Articles: intubation.
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Surg Gynecol Obstet · Dec 1991
The role of anesthetic induction agents and neuromuscular blockade in the endotracheal intubation of trauma victims.
Management of extensive trauma often requires immediate tracheal intubation and mechanical ventilation. The role of anesthetic induction agents and neuromuscular blockade in the airway management of the trauma victim is disputed. To better define the role of these agents in the acute management of trauma, the adult trauma registry of The Johns Hopkins Hospital was reviewed to determine the frequency of use of these agents in acute airway management and to assess the effect of these agents on the incidence of complications. ⋯ None of these patients received drugs prior to the first attempt at intubation. No hemodynamic or neurologic complications, related to relaxant or induction agent use, were observed. These findings suggest that oral intubation with drugs to facilitate airway management is most likely to result in successful intubation on the first attempt and that drug use in the trauma setting is safe.
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Randomized Controlled Trial Comparative Study Clinical Trial
Prospective study of manikin-only versus manikin and human subject endotracheal intubation training of paramedics.
To determine the effect of manikin-only training on field success of endotracheal intubation by paramedics. ⋯ Paramedics trained in endotracheal intubation using a systematic manikin-only teaching program can attain acceptable individual success rates in the actual field setting.
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Enteral delivery of nutrients is important for optimal treatment of critically ill patients. It maintains gut digestive and barrier functions, decreases gut bacterial translocation, decreases the incidence of sepsis, and improves outcome. Gastric emptying is impaired in many critically ill patients and feeding into a gastroparetic stomach leads to large gastric residuals and aspiration. ⋯ The average time for placement of small bowel feeding tubes was 40 +/- 14 min (mean +/- SD). Abdominal roentgenograms failed to properly locate 13 (6 percent) tubes. The most accurate and cheapest methods for confirming small bowel location of feeding tubes were bile aspiration, pH change from acidic to basic, and blue dye injection.
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Comparative Study
Comparison of train-of-four and posttetanic response as guides for endotracheal intubation in children.
To evaluate and compare the predictive values of the absence of train-of-four (TOF) or posttetanic response as guides for endotracheal intubation in children. ⋯ Good intubating conditions can generally be counted on when the TOF has disappeared; additional waiting for the disappearance of posttetanic response is unnecessary. The observation that the disappearance of the tetanus-twitch sequence is a good indicator of deep neuromuscular blockade during recovery from atracurium in children cannot be extrapolated to the induction period.
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Data on the normal depth of insertion of double-lumen tubes have not been published. We studied 101 adult patients undergoing thoracic operations whose tracheas were intubated with a left double-lumen tube. ⋯ The correlation between depth of insertion and height was highly significant (P less than 0.0001) for both male and female patients. As depth of DLT insertion at any given height was normally distributed, a technique to confirm correct double-lumen tube position always should be used after initial placement.