Articles: intubation.
-
Arterial plasma concentrations of lignocaine were studied in fifteen adult patients following insertion of a tracheal tube whose cuff area was smeared with 5% lignocaine ointment. Twelve patients had 2 ml of ointment (114 mg) and samples were taken every 5 minutes until 30 minutes and in eight of the 12 patients at 40, 50 and 60 minutes after insertion and inflation of the tracheal tube and cuff. ⋯ In the 2 ml lignocaine group mean plasma lignocaine levels were 1.9 (SD 0.9) micrograms/ml at 10 minutes, 2.3 (SD 0.8) micrograms/ml at 20 minutes, 2.3 (SD 0.8) micrograms/ml at 30 minutes and 1.7 (SD 1.0) micrograms/ml at 60 minutes. After 1 ml of lignocaine, levels were 1.2 (SD 0.1) micrograms/ml at 10 minutes, 1.1 (SD 0.7) micrograms/ml at 20 minutes, 0.8 (SD 0.3) micrograms/ml at 30 minutes and 0.75 (SD 0.1) micrograms/ml at 60 minutes.
-
Critical care medicine · Apr 1985
Predictability and consequences of spontaneous extubation in a pediatric ICU.
To determine the incidence of, and the factors contributing to spontaneous extubation (SE), we followed prospectively all intubated children admitted to a pediatric ICU. Eleven potential risk factors were monitored and scored twice daily for 8 consecutive months. Using data from the first 204 patient admissions, we evaluated the risk factors by orthogonal discriminant analysis and found that four factors (patient age, amount of secretions, endotracheal tube slippage, and state of consciousness), when considered together, had good discriminating power for SE vs. intentional extubation. ⋯ The effect of extubation on gas exchange was the same for spontaneously and intentionally extubated patients. No morbidity or deaths were attributed to SE. Standard ventilator low-pressure alarms did not reliably signal the presence of SE, nor did upper extremity restraints keep patients from extubating themselves.
-
Management of the airway in acutely injured patients demands special skills of the emergency physician. A technique of light-guided orotracheal intubation has been described in the literature and was performed under protocol by resident physicians in an urban mobile intensive care system. The method utilizes a flexible lighted stylet to provide a guide to correct placement through transillumination of the soft tissues of the neck. ⋯ Trauma to the soft tissues in one successfully intubated patient was the only complication reported with the technique. The advantages of this method, including rapidity of intubation, ability to intubate without manipulation of the head or neck, and the apparently few complications, make it particularly attractive to emergency personnel. We conclude that guided orotracheal intubation using a lighted stylet is an effective and safe method of emergency intubation, even in the adverse prehospital environment.
-
A major problem in the care of premature and other newborn infants is obtaining and maintaining correct position of an endotracheal tube. Improper placement of the distal tip of the endotracheal tube above the larynx or below the carina is a life-threatening hazard that not only impairs ventilation, but also may result in serious pulmonary complications such as lobar atelectasis and air leak. This problem was addressed by testing the hypothesis that a light source at the end of the endotracheal tube could be seen on the neck and chest and that, therefore, the endotracheal tube could be positioned and repositioned without radiologic guidance. ⋯ The illuminated endotracheal tube was used 33 times in 25 infants. This technique has been shown to provide a safe method (not requiring ionizing radiation) for positioning of the endotracheal tube by virtue of external visualization of a circle of light on the surface of the baby. This system will not permit differentiation of tracheal from esophageal intubation.
-
Comparative Study
Facilitation of rapid endotracheal intubations with divided doses of nondepolarizing neuromuscular blocking drugs.
The authors sought to determine whether prior administration of a small, subparalyzing dose of nondepolarizing muscle relaxant would shorten the onset time of an intubating dose of muscle relaxant. Initially, in 60 anesthetized patients, twitch response of adductor pollicis to ulnar nerve stimulation was studied after a small dose of pancuronium 0.015 mg . kg-1, metocurine 0.03 mg . kg-1, or d-tubocurarine 0.04 mg . kg-1, followed 3 min later by pancuronium 0.08 mg . kg-1 or atracurium 0.4 mg . kg-1 administered iv. After 60 s, the minimum neuromuscular block, in all patients was 79.0 +/- 5.0%. ⋯ In 17% of the patients, after atracurium intubating conditions were fair. When nondepolarizing neuromuscular blocking drugs are administered in divided doses, neuromuscular blockade adequate for endotracheal intubation is achieved in less than 90 s. This facilitates rapid endotracheal intubation in a time comparable to using succinylcholine, without undesirable effects of the depolarizing neuromuscular blocking drugs.