Articles: intubation.
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Various measures have been taken to minimize laser-specific hazards during laryngotracheal microsurgery with CO2-laser equipment. Endorsing Norton's view that only a metal tube ensures complete safety during laser surgery, we tested the "Laser-Flex", a new endotracheal tube (ETT) of high-grade stainless steel. This reconstructed, flexible, gas-tight ETT was designed to avoid perforation and even ignition of the tube with consecutive inhalation of combustion products known to be very strong lung irritants. ⋯ In view of the higher margin of patient safety, this tube might be used even from an economic point of view. In our tests we reused each tube five to eight times, thus lowering the costs with each reuse. Checks following sterilization after each use did not show any dysfunction of the cuffs or valves.
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This article has attempted to familiarize the anesthesiologist with the bronchoscopic appearance of normally and abnormally positioned double-lumen endobronchial tubes. Double-lumen tubes are being used in an increasing proportion of thoracic surgical cases in major centers. Double-lumen tubes are also being used more frequently in intensive care units for independent lung ventilation, bronchopleural fistula, massive hemoptysis, and other asymmetrical pulmonary disorders. ⋯ When used as described, the FOB is a monitor. Like all new monitors it will take some time before there is a general consensus whether it is to be used routinely or only for certain indications. Whatever the final consensus on the indications for the FOB in double-lumen tube positioning, it is certain that all anesthesiologists involved in managing thoracic cases should be familiar with this technique.
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J Cardiothorac Anesth · Aug 1989
Comparative StudyEarly extubation after coronary artery surgery in efficiently rewarmed patients: a postoperative comparison of opioid anesthesia versus inhalational anesthesia and thoracic epidural analgesia.
Twenty-eight patients were studied after uncomplicated aortocoronary bypass surgery with hypothermic cardiopulmonary bypass (CPB). In all patients residual hypothermia was effectively treated by the use of extended rewarming during CPB and postoperatively by an external heat source. This treatment almost eliminated postoperative shivering, and it resulted in the lowering of oxygen uptake, carbon dioxide production, and required ventilatory volumes to stable levels where spontaneous breathing could be used safely. ⋯ The patients had good pain relief and were mentally alert. Adequate spontaneous breathing was resumed quickly and endotracheal extubation was performed within the first two postoperative hours (1.6 +/- 0.5 hours). No complications or increased morbidity occurred, and no patient needed to be reintubated in Group II.
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J Cardiothorac Anesth · Aug 1989
Clinical experience with a new right-sided endobronchial tube in left main bronchus surgery.
Clinical experience during one-lung anesthesia using a new right-sided endobronchial tube (Portex Ltd, Hythe, Kent, UK) is reported in 148 patients with cancer of the left lung. The method allowed a reliable airtight separation of the lungs as well as right upper lobe ventilation in all cases. ⋯ Airway pressures and arterial blood gases were similar to those obtained with standard double-lumen tubes during one-lung ventilation. There were no complications due to the new tube system.
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Although intubation of emergency patients in the field is a routine measure, endotracheal tube misplacement remains a serious problem. Using radiologic criteria, the frequency of undetected endobronchial intubation by physicians was determined retrospectively in 100 (78 traumatized) field-intubated adult patients (72 men and 28 women; age, 18 to 90 years; mean age, 39.1 years) consecutively admitted to the University Hospital of Tuebingen, Tuebingen, Federal Republic of Germany, between January 1987 and February 1988. Position of tube tip relative to carina was evaluated on anteroposterior chest radiographs made on admission. ⋯ While unilateral intubation is not immediately catastrophic, the resulting systemic hypoxemia and hypercapnia are aggravated by potential accompanying injury (eg, lung contusion, hematothorax, pneumothorax, shock, or cerebrocranial trauma), which can lead to secondary damage (eg, acute respiratory insufficiency, ischemic brain damage). Evaluation of the depth of tube insertion with the aid of common clinical techniques is particularly unreliable in the case of thoracic trauma, aspiration, or previously existing pulmonary disease. Suggested measures for prevention of endobronchial intubation are improved and intensified training of emergency staff to increase awareness of and prevent the catastrophic effects of endobronchial malposition of the tube tip, tube shortening before intubation, assessment of insertion depth by checking length scale on the tube, and avoidance of patient head and neck movement.