Articles: intubation.
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Ann Oto Rhinol Laryn · Dec 1989
Comparative Study Clinical Trial Controlled Clinical TrialProspective studies evaluating the standard endotracheal tube and a prototype endotracheal tube.
Two prospective studies were designed to evaluate laryngeal injury sustained with the standard endotracheal tube (ETT) and the relative safety of a new prototype ETT. The first study followed patients after prolonged intubation with the standard ETT. Potential patient host factors were recorded and correlated with subjective complaints and objective findings on fiberoptic laryngoscopy. ⋯ The mechanisms of TVC granulomas and immobility are probably different, as suggested by the different host factor associations and onset times. The second study compared the standard ETT with the prototype ETT in short-term intubations. The prototype ETT was associated with no complications in this setting and is considered relatively safe for further testing in the patient with prolonged intubation.
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Anesthesia and analgesia · Dec 1989
What is the safest endotracheal tube for Nd-YAG laser surgery? A comparative study.
To determine whether a safe endotracheal tube for Nd-YAG surgery could be found, an Nd-YAG laser operating at 50 W was directed at six different endotracheal tubes that had 5 L/min of oxygen flowing through them. A plain Rusch red rubber endotracheal tube, a Bivona Fome-cuff laser endotracheal tube, a stainless steel Mallinckrodt Laser-Flex endotracheal tube, and a Xomed Laser-shield endotracheal tube were all ignited and perforated by the laser within 12 s. ⋯ Red rubber endotracheal tubes wrapped with 3M No. 425 or Venture copper foil tape were unaffected by 1 min of exposure to the laser beam. They are recommended for clinical use.
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The tracheas of 420 adult patients were intubated using the tip of a lighted stylet placed inside the lumen of the tracheal tube, just proximal to the tube cuff. The maximum point of transillumination was visible just distal to the cricoid cartilage, with proper cuff positioning. The lighted stylet was also introduced into the oesophagus to see whether transoesophageal illumination could be demonstrated. ⋯ Transoesophageal illumination could not be demonstrated in any patient. The mean distance between the tip of the tracheal tube and the carina varied between 3.7 and 4 cm. Transtracheal illumination is a simple, effective and reliable method that can be used during intubation for the recognition of optimal tube placement.
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Randomized Controlled Trial Comparative Study Clinical Trial
Cardiovascular effects of fibrescope-guided nasotracheal intubation.
The cardiovascular effects of fibrescope-guided nasotracheal intubation were compared to those of a control group of patients who were intubated using the Macintosh laryngoscope. The 60 patients studied received a standard anaesthetic technique which included a muscle relaxant and were allocated randomly to one of two groups immediately before tracheal intubation. Systolic and diastolic arterial pressures in the fibreoptic group were significantly lower than in the control group during the first minute after intubation. ⋯ The heart rate in the fibreoptic group was significantly higher than in the control group during all five minutes after intubation. The maximum increase in heart rate was significantly higher in the fibreoptic group. The cardiovascular responses to fibreoptic nasotracheal intubation under general anaesthesia should not cause undue concern in fit patients, but appropriate measures should be taken to prevent excessive tachycardia in compromised patients.
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We consecutively and prospectively studied 219 critically ill patients to evaluate the accuracy of the physical examination in assessing ETT position and the appropriateness of taking routine chest x-ray films after intubation in the ICU. As a result of x-ray findings, 14 percent of the patients required ETT repositioning, and 5 percent had main-stem intubations. Endobronchial intubation was more common in females than in males, and frequently occurred after emergency intubations. ⋯ This study confirms the unreliability of the physical examination to assess ETT position. Chest x-ray films after intubation are indicated to verify tube position, particularly after emergency intubations. Other techniques such as use of a lighted stylet require evaluation to determine whether they are more cost-effective in verifying ETT placement in patients who have no other indication for postintubation x-ray films.