Articles: intubation.
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Anesthesia and analgesia · Jun 1989
Intravenous magnesium sulfate inhibits catecholamine release associated with tracheal intubation.
The effects of pre-treatment with 60 mg/kg body weight magnesium sulfate intravenous on cardiovascular responses and catecholamine release associated with tracheal intubation were measured in 15 normal patients and in 15 saline solution pre-treated controls. Magnesium pre-treatment increased heart rate by 13 +/- 3.9 beats/minute. After intubation, heart rate was unchanged in the magnesium group at 107.3 +/- 3.6 beats/minute but increased in the control group to 120.9 +/- 4.6 beats/minute (P less than 0.05). ⋯ In controls, norepinephrine levels increased from 273.3 +/- 39.1 mg/ml to 944.6 +/- 68.7 pg/ml (P less than 0.05 for differences between groups). Epinephrine levels were unchanged from baseline after magnesium but in controls increased from 113.9 +/- 19.5 to 279.6 +/- 92.3 pg/ml (P less than 0.05). We conclude that magnesium sulfate attenuates the catecholamine mediated responses after tracheal intubation.
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Blind nasotracheal intubation attempts by paramedics in the field were prospectively reviewed. In particular, we analyzed the frequency, success rate, complication rate, frequency of performance by each paramedic, indications, and patient outcome. Blind nasotracheal intubation was attempted in 324 patients and successful in 231. ⋯ The incidence of complications tended to decline with increasing paramedic frequency but did not reach statistical significance (P greater than .05). Blind nasotracheal intubation is a safe initial field airway approach in spontaneously breathing patients in whom there are no contraindications. Even with a low frequency of performance, success and complication rates are acceptable.
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We describe a modification of retrograde guided intubation. With the help of a gliding knot fixed around the side hole of the tracheal tube, we use the catheter to pull and guide the tracheal tube down the larynx and trachea. The technique offers several advantages: it is surprisingly fast, relatively atraumatic, easy to perform, and eliminates most causes of failure.
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We evaluated the use of an inexpensive trans-illuminating light wand for tracheal intubation. Expertise in its use was acquired quickly, thereby providing successful per-oral intubation in all patients who were able to open the mouth, irrespective of the view obtained of the epiglottis and larynx.
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Although a number of studies have described endotracheal intubation of adult patients in the prehospital setting, there are few studies on prehospital endotracheal intubation of pediatric patients. The purposes of our study were to determine how frequently prehospital endotracheal intubation was used in pediatric cardiopulmonary arrests when a paramedic trained in endotracheal intubation was present, to determine the success rate and complications associated with the procedure in the field, and to compare resuscitation rates and outcome in patients with and without prehospital endotracheal intubation. Our retrospective study covered a 38-month period and included all prehospital victims of medical cardiopulmonary arrest under the age of 19 years. ⋯ In patients less than 1 year old, only six of 16 (38%) had endotracheal intubation attempted and only three of six (50%) attempts were successful. Of the 18 patients who were intubated successfully before arrival at the hospital, nine (50%) survived to hospital admission and one (6%) survived to discharge. The remainder died in the emergency department.(ABSTRACT TRUNCATED AT 250 WORDS)