Articles: intubation.
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparison of cocaine, lidocaine with epinephrine, and oxymetazoline for prevention of epistaxis on nasotracheal intubation.
The alpha-adrenergic agonist oxymetazoline was compared to cocaine and to lidocaine with epinephrine with respect to prevention of epistaxis on nasotracheal intubation. The nares of three groups of 14 patients each were topically pretreated with 4% lidocaine with 1:100,000 epinephrine (group 1), 10% cocaine (group 2), or 0.05% oxymetazoline (group 3) prior to nasotracheal intubation. After intubation, epistaxis was estimated on a scale of 0 to 3, with 0 indicating no bleeding, 1 representing blood on the nasotracheal tube only, 2 indicating blood pooling in the pharynx, and 3 representing blood in the pharynx sufficient to impede intubation. ⋯ In addition, heart rate (HR) and blood pressure (BP) were examined prior to administration of the medications; at 5 minutes, 10 minutes, and 15 minutes after administration of the medications; and after intubation. No significant differences were noted (p greater than 0.05) between the medications except for a slightly higher systolic BP for cocaine than for lidocaine with epinephrine at 15 minutes. The results of this double-blind, randomized trial demonstrate that the alpha-adrenergic agonist oxymetazoline is as effective as cocaine, and more effective than lidocaine with epinephrine, for the prevention of epistaxis associated with nasotracheal intubation.
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Intensive care medicine · Jan 1990
Randomized Controlled Trial Comparative Study Clinical TrialNosocomial maxillary sinusitis during mechanical ventilation: a prospective comparison of orotracheal versus the nasotracheal route for intubation.
Nosocomial maxillary sinusitis during mechanical ventilation may cause life-threatening complications in ICU patients. The aim of this prospective study was to compare the incidence of maxillary sinusitis according to the route of intubation. 111 consecutive adult patients (mean age: 53, mean SAPS: 12) were randomly assigned to receive either orotracheal (n = 53) or nasotracheal (n = 58) intubation. All had a nasogastric feeding tube. ⋯ This procedure proved successful in 12 out of 17 cases but secondary drainage was performed in 5 cases (1 failure). Incidents related to the route for long-term intubation were significantly (p less than 0.001) more frequent in the orotracheal group (8/53 vs 2/58), however no patient died because of them. In this study, long-term orotracheal intubation reduced significantly the incidence of maxillary sinusitis in comparison with nasotracheal intubation.
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Int J Clin Pharmacol Ther Toxicol · Jan 1990
Protection from stress of tracheal intubation with midazolam-sufentanil neuroleptanalgesia.
Although diazepam has been shown to reduce the stress response, the protective effect of midazolam, a newer benzodiazepine from a stressful event, tracheal intubation, has not been studied as yet by catecholamine assays in patients undergoing coronary artery bypass surgery, who also receive intravenous sufentanil as a component of the neuroleptanalgesic technique. Therefore, we evaluated the influence of midazolam in combination with sufentanil on the plasma free catecholamines before and after midazolam, after sufentanil and pancuronium and before and after intubation in 15 adult patients undergoing coronary artery surgery. After routine premedication, midazolam 0.14 +/- 0.01 mg.kg-1 i.v. was given over 1 min followed 5 min later by sufentanil in incremental i.v. doses of 1.5 micrograms.kg-1 to a total pre-intubation dose of 4.0-5.0 micrograms.kg-1 injected in 10 min. ⋯ Midazolam administration per se caused a significant decrease in systolic and diastolic blood pressures with a concomitant reduction in systemic vascular resistance. Sufentanil reduced the left ventricular stroke-work index. Tracheal intubation, a strong stressor during anesthesia, elicited no increase in catecholamines and/or adverse hemodynamic responses in contrast to a marked increase in plasma catecholamines routinely observed in patients anesthetized by the commonly used technique of intravenous barbiturates in combination with succinylcholine.
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Anaesthetists are responsible for the management of the airway in patients with unstable cervical spines. Unfortunately, the anaesthetic literature does not contain a recent, critical analysis of the current medical literature to aid anaesthetists attending such patients. This review is intended to serve such a purpose. ⋯ Relevant findings included the high prevalence of cervical spinal instability in such disorders such as Trisomy 21 and rheumatoid arthritis and the relatively low incidence after trauma. There are deficiencies in the minimalist approaches to assessing the cervical spine, such as a simple cross table lateral radiograph after trauma, as they are neither sensitive nor specific. Finally, recognizing the potential for instability and intubating with care, while avoiding spinal movement, appears to be more important than any particular mode of intubation in preserving neurological function.
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Gastrointest. Endosc. · Jan 1990
Randomized Controlled Trial Comparative Study Clinical TrialTopical pharyngeal anesthesia for easing endoscopy: a double-blind, randomized, placebo-controlled study.
The aim of this work was to compare the efficacy of the Cetacaine topical anesthetic spray preparation to placebo. Cetacaine and placebo, from coded but otherwise identically packaged and scented sprays, were administered to 150 consecutive patients. ⋯ No statistically significant differences were found between the full formula and placebo-treated patient responses to the amount of cough or gag, or the degree of difficulty of intubation of the endoscope. Analysis of physician responses showed that in the subgroup of patients being endoscoped for the first time, the gastroscope was introduced more easily (p less than 0.05) when the premedication had been full formula rather than placebo.