Articles: intubation.
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Although tracheostomy is performed most commonly for ventilator-dependent patients who have had prolonged periods of endotracheal intubation, it is still necessary and used for other airway problems. Patient management as it relates to indications, timing, various surgical techniques, types of tubes, and complications of tracheostomy and other forms of airway maintenance and control are discussed and evaluated.
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The haemodynamic responses to tracheal extubation at the end of surgery were compared with those occurring at tracheal intubation in 12 patients undergoing major elective surgery. Arterial cannulation was performed and heart rate (HR), systolic arterial pressure (SAP) and diastolic arterial pressure (DAP) were measured before induction of anaesthesia, before tracheal intubation, at the end of surgery and 1, 3 and 5 min after tracheal extubation. Laryngoscopy was avoided at the end of surgery. ⋯ Rate-pressure product (RPP) was derived from SAP x HR. After tracheal intubation there were significant (P less than 0.05) increases in HR, DAP, RPP and in plasma concentrations of both adrenaline and noradrenaline. After extubation, only HR and adrenaline concentration at 5 min after extubation increased significantly compared with measurements at the end of surgery.
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Editorial Comment
On the development of a new laser-resistant endotracheal tube.
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This study quantitated the force applied during tracheal intubation to determine (a) whether the force differed among novice and experienced intubators, and (b) whether the force required differed when intubating patients' tracheas versus intubating the trachea of a commonly used training mannequin. We studied 27 tracheal intubations performed by 17 experienced (greater than 100 prior intubations) and 10 novice (less than 10 prior intubations) intubators. Each intubation was performed with a No. 3 Macintosh blade instrumented with strain gauges to determine force applied in the sagittal plane. ⋯ The only difference was in the impulse (force x duration), which was more for the novice group largely because of the longer average duration of intubation (40 +/- 12 s vs 19 +/- 4 s, P = 0.06). Among experienced intubators, we found that applied force correlated with patient weight and Mallampati class. Intubation of the Laerdal Airway Management Trainer required mean forces comparable to those required in patients (26.6 +/- 2.5 N vs 22.3 +/- 2.9 N), although the maximum force applied during the intubation effort was greater (58.3 +/- 4.7 N vs 43.2 +/- 4.7 N, P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
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This study was designed to determine if induction of anaesthesia with etomidate titrated to an early EEG burst suppression pattern would produce minimal changes in cerebral perfusion pressure, and prevent increases in intracranial pressure (ICP) associated with tracheal intubation. Eight patients, 18-71 yr, with intracranial space-occupying lesions, were studied. In each patient ICP was monitored via a lateral ventriculostomy catheter placed preoperatively. ⋯ Compared with awake control values (mean +/- SE), the period from induction to burst suppression was associated with a 50% decrease in ICP (22 +/- 1 vs 11 +/- 1 mmHg, P less than 0.01), but there were no changes in MAP, CPP, or HR. The decrease in ICP was maintained during the first 30 sec and the following 60 sec after intubation as MAP and HR remained unchanged. Our results suggest that when etomidate was administered to early burst suppression pattern on EEG, minimal changes in CPP occurred during induction of anaesthesia and a marked reduction in ICP was maintained following tracheal intubation.