Articles: intubation.
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The TRISS system is an important, widely used method for predicting survival in trauma patients. One significant shortcoming of TRISS is its inability to include intubated patients in survival analysis because a respiratory rate and a verbal response are not obtainable. This report describes one approach to this problem. ⋯ Thus, our model has predictive performance comparable with TRISS. More importantly, it is applicable to intubated patients who are not pharmacologically paralyzed. Further investigation with larger data bases is necessary.
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Ann Fr Anesth Reanim · Jan 1992
Review[Consequences and prevention methods of hemodynamic changes during laryngoscopy and intratracheal intubation].
In patients ranked ASA 1, laryngoscopy and intubation lead to an average increase in blood pressure of 40 to 50%, and a 20% increase in heart rate. These changes, which are greatest one minute after intubation, last for 5 to 10 min. They are due to sympathetic and adrenal stimulation, which may also result in some arrhythmias. ⋯ In clinical practice, prevention will first rely on a sufficient dose of narcotics. In some cases, nitroglycerin or beta blockers may be used so as to decrease the doses of narcotics, without altering their efficacy; however, the risk of hypotension should be constantly borne in mind. If preventing measures have not been taken, short-acting antihypertensive agents (beta blockers, calcium blockers) should be used in patients who develop major hypertension during laryngoscopy and intubation.
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Ann Fr Anesth Reanim · Jan 1992
Review Case Reports[Tracheal intubation in patients with cervical spine injuries using a fiber optic laryngoscope].
Eleven patients, with a cervical spine injury and scheduled for elective cervical spine fusion at least 48 h after their initial trauma, were intubated using a new fiberoptic laryngoscope (Bullard). This technique uses either a semi-rigid guide independent of the laryngoscope blade, or a rigid one attached to the blade. The cervical spine was immobilized with either a collar or a halo. ⋯ This is confirmed by the time required, 44 +/- 22 sec for the rigid guide, and 97 +/- 92 sec for the semi-rigid one. In the patient in whom this technique failed at the first attempt, endotracheal intubation was carried out by the nasal route and controlled by the fiberoptic laryngoscope. This technique enables a rapid and easy orotracheal intubation in trauma patients with an immobilized cervical spine, but careful training is necessary.
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Anesth Pain Control Dent · Jan 1992
Displacement of the endotracheal tube caused by postural change: evaluation by fiberoptic observation.
Unexpected displacement of the endotracheal tube during anesthesia caused by postural change of the neck or passive compression by the mouth gag was investigated under transluminal fiberoptic observation. Twenty-two patients were divided into orotracheal and nasotracheal intubation groups according to the technical requirements of the planned oral and maxillofacial surgery. ⋯ Under orotracheal intubation, the mean length of displacement from the carina was 12 mm by extension of the neck and almost 28 mm with application of the mouth gag. To avoid accidental extubation or one-sided bronchial intubation during anesthesia, the tip (distal end) of the endotracheal tube should be located less than 32 mm from the carina before extension of the neck and more than 41 mm from the carina before application of the mouth gag.