Articles: intubation.
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Multicenter Study Comparative Study Clinical Trial Controlled Clinical Trial
A field comparison of the pharyngeotracheal lumen airway and the endotracheal tube.
A prospective, sequential study compared ease of use and bag-valve ventilation delivered by an endotracheal tube (ET) with that of the pharyngeotracheal lumen airway (PtL) for 111 victims of cardiac arrest in the pre-hospital setting. The PtL airway was found to be significantly easier to use as measured by the time required to intubate the patient and the number of attempts to place the device. Arterial blood gas determinations were made on arrival at the hospital and repeated 15 minutes later. ⋯ No adverse effects were reported. We conclude that the ability of the PtL to deliver effective ventilation is comparable with that of the ET as measured by arterial PCO2. When the ET method of airway control cannot be achieved, the PtL airway offers an effective alternative.
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Endoesophageal prostheses are sometimes used in palliative therapy of esophageal carcinoma. Placement or subsequent manipulation of these devices may require general anesthesia, and these anesthetics are fraught with potential complications, both from the patient's illness and from the prosthesis itself. The two patients in our report presented anesthetic challenges, including acute upper airway obstruction occurring outside the operating theater and management of malignant tracheoesophageal fistula.
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The reported incidence of hoarseness following short-term tracheal intubation varies widely. It has been reported as being permanent in 3%. This suggests that an enormous problem exists considering the numbers of patients intubated daily in the United Kingdom. ⋯ Those who were hoarse for 54 and 99 days had vocal cord granulomata. Regression analyses showed that certain patient and anaesthetic factors had a significant effect on the hoarseness. This study confirms a low incidence of prolonged or permanent hoarseness following short-term tracheal intubation.
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To assess the resistance of a new endotracheal tube to penetration and ignition by a carbon dioxide (CO2) laser at a clinically relevant power setting. ⋯ The protective coating of the Xomed Laser-Shield II is laser-resistant, but the unprotected silicone proximal and distal to the cuff is laser-vulnerable and can, under certain conditions, promote a blowtorch phenomenon. This tube would be acceptable for use in oral and pharyngeal laser surgery, but we recommend its use only in well-ventilated areas, out of concern for exposure to the products of the pyrolysis of Teflon, specifically the development of polymer-fume fever.
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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.