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Marked hypercapnia may act viacentral inhibition of respiratory muscle outputand/or by inducing chest wall distortion that cantrigger apnoea with laryngeal closure.

Attempts to obtain closure with localtissue advancement through undermining have a high likelihood of failure. In timesof decreased systemic perfusion, the distal branches of the SMA and IMA cannot providesufficient blood supply to portions of the colon, leading to ischemic injury

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