Articles: intubation.
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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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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.
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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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Trauma patients requiring intubation at the scene of the accident were entered into a study from June 1985 to June 1987 to determine: 1) the success rate of intubation by flight crews and 2) factors important in managing the difficult airway at the scene. One hundred thirty-six patients were reviewed. The success rate of trauma patients intubated in the field was 92.6%. ⋯ An aeromedical crew (MD, RN, RT) can successfully intubate trauma patients at the scene of the accident. Severe facial injuries with vomiting and blood in the oropharynx are factors in intubation failure. The use of muscle relaxants and sedatives facilitates difficult intubations.
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Rev Esp Anestesiol Reanim · Nov 1989
Historical Article[Spanish pioneers in the technics of laryngotracheal intubation].
Tracheal intubation technique is the result of centuries of experiments, studies and clinical trials. Among the pleiad of physicians who definitely introduced tracheal intubation in clinical practice, several Spanish physicians especially contributed to its diffusion with their research work and discoveries and in some cases they were true pioneers in techniques considered as so advanced at the beginning of this century that it was thought they would never be systematically used in clinical practice. In the present work, we discuss the contributions of these Spanish pioneers to laryngotracheal intubation technique, a technique widely used in modern medicine.