Articles: intubation.
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Randomized Controlled Trial Comparative Study Clinical Trial
Esmolol hydrochloride for management of the cardiovascular stress responses to laryngoscopy and tracheal intubation.
In a double-blind, randomized, controlled prospective study, 30 grade ASA I/II patients received a continuous i.v. infusion of normal saline or esmolol hydrochloride before induction of anaesthesia and tracheal intubation. Arterial pressure and heart rate were measured to assess the pressor response to laryngoscopy and intubation. The heart rate decreased in the esmolol group before induction of anaesthesia. The pressor response to laryngoscopy was significantly less marked in the esmolol group.
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The perioperative management and dissemination of critical information regarding a patient with an unexpected difficult intubation, including successful application of a difficult airway algorithm (Figure 1), are described. Documentation and dissemination of critical information include entry of patient data into an in-hospital computerized Difficult Airway/Intubation Registry, simultaneous application of a highly visible Difficult Airway/Intubation Patient Wrist Band (coded for access to computer registry), summary reports distributed to health care providers, and enrollment of the patient in the Medic Alert Foundation International's newly established category difficult airway/intubation for 24-hour access. We postulate that the widespread use of the procedures described in this report may reduce the contribution of unexpected difficult airway/intubation to anesthetic morbidity and mortality.
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Case Reports
Rapid orotracheal intubation in the clenched-jaw patient: a modification of the lightwand technique.
Emergency airway management of the patient with a clenched jaw can present a special challenge to the anesthesiologist. We describe four cases in which the patients had a clenched jaw and nasotracheal intubation was either contraindicated or several attempts had failed. All patients were successfully orotracheally intubated by a modification of the lightwand technique.
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Case Reports
Airway management in a case of neck impalement: use of the oesophageal tracheal combitube airway.
A patient presented with neck impalement after a traffic accident. Respiratory arrest demanded immediate tracheal intubation, which was impossible as a wooden splinter had partially obstructed the pharynx and prevented laryngoscopy. An oesophageal tracheal Combitube airway was inserted successfully and the patient's lungs were ventilated adequately until tracheotomy was performed.
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Case Reports
Pneumothorax due to ball-valve obstruction of an endotracheal tube in a mechanically ventilated patient.
Barotrauma is a well-known complication of mechanical ventilation, thought to be related to alveolar rupture from localized hyperinflation. Mishaps related to endotracheal intubation can lead to barotrauma such as inadvertent intubation of the right mainstem bronchus. In this report, we describe pneumothorax as a consequence of ball-valve occlusion, a previously undescribed endotracheal tube malfunction.