Articles: intubation.
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Randomized Controlled Trial Comparative Study Clinical Trial
Nosocomial sinusitis in ventilated patients. Nasotracheal versus orotracheal intubation.
A total of 68 postoperative patients whose lungs were ventilated for more than 4 days were studied prospectively during a one-year study period to investigate the effect of the mode of intubation on the paranasal sinuses. After an initial X ray of the skull showing no pathological findings, patients were assigned randomly to one of the study groups; the lungs of patients in group A were ventilated via an orotracheal tube (n = 32), and patients in group B via a nasotracheal tube (n = 36). X ray examinations of the sinuses were performed at regular intervals. ⋯ Two patients in group A developed signs of sinusitis in comparison to 15 patients in group B (p less than 0.01). However, there were significantly more airway complications in the orotracheal group, particularly during the period of weaning from ventilation. We conclude that orotracheal intubation should be preferred as the routine route of intubation.
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Prehosp Disaster Med · Apr 1992
An analysis of invasive airway management in a suburban emergency medical services system.
Airway management is the most critical and potentially life-saving intervention performed by emergency medical service (EMS) providers. Invasive airway management often is required in non-cardiac-arrest patients who are combative or otherwise uncooperative. The success of prehospital invasive airway management in this patient population was evaluated. ⋯ Prehospital providers can intubate a high but improvable proportion of non-cardiac-arrested patients by both the orotracheal and nasotracheal routes. The use of pharmacologic adjuncts to facilitate the prehospital intubation of selected, non-cardiac-arrested patients is a promising adjunct that needs further evaluation.
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Comparative Study
Cardiovascular responses to insertion of the laryngeal mask.
We have compared, in 40 healthy patients, the cardiovascular responses induced by laryngoscopy and intubation with those produced by insertion of a laryngeal mask. Anaesthesia was induced with thiopentone and maintained with enflurane and nitrous oxide in oxygen; vecuronium was used for muscle relaxation. ⋯ Increases in maximum heart rate were similar, (26.6% v 25.7%) although heart rate remained elevated for longer after tracheal intubation. We conclude that insertion of the laryngeal mask airway is accompanied by smaller cardiovascular responses than those after laryngoscopy and intubation and that its use may be indicated in those patients in whom a marked pressor response would be deleterious.
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Comparative Study
Resistance and additional inspiratory work imposed by the laryngeal mask airway. A comparison with tracheal tubes.
Laryngeal mask airways and tracheal tubes were studied to determine both their resistance to constant gas flows and additional inspiratory work during simulated inspiration. Laryngeal mask airways imposed less resistance and required lower additional inspiratory work compared with the corresponding sized tracheal tubes. If inspiratory loading during anaesthesia is an important consideration, then the laryngeal mask airway may be preferable to a tracheal tube.