Articles: intubation.
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In head-injured adults sudden increases in intracranial pressure (ICP) frequently occur in response to noxious stimuli, such as endotracheal suctioning (ETS). Transient increased ICP may have potentially harmful effects upon head-injured patients. One intervention clinicians believe to be efficacious in blunting ICP response to ETS is administration of lidocaine hydrochloride. ⋯ The literature to date, while providing conflicting results, does demonstrate tentative support for the use of lidocaine prior to ETS as a means of attenuating a rise in ICP. Support was found for the intratracheal route of administration. Additionally when intratracheal lidocaine was coupled with muscle relaxants or other anesthetic agents administered at appropriate times prior to suctioning, large rises in ICP may be effectively blunted.
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Most patients who require emergency airway control receive drugs to induce rapidly sufficient anesthesia for direct laryngoscopy and endotracheal intubation, but there are no protocols that outline the use of specific drugs in general use. Drugs should safely and rapidly produce (1) unconsciousness; (2) paralysis; and (3) blunt intracranial pressure (ICP) responses to airway procedures. Consequences to be considered include increased ICP, hemorrhagic shock, and a full stomach. ⋯ In two of 11 instances (18.3%) where succinylcholine was administered, no prior nondepolarizing agent was used. Complications of a full stomach at the time of emergency endotracheal intubation became evident in 10 patients (16.7%) who vomited during procedures to control the airway. Two patients (3.3%) aspirated.(ABSTRACT TRUNCATED AT 400 WORDS)
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A sore throat is the most frequent adverse side effect of general anesthesia. The purpose of this study was to determine the relationship between intravenous lidocaine given during induction of general endotracheal anesthesia and postanesthesia sore throat. In addition, the study examined selected variables (bucking; gender; smoking; type of laryngoscope blade; and use of succinylcholine, condenser-humidifiers, or analgesic medication during the previous hour) in relation to the occurrence of postoperative sore throat. ⋯ The researcher administered the visual analogue scale to 139 subjects at 21 to 27 hours following termination of the anesthetic in order to rate sore throat. A retrospective chart review provided data on the variables selected for study and those that were controlled. Chi-square and independent t-tests revealed that a decrease in the severity of the sore throat, as recorded on the visual analogue scale, was significantly related to use of intravenous lidocaine and condenser-humidifiers.
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Twenty-nine departments of anaesthesia in the North of England were questioned about the availability and teaching of fibreoptic tracheal intubation techniques. While 27 departments had both suitable equipment and trained consultant staff, only one offered formal teaching to all its junior anaesthetists.
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Difficult intubation has been much discussed in the anaesthetic literature. The incidence of difficult intubation (11:560) was higher in obstetric patients (6:277) as compared to gynaecological patients (5:283) in our hospital. We tested the Mallampati's classification as a predictor of difficult intubation in 277 obstetric and 283 gynaecological patients. We recommend that Mallampati's classification can be used reliably (p less than 0.05) to predict difficult intubation in obstetric but not in gynaecological patients.