Articles: intubation.
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Ugeskrift for laeger · Jan 1991
Review Comparative Study[Methods for ensuring correct tracheal intubation. A review].
To confirm correct intubation of the trachea, the literature mentions the following methods: Auscultation of thorax, the sensation of normal ventilation, gastric and thorax movement, condensation of water vapor in the tube lumen, external palpation on the patient's neck of the tube and the cuff, tactile palpation through the patient's mouth of the tube, x-ray of thorax and detection of hemoglobin oxysaturation with pulse oximetry. These methods can be used, but cannot be recommended, because they are not reliable. The following methods are recommended in the literature as reliable: Repeated laryngoscopy when there are direct visualization of the vocal cords, fiberoptic bronchoscopy, suction on the tube with a 60-ml syringe, auscultation of the upper abdomen and lungs and end-tidal carbon dioxide measurement. For the daily routine, control, of the endotracheal tube placement, by auscultation over the epigastrium, then in the right and left axilla, and continuous measurement of carbon dioxide in the expired air are recommended.
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Case Reports Randomized Controlled Trial Clinical Trial
A management option for leaking endotracheal tube cuffs: use of lidocaine jelly.
To evaluate the effectiveness of methods for sealing a small endotracheal tube cuff perforation. ⋯ The authors' in vitro results, in conjunction with the observations from their two cases, suggest that lidocaine jelly mixed with 1 to 3 parts normal saline may be useful in managing certain types of endotracheal tube cuff incompetence.
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A prospective study of unexpected, difficult laryngoscopy was carried out. During a 7-month period, all general surgery patients in whom the trachea was intubated were assessed; only those with obvious neck pathology were excluded. Ease or difficulty of laryngoscopy was graded by a standard method. ⋯ There were significant differences in the results recorded by different individuals; this did not correlate with seniority or with the type of surgery. Four factors have been identified which help to explain these discrepancies. These findings are analysed in relation to the training of junior staff, with particular reference to obstetric anaesthesia.
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Ann Fr Anesth Reanim · Jan 1991
Comparative Study[Comparative value of clinical signs of difficult tracheal intubation in women].
A prospective study was designed to compare the value of clinical signs aimed to predict difficult intubation in women. A group of 663 women, scheduled for elective surgery, were assessed by an anaesthetist at the preanaesthetic visit. Following parameters were assessed: the degree of mouth opening, the chin-hyoid bone and the chin-thyroid cartilage distances, dental and facial abnormalities, age, weight. ⋯ Other clinical criteria (mouth opening, the chin-hyoid bone distance) had a lower sensitivities, but seemed more specific. Multivariate analysis showed that specificity could be improved (0.84) if the distance between the upper and lower incisor teeth (mouth opening) was associated with Mallampati's rank, without any loss in sensitivity. A simple chart is proposed to assess the risk of difficult intubation.
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Pediatric pulmonology · Jan 1991
Effects of endotracheal tube size and ventilator settings on the mechanics of a test system during intermittent flow ventilation.
The effect of varying the size of standard neonatal endotracheal tubes on delivered tidal volumes (VT), resistance (R), dynamic compliance (Cdyn), and resistive work of breathing (WOB) was measured in a test system during intermittent flow ventilation at different ventilator settings. The experiments were performed with a Sechrist infant ventilator connected to a Dräger Test Lung via standard neonatal endotracheal tubes. R, inspiratory (Ri), and expiratory resistance (Re) as well as WOB were significantly affected by endotracheal tube size. ⋯ Also, ventilator settings with respect to the peak inspiratory pressure (PIP) - positive end-expiratory pressure (PEEP) difference had a significant influence on Cdyn for both tube sizes. On the other hand, flow and inspiratory time adjustments had no significant effect on ventilatory parameters. Endotracheal tube size and ventilator settings should be considered when comparing the pulmonary function tests in intubated and non-intubated newborn infants.