Articles: intubation.
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Tracheal wall movement can affect the lateral wall pressure and seal of an endotracheal cuff. This paper studies the relationship between proximal airway pressure (Paw) and the pressure in high-volume, low-pressure, tracheal tube cuffs. ⋯ Thus, adequate gas flow in the ventilator circuit cannot assure minimal pleural pressure changes. Decreases in cuff pressure may indicate inadequate CPAP and may explain why "just seal" pressure in endotracheal cuffs may not always prevent aspiration.
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Two cases of asymptomatic epiglottic cysts which presented as partial upper airway obstruction following induction of anaesthesia are described. The incidence, pathology and anaesthetic management are discussed.
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After transnasal placement of a tracheal and a gastric tube, the latter did not function properly. Several attempts to remove the gastric tube were unsuccessful, but this could not be explained on several laryngoscopic inspections. The palpating finger finally found a knot of tracheal and stomach tubes high in the epipharynx. This incident underlines the importance of faultless functioning of tracheal and stomach tubes, especially in patients with intended intermaxillary fixation.
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Randomized Controlled Trial Comparative Study Clinical Trial
Effect of topical lignocaine on the sympathoadrenal responses to tracheal intubation.
The catecholamine and cardiovascular responses to laryngoscopy and tracheal intubation have been studied in 30 patients undergoing elective gynaecological surgery, allocated randomly to one of three groups: group 1 received 4% lignocaine 160 mg using a Forrester Spray; group 2 received 4% lignocaine 160 mg by "Laryng-o-jet"; group 3 received an equal volume of saline administered by Forrester Spray. In all three groups, there were similar and statistically significant increases in mean arterial pressure and plasma adrenaline and noradrenaline concentrations 1 min after intubation, with diminution of these responses by 5 min after intubation. There were no differences between the three groups at any stage, which suggests that topical anaesthesia of the mucosa of the upper airway, as performed conventionally, is ineffective as a means of ameliorating the pressor and catecholamine responses to routine laryngoscopy and intubation.
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Case Reports
Fibreoptic bronchoscopy for tracheal and endobronchial intubation with a double-lumen tube.
A 68-year-old patient was scheduled for a thoracotomy. A double-lumen endobronchial tube was requested by the surgeon to facilitate operating conditions. Initial attempts at intubation by conventional methods were unsuccessful. ⋯ The patient's larynx was easily visualized and the bronchoscope was passed into the trachea. The double lumen tube was then advanced over the bronchoscope and correctly positioned. Shortening a double-lumen tube allows the use of a fibreoptic bronchoscope to aid in tracheal intubation in a patient whose larynx is difficult to visualize by conventional methods.