Articles: intubation.
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Tracheal intubation may be hindered by difficulty in insertion of the laryngoscope blade into the patient's mouth because the handle impinges on the patient's chest or on the hand of an assistant applying cricoid pressure. An adaptor is described which modifies the standard Penlon laryngoscope to enable lateral swivelling of the handle, thus avoiding the obstruction.
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Randomized Controlled Trial Clinical Trial
Attenuation of ocular and systemic responses to tracheal intubation by intravenous lignocaine.
This study was undertaken to determine whether intravenous lignocaine could mitigate or prevent the ocular reactions and especially the acute increase in intraocular pressure associated with laryngoscopy and tracheal intubation. Two groups of children undergoing minor eye surgery under nitrous oxide-oxygen-halothane anaesthesia were examined. The experimental group (n = 17) received 2 mg/kg lignocaine and the controls (n = 18) an equivalent volume of saline. ⋯ Other ocular reactions were recorded, and all were attenuated after lignocaine administration. The beneficial effects of lignocaine, a suppressant of autonomic reflexes, suggest that intraocular pressure, like the heart rate, rises after intubation as a result of autonomic stimulation. The use of intravenous lignocaine is thus recommended for children at risk, such as those needing an urgent operation because of lacerated eye injury under rapid sequence induction of anaesthesia.
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We developed the esophageal tracheal combitube (ETC), a plastic twin-lumen tube, one lumen resembling an esophageal obturator airway (EOA), the other resembling an endotracheal airway (ETA). Ventilation is possible after either esophageal or tracheal placement of the ETC. A specially designed pharyngeal balloon replaces the mask of the EOA and provides sufficient seal, preventing the escape of air through the mouth and nose. ⋯ Blood gas measurements showed a significantly higher (P less than .001) mean arterial oxygen tension during ventilation with the ETC. The reason for this is not yet clear. Preliminary investigations during CPR in 21 arrest patients indicate that the ETC is as effective as the ETA.