Articles: intubation.
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Anesthesia and analgesia · Nov 1989
Comparative StudyA comparative study of methods of detection of esophageal intubation.
The trachea and esophagus of 21 patients were simultaneously intubated to comparatively evaluate methods for detecting esophageal intubation. In succession, the trachea and esophagus were ventilated with the same inspiratory volume of 621 +/- 45 mL (mean +/- SD). Carbon dioxide (CO2) levels, volumes, and temperatures of expired gas were measured from the tracheal and esophageal tubes. ⋯ Peak temperatures of expired gas recorded from the tracheal tube (32.0 +/- 0.73 degrees C) were higher than those from the esophageal tube (27.3 +/- 1.2 degrees C) (P less than 0.001). The shape of temperature waveforms with a correctly placed tracheal tube remained constant with each ventilation, contrary to that obtained from an esophageal tube. Although the occasional detected of CO2 waveforms from an esophageal tube might lead to an incorrect assessment of tube placement, this limitation of CO2 analyzer can be offset by measurement of volume and temperature of expired gas in identifying placement of an endotracheal tube.
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Anesthesia and analgesia · Nov 1989
Comparative StudyBronchial cuff pressures of double-lumen tubes.
Pressure damage to respiratory mucosa from overinflation of bronchial cuffs has been implicated as a cause of bronchial rupture, a rare but devastating complication of double-lumen endobronchial tubes (DLTs). We compared the pressure/volume characteristics of the bronchial cuffs of three different polyvinylchloride (PVC) DLTs and an equivalent sized red-rubber Robertshaw DLT. At the volume needed to seal effectively our bronchial model, two of the three PVC tube cuffs tested generated significantly less pressure than did that of the cuffs of the third PVC and the red-rubber Robertshaw tubes.
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Minerva anestesiologica · Nov 1989
Randomized Controlled Trial Comparative Study Clinical Trial[The non-depolarizing myorelaxants in orotracheal intubation. A clinical comparison].
The present study was designed to compare the rapidity of onset of neuromuscular blockade after administration of 5 different neuromuscular relaxants (succinylcholine, d-tubocurarine, pancuronium, atracurium and vecuronium) in 75 patients, randomly allocated in 5 treatment groups. The facilitation for endotracheal intubation was evaluated using a clinical score. The for onset relaxation was shorter when using succinylcholine. Among non-depolarizing relaxants an adequate facilitation for endotracheal intubation was observed, two minutes after administration of atracurium and vecuronium, while endotracheal intubation was difficult when using d-tubocuranine and pancuronium.
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The critical need to maintain closed-circuit airways during maxillofacial surgery has led to a number of innovations in anesthetic tube placement and stabilization. Several redesigns and alterations of endotracheal tubes have been described and are currently in use. ⋯ In this report, a readily available and easy method of securing anesthetic tubes is described. This technique has been used successfully in hundreds of patients at our institutions.
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Case Reports
[Pneumothorax, subcutaneous emphysema and mediastinal emphysema in transnasally intubated patients].
A 41-year-old woman was admitted to our clinic because of an acute subdural hematoma. After an emergency operation her neurological status improved with an increase in the Glasgow Coma Scale score from 6 to 11. On the second postoperative day she developed frequent episodes of clonic convulsive seizures localized in the face and the left upper extremity, and her level of consciousness deteriorated. ⋯ When she was undergoing the CT scanning 3 days after intubation, she developed subcutaneous and mediastinal emphysema similarly to case 1. Although it is reported to be not a rare complication in patients on a mechanical ventilator, subcutaneous emphysema or pneumothorax is extremely rare in those intubated patients with spontaneous respiration. The mechanism of these complications in these cases is briefly discussed.