Articles: intubation.
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Stenosis of the larynx and trachea is an unfortunate sequel to many thermal injuries. Numerous surgical techniques have been developed for correction of such problems, many involving use of a tracheal T-tube. We report a serious complication attributed to the use of such a tube. Factors contributing to this complication are analyzed and methods for avoiding similar near-catastrophes discussed.
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Ann Oto Rhinol Laryn · Sep 1988
Comparative StudyMechanisms of pneumothorax following tracheal intubation.
To investigate the mechanism by which pneumothorax may occur as a complication of tracheal intubation, we submitted four cats to tracheotomy and three to tracheal intubation. To simulate the dissection of air along fascial planes following tracheotomy, we placed catheters in either the pretracheal or subcutaneous plane and applied positive pressure to the catheters. The cats undergoing tracheal intubation were ventilated with excessive positive pressure. ⋯ High positive pressures during mechanical ventilation led to pneumothorax and pneumomediastinum, and the mechanism was primarily the dissection of air along the perivascular sheaths of the pulmonary arteries, presumably due to rupture of perivascular alveoli. Dissection of air along the pretracheal fascia following tracheotomy produced pneumomediastinum but not pneumothorax. This suggests that pneumothorax occurring clinically is more likely a complication of assisted ventilation than a complication of tracheotomy surgery.
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Randomized Controlled Trial Clinical Trial
Cricoid pressure and the pressor response to tracheal intubation.
Forty healthy adults who underwent rapid sequence induction of anaesthesia were allocated randomly to receive either cricoid pressure or its stimulation. The anticipated increase in systolic arterial pressure and heart rate after laryngoscopy and tracheal intubation were not altered significantly by the application of cricoid pressure.
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Am. J. Obstet. Gynecol. · Sep 1988
Randomized Controlled Trial Clinical TrialThe use of labetalol for attenuation of the hypertensive response to endotracheal intubation in preeclampsia.
Twenty-five women with preeclampsia who were scheduled to undergo cesarean section under general anesthesia were randomly assigned to either a labetalol pretreatment group (n = 15) or a control group (n = 10) who did not receive any antihypertensive therapy before the induction of anesthesia. Patients in the labetalol group received 20 mg of labetalol intravenously followed by 10 mg increments up to a total dose of 1 mg/kg, which resulted in moderate reductions in the maternal mean arterial pressure and heart rate with attenuation of the hypertensive and tachycardiac responses to laryngoscopy and endotracheal intubation. ⋯ The neonatal Apgar scores and umbilical arterial and venous pH and blood gas values were similar in the two groups. Side effects such as hypotension, bradycardia, and hypoglycemia were not seen in the neonates in the labetalol treatment group.