Articles: intubation.
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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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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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The problems associated with "difficult airways" have almost subsided since the introduction of flexible fiberoptic bronchoscopes for tracheal intubation. Limitations of this technique persist with uncooperative patients, children and infants. ⋯ The device makes intubation possible with all sizes of fiberoptic bronchoscopes. The prerequisites for application of this technique include an airway that will be maintained by mask ventilation.
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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.