Articles: intubation.
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Randomized Controlled Trial Clinical Trial
The oesophageal detector device. An assessment with uncuffed tubes in children.
In 100 children between the ages of 1-10 years, observers of differing experience reliably and rapidly detected 50 oesophageal and 50 tracheal intubations in a randomised single-blind trial using the original oesophageal detector device. However, only two children under the age of 2 years were tested and no conclusions can be drawn for this age group from this study.
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The purposes of this study were to evaluate the clinical utility of a colorimetric end-tidal CO2 (ETCO2) detector in confirming proper endotracheal intubation in patients requiring emergency intubation, to determine if this new device can be used as an adjunct to judge the effectiveness of cardiopulmonary resuscitation (CPR), and to determine whether the device can predict successful resuscitation from cardiopulmonary arrest. We studied prospectively 110 patients requiring emergency intubation for either respiratory distress (53 patients) or cardiopulmonary arrest (57 patients) by recording the color range of the indicator after the initial intubation. In patients who suffered a cardiopulmonary arrest, the color range was also recorded during CPR after the endotracheal tube was confirmed to be in the tracheal position and perfusion optimized, and at the moment CPR was stopped. ⋯ A low ETCO2 color range in 19 patients undergoing CPR was interpreted as low cardiac output and prompted the physicians to attempt to increase perfusion. Of the patients who underwent CPR, no patient whose ETCO2 level remained less than 2% was successfully resuscitated. Those patients who had an ETCO2 level greater than or equal to 2% had a significantly higher incidence of successful resuscitation.(ABSTRACT TRUNCATED AT 250 WORDS)
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Randomized Controlled Trial Comparative Study Clinical Trial
Effects of pindolol on the cardiovascular response to tracheal intubation.
Laryngoscopy and tracheal intubation often cause hypertension, tachycardia and arrhythmias, which may be exaggerated during rapid-sequence induction of anaesthesia. We have studied the efficacy of pindolol in attenuating the cardiovascular responses to laryngoscopy and intubation in patients receiving pindolol 2 micrograms kg-1 or 4 micrograms kg-1 3 min before induction of anaesthesia in a double-blind design. The data were compared with those in a control group receiving saline. ⋯ These increases after tracheal intubation were reduced in pindolol 4 micrograms kg-1 treated patients compared with those in the control group (P less than 0.05). Pindolol 2 micrograms kg-1 attenuated tachycardia in response to intubation but did not affect hypertension. These data suggest that a bolus injection of pindolol 4 micrograms kg-1 is a simple, practical and effective method for attenuating cardiovascular responses to laryngoscopy and tracheal intubation.
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Randomized Controlled Trial Clinical Trial
Effects of adenosine triphosphate on the cardiovascular response to tracheal intubation.
Laryngoscopy and tracheal intubation often cause hypertension and tachycardia, which may be exaggerated during rapid-sequence induction of anaesthesia. The efficacy of adenosine triphosphate (ATP) in attenuating this response was studied in patients receiving ATP 0.05 mg kg-1 or 0.1 mg kg-1 simultaneously with the start of laryngoscopy. These data were compared with those for a control group receiving saline. ⋯ Patients receiving saline showed a significant increase in mean arterial pressure and rate-pressure product associated with tracheal intubation. These increase after tracheal intubation were reduced in ATP-treated patients compared with those of the control group (P less than 0.05). The data suggest that a bolus injection of ATP is a simple, practical and effective method for attenuating the hypertensive response to laryngoscopy and tracheal intubation.
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Ventilator autocycling can occur with any ventilator if the sensitivity is improperly set or if a gas leak exists in the respiratory system which creates a negative change in proximal airway pressure. We report a case of ventilator autocycling in a paralyzed patient secondary to an endotracheal cuff leak which was misconstrued as assisted ventilation. We believe this is the first report of autocycling due to a cuff leak.