Articles: intubation.
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Review Case Reports
Postextubation laryngeal spasm in an unanesthetized patient with Parkinson's disease.
We present a patient with Parkinson's disease who experienced laryngeal spasm after tracheal extubation without having been anesthetized. This patient's trachea was intubated because of respiratory arrest. We postulate that her postextubation laryngospasm was related to Parkinson's disease.
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Of 208 children who required relief of severe airway obstruction due to laryngotracheobronchitis by an artificial airway (nasotracheal intubation or tracheostomy) during a 10-year-period, 181 (87%) were intubated and later extubated. Twenty-seven children (13%) had tracheostomies performed. The tracheostomies were for severe subglottic narrowing precluding the passage of an adequate size endotracheal tube in 10 children, and for severe endotracheal tube trauma in 17 children. ⋯ It is concluded that nasotracheal intubation is a satisfactory artificial airway for laryngotracheobronchitis. Endoscopic evaluation in a selected group of these children will identify those with significant intubation trauma or severe subglottic narrowing in whom continued intubation may cause permanent subglottic damage. The low incidence of acquired subglottic stenosis in this series supports the practice of selective endoscopy and tracheostomy.
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Review Case Reports
Pneumothorax complicating small-bore feeding tube placement.
Small-bore Silastic feeding tubes are being used with increasing frequency for short- and long-term enteral hyperalimentation. We present three cases where these flexible tubes were passed into the tracheobronchial tree and then out into the pleural space. The result in each case was a pneumothorax or hydropneumothorax. ⋯ The traditional methods of assessing proper nasogastric tube placement are inadequate when applied to these small tubes. Only a chest roentgenogram can assure placement in the stomach. Education of hospital staff on methods to avoid malposition of feeding tubes has resulted in an absence of pulmonary complications over a subsequent 1-year period.
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Ugeskrift for laeger · Jan 1991
Review Comparative Study[Methods for ensuring correct tracheal intubation. A review].
To confirm correct intubation of the trachea, the literature mentions the following methods: Auscultation of thorax, the sensation of normal ventilation, gastric and thorax movement, condensation of water vapor in the tube lumen, external palpation on the patient's neck of the tube and the cuff, tactile palpation through the patient's mouth of the tube, x-ray of thorax and detection of hemoglobin oxysaturation with pulse oximetry. These methods can be used, but cannot be recommended, because they are not reliable. The following methods are recommended in the literature as reliable: Repeated laryngoscopy when there are direct visualization of the vocal cords, fiberoptic bronchoscopy, suction on the tube with a 60-ml syringe, auscultation of the upper abdomen and lungs and end-tidal carbon dioxide measurement. For the daily routine, control, of the endotracheal tube placement, by auscultation over the epigastrium, then in the right and left axilla, and continuous measurement of carbon dioxide in the expired air are recommended.