Articles: intubation.
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Randomized Controlled Trial Comparative Study Clinical Trial
Pressor and catecholamine response to nasal intubation of the trachea.
The catecholamine and cardiovascular responses to nasal intubation of the trachea with and without laryngoscopy have been compared in 23 patients allocated randomly to each treatment. Arterial pressure, heart rate and plasma concentrations of adrenaline and noradrenaline were measured before and after induction and at 1, 3 and 5 min after intubation of the trachea. There were significant increases in systolic and diastolic pressures after tracheal intubation in both groups. The values at 1 min after intubation were significantly higher in the group undergoing laryngoscopy and intubation compared with the group undergoing blind nasal intubation.
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Various measures have been taken to minimize laser-specific hazards during laryngotracheal microsurgery with CO2-laser equipment. Endorsing Norton's view that only a metal tube ensures complete safety during laser surgery, we tested the "Laser-Flex", a new endotracheal tube (ETT) of high-grade stainless steel. This reconstructed, flexible, gas-tight ETT was designed to avoid perforation and even ignition of the tube with consecutive inhalation of combustion products known to be very strong lung irritants. ⋯ In view of the higher margin of patient safety, this tube might be used even from an economic point of view. In our tests we reused each tube five to eight times, thus lowering the costs with each reuse. Checks following sterilization after each use did not show any dysfunction of the cuffs or valves.
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This article has attempted to familiarize the anesthesiologist with the bronchoscopic appearance of normally and abnormally positioned double-lumen endobronchial tubes. Double-lumen tubes are being used in an increasing proportion of thoracic surgical cases in major centers. Double-lumen tubes are also being used more frequently in intensive care units for independent lung ventilation, bronchopleural fistula, massive hemoptysis, and other asymmetrical pulmonary disorders. ⋯ When used as described, the FOB is a monitor. Like all new monitors it will take some time before there is a general consensus whether it is to be used routinely or only for certain indications. Whatever the final consensus on the indications for the FOB in double-lumen tube positioning, it is certain that all anesthesiologists involved in managing thoracic cases should be familiar with this technique.
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J Cardiothorac Anesth · Aug 1989
Comparative StudyEarly extubation after coronary artery surgery in efficiently rewarmed patients: a postoperative comparison of opioid anesthesia versus inhalational anesthesia and thoracic epidural analgesia.
Twenty-eight patients were studied after uncomplicated aortocoronary bypass surgery with hypothermic cardiopulmonary bypass (CPB). In all patients residual hypothermia was effectively treated by the use of extended rewarming during CPB and postoperatively by an external heat source. This treatment almost eliminated postoperative shivering, and it resulted in the lowering of oxygen uptake, carbon dioxide production, and required ventilatory volumes to stable levels where spontaneous breathing could be used safely. ⋯ The patients had good pain relief and were mentally alert. Adequate spontaneous breathing was resumed quickly and endotracheal extubation was performed within the first two postoperative hours (1.6 +/- 0.5 hours). No complications or increased morbidity occurred, and no patient needed to be reintubated in Group II.