Academic literature on the topic 'Combined Techniques in Difficult Airway Management'

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Journal articles on the topic "Combined Techniques in Difficult Airway Management"

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Kemal, Tolga Saracoglu. "Combined Techniques in Difficult Airway Management." Global Journal of Anesthesiology 2, no. 1 (2014): 001–2. https://doi.org/10.17352/2455-3476.000006.

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Difficult or failed tracheal intubation is an important cause of mortality and morbidity. Approximately 30% of anesthesiarelated deaths are caused by the complications of difficult airway management. Also, 85% of respiratory complications result in brain damage or death [1]. Awake tracheal intubation is the most appropriate method for protection of airway reflexes in patients, who are expected or known to have difficult intubation. However, the use of video laryngoscope in awake patients in a way similar to the use of classic direct laryngoscope, which requires hanging of epiglottis or th
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Tsay, Pei-Jiuan, Chih-Pin Yang, Hsiang-Ning Luk, Jason Zhensheng Qu, and Alan Shikani. "Video-Assisted Intubating Stylet Technique for Difficult Intubation: A Case Series Report." Healthcare 10, no. 4 (2022): 741. http://dx.doi.org/10.3390/healthcare10040741.

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Induction of anesthesia can be challenging for patients with difficult airways and head or neck tumors. Factors that could complicate airway management include poor dentition, limited mouth opening, restricted neck motility, narrowing of oral airway space, restricted laryngeal and pharyngeal space, and obstruction of glottic regions from the tumor. Current difficult airway management guidelines include awake tracheal intubation, anesthetized tracheal intubation, or combined awake and anesthetized intubation. Video laryngoscopy is often chosen over direct laryngoscopy in patients with difficult
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Moda, Nupur, and Niraj Kumar. "COMBINED USE OF VIDEO LARYNGOSCOPY AND FIBEROPTIC FOR AIRWAY MANAGEMENT IN A PATIENT WITH FIXED CERVICAL SPINE." Asian Journal of Pharmaceutical and Clinical Research 11, no. 11 (2018): 1. http://dx.doi.org/10.22159/ajpcr.2018.v11i11.27199.

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Airway management may be difficult in patients with fixed cervical spine who have undergone previous spine surgery. Among the various techniques, fiber-optic intubation is a preferred method for securing the airway in such situation. However, it has some limitations also like identification of landmarks, especially in a case of distorted anatomy of the airway. To overcome this inadequacy, we used video laryngoscopy as a complement, to guide the tip of bronchoscope beneath the epiglottis into the trachea and thus achieving the goal. We present a case of difficult airway of fixed cervical spine
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Lin, Judy, Ryan Bellinger, Andrew Shedd, et al. "Point-of-Care Ultrasound in Airway Evaluation and Management: A Comprehensive Review." Diagnostics 13, no. 9 (2023): 1541. http://dx.doi.org/10.3390/diagnostics13091541.

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Airway management is a common and critical procedure in acute settings, such as the Emergency Department (ED) or Intensive Care Unit (ICU) of hospitals. Many of the traditional physical examination methods have limitations in airway assessment. Point-of-care ultrasound (POCUS) has emerged as a promising tool for airway management due to its familiarity, accessibility, safety, and non-invasive nature. It can assist physicians in identifying relevant anatomy of the upper airway with objective measurements of airway parameters, and it can guide airway interventions with dynamic real-time images.
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Witkam, Richard L., Jörgen Bruhn, Nico Hoogerwerf, Rebecca M. Koch, and Lucas T. van Eijk. "Combining a McGrath Video Laryngoscope and C-MAC Video Stylet for the Endotracheal Intubation of a Patient with a Laryngeal Carcinoma Arising from the Anterior Side of the Epiglottis: A Case Report." Anesthesia Research 2, no. 1 (2025): 5. https://doi.org/10.3390/anesthres2010005.

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Introduction: Difficult airway management is a critical challenge in anesthesia, often necessitating advanced techniques to ensure patient safety. A patient presented with a malignant lesion on the epiglottis, significantly altering the airway anatomy. Flexible rhinolaryngoscopy revealed a laryngeal carcinoma affecting the entire epiglottis, causing thickening and displacement, which suggested the potential for difficult intubation. Methods: Given the expected feasibility of bag-mask ventilation and front-of-neck access, an asleep intubation technique was selected. The combined use of a McGrat
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Tsukamoto, Masanori, Kazuhiro Hano, and Takeshi Yokoyama. "Cuff Inflation Technique During Fiberoptic Nasal Intubation in Patients With Limited Mouth Opening." Anesthesia Progress 72, no. 1 (2025): 43–45. https://doi.org/10.2344/23-0056.

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Airway management is critical, particularly in patients who undergo oral maxillofacial surgery, and often involves use of nasotracheal intubation which can be difficult. We previously described a technique involving use of a flexible fiberoptic scope to provide continuous indirect vision of the endotracheal tube (ETT) tip and the glottis to assist with successful advancement of the ETT during nasotracheal intubation. Nevertheless, we often have experienced difficulties during intubation using this method as spatial manipulation and direction of the nasal ETT into the trachea may occasionally b
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Stoimenova, Plamena, Stoilka Mandadzhieva, and Blagoi Marinov. "Clinical applications of forced oscillation technique (FOT) for diagnosis and management of obstructive lung diseases in children." Folia Medica 66, no. 4 (2024): 453–60. http://dx.doi.org/10.3897/folmed.66.e135040.

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Obstructive lung diseases such as bronchial asthma, COPD, and cystic fibrosis are a burden on many patients across the globe. Spirometry is considered the gold standard for diagnosing airflow obstruction, but it can be difficult for pediatric patients to do and requires a lot of effort. As a result, healthcare providers need new, effortless methods to diagnose airway obstructions, particularly in young children and individuals unable to perform the spirometry maneuver. The forced oscillation technique is a modern method requiring only tidal breathing combined with the application of external,
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Gentili, Luca, Gianclaudio Guerriero, Fabio Nania, and Chiara Angeletti. "Effective anesthesia management for super obesity-related compartment syndrome with ultrasound and Doppler guidance: A different strategy." Saudi Journal of Anaesthesia 19, no. 3 (2025): 428–31. https://doi.org/10.4103/sja.sja_782_24.

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Acute compartment syndrome (ACS) arises from increased pressure within a confined osteofascial compartment, leading to tissue ischemia, metabolic deficits, and potential irreversible damage if untreated. Although trauma is the most common cause, obesity—especially when combined with immobility—can increase the risk of ACS, presenting significant challenges in anesthetic management. This case report details the anesthesiological management of a 42-year-old man with severe obesity (BMI 78 kg/m²), classified as super-super obese, who presented with ACS in his right lower limb. Given his complex a
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FEROZE, FAHEEM, NAVEED MASOOD, AMIN KHUWAJA, and Fakhar Ilyas Malik. "NEONATAL RESUSCITATION." Professional Medical Journal 15, no. 01 (2008): 148–52. http://dx.doi.org/10.29309/tpmj/2008.15.01.2716.

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Background: The key to success in newborn resuscitation is theknowledge about the neonatal physiology and adequate preparation of the staff involved in the resuscitation process.The pulmonary part of the resuscitation can be accomplished with either Endotracheal Tube (ETT) or Face Mask (FM),both of these techniques require expertise and are associated with high rates of failure. Hence a third potential optionhas been suggested to overcome these problems. Objectives: To evaluate the efficacy of Laryngeal Mask Airway(LMA) in neonatal resuscitation and artificial ventilation and to compare it wit
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Hews, J., K. El-Boghdadly, and I. Ahmad. "Difficult airway management for the anaesthetist." British Journal of Hospital Medicine 80, no. 8 (2019): 432–40. http://dx.doi.org/10.12968/hmed.2019.80.8.432.

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This article reviews the key considerations when managing a patient with a difficult airway. The difficult airway may be anticipated from preassessment allowing time for investigations and preparation. Alternatively, the unanticipated difficult airway can present in an emergency situation, or unexpectedly during a routine anaesthetic. The main airway management techniques are discussed with a description of their advantages and limitations. Current guidelines are included that demonstrate how the techniques are incorporated into an overall strategy with a plan A–D when failure occurs. It is cr
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Books on the topic "Combined Techniques in Difficult Airway Management"

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Ilic, Romina G. Difficult Airway. Edited by Matthew D. McEvoy and Cory M. Furse. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190226459.003.0014.

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The difficult airway chapter focuses on preparing the clinician for a challenging airway. Management of both the expected, as well as the unexpected, difficult airway is critical to the care of the perioperative patient. Proper patient evaluation, organization, and preparation with a variety of airway tools are imperative to successfully securing the airway. The chapter reviews the difficult airway algorithm and discusses advanced airway techniques such as the use of awake intubation, airway exchange catheters, supraglottic airway devices, and surgical airway. Gaining familiarity with and usin
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Cooper, Richard M., David B. Glick, and Andranik Ovassapian. Difficult Airway: An Atlas of Tools and Techniques for Clinical Management. Springer London, Limited, 2012.

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Glick, David B., Richard M. Cooper, and Andranik Ovassapian. The Difficult Airway: An Atlas of Tools and Techniques for Clinical Management. Springer, 2016.

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Glick, David B., Richard M. Cooper, and Andranik Ovassapian. The Difficult Airway: An Atlas of Tools and Techniques for Clinical Management. Springer, 2012.

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Cranshaw, Jules, and Tim Cook. Airway assessment and management. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198719410.003.0037.

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This chapter discusses the assessment and management of the airway. It begins with methods of assessing the airway and describes the approach to the unanticipated difficult airway. Topics covered include failed intubation, techniques for managing the anticipated difficult intubation, the cannot-intubate-cannot-ventilate scenario, the management of the obstructed airway, rapid sequence induction, inhalational induction, and awake fibreoptic intubation. It concludes with a discussion of extubating the patient after a difficult intubation.
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Cranshaw, Jules, and Tim Cook. Airway assessment and management. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198719410.003.0037_update_001.

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This chapter discusses the assessment and management of the airway. It begins with methods of assessing the airway and describes the approach to the unanticipated difficult airway. Topics covered include failed intubation, techniques for managing the anticipated difficult intubation, the cannot-intubate-cannot-ventilate scenario, the management of the obstructed airway, rapid sequence induction, inhalational induction, and awake fibreoptic intubation. It concludes with a discussion of extubating the patient after a difficult intubation.
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Martinez-Hurtado, Eugenio Daniel, and María Luisa Mariscal Flores, eds. An Update on Airway Management. BENTHAM SCIENCE PUBLISHERS, 2020. http://dx.doi.org/10.2174/97898114323851200301.

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In recent years, there have been many advances in the safe management of the patient's airway, a cornerstone of anesthetic practice. An Update on Airway Management brings forth information about new approaches in airway management in many clinical settings. This volume analyzes and explains new preoperative diagnostic methods, algorithms, intubation devices, extubation procedures, novelties in postoperative management in resuscitation and intensive care units, while providing a simple, accessible and applicable reading experience that helps medical practitioners in daily practice. The comprehe
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Prout, Jeremy, Tanya Jones, and Daniel Martin. Airway management and anaesthesia for ENT, maxillofacial, and dental surgery. Oxford University Press, 2014. http://dx.doi.org/10.1093/med/9780199609956.003.0011.

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This chapter covers airway assessment and management with the conduct of anaesthesia for ENT and maxillofacial procedures, both elective and emergency. Airway assessment allows some prediction of the difficult airway. Management of the anticipated difficult airway is discussed with techniques including awake fibreoptic intubation. Management of the unanticipated difficult airway and the obstructed airway is discussed following Difficult Airway Society algorithms. Emergency airway management includes cricothyroidotomy and jet ventilation. Indications for tracheostomy, descriptions of surgical a
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Frerk, Christopher, and Takashi Asai. The airway in anaesthetic practice. Edited by Michel M. R. F. Struys. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199642045.003.0048.

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This chapter provides a comprehensive review of current airway management set against its historical context and likely future developments in the field. Developments in equipment design are discussed against the background of a short review of the anatomy and physiology relevant to clinical airway management. An exploration of airway devices examines progress in design from the first facemasks and early hands-free delivery systems, through to current second-generation supraglottic airways and the future of providing improved protection against aspiration. Continuing advances in tracheal tube
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Sabbe, Bryan M. General Anesthesia. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199398348.003.0023.

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This chapter covers various aspects of Pediatric General Anesthesia. Within this chapter topics covered include techniques for achieving induction of general anesthesia, along with limitations and potential complications of each. Also discussed is how to manage the pediatric airway, including mask ventilation, supraglottic airway devices, and endotracheal intubation, in addition to handling both expected and unexpected pediatric difficult airways. This includes assessment and airway management of several congenital craniofacial syndromes, and the means of achieving single-lung ventilation and
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Book chapters on the topic "Combined Techniques in Difficult Airway Management"

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Benumof, J. L. "Management of The Difficult Airway Part II: Proper Preparation for the Awake Intubation, Fiberoptic and Retrograde Techniques." In Anesthesia and the Lung 1992. Springer Netherlands, 1992. http://dx.doi.org/10.1007/978-94-011-2724-0_17.

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Pinsky, Jay R., and Carin A. Hagberg. "Combined Airway Management Techniques." In The Difficult Airway. Oxford University Press, 2013. http://dx.doi.org/10.1093/med/9780199794416.003.0014.

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Al-Jindi, Piotr, and Ami Attali. "Cesarean Section." In Advanced Anesthesia Review, edited by Alaa Abd-Elsayed. Oxford University PressNew York, 2023. http://dx.doi.org/10.1093/med/9780197584521.003.0295.

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Abstract Cesarean delivery is the most common surgical procedure performed worldwide. There are various indications related to maternal, fetal, uterus, or placental pathology. Preoperative evaluation includes review of past medical and obstetric history, including physical examination of airway, heart, and lungs. A blood type and crossmatch, intravenous access, aspiration prophylaxis, postoperative nausea and vomiting (PONV) management, and prophylactic antibiotics are integrals part of a preoperative plan. Neuraxial anesthesia is the preferred method of anesthesia for caesarian section unless there is an absolute contraindication. Advantages of neuraxial anesthesia include decreasing maternal mortality, limited neonatal drug transfer, ability of the parents to be awake and take part in the delivery during the birth of their child, and avoiding airway manipulation in patients who have both a potentially difficult airway and an aspiration risk. Different neuraxial techniques used for caesarian section include epidural, single-shot spinal, combined spinal-epidural, and spinal catheter. In case of general anesthesia, all equipment should be readily available with standard American Society of Anesthesiologist monitoring, including pulse oximetry, electrocardiography (ECG), capnography, and noninvasive blood pressure (NIBP). Rapid sequence induction and intubation with cricoid pressure are preferred after preoxygenation. All airway instruments should be available for a potential difficult airway, including an awake intubation plan if indicated. Anesthetic complications include intraoperative awareness and recall, dyspnea following neuraxial anesthesia, hypotension, failure of neuraxial blockade, high neuraxial blockade, difficult airway/trauma to the airway, and nausea and vomiting. Some of the important aspects of postoperative management include postoperative pain, pruritus, hypothermia, hemorrhage, and thromboembolic events.
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Lyons, Craig, and Ellen P. O’Sullivan. "Difficult airway." In Oxford Textbook of Anaesthesia for Oral and Maxillofacial Surgery, Second Edition, 2nd ed. Oxford University PressOxford, 2022. http://dx.doi.org/10.1093/med/9780198790723.003.0002.

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Abstract Patients undergoing oromaxillofacial and head and neck surgery can have pathologies that threaten the reliability of oxygen delivery under anaesthesia. Airway management requires a patient-specific and procedure-specific focus, working within the skillset of the anaesthesia and surgical services of the day. This chapter on difficult airway management focuses upon airway assessment and the formation of an airway management plan. Core airway management techniques are discussed, including bag mask ventilation, use of supraglottic airway devices, and laryngoscopy by direct and video-based means. The importance of positioning, preoxygenation, and neuromuscular blockade is explained. Awake airway management techniques (awake fibreoptic intubation, awake videolaryngoscopy, and awake tracheostomy) are discussed, being viewed as essential components of anaesthetists’ armamentarium. Airway management for maxillomandibular fixation is afforded special attention due to the requirement for specific knowledge and skills. The extubation process is explored, with pre-emptive and rescue techniques that may reduce the likelihood of airway compromise during this period identified. Finally, the contribution of human factors to difficult airway management is considered, with task fixation and cognitive overload highlighted as potential threats that must be overcome by anaesthetists in order to prioritize reliable patient oxygenation.
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Huang, Andrea S., Lisa E. Sohn, Suman Rao, and Narasimhan Jagannathan. "Supraglottic Airway Equipment and Techniques." In Management of the Difficult Pediatric Airway. Cambridge University Press, 2021. http://dx.doi.org/10.1017/9781316658680.005.

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Matuszczak, Maria, and Cheryl K. Gooden. "Direct Laryngoscopy Equipment and Techniques." In Management of the Difficult Pediatric Airway. Cambridge University Press, 2021. http://dx.doi.org/10.1017/9781316658680.004.

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Hunyady, Agnes I., James Peyton, Sarah Lee, and Raymond Park. "Video Laryngoscopy Equipment and Techniques." In Management of the Difficult Pediatric Airway. Cambridge University Press, 2021. http://dx.doi.org/10.1017/9781316658680.007.

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Van Beek-King, Jessica M., and Jeffrey C. Rastatter. "Rigid Bronchoscopy Equipment and Techniques." In Management of the Difficult Pediatric Airway. Cambridge University Press, 2021. http://dx.doi.org/10.1017/9781316658680.010.

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Craig, Richard. "Advanced airway management." In Paediatric Anaesthesia. Oxford University Press, 2019. http://dx.doi.org/10.1093/med/9780198755791.003.0009.

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Management of the difficult paediatric airway is described in this chapter. Airway assessment and a structured approach to planning for the anticipated difficult airway are the essence of the chapter. This includes a plan for induction of anaesthesia, a plan for laryngoscopy and intubation, and a plan for safe extubation. Detailed, step-by-step guides describing the techniques for intubation using a flexible bronchoscope, Macintosh-style video laryngoscope, and rigid optical stylet are provided. The conditions commonly associated with the difficult paediatric airway are classified according to the mechanism by which they cause difficulty.
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Craven, Rachael, and Rachel McKendry. "The Difficult Airway." In Global Anaesthesia. Oxford University Press, 2020. http://dx.doi.org/10.1093/med/9780198809821.003.0006.

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The difficult airway can be challenging to deal with in any setting. In resource-poor environments pathologies are often advanced, specialist equipment may be absent and trained assistance may be lacking, adding to the challenge. The chapter offers practical advice on assessment, planning, and management of difficult airways under these circumstances. Useful techniques considered include spontaneously breathing ketamine anaesthesia, airway topicalization for awake airway management techniques, blind nasal intubation, and awake tracheostomy. Common airway pathologies that may be encountered are described. Practical considerations regarding decision making for tracheostomy, care of tracheostomy on the ward, and management of tracheostomy emergencies are also discussed.
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Conference papers on the topic "Combined Techniques in Difficult Airway Management"

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Gong, Qiuming, Yaoyu Li, and Zhong-Ren Peng. "Computationally Efficient Optimal Power Management for Plug-In Hybrid Electric Vehicles With Spatial Domain Dynamic Programming." In ASME 2008 Dynamic Systems and Control Conference. ASMEDC, 2008. http://dx.doi.org/10.1115/dscc2008-2241.

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The plug-in hybrid electric vehicles (PHEV), utilizing more battery power, has become a next-generation HEV with great promise of higher fuel economy. Global optimization charge-depletion power management would be desirable. This has so far been hampered due to the a priori nature of the trip information and the almost prohibitive computational cost of global optimization techniques such as dynamic programming (DP). Combined with the Intelligent Transportation Systems (ITS), our previous work developed a two-scale dynamic programming approach as a nearly globally optimized charge-depletion str
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Jansik, Danielle, Dawn M. Wellman, Shas V. Mattigod, et al. "Foam: Novel Delivery Technology for Remediation of Vadose Zone Environments." In ASME 2011 14th International Conference on Environmental Remediation and Radioactive Waste Management. ASMEDC, 2011. http://dx.doi.org/10.1115/icem2011-59019.

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Deep vadose zone environments can be a primary source and pathway for contaminant migration to groundwater. These environments present unique characterization and remediation challenges that necessitate scrutiny and research. The thickness, depth, and intricacies of the deep vadose zone, combined with a lack of understanding of the key subsurface processes (e.g., biogeochemical and hydrologic) affecting contaminant migration, make it difficult to create validated conceptual and predictive models of subsurface flow dynamics and contaminant behavior across multiple scales. These factors also mak
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Dhafeeri, Abdullah, Muzher Almusabeh, and Syed Muzafar Ali Bukhari. "Nano Chemical Technology to Reduce Produced Water from Oil Wells." In SPE Water Lifecycle Management Conference and Exhibition. SPE, 2024. http://dx.doi.org/10.2118/219011-ms.

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Abstract The excess of water production from oil and gas wells in several areas of the oil field is a subject of concern for reservoir management. A conformance chemical treatment can be used to improve the production profile of a well and minimize unwanted water. Unwanted water production causes major economic, operational, and environmental problems during oilfield operations. First time, Nano chemicals are implemented as a safe and unique system with a great deal of benefit in terms of well productivity enhancement taking into consideration the most challenging limestone carbonate reservoir
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Chen, Jian, Shenfang Yuan, Lei Qiu, and Yuanqiang Ren. "Fatigue Crack Growth Prognosis With the Particle Filter and On-Line Guided Wave Structural Monitoring Data." In ASME 2021 International Mechanical Engineering Congress and Exposition. American Society of Mechanical Engineers, 2021. http://dx.doi.org/10.1115/imece2021-73504.

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Abstract Prognostics and health management (PHM) techniques have been widely studied in recent years to increase reliability, availability, safety, and reducing maintenance costs of safe-critical systems, like aircraft and power plants. In these systems, fatigue cracking is still one of the most widespread problems affecting structural safety. However, it is difficult to determine the structure’s fatigue life of an individual system due to uncertainties arising from various sources such as intrinsic material properties, loading, and environmental factors. Even fatigue lives of the same specime
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Nottoli, Emmanuelle, Philippe Bienvenu, Didier Bourlès, Alexandre Labet, Maurice Arnold, and Maité Bertaux. "Determination of Long-Lived Radionuclide (10Be, 41Ca, 129I) Concentrations in Nuclear Waste by Accelerator Mass Spectrometry." In ASME 2013 15th International Conference on Environmental Remediation and Radioactive Waste Management. American Society of Mechanical Engineers, 2013. http://dx.doi.org/10.1115/icem2013-96054.

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Radiological characterization of nuclear waste is essential for storage sites management. However, most of Long-Lived RadioNuclides (LLRN), important for long-term management, are difficult to measure since concentration levels are very low and waste matrices generally complex. In an industrial approach, LLRN concentrations are not directly measured in waste samples but assessed from scaling factors with respect to easily measured gamma emitters. Ideally, the key nuclide chosen (60Co, 137Cs) should be produced by a similar mechanism (fission or activation) as the LLRN of interest and should ha
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Elshurafa, Basil, Ayman El Khamry, Adham Osman, and Waleed Fakhry. "Advancements in Oil-Based Mud Micro-Resistivity Imaging - How Enhanced Dynamic Range Improves Feature Detection in Low and High Resistivity Formations." In ADIPEC. SPE, 2024. http://dx.doi.org/10.2118/222987-ms.

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Abstract Subsurface imaging is essential in exploration and field development, primarily for resolving and integrating geological complexities to the reservoir structures & depositional environments. Acquiring high resolution image data in non-conductive drilling muds has been one of the key challenges which led to the development of a new measurement technique in recent generation Oil Based Mud (OBM) imaging tools. Further challenges arise while acquiring high resolution OBM image in maintaining the quality across a broader formation resistivity range and with coverage in large borehole s
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Gagnani, Mayur, Pugalenthi Nandagopal, and Kai Sueselbeck. "A Solution for Improving Gas Turbine Performance Degradation and Emissions: The “GT Auto Tuner” Product." In ASME 2023 Gas Turbine India Conference. American Society of Mechanical Engineers, 2023. http://dx.doi.org/10.1115/gtindia2023-117887.

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Abstract The main causes of gas turbine performance degradation in natural gas combined cycle power plants are corrosion, fouling, and high turbine inlet temperatures which increase the oxidation in the blades and vanes. Blade coatings, effective filters, and cutting-edge turbine cooling technology can all be used to solve this problem. It can be quite difficult to stop the degradation of gas turbine parameters like the compressor flow, compressor efficiency, and turbine efficiency. Turbine Inlet Temperature (TIT) deterioration, on the other hand, is a phenomenon exclusive to the gas turbine s
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