Articles: intubation.
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Ann Oto Rhinol Laryn · Feb 1989
Model of a new generation of tracheostomy and endotracheal tubes. A preliminary study of sensors to monitor obstruction.
The feasibility of monitoring cannula obstruction was studied by conversion of the electrical resistance of substances that are capable of causing obstruction into audible auditory signals. Copper-nickel-gold electrodes were thermal pressed onto polyimide-based flexible films placed as 1-mm wide strips along the inner surface of tracheostomy and endotracheal tubes. ⋯ Quantitative estimates of responses from the IC output were computer averaged. Instantaneous obstruction detection was made possible by the immediate responsiveness of the device in the presence of obstruction.
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Rev Stomatol Chir Maxillofac · Jan 1989
[Difficult intubation in maxillofacial surgery. Tracheotomy or fibroscopy?].
Prior to general anesthesia, some maxillofacial conditions may require tracheostomy or, in recent years, fiberoptic endotracheal intubation. This technic is efficient but delicate and therefore needs a skilled qualified operator. However, fiberoptic endoscope may avoid the inconvenience of tracheostomy. This article presents our method of fiberoptic endotracheal intubation with the specific indications and results.
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Randomized Controlled Trial Clinical Trial
Partial attenuation of hemodynamic responses to rapid sequence induction and intubation with labetalol.
The effectiveness of labetalol (a combination nonselective beta and alpha-1-adrenergic receptor antagonist) in modifying hemodynamic responses associated with rapid sequence induction and tracheal intubation was evaluated. In a double-blind study, 24 ASA physical status I or II male patients scheduled for elective surgery were given either IV labetalol, 0.25 mg/kg (n = 8) or 0.75 mg/kg (n = 8), or a saline placebo (n = 8). Five minutes later, patients were given oxygen by mask and IV vecuronium, 0.01 mg/kg. ⋯ Within 30 seconds after intubation, patients in all three groups exhibited increases in heart rate, mean arterial pressure, total peripheral resistance, and rate pressure product and a decrease in stroke volume. However, patients in the 0.25 and 0.75 mg/kg labetalol groups, compared to those in the placebo group, had significantly lower increases in peak heart rate (33 +/- 2 and 27 +/- 3 vs. 44 +/- 7 beats/minute), peak mean arterial pressure (38 +/- 6 and 38 +/- 7 vs. 58 +/- 7 mmHg), and peak rate pressure product (7,726 +/- 260 and 7,215 +/- 300 vs. 14,023 +/- 250 units). The results show that these doses of labetalol significantly blunt, but do not completely block, autonomic responses to rapid sequence induction and intubation.
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Clinical examination of a patient is very likely to reveal the factors making tracheal intubation difficult and thus increasing the likelihood of a traumatized temporo-mandibular joint or mouth. Although laryngoscopes and bronchoscopes incorporating fiberoptic visual devices are invaluable they are usually only employed for extremely difficult patients. ⋯ An atraumatic tracheal intubation will be assisted if the laryngoscope blade to be used is selected on the basis of the anatomic difficulties prescribed by the patient. The Miller, Jackson-Wisconsin, Macintosh, Soper, Bizarri-Guffrida, and Bainton blades together with appropriate handles and fittings comprise a group from which selection can be made.
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This report describes our experiences with 129 awake oral and nasal fibreoptic intubations in 123 patients considered to be at high risk of aspiration of gastric contents. I.v. sedation was used on all but six occasions. ⋯ Rigid laryngoscopy was necessary after fibreoptic laryngoscopy failed in one patient (with a bleeding peptic ulcer) who vomited a large amount of fresh and clotted blood. No other patient regurgitated during the procedure, and no patient developed evidence of aspiration.