Articles: intubation.
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Study of patients who exhibit only limited morphological abnormality yet present difficulty with direct laryngoscopy is facilitated by a standard intubating position. The "Angle Finder" instrument allows implementation of a simple reproducible geometric standard which is applied easily in formal research work and in clinical practice and teaching. ⋯ Initially, the standard was derived from a review of the literature, then validated in a study of the intubating practices of 10 senior anaesthetists. A more detailed study of 10 normal volunteers confirmed reproducibility and, for nine patients with a history of difficult direct laryngoscopy, the standard was shown to be appropriate.
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Minerva anestesiologica · Jan 1989
Comparative Study[Cuff pressure in intratracheal tubes. Evaluation of the new Mallinckrodt-Brandt model].
Cuff pressure of endotracheal tubes increases to dangerous levels during anesthesia with nitrous oxide. In a small clinical study the Authors conclude that Mallinckrodt-Brandt endotracheal tubes are the only "low pressure" tubes available at the moment.
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We describe a case of herniation of an endotracheal tube with a high volume and low pressure cuff. In contrast with the conventional endotracheal tube with a low volume and high pressure cuff, which, after recognition of cuff herniation, can be deflated, the herniation of this type of tube could not be resolved in such a way. The large and soft cuff material had spread itself over the tube tip, as a result of the herniation and this was aggravated by deflation, making it impossible to adequately ventilate the patient. Pulse oximetry turned out to be a most helpful way of monitoring the seriousness of the situation, in which the patient was fully covered by sterile drapes.
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This within-subject study compared the effects of hyperinflations with 20% above maintenance oxygen (O2) level and 100% O2 hyperinflations before and after endotracheal suction in 11 acutely ill patients with chronic obstructive pulmonary disease. Four hyperinflations were delivered at 1.5 times the calculated tidal volume (10 ml/kg) with 100% O2 or 20% above maintenance O2 level via resuscitator bag, followed by 10 seconds of continuous endotracheal suctioning. This sequence was repeated three times. ⋯ There was no change in heart rhythm for any of the subjects. The results of this study suggest that hyperinflation with 20% above maintenance O2 level can be used for oxygenation in patients with chronic obstructive pulmonary disease before and after endotracheal suctioning. Replication is needed before clinical implementation.