Articles: intubation.
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Minerva anestesiologica · Nov 1989
Randomized Controlled Trial Comparative Study Clinical Trial[The non-depolarizing myorelaxants in orotracheal intubation. A clinical comparison].
The present study was designed to compare the rapidity of onset of neuromuscular blockade after administration of 5 different neuromuscular relaxants (succinylcholine, d-tubocurarine, pancuronium, atracurium and vecuronium) in 75 patients, randomly allocated in 5 treatment groups. The facilitation for endotracheal intubation was evaluated using a clinical score. The for onset relaxation was shorter when using succinylcholine. Among non-depolarizing relaxants an adequate facilitation for endotracheal intubation was observed, two minutes after administration of atracurium and vecuronium, while endotracheal intubation was difficult when using d-tubocuranine and pancuronium.
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We consecutively and prospectively studied 219 critically ill patients to evaluate the accuracy of the physical examination in assessing ETT position and the appropriateness of taking routine chest x-ray films after intubation in the ICU. As a result of x-ray findings, 14 percent of the patients required ETT repositioning, and 5 percent had main-stem intubations. Endobronchial intubation was more common in females than in males, and frequently occurred after emergency intubations. ⋯ This study confirms the unreliability of the physical examination to assess ETT position. Chest x-ray films after intubation are indicated to verify tube position, particularly after emergency intubations. Other techniques such as use of a lighted stylet require evaluation to determine whether they are more cost-effective in verifying ETT placement in patients who have no other indication for postintubation x-ray films.
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The critical need to maintain closed-circuit airways during maxillofacial surgery has led to a number of innovations in anesthetic tube placement and stabilization. Several redesigns and alterations of endotracheal tubes have been described and are currently in use. ⋯ In this report, a readily available and easy method of securing anesthetic tubes is described. This technique has been used successfully in hundreds of patients at our institutions.
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Case Reports
[Pneumothorax, subcutaneous emphysema and mediastinal emphysema in transnasally intubated patients].
A 41-year-old woman was admitted to our clinic because of an acute subdural hematoma. After an emergency operation her neurological status improved with an increase in the Glasgow Coma Scale score from 6 to 11. On the second postoperative day she developed frequent episodes of clonic convulsive seizures localized in the face and the left upper extremity, and her level of consciousness deteriorated. ⋯ When she was undergoing the CT scanning 3 days after intubation, she developed subcutaneous and mediastinal emphysema similarly to case 1. Although it is reported to be not a rare complication in patients on a mechanical ventilator, subcutaneous emphysema or pneumothorax is extremely rare in those intubated patients with spontaneous respiration. The mechanism of these complications in these cases is briefly discussed.
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Trauma patients requiring intubation at the scene of the accident were entered into a study from June 1985 to June 1987 to determine: 1) the success rate of intubation by flight crews and 2) factors important in managing the difficult airway at the scene. One hundred thirty-six patients were reviewed. The success rate of trauma patients intubated in the field was 92.6%. ⋯ An aeromedical crew (MD, RN, RT) can successfully intubate trauma patients at the scene of the accident. Severe facial injuries with vomiting and blood in the oropharynx are factors in intubation failure. The use of muscle relaxants and sedatives facilitates difficult intubations.