Articles: intubation.
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Review
Management of the difficult adult airway. With special emphasis on awake tracheal intubation.
Difficulty in managing the airway is the single most important cause of major anesthesia-related morbidity and mortality. Successful management of a difficult airway begins with recognizing the potential problem. All patients should be examined for their ability to open their mouth widely and for the structures visible upon mouth opening, the size of the mandibular space, and ability to assume the sniff position. ⋯ Eighty percent of the 127 references in this article were published after 1985. However, there is much more to learn with regard to recognition of the difficult airway, preparation of the patient for an awake intubation, new techniques of endotracheal intubation, and establishment of gas exchange in patients who cannot be intubated or ventilated by mask. As the anesthesiologist's ability to manage the difficult airway significantly improves, respiratory-related morbidity and mortality will decrease.
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Surg. Clin. North Am. · Dec 1991
ReviewAirway injury after tracheotomy and endotracheal intubation.
Iatrogenic airway injury after tracheotomy and endotracheal intubation continues to be a serious clinical problem. Endotracheal tubes cause pressure injury to the glottis and may result in severe commissural scarring that is difficult to treat. ⋯ The technique of laryngotracheal resection and reconstruction has been well developed and may be applied successfully to most patients with subglottic and tracheal stenosis. The surgical treatment of glottic stenosis remains a challenge.
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Two pre-operative tests for the prediction of difficult intubation are assessed. A modified Mallampati test and a measurement of thyromental distance were performed at the pre-operative visit of 244 patients whose tracheas were subsequently intubated under general anaesthesia. Patients in whom the posterior pharyngeal wall could not be visualised below the soft palate, who also had a distance of less than 7 cm between the prominence of the thyroid cartilage and the bony point of the chin proved significantly more likely to present difficulty with intubation. The performance of these two simple tests on all patients before operation should allow the majority of cases of difficult intubation to be anticipated.
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Randomized Controlled Trial Clinical Trial
Pressure support ventilation using a new tracheal gas injection tube.
In order to explore new types of jet ventilation, we tested a tracheal gas injection tube (TGIT) which included six thin capillaries and provided high pressure injection. The driving pressure was chosen to yield a plateau of inspiratory tracheal pressure of 10 cm H2O. An original controller was built to monitor spirometry and trigger injection in order to deliver both pressure controlled ventilation (PCVTGIT) and a new mode of inspiratory pressure support jet ventilation (IPSTGIT). ⋯ IPSTGIT, compared with spontaneous breathing increased minute ventilation (from 5.7 (SD 1.6) to 7.1 (1.7) litre min-1) (P less than 0.001). It reduced the total work of breathing (from 0.625 (0.223) to 0.263 (0.151) J litre-1, respectively) (P less than 0.01) and the occlusion pressure (from 2.62 (1.28) to 1.36 (0.74) cm H2O, respectively) (P less than 0.01). It is concluded that this TGIT used with a specific system for sensing and triggering ventilation allows inspiratory pressure support during low frequency jet ventilation.