Articles: intubation.
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Two patients presented with almost total obliteration of the pharynx. In one, a membrane developed after corrosive poisoning; in the other, the oropharynx was filled with a dense cicatrix in the sclerosing phase of rhinoscleroma. ⋯ To overcome the problem of respiratory obstruction while the fibrescope passed through the opening in the membrane, either rapid intubation, or a technique using pre-oxygenation and voluntary hyperventilation followed by breath-holding during bronchoscopy, was used. The thin calibre and manoeuvrability of the flexible fibreoptic bronchoscope makes fibreoptic intubation an excellent technique of airway management in cicatricial membranes of the pharynx.
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We experienced troubled endotracheal intubation in an adult patient with asymptomatic tracheal bronchus. The breath sounds of the right upper lobe were found to be absent right after the placement of a tracheal tube. ⋯ In a patient with this anomaly, who is otherwise healthy, a placement of a tracheal tube may cause pulmonary complications. Thus, as a diminished breath sound is found to be located at the upper right lobe after endotracheal intubation, we have to think of tracheal bronchus as one of the possible causes.
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Randomized Controlled Trial Clinical Trial
Dexmedetomidine reduces intraocular pressure, intubation responses and anaesthetic requirements in patients undergoing ophthalmic surgery.
We studied the effects of a single i.v. dose of dexmedetomidine, a highly selective and specific alpha 2 adrenoceptor agonist, on intraocular pressure (IOP), haemodynamic and sympathoadrenal responses to laryngoscopy and tracheal intubation, and on anaesthetic requirements in ophthalmic surgery. Thirty ASA I-II patients undergoing cataract surgery were allocated randomly to receive either dexmedetomidine 0.6 microgram kg-1 or saline placebo i.v. 10 min before induction of anaesthesia in a double-blind design. After dexmedetomidine there was a 34% (95% confidence interval (CI) 27-43%) reduction in IOP (P less than 0.001) and 62% (CI 57-68%) decrease in plasma noradrenaline concentrations (P less than 0.001). ⋯ The induction dose of thiopentone was smaller (23% (CI 20-26%) P = 0.012), and the use of isoflurane or fentanyl supplements during anaesthesia was less frequent in the dexmedetomidine group. The patients premedicated with dexmedetomidine recovered faster from anaesthesia (P = 0.042). These results suggest that dexmedetomidine may be a useful anaesthetic adjunct in ophthalmic surgery.
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Anesthesia and analgesia · Jun 1992
Randomized Controlled Trial Clinical TrialSore throat after endotracheal intubation.
Nitrous oxide can diffuse into the cuff of an endotracheal tube during tracheal intubation, and the cuff pressure against the tracheal wall may cause mucosal damage. An endotracheal tube has been developed (Brandt Anesthesia Tube) that effectively limits nitrous oxide-related intracuff pressure increases. We determined whether the incidence of postoperative sore throat could be reduced by using this tube. ⋯ In the Mallinckrodt group, 12 of 20 patients had a sore throat and 10 patients had intracuff pressures greater than 25 mm Hg. Only 3 of 20 patients in the Brandt group had a sore throat. We found that the incidence of sore throats after intubation could be significantly reduced by using the Brandt Anesthesia Tube (P less than 0.005).