Articles: intubation.
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Randomized Controlled Trial Clinical Trial
Facilitation of rapid-sequence intubation with large-dose vecuronium with or without priming.
To determine the effect of priming on the intubation and onset times of vecuronium 0.3 mg/kg. ⋯ Seventy-five percent to 85% neuromuscular block of the adductor pollicis, required for atraumatic tracheal intubation, developed in 80 seconds or less when vecuronium 0.3 mg/kg was administered in divided doses and in 140 seconds or less when it was injected as a single bolus dose. Clinical duration of vecuronium 0.3 mg/kg is long and unpredictable, and reversal of residual neuromuscular block may require larger doses of anticholinesterases. It is recommended that an intubating dose of vecuronium 0.3 mg/kg be used only in patients undergoing long surgical procedures that require prolonged postanesthetic mechanical ventilation.
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The reported incidence of hoarseness following short-term tracheal intubation varies widely. It has been reported as being permanent in 3%. This suggests that an enormous problem exists considering the numbers of patients intubated daily in the United Kingdom. ⋯ Those who were hoarse for 54 and 99 days had vocal cord granulomata. Regression analyses showed that certain patient and anaesthetic factors had a significant effect on the hoarseness. This study confirms a low incidence of prolonged or permanent hoarseness following short-term tracheal intubation.
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Endoesophageal prostheses are sometimes used in palliative therapy of esophageal carcinoma. Placement or subsequent manipulation of these devices may require general anesthesia, and these anesthetics are fraught with potential complications, both from the patient's illness and from the prosthesis itself. The two patients in our report presented anesthetic challenges, including acute upper airway obstruction occurring outside the operating theater and management of malignant tracheoesophageal fistula.
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To assess the resistance of a new endotracheal tube to penetration and ignition by a carbon dioxide (CO2) laser at a clinically relevant power setting. ⋯ The protective coating of the Xomed Laser-Shield II is laser-resistant, but the unprotected silicone proximal and distal to the cuff is laser-vulnerable and can, under certain conditions, promote a blowtorch phenomenon. This tube would be acceptable for use in oral and pharyngeal laser surgery, but we recommend its use only in well-ventilated areas, out of concern for exposure to the products of the pyrolysis of Teflon, specifically the development of polymer-fume fever.
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Rev Esp Anestesiol Reanim · Mar 1992
Comparative Study Clinical Trial Controlled Clinical Trial[Pressure changes in the pneumoballoon of several endotracheal tubes after the administration of nitrous oxide].
We compare the degree of nitrous oxide diffusion in three types of endotracheal tubes available in the market, by means of continuous monitoring of the pressure attained at the pneumoballoon. Among the systems designed to impede or to minimize nitrous oxide diffusion, we have used in this study the so called "rediffusion system". ⋯ We believe that during anesthesia with nitrous oxide the pneumoballoon pressure should be monitored or systems that avoid diffusion of this inhalational agent should be inserted. Our results indicate that endotracheal tubes equiped with "rediffusion system" are effective in impeding diffusion of the inhalational agents.