Articles: intubation.
-
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.
-
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.
-
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.
-
Anaesth Intensive Care · Aug 1988
Criteria for estimating likelihood of difficulty of endotracheal intubation with the Macintosh laryngoscope.
Many anatomical factors in difficult intubation at direct laryngoscopy have been evaluated. Lateral radiographs were taken of nineteen patients in whom tracheal intubation proved particularly difficult, and fourteen patients whose intubation was reasonably straightforward. ⋯ A formula and graph have been derived to relate these variables with likelihood of difficulty, and a method has been described of applying this information at the bedside, without using X-ray examination, to estimate the likelihood of difficulty in intubating a new patient. Eighteen months' experience of the application of this clinical evaluation have so far found it reliable.