Articles: intubation.
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Oral Surg. Oral Med. Oral Pathol. · Mar 1989
Case ReportsNasotracheal tube obstruction from a central incisor. Report of a case.
After maxillofacial trauma, teeth and other objects can become potential foreign bodies. Whenever possible, careful examination before intubation should be undertaken to avoid serious morbidity secondary to aspiration. The anesthesiologist should be informed and necessary preventive measures taken. This article describes a situation in which this not being done could potentially have led to serious complications.
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Randomized Controlled Trial Comparative Study Clinical Trial
Successful extubation of newborn infants without preextubation trial of continuous positive airway pressure.
Sixty newborn infants who had been mechanically ventilated through 3.0- or 3.5-mm endotracheal tubes were studied to examine the necessity of a preextubation trial of continuous positive airway pressure (CPAP). Thirty randomly assigned study infants were directly extubated from intermittent mandatory ventilation rates of six per minute; 30 randomly assigned control infants were extubated after a six-hour trial of continuous positive airway pressure of 3 cm H2O. Changes in respiratory rate, in PCO2, and in PO2/FIO2 were similar. ⋯ Five control and no study infants had apneic episodes greater than or equal to 0.5 per hour (chi 2 = 5.5, P less than .02). The results of this study suggest that newborn infants may tolerate direct extubation from low intermittent mandatory ventilation rates without a preextubation trial of CPAP. A preextubation trial of CPAP appears to be unnecessary and may cause more frequent apnea in newborn infants if used for more than several hours.
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Minerva anestesiologica · Mar 1989
Comparative Study[Tracheal cannulation technics in cervical vertebral and spinal cord injuries. A comparative study].
Cervical vertebral dislocations and fractures require the complete immobility of the neck until an intervention of stabilization of the spinal cord, by surgery or external means, is performed. Endotracheal intubation, which might represent a harmful operation, can become difficult when the stabilization of the spinal cord has been obtained by external means. ⋯ Each method presents advantages with regard to the grading of visualization of the larynx, but also limitations due to the time required to perform the intubation and the appearance of complications. It seems therefore useful to continue the search for the ideal method for tracheal intubation, which should be absolutely atraumatic, fast, and completely successful.
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A patient with previously undiagnosed Mounier-Kuhn syndrome (tracheobronchomegaly) was admitted with a head injury after a fall. The trachea was intubated with an oral tracheal tube with high-volume low-pressure cuff. The intracuff pressure was within the normal safe range recommended by the manufacturer. ⋯ The trachea was extubated on the 15th day, and it was noticed 48 hours later that the patient was developing a tracheal stenosis at the site of the previous dilatation. The stenosis was so severe that the patient underwent resection-anastomosis surgery of his stenotic tracheal segment 2 months after extubation. It may be preferable in patients with Mounier-Kuhn syndrome who require mechanical ventilation to intubate the trachea with an uncuffed tube and to pack the throat to decrease the chances of gas leak and inhalation.
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Fiberoptic endotracheal intubation is a procedure recently introduced that allows a safe and atraumatic intubation in those patients with anatomic difficulties and associated pathology. Our experience on 30 patients submitted to fiberoptic endotracheal intubation is described. ⋯ Due to fibroscope handling conditions and the careful procedure, it is not recommended in emergency situations. We conclude that the method is simple and safe and that its knowledge would spread among anesthesiologists.