Articles: intubation.
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Critical care medicine · Dec 1985
Resistance and inertia of endotracheal tubes used in infants during periodic flow.
To study the effects of a periodic pattern of gas flow on the dynamic behavior of infant endotracheal tubes, we measured the resistance (expressed as a function of gas flow) and inertia of endotracheal tubes of 2.5, 3.0, and 3.5-mm internal diameter under conditions of both periodic and quasisteady gas flow. We examined how resistance and inertia are affected by ventilatory rate, the direction of gas flow through the tube, and the expansion of the airway caliber at the junction of the tube and the trachea. ⋯ All tubes exhibited measureable inertia, as predicted from their small diameter. The resistive and inertial properties of the endotracheal tubes described in this report can be used to evaluate the contribution of the endotracheal tube to the dynamics of breathing in intubated infants.
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Laryngeal sequelae following prolonged endotracheal intubation are being observed with increasing frequency as this technique of airway management is being employed for extended periods of time. Many etiologic factors have been implicated in the development of these problems with the exact reasons being as yet unknown. After reviewing the records of 372 consecutive patients intubated over an 18-month period, we have observed an increased frequency of these complications in the diabetic female patient and suggest that early tracheostomy should be considered in these individuals when the use of prolonged intubation is anticipated. The possible pathophysiology of this problem in the diabetic, as well as the non-diabetic intubated patient, and its possible prevention will be discussed.
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Anesthesia and analgesia · Dec 1985
Randomized Controlled Trial Clinical TrialDoes intravenous lidocaine prevent laryngospasm after extubation in children?
One hundred otherwise healthy children undergoing tonsillectomy were investigated in a double-blind study to examine the effect of intravenous lidocaine in preventing laryngospasm upon extubation. The children were anesthetized with N2O-O2-halothane and orally intubated. ⋯ Eleven children (2%) in each group of 50 developed laryngospasm. From our findings it is concluded that lidocaine, 1.5 mg/kg, does not prevent laryngospasm upon extubation when extubation is carried out at the start of swallowing activity.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Vecuronium: onset of effect and intubation conditions in comparison to pancuronium and suxamethonium].
The onset of neuromuscular blockade following the i.v. injection of vecuronium and pancuronium 0.05, 0.08 or 0.1 mg/kg and suxamethonium 0.5 or 1.0 mg/kg was studied in 304 patients during induction of anaesthesia by means of the compound action potential derived from the adductor pollicis muscle, which was indirectly stimulated via the ulnar nerve. The intubation conditions 1-5 min after injection were assessed using a scoring system related to ease of laryngoscopy, movement of vocal cords and coughing, and reflex movements of extremities. Development of motor blockade was time- and dose-dependent. ⋯ Although suxamethonium acts the fastest and tracheal intubation can be achieved within 0.5-1.0 min, its use involves certain side effects and disadvantages. Vecuronium acts considerably faster than pancuronium and good or excellent intubation conditions are present within 2 min. Suxamethonium is no longer the muscle relaxant of choice for intubation except for crash intubation, e.g., in patients with a full stomach.