Articles: intubation.
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An anaesthetic technique suitable for training in fibreoptic intubation is described. It uses a capped oropharyngeal airway which leaves the nose free for fibreoptic intubation and allows the airway to be maintained and ventilation to be controlled if necessary. An assessment is made of the technique after 50 fibreoptic intubations with the Olympus LF-1 fibrescope. There were no failed intubations and no serious complications.
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Problems associated with the presence of a tracheal tube during anaesthesia for infant laryngeal surgery using the carbon dioxide laser are described. This paper discusses alternatives and describes an effective anaesthetic technique and a new tracheal tube.
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Although endotracheal intubation is considered the optimal technique for airway management in critically ill patients, performance of this task in the prehospital setting is at times difficult due to increased masseter muscle tone, vocal cord spasm, or patient combativeness. Use of short-acting paralyzing agents by paramedics to facilitate intubation in these situations is an uncommon practice. We report the recent experience of an emergency medical service system that has used succinylcholine (SUX) for more than ten years. ⋯ Review of hospital records showed no difference between the groups for frequency of either aspiration pneumonia or mechanical ventilation in patients surviving to hospital admission. No patient receiving SUX required emergency cricothyrotomy, nor was esophageal intubation noted in either group. Succinylcholine-assisted intubation was used safely and selectively by the paramedics in this EMS system to permit airway control and ventilation of patients with more difficult intubations.
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The incidence of tracheal tube cuff rupture was noted in 30 polyvinyl chloride tracheal tubes lubricated with three different solutions. All cuffs moistened with water were intact after 2 hours of cuff inflation whereas two of 10 lubricated with 4% lignocaine solution had burst. Both of these had leaked at the site of cuff attachment to the tube. ⋯ Four of the five had developed pinholes in the cuffs themselves. The remaining 50% of this group showed marked distortion and thinning of their intact cuff walls. The implications of these findings are discussed in view of the widespread use of PVC tracheal tubes.