Articles: intubation.
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Anesthesia and analgesia · Jul 1989
Comparative StudyComparison of tracheal intubating conditions and neuromuscular blocking profiles after intubating doses of mivacurium chloride or succinylcholine in surgical outpatients.
Thirty ASA physical status I or II outpatients scheduled to undergo short procedures (less than 1 hr in duration) requiring tracheal intubation received either 1.0 mg/kg succinylcholine or 0.20 mg/kg (2.5 x ED95) or 0.25 mg/kg (3 x ED95) mivacurium. A N2O/O2/narcotic anesthetic technique was utilized and the ulnar nerve was stimulated with subcutaneous electrodes placed at the wrist. Tracheal intubation was attempted in all patients either 2 min after mivacurium or 1 min after succinylcholine. ⋯ The mean infusion rates were 6.6 micrograms.kg-1.min-1 mivacurium and 41.2 micrograms.kg-1.min-1 for succinylcholine. Spontaneous recovery from neuromuscular blockade occurred more quickly after succinylcholine than after mivacurium: the time from cessation of infusion to recovery of T1 to 95% of baseline was 6.5 min in patients given succinylcholine and 16.7 min in patients given mivacurium. When reversal was in order, residual mivacurium-induced blockade was readily antagonized by 0.045 mg/kg neostigmine.(ABSTRACT TRUNCATED AT 250 WORDS)
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Am. Rev. Respir. Dis. · Jul 1989
Comparative StudyIn vitro versus in vivo comparison of endotracheal tube airflow resistance.
The mechanics of gas flow in endotracheal (ET) tubes have been evaluated extensively in vitro under static and dynamic conditions. Previous bedside determinations of respiratory system mechanics in patients with acute respiratory failure have been based on assumptions derived from in vitro measurements without direct measurement of in vivo ET tube resistance (RET). We hypothesized that the RET measured in vivo would be greater than those values obtained in vitro when peak flow rates and ET tube size were held constant. ⋯ Although there was considerable individual variation, values of RET measured in vivo were generally higher than those derived from in vitro measurements at both peak flow rates tested, perhaps because of secretions, head or neck position, tube deformation, or increased turbulence. We conclude that ET tubes contribute significantly to total airflow resistance and that RET is often significantly greater than indicated by in vitro studies. Estimates of work of breathing in critically ill patients must take into consideration the contribution of in vivo RET on total pulmonary system resistance.
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Comparative Study
The pressor response and laryngeal mask insertion. A comparison with tracheal intubation.
The pressor response associated with laryngoscopy and tracheal intubation may be harmful to certain patients. The laryngeal mask airway avoids the need for laryngoscopy and allows positive pressure ventilation of the lungs in appropriate patients. ⋯ We have shown a similar, but attenuated pattern of response associated with mask insertion in comparison with laryngoscopy and intubation; significant differences between the groups were evident in arterial diastolic blood pressure immediately after insertion and again 2 minutes later. Use of the laryngeal mask may therefore offer some limited advantages over tracheal intubation in the anaesthetic management of patients where the avoidance of the pressor response is of particular concern.
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The decision for timing of tracheostomy remains controversial. The relative complication rates in two retrospective series, in which 79 and 150 critically ill patients were examined, respectively, showed increased incidence of late complications with tracheostomy and led Petty's group to conclude "The value of tracheotomy when an artificial airway is required for periods as long as 3 weeks is not supported by data obtained in this study."