Articles: intubation.
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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.
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Smooth emergence from general endotracheal anesthesia is frequently complicated by coughing induced by stimulation from an endotracheal tube. Lidocaine and other local anesthetics have been shown to anesthetize important rapidly adpating stretch receptors in the dog trachea. With the aim of providing a reservoir for continuous lidocaine release to adjacent tracheal tissue, we examined the ability of clinically used concentrations of lidocaine to diffuse across a commonly used endotracheal tube cuff. ⋯ The highest concentration obtained was 17.49 +/- 2.03 micrograms/mL after 360 minutes. We conclude lidocaine diffuses across endotracheal tube cuffs in a fashion that may enable the cuff to serve a potentially useful role as a reservoir for local anesthetic. This in turn appears to have the potential to smooth emergence from general endotracheal anesthesia in those patients in whom tracheal stimulation may be a complicating factor.
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The five components integral to modern, sophisticated airway management in trauma patients include equipment, pharmacologic adjuncts, manual techniques, physical circumstances, and patient profile. Although there is a finite number of pieces and types of equipment, pharmacologic adjuncts, and manual techniques, the last two components are variable. ⋯ We believe that the commonly used airway management algorithms are a poor substitute for a conceptual understanding of the basic principles of the five components of airway management, although these decision trees may be useful as learning tools. The construction of a truly complete decision tree is virtually impossible because of the high number of individual patient profiles.
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A historical review of the development of endotracheal intubation is made. Clinical and some X-ray features, allowing to prognosticate the difficult intubation are searched for. Classifications are suggested of the possible reasons for difficulties. ⋯ It is a stress moment both for the patient and for the anesthesiologist. The signs through which the anesthesiologist may determine the position of the tube and rule out eventual esophageal intubation are systematized. Percentages are given on the relative incidence of difficult intubations and fiber optic intubations [correction of fibrointubations] in the different aspects of operative surgery.