Articles: intubation.
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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.
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Ann Fr Anesth Reanim · Jan 1990
Randomized Controlled Trial Comparative Study Clinical Trial[Intubation in otorhinolaryngologic surgery: propofol versus propofol-suxamethonium].
This study was carried out to assess the conditions of intubation in head and neck surgery when using propofol alone or associated with suxamethonium. Sixty patients were randomly allocated in two groups of 30. Group I was given 3 mg.kg-1 propofol and Group II 3 mg.kg-1 propofol immediately followed by 1.5 mg.kg-1 suxamethonium. ⋯ Opening of the glottis was found to be better in group II than in group I (p less than 0.01) and bucking was more frequent in group I (p less than 0.01). Successful intubation was obtained after one attempt at a similar rate in the two groups. The haemodynamic variations consisted in a significant decrease of systolic blood pressure compared to the initial value but these variations were similar in the two groups at each time (2.3 and 5 min) from induction.(ABSTRACT TRUNCATED AT 250 WORDS)
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Critical care medicine · Jan 1990
Correct positioning of an endotracheal tube using a flexible lighted stylet.
Endotracheal intubation is not without complications, among the most serious of these being misplacement of the endotracheal (ET) tube. Unrecognized esophageal placement is a lethal complication, but even when placed in the trachea, ET tubes can be displaced distally and enter a mainstem bronchus. Correct positioning of an ET tube is usually defined as the placement of the tube within the trachea approximately 5 cm above the carina. ⋯ A chest x-ray was taken and the distance of the tube tip from the carina was calculated. In each case the tube tip could be placed consistently at a level 5 +/- 1 cm from the carina by observing the maximal transilluminated glow at the sternal notch. We conclude that transillumination of the neck using a flexible lighted stylet can accurately and consistently position an ET tube at an appropriate distance above the carina.(ABSTRACT TRUNCATED AT 250 WORDS)
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AJR Am J Roentgenol · Jan 1990
Radiographic detection of esophageal malpositioning of endotracheal tubes.
Insertion of an endotracheal tube into the esophagus is an infrequent but life-threatening complication of endotracheal intubation. This complication is difficult to detect on standard, anteroposterior, portable chest radiographs because the incorrectly placed endotracheal tube is usually projected over the tracheal air column. To evaluate the use of chest radiographs to detect the malposition, we performed a two-part study. ⋯ The study of the portable chest radiographs showed that the endotracheal tube position could be identified correctly in 81 (92%) of 88 of the films made with the patient in a 25 degrees right posterior oblique position. The trachea and esophagus were superimposed in 25 (96%) of 26 of the radiographs made with the head turned to the left and with the patient in a 25 degrees left posterior oblique projection. Our results show that by positioning patients for chest radiographs in a 25 degrees right posterior oblique position, the location of endotracheal tubes can be identified accurately.
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Numerous anaesthetic techniques exist for a patient who presents with a difficult endotracheal intubation. They all require an anaesthetic protocol which cannot be improvised. ⋯ When a fiberoptic bronchoscope is not available, several alternatives can be suggested: local anaesthesia of the glottis, retro-molar and retrograde intubation, or the use of a guide threaded over a lighted stylet; these techniques can be used in an anaesthetized patient breathing spontaneously. In the paralyzed patient impossible to intubate, various trans-laryngeal techniques of ventilation can be used in emergency: jet ventilation via the trans-crico-thyroid route, the use of a cricotomy cannula, or a minitracheotomy set.