Articles: intubation.
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An unexpected, potentially hazardous complication during the use of Robertshaw double-lumen endobronchial tubes is reported. A material defect causing obstruction of the lumen made endotracheal suction during surgery impossible even with very thin suction catheters. The authors recommend the internal diameter of double-lumen endobronchial tubes checking before intubation.
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Seventy-one adult patients (31 male, 40 female) who presented for surgery underwent orotracheal intubation with Portex Blue Line standard cuff disposable tubes (9-mm for males, 8-mm for females). The tracheal tube cuff was inflated by a trained assistant using a syringe and the initial cuff pressure measured; the minimum cuff pressure required to prevent respiratory gas leakage was also measured and the cuff pressure maintained above this pressure throughout the operation by means of the Cardiff Cuff Controller. ⋯ It is concluded that the present method of inflation may lead to gross overinflation of tracheal tube cuffs and that cuff pressure monitoring may be performed simply by means of an electropneumatic controller. The difference in minimum cuff pressure between males and females suggests that the difference in tracheal size between the sexes is greater than the 9-mm to 8-mm difference in tracheal tube size.
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Randomized Controlled Trial Clinical Trial
Effect of nifedipine on cardiovascular responses to laryngoscopy and intubation.
The efficacy of sublingual nifedipine in attenuating the pressor responses to laryngoscopy and intubation was studied in 40 patients undergoing elective surgery. Anaesthesia was induced with thiopentone 5.5 mg kg-1 i.v. and tracheal intubation was facilitated with suxamethonium 1.5 mg kg-1 i.v. ⋯ The increases in arterial pressure and rate-pressure product were reduced in nifedipine treated patients (P less than 0.001). Heart rate increased significantly in both groups immediately after intubation.
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A stable breathing pattern during unassisted ventilation through an endotracheal tube (ETT) prior to extubation is an important factor in determining whether a patient can be successfully extubated. Proper interpretation of changes in the breathing pattern requires knowledge of the normal variability of the breathing pattern in critically ill, intubated patients. To establish these guidelines, 50 spontaneously breathing patients who were being weaned from mechanical ventilation were monitored with respiratory inductive plethysmography for one hour immediately prior to and following successful extubation. ⋯ By 30 minutes postextubation, these parameters were similar to preextubation values. There was no significant change in variability of f or VT. Although the breathing pattern of these relatively stable, intensive care patients differed from values of normal ambulatory subjects, values were similar in the preextubation and postextubation periods.