Anaesthesia and intensive care
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Anaesth Intensive Care · Feb 1989
Randomized Controlled Trial Comparative Study Clinical TrialCardiovascular responses to tracheal intubation: a comparison of direct laryngoscopy and fibreoptic intubation.
The cardiovascular responses to tracheal intubation using a fibreoptic bronchoscope or Macintosh laryngoscope were compared in twenty in-patients and twenty day-stay patients. Within these groups patients were randomly allocated to direct laryngoscopic or fibreoptic bronchoscopic intubation. Arterial blood pressure, heart rate and arterial oxygen saturation were recorded before induction and at one-minute intervals until four minutes after intubation. ⋯ In the in-patients mean heart rate was significantly higher in those patients intubated with the bronchoscope at three and four minutes after intubation. Time taken for intubation was significantly longer in those patients intubated with the bronchoscope. In no patient did the arterial oxygen saturation fall below 98%.
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Undiagnosed oesophageal intubation during anaesthesia is a major cause of anaesthetic-related morbidity and mortality. A test was devised and evaluated to distinguish between placing an endotracheal tube in the trachea and in the oesophagus. The test involves threading a lubricated nasogastric tube through the endotracheal tube, applying continuous suction to the nasogastric tube and then attempting to withdraw the nasogastric tube. ⋯ An evaluation was performed on twenty patients in whom both the trachea and oesophagus were intubated simultaneously. In all twenty cases, each of the two endotracheal tubes was correctly identified as being either tracheal or oesophageal. The ability to maintain suction and the ease of withdrawal most clearly distinguished between the two positions.
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These are thoughts and impressions on the practice of anaesthesia, the management of operating theatres, and a plan for the training of anaesthetists for the Pacific island nations. They are based on accumulated experience and personal observations gained over ten years of working and travelling throughout the Pacific region. The concepts and ideas expressed are a correlation and condensation of many conversations with local anaesthetists and people involved with managing hospitals and administering the health services of many of the countries in the Pacific.