Articles: intubation.
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Seventy-one adult patients (31 male, 40 female) who presented for surgery underwent orotracheal intubation with Portex Blue Line standard cuff disposable tubes (9-mm for males, 8-mm for females). The tracheal tube cuff was inflated by a trained assistant using a syringe and the initial cuff pressure measured; the minimum cuff pressure required to prevent respiratory gas leakage was also measured and the cuff pressure maintained above this pressure throughout the operation by means of the Cardiff Cuff Controller. ⋯ It is concluded that the present method of inflation may lead to gross overinflation of tracheal tube cuffs and that cuff pressure monitoring may be performed simply by means of an electropneumatic controller. The difference in minimum cuff pressure between males and females suggests that the difference in tracheal size between the sexes is greater than the 9-mm to 8-mm difference in tracheal tube size.
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Comparative Study
Prehospital use of neuromuscular blocking agents in a helicopter ambulance program.
We prospectively studied the use of succinylcholine chloride and pancuronium bromide by the physician/nurse flight team of our hospital-based helicopter ambulance service. Patients who received these agents at the scene of an accident (prehospital group, n = 39) were compared with patients who were paralyzed by the flight team in the emergency department of transferring hospitals (control group, n = 35). By protocol, succinylcholine was used primarily for endotracheal intubation and pancuronium for prolonged paralysis after endotracheal intubation. ⋯ There was no significant difference in successful intubation or complication rate between the prehospital and control group. Paralysis allowed airway stabilization in a significant number of critically ill patients who could not otherwise be endotracheally intubated, with a lower incidence of complications than has been previously reported for ED patients. These results suggest that neuromuscular blocking agents can be used safely and effectively at accident scenes by a physician/nurse team.
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Comparative Study
An additional tactile test. Further developments in tactile tests to confirm laryngeal placement of tracheal tubes.
An additional clinical test to confirm laryngeal placement of tracheal tubes is described. Using the new test, placement was confirmed in all of 50 patients studied in whom difficulty would have been anticipated using previously described tactile tests (male patients with lower molar teeth). Two anaesthetists with small hands averaged 98% confirmations in two series each of 100 consecutive unselected intubations. ⋯ The three tactile tests are reviewed and analysed. In the authors' combined experience of 14 cases of difficult laryngoscopy the tests gave reliable confirmation in 12 patients. Familiarity with these tests is stressed to be important for their reliable implementation.
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Randomized Controlled Trial Clinical Trial
Modification by alfentanil of the haemodynamic response to tracheal intubation in elderly patients. A dose-response study.
Fifty-five elderly patients undergoing elective ophthalmological surgery were randomly allocated to four groups. Following the induction of anaesthesia with thiopentone (given over 2 min) and the administration of atracurium 0.6 mg kg-1, patients received alfentanil 400, 600, 800 or 1000 micrograms. Intubation of the trachea was performed 90 s later. ⋯ In each of the groups there was a significant decrease in systolic arterial pressure and a significant increase in heart rate on induction of anaesthesia. In those patients who received either 400 or 600 micrograms of alfentanil, arterial pressure increased immediately after tracheal intubation, whereas in those receiving alfentanil 800 or 1000 micrograms, arterial pressure decreased immediately after tracheal intubation, and when measured 10 min after intubation. It is suggested that alfentanil 600 micrograms (10 micrograms kg-1) constitutes the optimal dose with which to obtund the haemodynamic response to tracheal intubation in elderly patients, and to minimize cardiovascular depression after tracheal intubation.