Articles: intubation.
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Randomized Controlled Trial Clinical Trial
Intravenous lignocaine and sympathoadrenal responses to laryngoscopy and intubation. The effect of varying time of injection.
We have studied the effect of varying the timing of a prior dose of intravenous lignocaine 1.5 mg/kg on the cardiovascular and catecholamine responses to tracheal intubation. Forty healthy patients were given an intravenous injection of either placebo or lignocaine 2, 3 or 4 minutes before tracheal intubation. There was a significant increase in heart rate of 21-26% in all groups. There was no significant increase in mean arterial pressure in response to intubation in any group of patients given lignocaine before intubation, but in the placebo group, mean arterial pressure increased by 19.1% compared to baseline values (p less than 0.05).
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Randomized Controlled Trial Clinical Trial
Effects of trimetaphan on the cardiovascular response to tracheal intubation.
In three groups of 10 patients, we have studied the effect on the cardiovascular responses to laryngoscopy and intubation of bolus doses of saline or trimetaphan 0.05 mg kg-1 or 0.1 mg kg-1 given 1.75 min before the start of laryngoscopy. Anaesthesia was induced with thiopentone 5 mg kg-1 i.v. and tracheal intubation was facilitated with vecuronium 0.2 mg kg-1. During anaesthesia, ventilation was assisted or controlled with 1% enflurane and 50% nitrous oxide in oxygen. ⋯ These increases following tracheal intubation were less in trimetaphan-treated patients compared with those of the control group (P less than 0.05). There was no significant difference in heart rate following tracheal intubation between the three groups. These data suggest that trimetaphan may be used as a supplement during induction, to attenuate the hypertensive response associated with laryngoscopy and tracheal intubation.
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Randomized Controlled Trial Comparative Study Clinical Trial
The effects of suxamethonium and pancuronium on the haemodynamic response to endotracheal intubation.
The pharmacological effects of suxamethonium and pancuronium on the cardiovascular system may vary and therefore alter the haemodynamic response to intubation. The arterial blood pressure, the heart rate and the rate pressure product were measured as parameters of haemodynamic change in forty adult ASA. I and II patients undergoing laryngoscopy and endotracheal intubation in a randomised controlled study. ⋯ Pancuronium, however, caused a significantly higher rise in the heart rate after endotracheal intubation compared to suxamethonium. In both groups the maximum rate pressure product occurred one minute after intubation, rising by 56% in the suxamethonium group and 64% in the pancuronium group compared to control values. In conclusion, there were significant and statistically similar increases in systolic and diastolic blood pressures and rate pressure product following intubation in both groups with values significantly above baseline until three minutes post intubation but the increase in heart rate in group A was significantly less than that in group B.
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Review Case Reports
Pneumothorax complicating small-bore feeding tube placement.
Small-bore Silastic feeding tubes are being used with increasing frequency for short- and long-term enteral hyperalimentation. We present three cases where these flexible tubes were passed into the tracheobronchial tree and then out into the pleural space. The result in each case was a pneumothorax or hydropneumothorax. ⋯ The traditional methods of assessing proper nasogastric tube placement are inadequate when applied to these small tubes. Only a chest roentgenogram can assure placement in the stomach. Education of hospital staff on methods to avoid malposition of feeding tubes has resulted in an absence of pulmonary complications over a subsequent 1-year period.
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Comparative Study
Comparison of two methods for predicting difficult intubation.
Two methods of predicting difficult laryngoscopy were compared prospectively. Mallampati class and Wilson risk-sum were determined before operation and laryngeal view graded in 675 patients. ⋯ Inter-observer variation was minimal using Wilson risk-sum, but considerable for Mallampati classification. We prefer the Wilson risk-sum for assessment of the airway, while noting that both tests have poor sensitivities.