Articles: intubation.
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Randomized Controlled Trial Clinical Trial
Attenuation of hemodynamic responses to rapid sequence induction and intubation in healthy patients with a single bolus of esmolol.
The effectiveness of a single preinduction intravenous (IV) bolus of esmolol in blunting hemodynamic responses to rapid sequence induction and tracheal intubation was evaluated. In a randomized double-blind study, 32 ASA I and II healthy patients scheduled for surgery were monitored with electrocardiography (EKG) lead V5, arterial cannulation, and impedance cardiography. After preoxygenation and a priming dose of vecuronium (0.01 mg/kg), patients received either saline (n = 12), esmolol 100 mg (n = 10), or esmolol 200 mg (n = 10) as an IV bolus (20 ml volume). ⋯ Plasma norepinephrine levels at 1.5 minutes after intubation increased in the esmolol groups about 130% above that measured in the placebo group. This finding was associated with a more gradual return of peripheral resistance to baseline following tracheal intubation. However, both doses of esmolol effectively attenuated heart rate (HR), SP, and rate pressure product (RPP) increases (p less than 0.05 vs placebo) produced by laryngoscopy and tracheal intubation.
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Randomized Controlled Trial Clinical Trial
A single bolus dose of esmolol in the prevention of intubation-induced tachycardia and hypertension in an ambulatory surgery unit.
The efficacy of a single bolus dose of esmolol in the prevention of intubation-induced tachycardia and hypertension was studied in a double-blind manner. Thirty patients from the Ambulatory Surgery Unit at Rush-Presbyterian-St. Luke's Medical Center were prospectively randomized to receive a placebo, 100 mg of esmolol, or 200 mg of esmolol immediately prior to induction (2.5 to 3.0 minutes before intubation). ⋯ The average maximum BP increase was 47% in the placebo group versus 22% and 19% in the esmolol 100 mg and esmolol 200 mg groups, respectively. There were no significant differences between the two esmolol groups. This study demonstrates the efficacy of a single bolus dose of esmolol in blunting the tachycardic and hypertensive responses to laryngoscopy and intubation in an ambulatory surgery setting.
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Five patients requiring general anesthesia but presenting with compromised airways were successfully intubated by blind awake intubation with the aid of regional anesthesia and the use of appropriate sedation. Arterial blood gases were collected at three intervals: presedation, postsedation, and postintubation. ⋯ Supplemental oxygen is suggested to avoid the effects of arterial desaturation during the sedation process. If oxygen is not administered, the risk of moderate hypoxia associated with blind awake intubation must be considered along with alternative problems including loss of protective reflexes or the inability to ventilate during induction and intubation via a direct technique.
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Critical care medicine · Jul 1990
Prospective evaluation of a nonradiographic device for determination of endotracheal tube position in children.
A new noninvasive, nonradiographic endotracheal tube (ETT) position detection system (ETT-PDS) for guidance of ETT positioning was evaluated in pediatric ICU patients. The system includes an ETT with a metallic element embedded at a defined distance from the ETT tip, and a portable locator instrument which detects transcutaneously the position of the metallic element. ⋯ The ETT malposition rates observed on the postintubation chest radiographs were 39.1% after positioning guided by clinical assessment alone, and 19.6% after positioning guided by clinical assessment plus the ETT-PDS (p less than 0.5). This reduction in malnutrition rate could not be demonstrated when the ETT-PDS was used to guide routine ETT positioning performed before morning chest radiographs.