Articles: intubation.
-
Clin Intensive Care · Jan 1991
Physiological responses to endotracheal and oral suctioning in paediatric patients: the influence of endotracheal tube sizes and suction pressures.
To study the influence of varying outer suction catheter (SC) diameter (OD) to inner endotracheal tube (ETT) diameter (ID) and suction pressures (SP) on heart rate (HR), respiratory rate (RR), mean arterial pressure (MAP), arterial oxygen saturation (SaO 2) and intracranial pressure (ICP) during ETT and oral suctioning. An additional aim was to define an optimal suction catheter size that would prove easy to introduce and be rapidly effective in clearing secretions with the least physiological alteration. ⋯ Our study suggests that: 1. Tracheal toilet using variations in OD/ID ratios and SP within limits tested resulted in similar significant adverse changes in HR, ICP and SaO 2 and similar trends in RR and MAP. 2. Based on the ease of introduction and the effectiveness of clearing secretions, a medium SC (OD/ID = 0.7) is most appropriate for infants and children. 3. Oral suctioning also results in adverse physiological changes, therefore similar precautions to those taken during tracheal suctioning should be followed for oral suctioning.
-
Ann Fr Anesth Reanim · Jan 1991
Case Reports[Intratracheal intubation using a fiberoptic laryngoscope].
Experience with a new type of laryngoscope (Bullard) is reported. It weighs 1,200 kg, and has fiberoptic fibers both for lighting and viewing. Angle of vision is about 55 degrees. ⋯ The use of this apparatus in an obese patient with reduced mobility of the cervical spine, who was ranked 4 on the Mallampati scale, is reported. The Bullard laryngoscope enabled easy tracheal intubation (duration 1 min 30 s), whereas direct laryngoscopy and the use of a Huffman prism were unsuccessful. The fiberoptic laryngoscope may be of help in case of difficult intubation.
-
Detection of expired carbon dioxide is one of the most reliable methods of avoiding accidental esophageal intubation. Although capnography has become a standard monitoring technique in the hospital operating room, it is rarely available in the office setting or other arenas where emergency endotracheal intubation may be required. ⋯ This semi-quantitative detector fits between the endotracheal tube and the breathing circuit and uses a pH-sensitive indicator that changes color in response to different concentrations of carbon dioxide. Clinical studies indicate that this device provides similar results to standard capnography, and its inclusion in the emergency kit is strongly recommended.
-
The laryngeal mask (LM), a recently commercialized device, provides a totally patent airway when positioned in the hypopharynx. The major advantages of the LM are its ease of insertion, the absence of contact with the vocal cords, and the fact that if frees the hands of the anesthesiologist. Contraindications to its use result from its failure to seal the airway against regurgitation of gastric content. ⋯ Only 13% of patients complained of mild pharyngeal discomfort postoperatively. We conclude that this device is reliable, easy to use, and causes minimal postoperative problems. Its use, for both spontaneous and controlled ventilation, is increasing in our hospital.
-
Eur J Anaesthesiol Suppl · Jan 1991
Endotracheal intubation through the Laryngeal Mask--helpful when laryngoscopy is difficult or dangerous.
The correctly placed Laryngeal Mask will act as a guide to endotracheal intubation in over 90% of adult patients. Although the size of tube is limited to a 6-mm-internal-diameter cuffed oral or nasal pattern tube the technique is easy to learn and can provide a rapid solution when endotracheal intubation is necessary but conventional laryngoscopy is unexpectedly difficult or dental restorations are at risk. Application of cricoid pressure reduces the success rate of the technique; therefore, if this manoeuvre is indicated to reduce the risks of regurgitation, anaesthetists are advised to arrange for its momentary relaxation during the final stages of placement of the Laryngeal Mask and of the endotracheal tube.