Articles: intubation.
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Anterior fontanelle pressure responses to tracheal intubation in the awake and anaesthetized infant.
In order to define the changes in intracranial pressure which occur during tracheal intubation in young infants, a Ladd transducer was used to monitor anterior fontanelle pressure (AFP) non-invasively in awake (group 1, n = 14) and anaesthetized (group 2, n = 10) infants during intubation of the trachea. Heart rate and systolic arterial pressure were also recorded. In quiet, undisturbed infants, AFP (mean +/- SEM) was similar in groups 1 (9.6 +/- 0.5 mm Hg) and 2 (8.7 +/- 0.8 mm Hg); with crying, AFP increased significantly in both groups. ⋯ Neither heart rate nor systolic arterial pressure changed significantly in either group during laryngoscopy--when compared with measurements in the quiet state. It was concluded that AFP increases significantly during intubation and during crying in the infant. The response to intubation is only partially attenuated by the prior administration of general anaesthesia.
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An endoscopic procedure has been developed to enable constant monitoring of the mucous membrane of the larynx and trachea. The examination can be divided into four stages. 1. Transnasal inspection. 2. ⋯ A final check on the above-mentioned critical points during complete extubation after long-term intubation. Regular examination by this atraumatic method provides an early diagnosis of any mucosal damage caused by tubes. The recommendation that a secondary tracheotomy should be carried out after 48 h, and at the latest after a week, can no longer be supported, provided the necessary modern anaesthetic equipment and management is available.