Articles: intubation.
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Randomized Controlled Trial Comparative Study Clinical Trial
Arterial oxygen saturation during induction of anaesthesia and laryngeal mask insertion: prospective evaluation of four techniques.
In a prospective, randomized study of 87 patients, we have compared the incidence of hypoxaemia during induction of anaesthesia with subsequent Laryngeal Mask Airway (LMA) insertion in healthy adults when four different techniques were used: one without supplementary oxygen, and three with supplementary oxygen. Twelve patients did not receive supplementary oxygen before LMA placement, 25 underwent partial denitrogenation by breathing oxygen from the start of injection of the induction agent, 25 underwent formal denitrogenation by breathing oxygen for 3 min, and 25 received five tidal volume breaths of oxygen by face mask using positive pressure immediately after induction of anaesthesia. Anaesthesia was induced with propofol 2.0 mg kg-1 and fentanyl 1 microgram kg-1. ⋯ Desaturation occurred in 11 of 12 patients who did not receive supplementary oxygen, and in 19 of 25 patients who received manual ventilation with 100% oxygen after induction of anaesthesia before LMA insertion. Full denitrogenation and partial denitrogenation were equally successful in preventing desaturation. Failure to position the LMA successfully occurred in 3% of patients, and some difficulty was encountered in another 18%.
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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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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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Multicenter Study Clinical Trial
Multicenter study of a portable, hand-size, colorimetric end-tidal carbon dioxide detection device.
To evaluate continuous, semiquantitative end-tidal carbon dioxide (ETCO2) monitoring in the prehospital and emergency department setting for confirming proper endotracheal tube placement and assessing prognosis and blood flow during CPR. ⋯ The colorimetric ETCO2 device is highly accurate for confirming endotracheal tube position in nonarrest patients. In cardiac arrest patients, a reading signifying more than 0.5% ETCO2 confirms correct endotracheal tube placement, while a value signifying less than 0.5% ETCO2 during resuscitation suggests that something is wrong (eg. esophageal intubation, inadequate circulatory flow, prolonged down-time interval, hypothermia, or significant ventilation/perfusion mismatch).
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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.