Articles: intubation.
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Minerva anestesiologica · Mar 2022
Compatibility of left-sided double-lumen endobronchial tubes with tracheal and bronchial dimensions: a retrospective comparative study.
Double-lumen endobronchial tubes (DLT) continue to be the most widely used method for obtaining lung isolation during anesthesia. We compared recommendations for DLT size selection with radiologically assessed lower airway dimensions gathered from a large patient population. ⋯ A considerable proportion of the recommended DLT sizes from all three manufacturers was incompatible with individual patient's lower airway dimensions.
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Different introducers are available to assist with tracheal intubation. Subtle differences in the design of introducers can have a marked effect on safety and performance. The Difficult Airway Society's Airway Device Evaluation Project Team proposal states that devices should only be purchased for which there is at least a case-control study on patients assessing airway devices. ⋯ Median time to successful placement in the trachea varied from 9 s (Frova) to 22 s (Armstrong) (p = 0.037). We found that the Armstrong and P3 devices were not as acceptable as other introducers and, without significant improvements to their design and characteristics, the use of these devices in studies on patients is questionable. The study protocol is suitable for differentiating between different introducers and could be used as a basis for assessing other types of devices.
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A 27-year-old man with a history of bronchiolitis obliterans caused by a severe viral illness during early childhood that necessitated lung transplantation who was receiving tacrolimus therapy presented with rapidly worsening mental status. Prior to his change in mental status, his postoperative course was complicated by severe primary graft dysfunction and acute renal failure due to acute tubular necrosis that required continuous renal replacement therapy (CRRT). The patient had a prolonged intubation that required periodic BAL for mucous plugging. ⋯ After arousing that morning, the patient became combative, violent, and confused. This altered mentation progressed throughout the day to somnolence and lethargy, necessitating endotracheal intubation for airway protection. The patient experienced subsequent hypotension that necessitated low-dose epinephrine and vasopressin infusions.
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General anaesthesia is associated with higher maternal morbidity and mortality when compared with regional anaesthesia, related mainly to failure of intubation, hypoxia and aspiration. The aim of this retrospective review was to define the incidence of failed and difficult intubation in parturients undergoing general anaesthesia for Caesarean delivery at a high-volume obstetric hospital in Singapore. ⋯ The local incidence of difficult obstetric intubation was one in 20. No failure of intubation was observed.