Articles: intubation.
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Randomized Controlled Trial Clinical Trial
Obtunding the sympathetic response to intubation. Experience at 2 minutes after administration of the test agent in patients with cerebral aneurysms.
The sympathetic response to laryngoscopy and intubation was studied in 39 patients who were to undergo surgical clipping of a cerebral aneurysm. Intravascular radial artery pressure and ECG monitoring for ST-segment changes or dysrhythmias were used. Ward blood pressures were controlled on bed rest and labetalol. ⋯ Intubation produced an immediate increase in blood pressure and pulse rate, maximal at 30-60 seconds, falling rapidly towards normal within 2-3 minutes. Alfentanil was very effective in obtunding this response with stable cardiovascular parameters; fentanyl produced a more variable response; and intravenous lignocaine was less satisfactory. Lignocaine spray was ineffective.
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J. Oral Maxillofac. Surg. · May 1988
Randomized Controlled Trial Clinical TrialEffect of mechanical dilation on nasotracheal intubation.
Various techniques, both chemical and mechanical, have been proposed to decrease trauma and hemorrhage associated with nasotracheal intubation. Nasotracheal intubation was performed on 44 healthy patients scheduled for oral surgical procedures to determine whether incremental dilation with nasopharyngeal airways helps to decrease nasal passage hemorrhage during nasotracheal intubation. ⋯ Repeated passage of the nasopharyngeal airway and nasotracheal tube over relatively friable nasal mucosa accounted for increased hemorrhage in the dilated group. For routine nasotracheal intubation of healthy patients, dilation with nasopharyngeal airways needlessly adds time, trauma, and hemorrhage to the induction of anesthesia.
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Although endotracheal intubation is considered the optimal technique for airway management in critically ill patients, performance of this task in the prehospital setting is at times difficult due to increased masseter muscle tone, vocal cord spasm, or patient combativeness. Use of short-acting paralyzing agents by paramedics to facilitate intubation in these situations is an uncommon practice. We report the recent experience of an emergency medical service system that has used succinylcholine (SUX) for more than ten years. ⋯ Review of hospital records showed no difference between the groups for frequency of either aspiration pneumonia or mechanical ventilation in patients surviving to hospital admission. No patient receiving SUX required emergency cricothyrotomy, nor was esophageal intubation noted in either group. Succinylcholine-assisted intubation was used safely and selectively by the paramedics in this EMS system to permit airway control and ventilation of patients with more difficult intubations.
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Acta Anaesthesiol Scand · May 1988
Comparative StudyDifficulties with tooth protectors in endotracheal intubation.
The suitability of three tooth protectors for routine use during endotracheal intubation was studied in 300 consecutive patients undergoing elective operations under general anaesthesia. The main disadvantages of the protectors were lack of space and the consequent difficulty of guiding the endotracheal tube into the larynx, and poor visibility, especially when the Camo protector was used. These difficulties could be avoided in most cases by cutting off the right angle of the Camo protector. ⋯ Two patients lost a maxillary incisor despite the proper use of a protector (Denex). Thus the use of a tooth protector alone does not guarantee avoidance of dental trauma. Better results could be obtained by improving the design of the protectors and by careful pre-anaesthetic dental examination.