Articles: intubation.
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Minerva anestesiologica · Nov 2007
Randomized Controlled Trial Multicenter Study Comparative StudyThe unanticipated difficult intubation: rigid or flexible endoscope?
Unanticipated difficult intubation occurs with a frequency between 1.5% and 8.5%. The aim of this study was to compare the use of flexible versus rigid endoscopy in such a patient population, with respect to the preparation time and feasibility of each device. ⋯ Both endoscopic techniques enable quick and safe intubation. The Bonfils method could be the method of choice in cases of already relaxed patients with unanticipated difficult conventional laryngoscopy, presuming that the anaesthetist is familiar with this technique. Because the clinical re-evaluation for possible predictors of difficult intubation revealed no unknown new factors, the preoperative examination for anatomical peculiarities and being aware are the best protection against unanticipated intubation problems.
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J. Cardiothorac. Vasc. Anesth. · Oct 2007
Randomized Controlled Trial Multicenter Study Comparative StudySevoflurane provides earlier tracheal extubation and assessment of cognitive recovery than isoflurane in patients undergoing off-pump coronary artery bypass surgery.
To determine whether sevoflurane, because of its lower blood/gas partition coefficient, compared with isoflurane as the primary anesthetic agent, allows earlier tracheal extubation and assessment of cognitive function after off-pump coronary artery bypass (OPCAB) surgery. ⋯ Both sevoflurane and isoflurane may be safely used as maintenance agents in OPCAB. Sevoflurane has the advantage of allowing earlier extubation and evaluation of cognitive and neurologic function after OPCAB.
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Multicenter Study Comparative Study
Light intensity of curved laryngoscope blades in Philadelphia emergency departments.
Laryngoscopy and tracheal intubation requires laryngeal exposure and illumination. The objective of this study is to assess variation in laryngoscope lights across different emergency departments (EDs). ⋯ Curved laryngoscope blades in different EDs have marked variation in light intensity. The contribution of luminance to laryngoscopy performance warrants investigation.
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Multicenter Study Comparative Study
Estimation of tracheostomy tube cuff pressure by pilot balloon palpation.
Two methods can be used to assess the intra-cuff pressure of tracheostomy tubes: digital palpation of the pilot balloon and use of a hand-held manometer. We conducted a telephone survey to determine the prevalence of both methods in intensive care units within 21 teaching hospitals across the United Kingdom. Forty-two per cent of the intensive care units surveyed used a protocol for monitoring cuff pressure with a manometer. ⋯ The cuff pressure was correctly estimated in pre-inflated tracheostomy tubes, in a tracheal model, by 61 per cent of a cross-section of intensive care unit and otolaryngology staff. Using pilot balloon palpation is inaccurate and leaves a significant proportion of patients at risk of tracheal injury. We advocate the wider availability of hand-held pressure manometers in intensive care units and the institution of protocols for monitoring cuff pressure for any patient with a tracheostomy tube with an inflated cuff in situ.
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Ann Oto Rhinol Laryn · Sep 2007
Multicenter Study Comparative StudyMonitoring tracheal tube cuff pressures in the intensive care unit: a comparison of digital palpation and manometry.
Tracheal tube cuff overinflation is a recognized risk factor for tracheal injury and stenosis. International studies report a 55% to 62% incidence of cuff overinflation among intensive care unit (ICU) patients. However, there are no data on tracheotomy tubes, and no recent data from ICUs in the United States. It is unknown whether routine cuff pressure measurement is beneficial. We sought to determine the incidence of cuff overinflation in the contemporary American ICU. ⋯ Despite increasing awareness among intensivists and respiratory therapists, the incidence of tracheal tube overinflation remains high, with both endotracheal and tracheotomy tubes. Our finding that the use of manometry to assess cuff pressures did not reduce the incidence of overinflation suggests that a more vigilant management protocol may be necessary.