Articles: intubation.
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The 'cuff-leak' test, which involves demonstrating a leak around a tracheal tube with the cuff deflated, has been advocated to determine the safety of extubation in patients with upper airway obstruction. In 62 such patients we were able safely to extubate all patients with a cuff leak. ⋯ Subsequently, we extubated 10 patients who were stable on spontaneous ventilation and did not have cuff leak; three later required tracheostomy and seven were uneventfully extubated. While the presence of cuff leak demonstrates that extubation is likely to be successful, a failed cuff-leak test does not preclude uneventful extubation and if used as a criterion for extubation may lead to unnecessarily prolonged intubation or to unnecessary tracheostomy.
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The applied anatomy of the cricothyroid and cricotracheal region of the neck and a retrograde method of tracheal intubation using the subcricoid region are described. This approach has several advantages, including absence of bleeding complications, as there are no major blood vessels on the cricotracheal membrane, and reduction in the possible development of subglottic oedema and stenosis.
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This study was undertaken to examine the effects of nicardipine on circulatory responses to laryngoscopy and tracheal intubation in normotensive (n = 39) and hypertensive (n = 36) patients. Laryngoscopy and tracheal intubation were performed after induction of anaesthesia with thiamylal, followed by administration of intravenous saline or nicardipine 20 or 30 micrograms.kg-1 and suxamethonium. Blood pressure and heart rate were recorded, and rate-pressure product was calculated. ⋯ The changes in heart rate after intubation were significantly greater in normotensive patients than in hypertensive patients when 20 or 30 micrograms.kg-1 of nicardipine was given (p less than 0.05 and p less than 0.01 respectively). Rate-pressure product increased significantly (p less than 0.01) after intubation in normotensive patients whether nicardipine was administered or not, but the increase was suppressed completely by nicardipine 20 or 30 micrograms.kg-1 in hypertensive patients. We conclude that nicardipine is effective in preventing the circulatory responses to laryngoscopy and tracheal intubation in hypertensive patients.
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Neuromuscular blocking agents (NMBs) are frequently used to facilitate intubations in the hospital. The 1987 membership of the Association of Air Medical Services (AAMS) was surveyed to determine the frequency of NMB use by flight programs both before and after definitive airway control. Out of 141 programs, 101 returned completed survey forms. ⋯ The presence of a physician on the flight crew was associated with the use of succinylcholine prior to definitive airway control. Reported complications included three deaths attributed to use of NMBs in the preceding two years. We conclude that NMBs are commonly used following intubation, and that NMBs are used before intubation by some flight programs, especially those that have physician crew members.