Articles: intubation.
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In response to interest from readers the authors provide an update of their 1986 papers on coping with medical emergencies in dental practice. In particular they review drug regimes and the technique of cricothyroidostomy.
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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.