Articles: intubation.
-
Anasth Intensivther Notfallmed · Oct 1988
Biography Historical Article[Joseph O'Dwyer--a pioneer in endotracheal intubation and pressure respiration].
The oro- and nasotracheal intubation has been developed into one of the most important techniques in anaesthesiology. Originally, intubations were carried out for overcoming acute diphteric airway obstruction in children. As late as the end of the 19 century, the only life saving chance was to perform tracheotomy. ⋯ Working together with the surgeon George Fell, O'Dwyer designed an apparatus, for artificial respiration. As Fell-O'Dwyer Apparatus it was widely used in cases of asphyxia, - even in those caused by overdosage of anaesthetics. Further developments of the apparatus permitted positive pressure ventilation and the combination with a funnel for narcotics increased the repertory of anaesthesiological possibilities.
-
J Cardiothorac Anesth · Oct 1988
Randomized Controlled TrialInfluence of beta-blockers on vecuronium/sufentanil or pancuronium/sufentanil combinations for rapid induction and intubation of cardiac surgical patients.
Use of pancuronium or vecuronium with the priming principle was evaluated in regards to hemodynamic changes and adequacy of relaxation for a rapid induction-endotracheal intubation sequence with sufentanil in 24 ASA Class III-IV patients undergoing cardiac surgery. Twelve patients taking beta-blockers (groups B-P and B-V) were compared with 12 patients not receiving beta-blockers (groups NB-P and NB-V). Patients randomly received vecuronium or pancuronium (15 microg/kg), followed in 4 minutes by sufentanil 5 microg/kg and another 85 microg/kg of the appropriate relaxant through a central vein. ⋯ Chronic beta-blocker therapy was able to attenuate the tachycardia from pancuronium and was not associated with bradycardia when used with vecuronium. In patients with cardiac disease not on beta-blockers, pancuronium was associated with tachycardia. Therefore, vecuronium appears to be more suitable for these patients.
-
Critical care medicine · Sep 1988
Comparative StudyUse of flexible fiberoptic endoscopy for determination of endotracheal tube position in the pediatric patient.
Flexible fiberoptic endoscopy (FFE) was utilized in a series of 24 critically ill pediatric patients to determine the position of the endotracheal tube (ETT) tip relative to the carina. Training on a model system revealed no significant differences in predicting ETT-to-carina distance (ETT-C) with respect to operator, ETT size, or absolute ETT-C as measured directly. No significant differences in ETT-C could be determined between traditional bedside chest x-ray (CXR) or FFE when FFE was performed on intubated pediatric ICU patients. ⋯ No clinically significant changes in patient pulse oximetry, heart rate, or physical exam were observed during FFE. Only copious secretions impaired the utility of FFE. We concluded that FFE is a safe, fast, easily learned method to determine relative ETT position or precise ETT-C in the mechanically ventilated pediatric patient.
-
We describe our experience with 60 consecutive intubations using flexible fiberoptic nasotracheal technique in the emergency setting. Fifty-seven of the procedures were carried out by two emergency physicians initially trained on intubation manikins. A learning curve is constructed demonstrating that time to intubation is decreased after nine or ten intubations. ⋯ Bleeding occurred in 22% of patients; the technique failed in 13%. Failure to intubate with fiberoptic technique was associated with specific problems such as bleeding, tumor, or agitation. Our results demonstrate both the limitations and special use of flexible fiberoptic technique.