Articles: intubation.
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Randomized Controlled Trial Comparative Study Clinical Trial
Effects of alfentanil and lidocaine on the hemodynamic responses to laryngoscopy and tracheal intubation.
This study was undertaken to determine whether lidocaine and/or alfentanil can effectively abolish or attenuate the increase in mean arterial pressure (MAP), heart rate (HR), and rate pressure product (RPP) associated with rapid sequence induction of anesthesia. Sixty patients were randomly divided into four groups. Group 1 received saline 10 ml, group 2 received lidocaine 2 mg/kg, group 3 received alfentanil 15 micrograms/kg, and group 4 received alfentanil 30 micrograms/kg. ⋯ Blood pressure (BP) and HR were recorded at the following times: before induction; after induction but before laryngoscopy and intubation; and 1, 3, and 5 minutes after intubation. Alfentanil 15 and 30 micrograms/kg given in rapid sequence fashion with thiopental and succinylcholine effectively blunted the hemodynamic responses to laryngoscopy and tracheal intubation. Lidocaine 2 mg/kg and saline were found to be ineffective in blunting these same responses.
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Case Reports
Management of the difficult pediatric airway in an austere environment using the lightwand.
Increasingly, medical teams are providing sophisticated surgical treatment to pediatric patients in developing nations. Such care is often administered under relatively austere conditions using easily transported equipment. Because some of these patients may present with congenital or acquired airway abnormalities that make direct laryngoscopy difficult or impossible, alternative methods of endotracheal intubation should be available. ⋯ Use of the lightwand has a proven record of success and obviates the need for the heavier, more delicate, and more expensive flexible fiber-optic laryngoscope or pediatric bronchoscope. Two cases are reported in which pediatric patients with difficult airway anatomy due to severe burn scar contractures were successfully and easily intubated using the lightwand. This technique is useful for management of the difficult pediatric airway in the austere environment of the typical medical relief mission.
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Randomized Controlled Trial Clinical Trial
A bolus dose of esmolol attenuates tachycardia and hypertension after tracheal intubation.
Forty-five patients of ASA physical status I and II undergoing a variety of non-cardiac surgical procedures were studied to determine the effect of bolus administration of esmolol, a new short-acting beta blocking drug, on heart rate and blood pressure responses to induction of anaesthesia and tracheal intubation. Subjects were allocated randomly to receive placebo, 100 mg or 200 mg of esmolol IV as part of an anaesthetic induction technique. ⋯ In the 200 mg group there was a significant decrease, compared with placebo, in systolic blood pressure at 0.5 min (144 +/- 32.1 vs 165 +/- 18.7 mmHg) and 1.5 min (154 +/- 25.0 vs 170 +/- 19.5 mmHg) after intubation. In this study, adequate haemodynamic control was obtained following administration of 200 mg of esmolol.