a future Apple TV set. Digitimes sources stated that Apple is still testing the technology and hasn't reached the agreement with LG yet. The sources claim Apple may also consider Sharp as a potential supplier.
People's love for AirPlay continues unabated as recent report by a market research outfit shows that Apple TV worldwide sales are over half of all dedicated streaming boxes. A report by Frost & Sullivan dubbed the Consumer Video Devices Market report indicates that Apple TV devices global sales account for 56.1 percent, with Roku coming in second at 21.5 percent and TiVo third with a mere 6.5 percent.


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ACROSS MISSISSIPPI — Fall planting of the state's winter wheat crop is on schedule, and early-season growth looks good in fields planted so far. According to the U.S. Department of Agriculture's Oct. 27 report, 28 percent of the state's expected wheat crop had been planted. Unlike spring, when all row crops were well behind schedule, this estimate puts wheat exactly ...Read More »
Tag Archives: winter wheat
USDA: State's winter wheat harvest up 14 percent
ACROSS MISSISSIPPI — Mississippi's winter wheat harvest grew 14 percent this year. The U.S. Department of Agriculture announced the total yesterday, saying the state's farmers reaped 22.3 million bushels, up from 19.7 million in 2012. The number of acres harvested in the state rose 12 percent to 385,000. Yield grew slightly to 58 bushels per acre. Mississippi's yield is much ...Read More »
Wet, cool weather impacted winter wheat's growth, harvest
ACROSS MISSISSIPPI — Producers are bringing in Mississippi's amber waves of grain later than usual, but sunny weather has allowed them to make strong progress on the winter wheat harvest during the last two weeks. Wet conditions that began in February and cooler-than-normal conditions in March, April and most of May delayed the crop's maturity. Erick Larson, small grains agronomist ...Read More »
State's winter wheat crop struggling with cool weather
ACROSS MISSISSIPPI — Cool temperatures through March kept some Mississippians comfortable, but they slowed the development of wheat, the state's only row crop grown through winter. Erick Larson, corn and wheat state specialist with the Mississippi State University Extension Service, said wheat acreage is high this year, with 420,000 acres planted in the fall. State growers planted 500,000 acres in ...Read More »
Winter wheat planting lags compared to last year
ACROSS MISSISSIPPI — Growing winter wheat in Mississippi leaves no rest for the weary, as planting begins just as soon as the summer row crops are out of the field. The U.S. Department of Agriculture predicted the state's winter wheat was 29 percent planted by Oct. 31. It is on schedule for the five-year average, but a good bit behind ...Read More »


text:
OSHA News Release - (Archived) Table of Contents
OSHA News Release – Region 2
U.S. Department of Labor
Region 2 News Release: 05-281-NEW/BOS 2005-030
Friday, February 18, 2005
Contact: Ted Fitzgerald
Phone: (617) 565-2074
Fatal Trench Collapse at Cohoes Worksite
ALBANY, N.Y. -- The U.S. Labor Department's Occupational Safety and Health Administration (OSHA) has cited an Albany construction contractor for an unguarded trench and other safety hazards following the death of one of its workers at a Cohoes worksite.
An employee of K & M Construction Inc. died July 21, 2004, after the nine-foot-deep excavation in which he was working collapsed on him. The accident took place at the Brighton Pointe housing complex construction site off Western Ave. in Cohoes, where K & M was installing a storm sewer system.
OSHA's inspection determined that the excavation lacked any form of cave-in protection. Safety standards require that all excavations five feet or deeper be protected against the collapse of their sidewalls. Protection can include shoring the excavation's walls or using a protective trenchbox, but neither safeguard was in use at the time of the accident.
"Cave-in protection is necessary to prevent accidents just like this one," said John Tomich, OSHA's Albany area director. "The walls of a trench can collapse without warning and with great force, trapping workers beneath tons of soil before they have a chance to react or escape."
The inspection identified additional hazards, including piles of excavated material placed too close to the trench's edge, no proper means for workers to safely exit the trench, employees working underneath the operating bucket of a track-hoe removing soil from the trench, and no protective helmets for workers.
As a result, K & M Construction was cited for five alleged serious violations of the Occupational Safety and Health Act and faces $5,800 in proposed fines. OSHA defines a serious violation as a condition where there is a substantial possibility that death or serious physical harm can result to an employee.
The company has elected to contest its citations and proposed fines before the independent Occupational Safety and Health Review Commission. OSHA's Albany area office conducted the inspection. Its telephone number is (518) 464-4338. OSHA offers a "Quick Card" about trenching safety at the Web site: http://www.osha.gov/Publications/trench/trench_safety_tips_card.pdf.
Employers are responsible for providing a safe and healthful workplace for their employees. OSHA's role is to assure the safety and health of America's workers by setting and enforcing standards; providing training, outreach and education; establishing partnerships; and encouraging continual improvement in workplace safety and health. For more information, visit www.osha.gov.
U.S. Labor Department releases are accessible on the Internet at www.dol.gov. The information in this news release will be made available in alternate format upon request (large print, Braille, audio tape or disc) from the COAST office. Please specify which news release when placing your request at (202) 693-7765 or TTY (202) 693-7755. The U.S. Department of Labor is committed to providing America's employers and employees with easy access to understandable information on how to comply with its laws and regulations. For more information, please visit www.dol.gov/compliance.
|OSHA News Release - (Archived) Table of Contents


text:
Iv recently installed Suse 10 OSS on my Pc after gettting so annoyed with Micro$oft and they rubbish Os's. Its all installed no probs so I wnet around installing UT2004 on they system. It all installed fine but when i came to fire it up it would get the UT splase screen and no further. So I had a look in the graphics ection of Yast and found 3d acceleration was disabled so I turned it on logged out and back in again to restart x server and tryed again. This time it got past the splas screen and went through the videos but they were flashing on and off with black and going very slow and juddery. I have also tryed Quake 4 with similar results. I have also downloaded and installed the drivers of the ATI site but it still wont work! I have a GeCube ATI 9250 256Mb grafics card. I have also noticed that it is being displayed as ATI RV280 5960 in SaX2. Is it using the wrong dirvers for it or what!?!?!
All help on this would be very much aperciated!


text:
The 2016 Commencement ceremony has been moved outside to NELSON STADIUM. The time of the ceremony will remain the same: Saturday, May 14 at 2:00 p.m. Seating in the stadium is open to all guests of graduates. Doors will open at 1:00 p.m.
In addition to being able to view the ceremony online, we will be offering an indoor viewing area in O'Connell 107, close to the Campus Center where the graduation brunch will be held. This remote viewing area may be a good option for people who do not feel comfortable sitting at an outdoor ceremony in the stadium.
Below is some context for the decision to move the 2016 ceremony outside:
Due to fire code regulations at the Carroll P.E. Center and a recent reminder by the Fire Marshal, and given that we have a record number of students graduating, the College recently announced that we would need to issue tickets this year rather than having open seating as planned. We received an overwhelming response to the notice about ticketing at Commencement, and thus plans are in motion to move the ceremony outside to Nelson Stadium, where seating can remain open. We understand the concerns and frustrations of our students and their families, and we have taken your suggestions to heart.
In the phone calls and emails the College received in response to the ticketing announcement, the overwhelming message was that you want and expect your family, friends, and support network to be there by your side, celebrating this huge accomplishment with you. We are proud that our students value their communities so strongly, and we couldn't agree more. You have worked hard to get to this moment, and we want graduation to be a special and memorable day for you and those who love and support you.
The Commencement ceremony for the Carroll College Class of 2016 will be held on Saturday, May 14, 2016. A more detailed list of graduation events is included below.
Cap & Gown Distribution
Wednesday 10:00 AM - 3:00 PM, Thursday 9:00 AM - 12:00 PM, O'Connell Hall Lobby & Conference Rooms
Pick up your cap, gown, hood, Baccalaureate tickets, brunch tickets, and line-up number.
At this time, you may bring items for the class time capsule. Smaller mementos like your ID cards, nametags, and photos are best because space is limited.
Be sure you have submitted your graduate survey, completed your financial aid exit interview and cleared all bills (parking tickets, library fines, Wellness Center charges, student account payments, etc.) beforehand.
Graduation Rehearsal
1:00 PM, PE Center
Come learn all of the details for Commencement Day. You will also practice lining up, processing in, and walking across the stage. Rehearsal is mandatory for all graduates.
President's Toast
3:00 PM, St. Charles Steps
Join your classmates for the President's Toast to the Class of 2016, followed by the Unveiling of Bricks. This event will begin on the steps of St. Charles and will move to the Alumni Walk near St. Al's. Graduates will also fill their class time capsule. Families and special guests are invited.
Baccalaureate Mass
10:00 AM, Cathedral of St. Helena
Graduates assemble on the south lawn of the Cathedral at 9:30 a.m. In case of inclement weather, a rain plan will be announced. Immediately following Mass, you will proceed to the front steps of the Cathedral for a class photograph. Because of limited seating capacity in the Cathedral, admission to Baccalaureate is by ticket only. Each graduate is issued TWO (2) tickets for family members or guests; tickets grant admission to the main level of the Cathedral but do not guarantee a seat since space is extremely limited. Additional seating is set up in the lower level of the Cathedral in the Brondel Center, where the Mass will be simulcast and Communion will be distributed. Doors to the Cathedral open at 8:30 a.m.
Commencement Brunch
11:30 AM - 1:00 PM, Campus Center
Commencement Brunch for graduates, families, and guests is offered at the Carroll College dining hall. Tickets are $15 each, with children age 10 and under charged $8 (Graduates are free!). Tickets must be purchased online by Thursday, May 5th. All tickets will be distributed at cap and gown pick-up. No charge for graduates, but you STILL NEED TO ORDER YOUR TICKET. The deadline to order brunch tickets has now passed.
2:00 PM, NELSON STADIUM - Please note location change!
Degree candidates assemble at 1:30 p.m. underneath the stadium. Friends and family of graduates are encouraged to arrive early to select suitable seats. Doors to the stadium will open at 1:00 p.m.
I want to extend my sincere congratulations to you as a parent. Your guidance, moral support, and financial assistance have played an important part in your daughter or son's college journey. Thank you for entrusting Carroll College with your student. Now it is time to celebrate your son or daughter's significant achievement!
If you have questions or need additional information, please feel free to call the Registrar's Office at (406) 447-5435.
Cassie E. Hall
Helena Photography will be taking a class and individual photographs at graduation. Kevin Hudson, the owner of Helena Photography, will be sending information to graduates and their families about how to order pictures. He can also be contacted via www.helenaphotography.com
Graduation Announcements
Standard graduation announcements can be ordered at the Carroll Bookstore at the cost of $1.50 each. For personalized graduation announcements, visit jostens.com to place your order.
Need Lodging?
Families planning to seek lodging in the Helena area should make your reservations as soon as possible. For information about lodging, visit the official Travel Montana website.
Special Accommodations
Guests who might need special seating accommodations during the Commencement ceremony, such as wheelchair access or seating on a lower level, can contact the Registrar's Office at (406) 447-5435. We will do our best to help meet your needs, but with a record number of graduates in 2016 these accommodations will need to be limited to one seat for the person with special needs and one companion.
Brunch Tickets
Carroll graduates, students, families and guests are encouraged to join in the Commencement Brunch. Brunch tickets must be purchased online by Thursday, May 5th, and will not be available at the door. Tickets are $15 per person, with a reduced price for children under the age of 10 at $8 per child. No charge for graduates, but you STILL NEED TO ORDER YOUR TICKET. The deadline to order brunch tickets has now passed.
Additional Questions
If you have any questions regarding rehearsal, Baccalaureate Mass, or Commencement, please feel free to stop by the Registrar's Office, call (406) 447-5435, or email firstname.lastname@example.com.


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Hurray! My old hood... I grew up right by Macquarie. Are you in Sydney now?
Vanessa SchneiderShared publicly -
Google Earth Outreach is now live in Australia and New Zealand! The team's in Sydney right now kicking things off at Macquarie University, announcing partner projects and grants. Later this week we're hosting hands-on mapping workshops with 75 non-profit partners. Exciting stuff!
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Anesthetic management of patients with mediastinal masses remains challenging as acute cardiorespiratory decompensation may follow induction of anesthesia. We describe a 57 year old lady with massive retrosternal goiter and severe intrathoracic tracheal compression who had a total thyroidectomy. Comprehensive contingency plans were an essential prerequisite for successful management of difficult airway, including multidisciplinary involvement of otorhinolaryngologic and cardiothoracic surgeons preparing for rigid bronchoscopy and cardiopulmonary bypass. Awake oral fiberoptic intubation was performed under dexmedetomidine sedation. Severe tracheal narrowing necessitated usage of a 5.0 mm uncuffed flexometallic endotracheal tube. Anesthesia was maintained with sevoflurane and dexmedetomidine infusion with target controlled infusion of remifentanil as analgesia. No muscle relaxant was given. Surgical manipulation led to intermittent total tracheal compression and inadequate ventilation. The tumor was successfully removed via the cervical approach. A close working relationship between anesthesiologists and surgeons was the key to the safe use of anesthesia and uneventful recovery of this patient.
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Congenital tracheal stenosis (CTS), though rare, is important because the mortality and morbidity rates are high in infants. Especially, associated congenital heart disease (CHD) in these infants may compound the effects of airway pathology. A 3-week-old patient with long-segmental tracheal stenosis below an anomalous right-upper lobe (RUL) bronchus had undergone a total correction of double outlet right ventricle. On third postoperative day, hypercarbia developed, and severe airway obstruction and atelectasis were detected. An emergency slide tracheoplasty was performed under cardiopulmonary bypass (CPB). The patient recovered well after the surgery. Thus, special attention needs to be paid during the postoperative intensive care of patients with congenital tracheal anomalies. Early detection and prompt diagnosis of airway obstruction can help reduce the morbidity and mortality rates. Further, it is important to select the suitable treatment of CTS associated with CHD.
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Feng, Zhichun
International Journal of Clinical and Experimental Medicine
Objectives: Pulmonary artery sling (PA sling) is frequently associated with tracheal and/or bronchial stenosis. Most PA sling patients receive left pulmonary artery (LPA) re-implantation and tracheoplasty under the cardiopulmonary bypass, but the postoperative complications of tracheoplasty remain a great challenge. In this study, we reviewed 14 PA sling children who received surgery in our hospital, and tried to find out whether tracheoplasty could be avoided or not. Methods: A total of 14 patients receiving surgery due to PA sling/tracheal stenosis were recruited. Complete tracheal ring was confirmed by fiberoptic bronchoscopy in all the patients preoperatively. The clinical outcome and the severity of trachea stenosis (tracheal diameter and length) were evaluated, and effectiveness of various managements was analyzed. Results: Fourteen PA sling/tracheal stenosis children underwent surgical treatment. Three patients needed intubation and mechanical ventilation for severe respiratory symptoms preoperatively. Eight patients received LPA re-implantation alone to relieve the trachea compression, and slide tracheoplasty was performed in one patient for extubation failure who finally died of air leakage. Six patients received LPA re-implantation and tracheal intervention simultaneously. Three patients received slide tracheoplasty, and one was discharged after recovery. The remaining 3 patients received tracheal stent implantation, but finally died. The diameter/length (%) in the survivors without tracheal intervention was significantly higher than that in patients with tracheal intervention. Conclusions: Patients with PA sling undergoing LPA re-implantation achieved a good outcome. Diameter/length (%) may be a more reliable indicator used for determination of tracheal intervention in surgical management of PA sling.
Pulmonary artery sling; left pulmonary artery; implantation
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Surgical treatment of postintubation tracheal stenosis: Iranian experience of effect of previous tracheostomy
Hashemzadeh, Shahryar
Hashemzadeh, Khosrow
Kakaei, Farzad
Aligholipour, Raheleh
Ghabili, Kamyar
International Journal of General Medicine
Postintubation tracheal stenosis remains the most common indication for tracheal surgery. In the event of a rapid and progressive course of the disease after extubation, surgical approaches such as primary resection and anastomosis or various methods of tracheoplasty should be selected. We report our experience with surgical management of moderate to severe postintubation tracheal stenosis. We also compared intraoperative variables in postintubation tracheal stenosis between those with and without previous tracheostomy.
Over a 5-year period from June 2005 to July 2010, 50 patients aged 14–64 years with moderate (50%–70% of the lumen) to severe (>70%) postintubation tracheal stenosis underwent resection and primary anastomosis. Patients were followed up to assess the surgical outcome. To study the effect of previous tracheostomy on treatment, surgical variables were compared between patients with previous tracheostomy (group A, n = 27) and those without previous tracheostomy (group B, n = 23).
Resection and primary anastomosis was performed via either cervical incision (45 patients) or right thoracotomy (five patients). In two patients with subglottic stenosis, complete resection of the tracheal lesion and anterior portion of cricoid cartilage was performed, and the remaining trachea was anastomosed to the thyroid cartilage using a Montgomery T-tube. There was only one perioperative death in a patient with a tracheo-innominate fistula. The length of the resected segment, number of resected rings, and subsequent duration of surgery were significantly greater in group A compared with group B (P < 0.05). Six months after surgery, the outcome was satisfactory to excellent in 47 (95.9%) patients.
This surgical approach leads to highly successful results in the treatment of moderate to severe postintubation tracheal stenosis. In addition, previous tracheostomy might prolong the duration of surgery and increase the need for postoperative interventions due to an increase in the length and number of resected tracheal segments. Therefore, in the event of emergency tracheostomy in postintubation tracheal stenosis, insertion of the tracheostomy tube close to the stenotic segment is recommended.
trachea; tracheostomy; tracheal stenosis; intubation; tracheal resection
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Microbubbles detection during cardiopulmonary bypass with transoesophageal echocardiography: a case report
Zanatta, Paolo
Bosco, Enrico
Salandin, Valeria
Salvador, Loris
Valfrè, Carlo
Sorbara, Carlo
Cases Journal
Microembolic signals are usually detected with transcranial doppler during cardiac surgery.
This report focuses on suggesting the transesophageal echocardiography as a different diagnostic approach to detect microemboli during cardiopulmonary bypass.
Case presentation
A 58 year old male patient, caucasian race, was operated on video assisted minimally invasive mitral valve repair using right minithoracotomy approach. His past medical history included an uncontrolled hypertension, dyslipidemia, insulin dependent diabetes mellitus, carotid arteries stenosis. The extracorporeal circulation was performed with femoral-femoral artery and venous approach. Negative pressure for vacuum assist venous drainage was applied in order to facilitate venous blood return. The patient had a brain monitoring with bilateral transcranial doppler of middle cerebral arteries and a double channels electroencephalogram. A three dimensional transesophageal echocardiography to evaluate the mitral valve repair was performed.
During the cardiopulmonary bypass a significant microembolic activity was detected in the middle cerebral arteries spectrum velocities due to gas embolism from venous return. Simultaneous recording of microbubbles was also observed on the descending thoracic aorta transesophageal echo views.
During the aortic cross-clamping time the transesophageal echocardiography can be useful as an alternative method to assess the amount of gas embolism coming from cardiopulmonary bypass. These informations can promote immediate interaction between perfusionist, surgeon and anesthesiologist to perform adequate manoeuvres in order to reduce the microembolism during extracorporeal circulation.
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Extracorporeal Lung Support Technologies – Bridge to Recovery and Bridge to Lung Transplantation in Adult Patients
Ontario Health Technology Assessment Series
Executive Summary
For cases of acute respiratory distress syndrome (ARDS) and progressive chronic respiratory failure, the first choice or treatment is mechanical ventilation. For decades, this method has been used to support critically ill patients in respiratory failure. Despite its life-saving potential, however, several experimental and clinical studies have suggested that ventilator-induced lung injury can adversely affect the lungs and patient outcomes. Current opinion is that by reducing the pressure and volume of gas delivered to the lungs during mechanical ventilation, the stress applied to the lungs is eased, enabling them to rest and recover. In addition, mechanical ventilation may fail to provide adequate gas exchange, thus patients may suffer from severe hypoxia and hypercapnea. For these reasons, extracorporeal lung support technologies may play an important role in the clinical management of patients with lung failure, allowing not only the transfer of oxygen and carbon dioxide (CO2) but also buying the lungs the time needed to rest and heal.
The objective of this analysis was to assess the effectiveness, safety, and cost-effectiveness of extracorporeal lung support technologies in the improvement of pulmonary gas exchange and the survival of adult patients with acute pulmonary failure and those with end-stage chronic progressive lung disease as a bridge to lung transplantation (LTx). The application of these technologies in primary graft dysfunction (PGD) after LTx is beyond the scope of this review and is not discussed.
Clinical Applications of Extracorporeal Lung Support
Extracorporeal lung support technologies [i.e., Interventional Lung Assist (ILA) and extracorporeal membrane oxygenation (ECMO)] have been advocated for use in the treatment of patients with respiratory failure. These techniques do not treat the underlying lung condition; rather, they improve gas exchange while enabling the implantation of a protective ventilation strategy to prevent further damage to the lung tissues imposed by the ventilator. As such, extracorporeal lung support technologies have been used in three major lung failure case types:
As a bridge to recovery in acute lung failure – for patients with injured or diseased lungs to give their lungs time to heal and regain normal physiologic function.
As a bridge to LTx – for patients with irreversible end stage lung disease requiring LTx.
As a bridge to recovery after LTx – used as lung support for patients with PGD or severe hypoxemia.
Ex-Vivo Lung Perfusion and Assessment
Recently, the evaluation and reconditioning of donor lungs ex-vivo has been introduced into clinical practice as a method of improving the rate of donor lung utilization. Generally, about 15% to 20% of donor lungs are suitable for LTx, but these figures may increase with the use of ex-vivo lung perfusion. The ex-vivo evaluation and reconditioning of donor lungs is currently performed at the Toronto General Hospital (TGH) and preliminary results have been encouraging (Personal communication, clinical expert, December 17, 2009). If its effectiveness is confirmed, the use of the technique could lead to further expansion of donor organ pools and improvements in post-LTx outcomes.
Extracorporeal Lung support Technologies
The ECMO system consists of a centrifugal pump, a membrane oxygenator, inlet and outlet cannulas, and tubing. The exchange of oxygen and CO2 then takes place in the oxygenator, which delivers the reoxygenated blood back into one of the patient's veins or arteries. Additional ports may be added for haemodialysis or ultrafiltration.
Two different techniques may be used to introduce ECMO: venoarterial and venovenous. In the venoarterial technique, cannulation is through either the femoral artery and the femoral vein, or through the carotid artery and the internal jugular vein. In the venovenous technique cannulation is through both femoral veins or a femoral vein and internal jugular vein; one cannula acts as inflow or arterial line, and the other as an outflow or venous line. Venovenous ECMO will not provide adequate support if a patient has pulmonary hypertension or right heart failure. Problems associated with cannulation during the procedure include bleeding around the cannulation site and limb ischemia distal to the cannulation site.
Interventional Lung Assist (ILA) is used to remove excess CO2 from the blood of patients in respiratory failure. The system is characterized by a novel, low-resistance gas exchange device with a diffusion membrane composed of polymethylpentene (PMP) fibres. These fibres are woven into a complex configuration that maximizes the exchange of oxygen and CO2 by simple diffusion. The system is also designed to operate without the help of an external pump, though one can be added if higher blood flow is required. The device is then applied across an arteriovenous shunt between the femoral artery and femoral vein. Depending on the size of the arterial cannula used and the mean systemic arterial pressure, a blood flow of up to 2.5 L/min can be achieved (up to 5.5 L/min with an external pump). The cannulation is performed after intravenous administration of heparin.
Recently, the first commercially available extracorporeal membrane ventilator (NovaLung GmbH, Hechingen, Germany) was approved for clinical use by Health Canada for patients in respiratory failure. The system has been used in more than 2,000 patients with various indications in Europe, and was used for the first time in North America at the Toronto General Hospital in 2006.
Evidence-Based Analysis
The research questions addressed in this report are:
Does ILA/ECMO facilitate gas exchange in the lungs of patients with severe respiratory failure?
Does ILA/ECMO improve the survival rate of patients with respiratory failure caused by a range of underlying conditions including patients awaiting LTx?
What are the possible serious adverse events associated with ILA/ECMO therapy?
To address these questions, a systematic literature search was performed on September 28, 2009 using OVID MEDLINE, MEDLINE In-Process and Other Non-Indexed Citations, EMBASE, the Cumulative Index to Nursing & Allied Health Literature (CINAHL), the Cochrane Library, and the International Agency for Health Technology Assessment (INAHTA) for studies published from January 1, 2005 to September 28, 2008. Abstracts were reviewed by a single reviewer and, for those studies meeting the eligibility criteria, full-text articles were obtained. Reference lists were also examined for any additional relevant studies not identified through the search. Articles with an unknown eligibility were reviewed with a second clinical epidemiologist and then a group of epidemiologists until consensus was established.
Inclusion Criteria
Studies in which ILA/ECMO was used as a bridge to recovery or bridge to LTx
Studies containing information relevant to the effectiveness and safety of the procedure
Studies including at least five patients
Exclusion Criteria
Studies reporting the use of ILA/ECMO for inter-hospital transfers of critically ill patients
Studies reporting the use of ILA/ECMO in patients during or after LTx
Animal or laboratory studies
Case reports
Outcomes of Interest
Reduction in partial pressure of CO2
Correction of respiratory acidosis
Improvement in partial pressure of oxygen
Improvement in patient survival
Frequency and severity of adverse events
The search yielded 107 citations in Medline and 107 citations in EMBASE. After reviewing the information provided in the titles and abstracts, eight citations were found to meet the study inclusion criteria. One study was then excluded because of an overlap in the study population with a previous study. Reference checking did not produce any additional studies for inclusion. Seven case series studies, all conducted in Germany, were thus included in this review (see Table 1).
Also included is the recently published CESAR trial, a multicentre RCT in the UK in which ECMO was compared with conventional intensive care management. The results of the CESAR trial were published when this review was initiated. In the absence of any other recent RCT on ECMO, the results of this trial were considered for this assessment and no further searches were conducted. A literature search was then conducted for application of ECMO as bridge to LTx patients (January, 1, 2005 to current). A total of 127 citations on this topic were identified and reviewed but none were found to have examined the use of ECMO as bridge to LTx.
Quality of Evidence
To grade the quality of evidence, the grading system formulated by the GRADE working group and adopted by MAS was applied. The GRADE system classifies the quality of a body of evidence as high, moderate, low, or very low according to four key elements: study design, study quality, consistency across studies, and directness.
Trials on ILA
Of the seven studies identified, six involved patients with ARDS caused by a range of underlying conditions; the seventh included only patients awaiting LTx. All studies reported the rate of gas exchange and respiratory mechanics before ILA and for up to 7 days of ILA therapy. Four studies reported the means and standard deviations of blood gas transfer and arterial blood pH, which were used for meta-analysis.
Fischer et al. reported their first experience on the use of ILA as a bridge to LTx. In their study, 12 patients at high urgency status for LTx, who also had severe ventilation refractory hypercapnea and respiratory acidosis, were connected to ILA prior to LTx. Seven patients had a systemic infection or sepsis prior to ILA insertion. Six hours after initiation of ILA, the partial pressure of CO2 in arterial blood significantly decreased (P < .05) and arterial blood pH significantly improved (P < .05) and remained stable for one week (last time point reported). The partial pressure of oxygen in arterial blood improved from 71 mmHg to 83 mmHg 6 hours after insertion of ILA. The ratio of PaO2/FiO2 improved from 135 at baseline to 168 at 24 hours after insertion of ILA but returned to baseline values in the following week.
Trials on ECMO
The UK-based CESAR trial was conducted to assess the effectiveness and cost of ECMO therapy for severe, acute respiratory failure. The trial protocol were published in 2006 and details of the methods used for the economic evaluation were published in 2008. The study itself was a pragmatic trial (similar to a UK trial of neonatal ECMO), in which best standard practice was compared with an ECMO protocol. The trial involved 180 patients with acute but potentially reversible respiratory failure, with each also having a Murray score of ≥ 3.0 or uncompensated hypercapnea at a pH of < 7.2. Enrolled patients were randomized in a 1:1 ratio to receive either conventional ventilation treatment or ECMO while on ventilator. Conventional management included intermittent positive pressure ventilation, high frequency oscillatory ventilation, or both. As a pragmatic trial, a specific management protocol was not followed; rather the treatment centres were advised to follow a low volume low pressure ventilation strategy. A tidal volume of 4 to 8 mL/kg body weight and a plateau pressure of < 30 cm H2O were recommended.
Bridge to recovery
No RCTs or observational studies compared ILA to other treatment modalities.
Case series have shown that ILA therapy results in significant CO2 removal from arterial blood and correction of respiratory acidosis, as well as an improvement in oxygen transfer.
ILA therapy enabled a lowering of respiratory settings to protect the lungs without causing a negative impact on arterial blood CO2 and arterial blood pH.
The impact of ILA on patient long-term survival cannot be determined through the studies reviewed.
In-hospital mortality across studies ranged from 20% to 65%.
Ischemic complications were the most frequent adverse events following ILA therapy.
Leg amputation is a rare but possible outcome of ILA therapy, having occurred in about 0.9% of patients in these case series. New techniques involving the insertion of additional cannula into the femoral artery to perfuse the leg may lower this rate.
Bridge to LTx
The results of one case series (n=12) showed that ILA effectively removes CO2 from arterial blood and corrects respiratory acidosis in patients with ventilation refractory hypercapnea awaiting a LTx
Eight of the 12 patients (67%) awaiting a LTx were successfully transplanted and one-year survival for those transplanted was 80%
Since all studies are case series, the grade of the evidence for these observations is classified as "LOW".
Bridge to recovery
Based on the results of a pragmatic trial and an intention to treat analysis, referral of patient to an ECMO based centre significantly improves patient survival without disability compared to conventional ventilation. The results of CESAR trial showed that:
For patients with information about disability, survival without severe disability was significantly higher in ECMO arm
Assuming that the three patients in the conventional ventilation arm who did not have information about severe disability were all disabled, the results were also significant.
Assuming that none of these patients were disabled, the results were at borderline significance
A greater, though not statistically significant, proportion of patients in ECMO arm survived.
The rate of serious adverse events was higher among patients in ECMO group
The grade of evidence for the above observations is classified as "HIGH".
Bridge to LTx
No studies fitting the inclusion criteria were identified.
There is no accurate data on the use of ECMO in patients awaiting LTx.
Economic Analysis
The objective of the economic analysis was to determine the costs associated with extracorporeal lung support technologies for bridge to LTx in adults. A literature search was conducted for which the target population was adults eligible for extracorporeal lung support. The primary analytic perspective was that of the Ministry of Health and Long-Term Care (MOHLTC). Articles published in English and fitting the following inclusion criteria were reviewed:
Full economic evaluations including cost-effectiveness analyses (CEA), cost-utility analyses (CUA), cost-benefit analyses (CBA);
Economic evaluations reporting incremental cost-effectiveness ratios (ICER) i.e. cost per quality adjusted life year (QALY), life years gained (LYG), or cost per event avoided; and
Studies in patients eligible for lung support technologies for to lung transplantation.
The search yielded no articles reporting comparative economic analyses.
Resource Use and Costs
Costs associated with both ILA and ECMO (outlined in Table ES-1) were obtained from the University Health Network (UHN) case costing initiative (personal communication, UHN, January 2010). Consultation with a clinical expert in the field was also conducted to verify resource utilization. The consultant was situated at the UHN in Toronto. The UHN has one ECMO machine, which cost approximately $100,000. The system is 18 years old and is used an average of 3 to 4 times a year with 35 procedures being performed over the last 9 years. The disposable cost per patient associated with ECMO is, on average, $2,200. There is a maintenance cost associated with the machine (not reported by the UHN), which is currently absorbed by the hospital's biomedical engineering department.
The average capital cost of an ILA device is $7,100 per device, per patient, while the average cost of the reusable pump $65,000. The UHN has performed 16 of these procedures over the last 2.5 years. Similarly, there is a maintenance cost not that was reported by UHN but is absorbed by the hospital's biomedical engineering department.
Resources Associated with Extracorporeal Lung Support Technologies
Hospital costs associated with ILA were based on the average cost incurred by the hospital for 11 cases performed in the FY 07/08 (personal communication, UHN, January 2010). The resources incurred with this hospital procedure included:
Device and disposables
OR transplant
Surgical ICU
Laboratory work
Medical imaging
Clinical nutrition
Occupational therapy
Speech and language pathology
Social work
The average length of stay in hospital was 61 days for ILA (range: 5 to 164 days) and the average direct cost was $186,000 per case (range: $19,000 to $552,000). This procedure has a high staffing requirement to monitor patients in hospital, driving up the average cost per case.
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Direct Cannulation of the Infrahepatic Vena Cava for Emergent Cardiopulmonary Bypass Support
Gopaldas, Raja R.
Patel, Kirti P.
Livesay, James J.
Cooley, Denton A.
Texas Heart Institute Journal
Cannulation for cardiopulmonary bypass, although seemingly routine, can pose technical challenges. In patients undergoing repeat sternotomy, for example, peripherally established cardiopulmonary bypass may be necessary to ensure safe entry into the chest; however, establishing bypass in this way can sometimes be complicated by patients' body habitus. We describe a technique for direct cannulation of the infrahepatic abdominal vena cava that was required for emergent cardiopulmonary bypass. The patient was a 62-year-old woman who had presented with severely symptomatic left main coronary stenosis 3 months after elective aortic valve replacement. She had gone into cardiogenic shock as general anesthesia was being induced for repeat sternotomy and myocardial revascularization. Emergent establishment of femorofemoral cardiopulmonary bypass was precluded by difficulties in advancing the femoral venous cannula beyond the pelvic brim. Hence, an emergent celiotomy was performed, and the abdominal vena cava was directly cannulated to establish venous drainage for cardiopulmonary bypass. The rest of the operation was uneventful. Our technique for direct cannulation of the infrahepatic abdominal vena cava may be used in exceptional circumstances. Necessary precautions and potential pitfalls are also presented.
Cardiopulmonary bypass/instrumentation/methods; shock, cardiogenic; vena cava, inferior
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The effect of tracheal tube size on air leak around the cuffs
Hwang, Jin-Young
Park, Sang-Hyun
Han, Sung-Hee
Park, Seong-Joo
Park, Soo-kyung
Kim, Jin-Hee
Korean Journal of Anesthesiology
This randomized single-blinded, cross-over study was done to evaluate the influence of the size of tracheal tubes on air leaks around the cuffs.
In a benchtop model, the number of longitudinal folds on the cuffs was evaluated for different sizes of tracheal tubes. In an anesthetized patient study, thirty patients scheduled for elective surgery under general anesthesia were included. After induction of anesthesia, the trachea was intubated with two sizes of tracheal tubes in a random sequence: in men, internal diameter of 7.5 mm and 8.0 mm; in women, internal diameter of 7.0 mm and 7.5 mm. After tracheal intubation with each tube, air leak pressures were evaluated at intracuff pressures of 20, 25 and 30 cmH2O by auscultation. To calculate the tracheal tube resistance (R), an inspiratory pause of 20% was applied and the resulting peak airway pressure (Ppeak), plateau pressure (Ppl) and mean expiratory tidal volume (Flow) were inserted in the formula R = (Ppeak - Ppl)/Flow.
More longitudinal folds of the tracheal tube cuffs occurred in larger sized tubes compared to the smaller ones in a benchtop model. Air leakage was significantly less for the smaller tracheal tubes than for the larger ones for each gender at intracuff pressures of 20, 25 and 30 cmH2O. Tracheal tube resistances were not significantly altered by the size of tracheal tube.
The use of a smaller tracheal tube within an acceptable size can reduce air leakage around the cuff without significantly changing the tracheal tube resistance.
Anesthesia; Intratracheal; Intubation
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AB 63. Management of complex benign post-tracheostomy tracheal stenosis with bronchoscopic insertion of silicon tracheal stents, in patients with failed or contraindicated surgical reconstruction of trachea
Tsakiridis, Kosmas
Darwiche, Kaid
Visouli, Aikaterini N.
Zarogoulidis, Paul
Machairiotis, Nikolaos
Christofis, Christos
Stylianaki, Aikaterini
Katsikogiannis, Nikolaos
Mpakas, Andreas
Courcoutsakis, Nicolaos
Zarogoulidis, Konstantinos
Journal of Thoracic Disease
2012;4(Suppl 1):AB63.
Tracheal stenosis is a potentially life-threatening condition. Tracheostomy and endotracheal intubation remain the commonest causes of benign stenosis, despite improvements in design and management of tubes. Post-tracheostomy stenosis is more frequently encountered due to earlier performance of tracheostomy in intensive care units, while the incidence of post-intubation stenosis has decreased with application of high-volume low-pressure cuffs. We present tracheal stenting in complex post-tracheostomy stenoses.
Patients and methods
We inserted tracheal silicone stents (Dumon) under general anaesthesia through rigid bronchoscopy in two patients with benign post-tracheostomy stenoses: a 39-year old woman treated for acute respiratory failure (dyspnoea, hemoptysis, alveolar bleeding, attributed to seronegative lung vasculitis) who initially underwent surgical resection and end-to-end anastomosis, but developed restenosis (anastomotic granulation/scarring), and suffered continuous relapses after multiple bronchoscopic interventions, underwent silicone stenting (length 4.5 cm, diameter 12 mm). A 20-year old man treated for severe head trauma after a car accident developed a long tracheal stricture involving the subglottic larynx (lower posterior part), having inflamed tracheostomy site tissues (positive for methicillin resistant staphylococcus aureus), underwent silicone stenting (length 7 cm, diameter 14 mm).
The airway was immediately re-establish, without complications (tracheal rupture/pneumomediastinum, bleeding). At 15 and 10 months follow-up (respectively) there was no stent migration, luminal patency was maintained without: adjacent structure erosion, secretion adherence inside the stents, granulation at the ends. Tracheostomy tissue inflammation was resolved (2nd patient), new infection was not noted. The patients maintain good respiratory function and will be evaluated for scheduled stent removal.
In symptomatic benign tracheal stenosis the gold standard is surgical reconstruction (often after interventional bronchoscopy). Stenting is reserved for symptomatic tracheal narrowing deemed inoperable due to local or general reasons: inflammation, long strictures, previous failed operation, poor respiratory, cardiac or neurological status. When stenting is decided, silicone stent insertion is considered treatment of choice in the presence of inflammation and/or when removal is desirable. Silicone stents are removable, resistant to microbial colonization and are associated with minimal granulation. In benign post-tracheostomy stenosis silicone stenting was safe and effective in re-stenosis after surgery and multiple bronchoscopic interventions, and in long stenosis in the presence on inflammation and poor neurological status.
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Anesthetic management of a patient with Mounier-Kuhn syndrome undergoing off-pump coronary artery bypass graft surgery -A case report-
Min, Jeong Jin
Lee, Jung-Man
Kim, Jun Hyun
Hong, Deok Man
Jeon, Yunseok
Bahk, Jae-Hyon
Korean Journal of Anesthesiology
Mounier-Kuhn-syndrome patients have markedly dilated trachea and main bronchi due to an atrophy or absence of elastic fibers and thinning of smooth muscle layers in the tracheobronchial tree. Although this syndrome is rare, airway management is challenging and general anesthesia may produce fatal results. However, only a few cases have been reported and this condition is not widely known among anesthesiologists. We present the case of a tracheobronchomegaly patient undergoing an emergency off-pump coronary artery bypass. Although the trachea was markedly dilated with numerous tracheal diverticuli, there was an undilated 2 cm portion below the vocal cords found on the preoperative CT. Under a preparation of extracorporeal membrane oxygenation, we intubated and placed the balloon of an endotracheal tube (I.D. 9 mm) at this portion, and maintained ventilation during the operation. This case showed that a precise preoperative evaluation and anesthetic plan is essential for successful anesthetic management.
Mounier-Kuhn syndrome; Tracheal diverticuli; Tracheobronchomegaly
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Case Report: Spinal Anesthesia by Mini-laminotomy for a Patient with Ankylosing Spondylitis who was Difficult to Anesthetize
Leung, K. H.
Chiu, K. Y.
Wong, Y. W.
Lawmin, J. C.
Clinical Orthopaedics and Related Research
Orthopaedic surgeons frequently encounter patients with ankylosing spondylitis who would benefit from various types of lower limb operations; however, some of these patients present challenges for anesthesiologists.
Case Description
We report the case of a 65-year-old patient with a fractured femoral component 30 years after a cemented THA. The patient had severe tracheal stenosis and ankylosing spondylitis making general endotracheal and conventional neuraxial anesthesia nearly impossible.
Literature Review
Possible alternative anesthetic approaches described in the literature include awake fiberoptic bronchoscopic guided intubation, laryngeal mask airway, and caudal anesthesia.
Purposes and Clinical Relevance
We achieved successful anesthesia using spinal laminotomy with the patient under local anesthesia followed by insertion of a spinal catheter and injection of an anesthetic agent. The loosened component was revised to a cementless THA.
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Case Report: Spinal Anesthesia by Mini-laminotomy for a Patient with Ankylosing Spondylitis who was Difficult to Anesthetize
Leung, K. H.
Chiu, K. Y.
Wong, Y. W.
Lawmin, J. C.
Clinical Orthopaedics and Related Research
Orthopaedic surgeons frequently encounter patients with ankylosing spondylitis who would benefit from various types of lower limb operations; however, some of these patients present challenges for anesthesiologists.
Case Description
We report the case of a 65-year-old patient with a fractured femoral component 30 years after a cemented THA. The patient had severe tracheal stenosis and ankylosing spondylitis making general endotracheal and conventional neuraxial anesthesia nearly impossible.
Literature Review
Possible alternative anesthetic approaches described in the literature include awake fiberoptic bronchoscopic guided intubation, laryngeal mask airway, and caudal anesthesia.
Purposes and Clinical Relevance
We achieved successful anesthesia using spinal laminotomy with the patient under local anesthesia followed by insertion of a spinal catheter and injection of an anesthetic agent. The loosened component was revised to a cementless THA.
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To assess the efficacy of i-gel for ventilation, blind tracheal intubation and nasogastric tube insertion
Bhandari, Geeta
Shahi, K. S.
Asad, Mohd
Parmar, Nitish Kumar
Bhakuni, Rajni
Anesthesia, Essays and Researches
The i-gel is a novel supraglottic airway device with a soft and non-inflatable cuff. In our study we attempted to evaluate the performance of i-gel as a ventilatory device, as a conduit to blind tracheal intubation using conventional polyvinyl chloride tracheal tube and gastric tube insertion through it.
Materials and Methods:
A total of 180 patients of American Society of Anesthesiologist (ASA) physical status I/II undergoing elective surgery under general anesthesia were included in this study. After induction of anesthesia, i-gel was inserted and the following parameters were recorded: Time taken for successful i-gel insertion, airway leak pressures, ease of gastric tube insertion and laryngeal view using fiberscope. Following this blind tracheal intubation was attempted. First attempt and overall success rate in blind tracheal intubation and gastric tube insertion were evaluated and tracheal intubation time was measured. Also presence of any side effects or complication following removal was recorded.
We achieved a 100% success rate in insertion of i-gel and in 171 out of 180 patients; i-gel was inserted in the 1st attempt itself. We also were able to achieve an overall success rate for blind endotracheal intubation via i-gel in 78.33% cases, and successful gastric tube placement was possible in 92.22%. In our study we also achieved a leak pressure of 25.52 (±2.33) cm of H2O.
I-gel may be effectively used for ventilation, nasogastric tube insertion and as a conduit to blind endotracheal intubation with minimal complication and acceptable airway sealing pressures.
I-gel; nasogastric tube; seal pressure; tracheal intubation
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Resection of thyroid carcinoma infiltrating the trachea.
Ishihara, T
Kikuchi, K
Ikeda, T
Inoue, H
Fukai, S
Ito, K
Mimura, T
We have treated surgically 11 patients with thyroid carcinoma that had infiltrated into the trachea. Three patients had primary tumours, and eight had recurrent tumours after previous operations. Sleeve resection of trachea was performed where thyroid carcinoma had proliferated; the trachea was reconstructed by end-to-end anastomosis. In two patients 10 rings of the trachea were resected. In three patients the anterior half of the cricoid cartilage was resected along with the cervical trachea. In one patient tracheoplasty was performed using partial extracorporeal circulation because severe tracheal stenosis prevented endotracheal intubation. Two of the 11 patients died from the surgery and one from disseminated metastases. One patient who had undergone tracheal resection for thyroid carcinoma three years and five months previously had a recurrence of the tumour in the trachea adjacent to the anastomosis, and a second tracheal resection was performed. In three patients postoperative laryngeal stenosis occurred. Five patients are alive and well two years and one month to four years and seven months after their operations. The histological pattern of the tumour was papillary adenocarcinoma in all 11 patients.
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Perioperative medical management of patients with COPD
Licker, Marc
Schweizer, Alexandre
Ellenberger, Christoph
Tschopp, Jean-Marie
Diaper, John
Clergue, François
International Journal of Chronic Obstructive Pulmonary Disease
Chronic obstructive pulmonary disease (COPD) and heart diseases are considered independent risk factors for mortality and major cardiopulmonary complications after surgery. Coronary artery disease, heart failure and COPD share common risk factors and are often encountered, - isolated or combined -, in many surgical candidates. Perioperative optimization of these high-risk patients deserves a thorough understanding of the patient cardiopulmonary diseases as well as the respiratory consequences of surgery and anesthesia.
In contrast with cardiac risk stratification where the extent of heart disease largely influences postoperative cardiac outcome, surgical-related factors (ie, upper abdominal and intra-thoracic procedures, duration of anesthesia, presence of a nasogastric tube) largely dominate patient's comorbidities as risk factors for postoperative pulmonary complications.
Although most COPD patients tolerate tracheal intubation under "smooth" anesthetic induction without serious adverse effects, regional anesthetic blockade and application of laryngeal masks or non-invasive positive pressure ventilation should be considered whenever possible, in order to provide optimal pain control and to prevent upper airway injuries as well as lung baro-volotrauma. Minimally-invasive procedures and modern multimodal analgesic regimen are helpful to minimize the surgical stress response, to speed up the physiological recovery process and to shorten the hospital stay. Reflex-induced bronchoconstriction and hyperdynamic inflation during mechanical ventilation could be prevented by using bronchodilating volatile anesthetics and adjusting the ventilatory settings with long expiration times. Intraoperatively, the depth of anesthesia, the circulatory volume and neuromuscular blockade should be assessed with modern physiological monitoring tools to titrate the administration of anesthetic agents, fluids and myorelaxant drugs. The recovery of postoperative lung volume can be facilitated by patient's education and empowerment, lung recruitment maneuvers, non-invasive pressure support ventilation and early ambulation.
anesthesia; surgery; COPD; atelectasis; functional residual capacity
Related Articles
Isolated congenital tracheal stenosis in a preterm newborn
Krause, Ulrich
Rödel, Ralph M. W.
Paul, Thomas
European Journal of Pediatrics
Severe tracheal stenosis, resulting in functional atresia of the trachea is a rare congenital malformation with an estimated occurrence of two in 100,000 newborns. If no esophagotracheal fistula is present to allow for spontaneous breathing, this condition is usually fatal. We report on a male infant born at 32 weeks of gestation. The patient presented with respiratory distress immediately after delivery due to severe congenital tracheal stenosis resulting in functional atresia of the trachea. Endotracheal intubation failed and even emergency tracheotomy did not allow ventilation of the patient lungs. The patient finally succumbed to prolonged hypoxia due to functional tracheal atresia. The etiology of tracheal atresia and tracheal stenosis is still unclear, but both conditions are frequently combined with other anomalies of the VACTERL (vertebral anomalies, anal atresia, cardiovascular anomalies, tracheoesophageal fistula, esophageal atresia, renal/radial anomalies and limb defects) and TACRD (tracheal agenesis, cardiac, renal and duodenal malformations) association. Conclusion Successful treatment of severe congenital tracheal stenosis and tracheal atresia depends on either prenatal diagnosis or recognition of this condition immediately after birth to perform tracheotomy without delay. Nevertheless, despite any efforts, the therapeutical results of severe tracheal stenosis and tracheal atresia are still unsatisfactory.
Congenital tracheal stenosis; Neonate; Respiratory failure; VACTERL association
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TRALI Syndrome Complicated by Retroperitoneal Bleeding
Singh, Vijay A.
Zeltsman, David
The International Journal of Angiology : Official Publication of the International College of Angiology, Inc
Transfusion-related acute lung injury (TRALI) is an underdiagnosed and underreported syndrome which by itself is the third leading cause of transfusion-related mortality. The incidence of TRALI is reported to be 1 in 2000 to 5000 transfusions. When combined with uncontrollable bleeding, survival is unachievable. We report the case of a 25-year-old man, who underwent open heart surgery as an infant to correct his congenital heart disease in association with right pulmonary artery atresia. He presented with hemoptysis secondary to aspergilloma and required a pneumonectomy of the nonfunctional right lung. During pneumolysis, significant bleeding occurred from the superior vena cava. The patient required a blood transfusion and was placed on cardiopulmonary bypass to control the bleeding. Simultaneous occurrence of severe pulmonary edema and retroperitoneal bleeding were noted. Approximately 8 L of frothy edema fluid were drained from the only functional left lung starting ~15 minutes after the transfusion and lasting for several hours until the end of the case. It most likely represented TRALI syndrome. Increasing abdominal girth and poor volume return to the pump were consistent with and pathognomonic for retroperitoneal bleeding. Though primary surgical bleeding in the chest was controlled successfully and a pneumonectomy performed without further difficulty, we were unable to separate the patient from cardiopulmonary bypass due to the inability to oxygenate. As a result, we could not reverse the anti-coagulation which potentially exacerbated the retroperitoneal bleeding. After multiple unsuccessful attempts the patient succumbed. This ill-fated case demonstrates the quandary of obtaining vascular access for emergency cardiopulmonary bypass while in the right thoracotomy position. It may be beneficial to have both the femoral artery and vein cannulated before positioning a patient in a lateral decubitus position. In addition, early direct access to the right atrium may obviate a need for femoral venous cannulation. Also, adult extracorporeal membrane oxygenation may be indicated if faced with such a severe pulmonary edema without ongoing hemorrhage.
Transfusion; lung injury; pulmonary atresia; retroperitoneal hematoma
Related Articles
Comparison of combitube, easy tube and tracheal tube for general anesthesia
Sethi, Ashok Kumar
Desai, Manisha
Tyagi, Asha
Kumar, Surendra
Journal of Anaesthesiology, Clinical Pharmacology
Background & Aims:
The Combitube® and EasyTube™ enable effective ventilation whether placed in the trachea or esophagus and can be used in prehospital settings, as well as in "Cannot Ventilate Cannot Intubate" situations in the operating room. Whether they can be continued to provide general anesthesia, if required, is not established. Thus the efficacy of Combitube and EasyTube was evaluated and compared with the tracheal tube for general anesthesia using controlled ventilation.
Materials and Methods:
Combitube, EasyTube and tracheal tubes were used in 30 patients each to secure the airway in a randomized controlled manner. Ventilatory parameters were measured along with hemodynamic variables, and characteristics related to device placement.
There was no significant difference in the various ventilatory parameters including minute ventilation requirement to maintain eucapnia amongst the three groups at any time point. There was no hypoxia or hypercarbia in any patient at any time. Placement of EasyTube was more difficult (P = 0.01) as compared with both Combitube and tracheal tube. EasyTube and Combitube resulted in higher incidence of minor trauma than with a tracheal tube (P = 0.00).
Combitube and EasyTube may be continued for general anesthesia in patients undergoing elective nonlaparoscopic surgeries of moderate duration, if placed for airway maintenance. Given the secondary observations regarding placement characteristics of the airway devices, it, however cannot be concluded that the devices are a substitute for endotracheal tube for airway maintenance per se, unless specifically indicated
Combitube; EasyTube; general anesthesia
Related Articles
Subglottic stenosis following percutaneous tracheostomy: a single centre report as a descriptive study
Acta Otorhinolaryngologica Italica
Tracheal stenosis is a potential complication of tracheostomy. The present study aimed to describe the epidemiologic profile of subglottic stenosis in a referral medical centre. During a 4-year period, all patients who had been admitted in an Intensive Care Unit of Imam Khomeini Hospital (affiliated to Tehran University of Medical Sciences) and had undergone percutaneous tracheostomy during 7-10 days after endotracheal intubation were enrolled in the study. After removing the tracheostomy tube, patients were evaluated regarding development of tracheal stenosis using fiberoptic bronchoscopy and multi-slice computed tomography scan. During the study period, percutaneous tracheostomy was performed in 140 patients with a mean age of 38 years. Overall 54 patients died due to the severity of the disorder during hospitalization. In the remaining 86 patients, 54 cases needed permanent or long-term mechanical ventilation and were excluded from the study. Twelve patients died during the first 3 months and 20 patients were left for final assessment. Multi-slice computed tomography scan imaging showed subglottic stenosis in 17 cases (85%). Of these, 9 patients (52%) had tracheal stenosis of < 50%. Tracheal stenosis of 25- 40% was found in 5 cases (25%). Patients in whom the tracheostomy tube had been removed in the first 3 weeks after tracheostomy did not present tracheal stenosis (n = 3, 15%). The present study revealed that subglottic stenosis is frequent in patients who have undergone percutaneous tracheostomy in the Intensive Care unit setting. However, the stenosis is generally mild and is not associated with serious and/ or life-threatening clinical manifestations.
Percutaneous tracheostomy; Intensive Care Unit; Subglottic stenosis
Related Articles
An unanticipated difficult airway in Lesch–Nyhan syndrome
Salhotra, Rashmi
Sharma, Chhavi
Tyagi, Asha
Kumar, Surendra
Sethi, AK
Bhatt, Shuchi
Journal of Anaesthesiology, Clinical Pharmacology
An 11-year-old boy with Lesch–Nyhan syndrome presented to the emergency for fixation of a fractured femur. During induction of general anesthesia, unexpected difficult intubation was encountered with a 6.5-mm ID endotracheal tube and successively smaller tubes, also failing to pass 1 cm beyond the vocal cords. Intubation was finally achieved with a 4.5-mm ID tube. The surgery was completed uneventfully. A tracheal diverticulum was found in the computerized tomography (CT) scan performed postoperatively to account for this unexpected difficult intubation. This case highlights the anesthetic concerns in Lesch-Nyhan syndrome and also reports the rare occurrence of a tracheal diverticulum associated with it.
Difficult airway; Lesch–Nyhan syndrome; tracheal diverticulum
Related Articles
Endotracheal tube cuff pressure monitoring during neurosurgery - Manual vs. automatic method
Jain, Mukul Kumar
Tripathi, Chander Bushan
Journal of Anaesthesiology, Clinical Pharmacology
Inflation and assessment of the endotracheal tube cuff pressure is often not appreciated as a critical aspect of endotracheal intubation. Appropriate endotracheal tube cuff pressure, endotracheal intubation seals the airway to prevent aspiration and provides for positive-pressure ventilation without air leak.
Materials and Methods:
Correlations between manual methods of assessing the pressure by an experienced anesthesiologists and assessment with maintenance of the pressure within the normal range by the automated pressure controller device were studied in 100 patients divided into two groups. In Group M, endotracheal tube cuff was inflated manually by a trained anesthesiologist and checked for its pressure hourly by cuff pressure monitor till the end of surgery. In Group C, endotracheal tube cuff was inflated by automated cuff pressure controller and pressure was maintained at 25-cm H2O throughout the surgeries. Repeated measure ANOVA was applied.
Repeated measure ANOVA results showed that average of endotracheal tube cuff pressure of 50 patients taken at seven different points is significantly different (F-value: 171.102, P-value: 0.000). Bonferroni correction test shows that average of endotracheal tube cuff pressure in all six groups are significantly different from constant group (P = 0.000). No case of laryngomalacia, tracheomalacia, tracheal stenosis, tracheoesophageal fistula or aspiration pneumonitis was observed.
Endotracheal tube cuff pressure was significantly high when endotracheal tube cuff was inflated manually. The known complications of high endotracheal tube cuff pressure can be avoided if the cuff pressure controller device is used and manual methods cannot be relied upon for keeping the pressure within the recommended levels.
Automatic cuff pressure controller; endotracheal tube cuff pressure; manual method; neurosurgery
Related Articles
Management of complex benign post-tracheostomy tracheal stenosis with bronchoscopic insertion of silicon tracheal stents, in patients with failed or contraindicated surgical reconstruction of trachea
Tsakiridis, Kosmas
Darwiche, Kaid
Visouli, Aikaterini N.
Zarogoulidis, Paul
Machairiotis, Nikolaos
Christofis, Christos
Stylianaki, Aikaterini
Katsikogiannis, Nikolaos
Mpakas, Andreas
Courcoutsakis, Nicolaos
Zarogoulidis, Konstantinos
Journal of Thoracic Disease
2012;4(Suppl 1):32-40.
Tracheal stenosis is a potentially life-threatening condition. Tracheostomy and endotracheal intubation remain the commonest causes of benign stenosis, despite improvements in design and management of tubes. Post-tracheostomy stenosis is more frequently encountered due to earlier performance of tracheostomy in the intensive care units, while the incidence of post-intubation stenosis has decreased with application of high-volume, low-pressure cuffs. In symptomatic benign tracheal stenosis the gold standard is surgical reconstruction (often after interventional bronchoscopy). Stenting is reserved for symptomatic tracheal narrowing deemed inoperable, due to local or general reasons: long strictures, inflammation, poor respiratory, cardiac or neurological status. When stenting is decided, silicone stent insertion is considered the treatment of choice in the presence of inflammation and/or when removal is desirable. We inserted tracheal silicone stents (Dumon) under general anaesthesia through rigid bronchoscopy in two patients with benign post-tracheostomy stenosis: a 39-year old woman with failed initial operation, and continuous relapses with proliferation after multiple bronchscopic interventions, and a 20-year old man in a poor neurological status, with a long tracheal stricture involving the subglottic larynx (lower posterior part), and inflamed tracheostomy site tissues (positive for methicillin resistant staphylococcus aureus). The airway was immediately re-establish, without complications. At 15- and 10-month follow-up (respectively) there was no stent migration, luminal patency was maintained without: adjacent structure erosion, secretion adherence inside the stents, granulation at the ends. Tracheostomy tissue inflammation was resolved (2nd patient), new infection was not noted. The patients maintain good respiratory function and will be evaluated for scheduled stent removal. Silicone stents are removable, resistant to microbial colonization and are associated with minimal granulation. In benign post-tracheostomy stenosis silicone stenting appeared safe and effective in re-stenosis after surgery and multiple bronchoscopic interventions, and in long stenosis, involving the lower posterior subglottic larynx in the presence on inflammation and poor neurological status.
Airway obstruction/therapy; tracheal stenosis/therapy; stents; airway stenting; benign tracheal stenosis
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text:
Tuesday Tutorial - Rubber Stamping With Sugar/Cupcake Dome/Fabric Flowers
I wanted to send a few thank-you shoutouts before I jumped into today's post...talk about 'Crazy It Forward' (oh, I like that, I may have to start a new series...)
those crazy felt owls that inspired monsters inspired
Home Sweet Home
to help her kids make one of each...
and my Airplane Party was featured at
Act Different, Be Normal
. It's funny, because I found her through another blog and was bopping through her parties, and there it was!
The handprint tiles made an appearance at
These Magical Years
, a blog dedicated to all things crafty.
OK, back to the subject at hand. Today's post is all about party 'umph', it's that little extra that takes your party from pretty to awesome! And all so deliciously flexible you can adapt them for all types of parties. Check these out, they all have super easy tutorials.
Move over rimmers, here's
a great tutorial
on rubber stamping with sugar at Paper Crave. What a pretty and cost effective way to create an elegant and edible design.
this cupcake dome
and how she hung them from trees; imagine the look on your guests' faces when they walk into your backyard and see them.
Can't you just see
these felt flowers
clips as party favors, or one attached to ribbon for napkin ring toppers, or maybe covering a small foam wreath...
How about attaching
jersey knit flowers
to a manzanita branch for a pretty centerpiece?
Tuesday Tutorial


text:
Topic: Podiatrists
Broadcast Tuesday, August 2, 7:30 p.m. on 21Alive
Podiatrists, Dr. DeTommaso and Dr. Caudell will discuss the most common foot and ankle conditions cared for at The Orthopedic Hospital at Lutheran.
What are your thoughts CLICK HERE to leave us a "QUESTION OF THE DAY" comment.
© Copyright 2016, A Quincy Media broadcasting station. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.


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Epic Sports
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text:
Cypress After 2000
On May 22, 2000, Patrick Importuna became the City's sixth City Manager. The 2000 census revealed that Cypress had approximately 48,000 residents. The City celebrated its 45th birthday in 2001.
In the fall of 2003, both Costco Wholesale and Cottonwood Christian Center formally filed their respective plans to develop sites within the Los Alamitos Race Track and Golf Course Redevelopment Project Area-Costco on the northeast corner of Katella Avenue and Walker Street, and Cottonwood Christian Center on the northwest corner of Katella Avenue and Lexington Street. These projects anchor the two corners of the Katella Avenue frontage and compliment the existing Race Track and Residence Inn developments. Costco's plans for a 150,000 square foot store on an 18-acre site plans include a tire center, pharmacy, photo lab, food concession area and a free standing fueling station. The groundbreaking ceremony was held on September 28, 2004. The Cottonwood Christian Center plans call for a seven building campus with approximately 490,000 sq. ft. in 28 acres. The architecture is designed to compliment that of the existing Business Park uses to the east. Completion of these projects formed the foundation of a new economic era for the community.
On November 10, 2003, the City Council approved plans for the development of a new 74,100 square foot retail commercial center at the northwest corner of Katella Avenue and Siboney Street- between the entrance to the Los Alamitos Race Track and the Residence Inn. For years Cypress residents and businesses have been asking for more restaurants, shopping and quality of life amenities within the community. Among the companies located in this center are Office Depot and 24 Hour Fitness.
In January 2004, the Cypress City Council approved a contract to undergo a significant remodel to the Council Chamber. This facility had not been renovated since its construction in 1967. Upgrades included federally mandated requirements for accessibility by the Americans with Disability Act and improved lighting for use by those in the room as well as to enhance picture quality for those watching City Council meetings at home. Improved aesthetics, pathways and seating for the comfort of the public in the audience were also provided. A rededication ribbon-cutting ceremony was held on Wednesday, September 29, 2004.
Having been abandoned for several years, removal of the railroad tracks around which Cypress was originally built was completed in 2004.
The spring of 2005 saw the Civic Center expansion and renovation project continue. The project created six new tennis courts and much needed improvements to the parking lots at the Civic Center and Library. Extensive remodeling to the Civic Center building itself began at the end of 2005 and was completed in April of 2006.
The long awaited Costco Wholesale retail center, at the northwest corner of Katella Avenue and Walker Street, opened on July 14, 2005.
On August 1, 2005, Dave Norman became the City's seventh City Manager.
2006 marked Cypress' 50th Anniversary. An Oral History project began the year with interviews of many long-time residents conducted by City staff and televised on City Channel 36. "Flight" sculpture by Kirsten Kokkin was placed in front of the Council Chamber and dedicated on April 15. June 17 kicked off the Summer Concerts on the Green Series with an exceptional performance of the Cypress Pops Orchestra featuring the Southern California Mormon Choir. A well attended reunion of former City Council Members and City Officials was held on the day of the Community Festival, July 22. On July 24, the official "birthday" of Cypress, many long-time residents and business owners were honored at a special City Council meeting.
On February 14, 2007, John B. Bahorski began work as Cypress' eighth City Manager.
Beginning in October of 2006, the Cypress Community Center underwent an extensive, modernization, expansion and renovation. Originally built in 1974, the needs of the community had outgrown the aging facility. The modernized Community Center had a grand reopening celebration on July 24, 2007.
"American Pride" Art in Public Places sculpture by Dave Chapple was dedicated on April 29, 2008. It was placed on the north side of the Cypress City Council Chamber.
The City of Cypress and the Orange County Business Service Center joined forces for the 2010 Cypress Job Fair held on Thursday, October 14, 2010 at the Cypress Community Center. The Job Fair provided opportunities for job seekers to speak with major employers that are currently recruiting. Over 1,800 job seekers attended the Job Fair, far exceeding the organizers' and the employers expectations. 34 employers took part in the successful event.
The City of Cypress and the Orange County Business Service Center joined forces once again for the 2011 Cypress Job Fair held on Thursday, October 13, 2011 at the Cypress Community Center. 36 employers took part in the event. Over 260 job seekers had their first interview with the employers, and many had second interviews scheduled. Over 1,600 job seekers attended the Job Fair, mirroring the success of the City's first job fair held in 2010. Also available were free job seeker workshops, covering topics such as interview skills and résumé writing. Business professionals were on hand to offer free résumé critique for the job seekers.
On July 7, 2014, Peter Grant became the City's ninth City Manager. Mr. Grant previously served as the Assistant City Manager in the City of Redondo Beach where he was responsible for the city's economic development initiatives, labor relations, special projects and capital improvement budget. Prior to working in Redondo Beach, Mr. Grant worked for the cities of Burbank, Manhattan Beach, Huntington Beach and Irvine. He also spent five years working in the private sector for LINC Housing, in Long Beach, and The Olson Company, in Seal Beach, partnering with cities to create in fill and affordable housing developments. Mr. Grant graduated cum laude from the University of California, Riverside, and was honored as a Harry Hufford Fellow while earning his Master's in Public Administration at the University of Southern California.


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Amitabha Sutra
|Part of a series on
|Mahāyāna Buddhism
Mahāyāna schools
The Amitābha Sūtra (traditional Chinese: 阿彌陀經; pinyin: Āmítuó Jīng; Japanese: 阿弥陀経; Vietnamese: A di đà kinh) is a popular colloquial name for the Shorter Sukhāvatīvyūha Sūtra. The Amitābha Sūtra is a Mahayana sutra and is one of the three primary texts of Pure Land Buddhism, along with the Infinite Life Sutra and the Amitayurdhyana Sutra.
The Amitābha Sūtra was translated from Sanskrit into Classical Chinese by Tripiṭaka master Kumārajīva in 402, but may have existed in India as early as the year 100 in a Prakrit.[1]
The bulk of the Amitābha Sūtra, considerably shorter than other Pure Land sutras, consists of a discourse which Gautama Buddha gave at Jetavana in Śrāvastī to his disciple Śāriputra. The talk concerned the wondrous adornments that await the righteous in the western pure land of Sukhāvatī as well as the beings that reside there, including the buddha Amitābha. The text also describes what one must do to be reborn there.
In Buddhist traditions[edit]
In Pure Land and Chan Buddhism, the sutra is often recited as part of the evening service (Chinese: 晚課; pinyin: wǎnkè), and is also recited as practice for practitioners. The Jōdo shū and Jōdo Shinshū also recite this sutra when necessary. It is frequently recited at Chinese, Japanese and Vietnamese Buddhist funeral services in the hope that the merit generated by reciting the sutra may be transmitted to the departed.
A common format for the recitation of the Amitābha Sūtra in the Chinese tradition may include some or all of the following:
- Praise for the Incense Offering (盧香讚)
- Praise to the Lotus Pond (蓮池讚)
- The Amitābha Sūtra (阿彌陀經)
- Pure Land Rebirth dhāraṇī (往生咒).
- Amitābha Gāthā (彌陀偈)
- Recitation of Amitābha Buddha's Name (佛號)
- Transfer of Merit (迴向)
In the Taishō Tripiṭaka, the Amitābha Sūtra is preceded by the Pure Land Rebirth Dhāraṇī:
- namo amitābhāya tathāgatāya tadyathā
- amṛtabhave amṛtasaṃbhave
- amṛtavikrānte amṛtavikrāntagāmini
- gagana kīrtīchare svāhā
See also[edit]
- Infinite Life Sutra (Longer Sukhāvatīvyūha Sūtra)
- Amitayurdhyana Sutra (Amitāyus Meditation Sūtra)
- Pure Land Buddhism
- Sukhavati
- Amitābha
- ^ Thích 2003, pp. 11-12.
- Inagaki, Hisao; Stewart, Harold (2003). The Three Pure Land Sutras (PDF). Berkeley, CA: Numata Center for Buddhist Translation and Research. pp. 89–96. ISBN 1-886439-18-4.
- Müller, F. Max (1894). Buddhist Mahâyâna texts, Vol.2. Oxford: Clarendon Press. pp. 87–104. (translation from the Sanskrit MS)
- Shih, Hsuan Hua (2013). The Buddha Speaks of Amitabha Sutra: A General Explanation. ISBN 978-1-60103-029-0.
- Thích, Nhất Hạnh (2003). Finding Our True Home: Living in the Pure Land Here and Now. Parallax Press. ISBN 978-1-888375-34-3.
External links[edit]
|Wikisource has original text related to this article:
- The Shorter Sukhāvatīvyūha Sūtra. Lapis Lazuli Texts.
- The Smaller Sukhavativyuha Sutra, translated by Nishu Utsuki
- English translation of the Amitabha Sutra
- Chinese / English bilingual version of the Amitabha Sutra