Articles: intubation.
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Randomized Controlled Trial
Influence of intravenous lidocaine infusion on haemodynamic response to tracheal intubation and metabolic-hormonal responses during laparoscopic procedures in children: a randomised controlled trial.
Lidocaine, a widely used local anaesthetic, also serves as an adjuvant in pain management. However, its use in children is off-label. This study aimed to determine if intravenous lidocaine alleviates the haemodynamic, metabolic, and hormonal responses to intubation and laparoscopic surgery in children. ⋯ Although the studied intervention appears to be safe, with no clinical side effects observed and serum lidocaine levels remaining below the toxic threshold, its intraoperative administration is not recommended, as it does not demonstrate any significant benefit during the anaesthesia period when compared to placebo.
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Pediatric emergency care · Jan 2025
Postintubation Sedation of Pediatric Patients in the Emergency Department: A Systematic Review and Meta-Analysis.
Postintubation sedation is a critical intervention for patients undergoing mechanical ventilation. Research in the intensive care unit (ICU) and adult emergency department (ED) demonstrates that appropriate postintubation sedation has a significant impact on patient outcomes. There are minimal published data regarding postintubation sedation for pediatric ED patients. ⋯ Data on postintubation sedation in pediatric ED patients are limited. Administration of postintubation sedation is inconsistent and may be substantially delayed. Further high-quality research into the use of postintubation sedation in this setting is needed, and appropriate postintubation sedation should be a target for quality improvement.
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In resource-limited settings, advanced airway management tools like fiberoptic bronchoscopes are often unavailable, creating challenges for managing difficult airways. We present the case of a 25-year-old male with post-burn contractures of the face, neck, and thorax in Nigeria, who had been repeatedly denied surgery due to the high risk of airway management complications. This case highlights how an awake intubation was safely performed using an Airtraq® laryngoscope, the only device available, as fiberoptic intubation was not an option. The patient had a mouth opening of 3.5 cm, a Mallampati score of 4, and no neck extension, making intubation challenging. Pre-procedural counseling was provided, and after explaining the risks, the patient gave informed consent. ⋯ This case emphasizes that safe awake intubation with an Airtraq® laryngoscope is feasible in low-resource environments when key principles-oxygenation, topical anesthesia, and careful procedural steps-are followed. The reuse of a single-use device like the Airtraq® laryngoscope extends its utility in resource-constrained settings, enabling complex airway management when alternatives are unavailable. The patient tolerated the procedure well and reported minimal discomfort. This experience underscores the critical importance of innovation, resourcefulness, and patient cooperation in managing difficult airways when standard tools are unavailable, offering valuable lessons for similar resource-constrained environments.
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J Neurosurg Anesthesiol · Jan 2025
Radiographic Predictors of Difficult Fiberscopic Intubation During General Anesthesia in Patients With a Cervical Collar to Simulate a Difficult Airway.
Predictors of difficult fiberscopic intubation have not been fully elucidated. This study focused on identifying radiographic predictors of difficult fiberscopic intubation during general anesthesia in patients with a cervical collar. ⋯ High tongue area/oral cavity area and long skin-glottis distance were predictive of difficult fiberscopic intubation during general anesthesia in patients with a cervical collar.