Articles: intubation.
-
J Cardiothorac Anesth · Aug 1989
Clinical experience with a new right-sided endobronchial tube in left main bronchus surgery.
Clinical experience during one-lung anesthesia using a new right-sided endobronchial tube (Portex Ltd, Hythe, Kent, UK) is reported in 148 patients with cancer of the left lung. The method allowed a reliable airtight separation of the lungs as well as right upper lobe ventilation in all cases. ⋯ Airway pressures and arterial blood gases were similar to those obtained with standard double-lumen tubes during one-lung ventilation. There were no complications due to the new tube system.
-
Asymptomatic bacteraemia following balloon dilatation was assessed in 20 adults with oesophageal stricture. Asymptomatic bacteraemia occurred in 12 of 19 patients. The source of the bacteraemia appeared to be the patients' oropharyngeal flora. The bacteraemia was not of clinical importance in our patients, but might lead to endocarditis in predisposed individuals.
-
Although intubation of emergency patients in the field is a routine measure, endotracheal tube misplacement remains a serious problem. Using radiologic criteria, the frequency of undetected endobronchial intubation by physicians was determined retrospectively in 100 (78 traumatized) field-intubated adult patients (72 men and 28 women; age, 18 to 90 years; mean age, 39.1 years) consecutively admitted to the University Hospital of Tuebingen, Tuebingen, Federal Republic of Germany, between January 1987 and February 1988. Position of tube tip relative to carina was evaluated on anteroposterior chest radiographs made on admission. ⋯ While unilateral intubation is not immediately catastrophic, the resulting systemic hypoxemia and hypercapnia are aggravated by potential accompanying injury (eg, lung contusion, hematothorax, pneumothorax, shock, or cerebrocranial trauma), which can lead to secondary damage (eg, acute respiratory insufficiency, ischemic brain damage). Evaluation of the depth of tube insertion with the aid of common clinical techniques is particularly unreliable in the case of thoracic trauma, aspiration, or previously existing pulmonary disease. Suggested measures for prevention of endobronchial intubation are improved and intensified training of emergency staff to increase awareness of and prevent the catastrophic effects of endobronchial malposition of the tube tip, tube shortening before intubation, assessment of insertion depth by checking length scale on the tube, and avoidance of patient head and neck movement.
-
The respiratory flow velocity of 74 infants under halothane-nitrous oxide-oxygen anesthesia was measured, and the statistical relationship between the age in months and the flow velocity was obtained with least square method. The flow resistance of endotracheal tubes (size of 2.5, 3.0, 3.5, 4.0, 4.5 and 5.0 mmI. ⋯ The mean flow resistance and respiratory work with each size of endotracheal tube were calculated by simulation technique using these data. These data coincided well with the data obtained by calculation based on in vitro experiments.