Articles: intubation.
-
Anaesth Intensive Care · Nov 1987
The position of the larynx in children and its relationship to the ease of intubation.
Lateral radiographs of the upper airway of children aged from birth to puberty were used to determine the changes in position, with growth, of the tip of the epiglottis, the hyoid, the glottis, and the inferior margin of the cricoid cartilage. There is a marked descent of these structures relative to the cervical spine during the first two years of life. ⋯ In adults the best view is obtained with the atlanto-occipital joint fully extended and the head resting on a low pillow. Anatomical explanations for these observations are presented.
-
Two methods for modifying standard orotracheal intubation models, in order to teach and practice special airway management skills, are described. Using these quick and inexpensive manipulations, an intubation manikin can be modified for use as a teaching model for standard nasotracheal intubation techniques as well as both orotracheal and nasotracheal intubation with a lighted stylet.
-
Randomized Controlled Trial Clinical Trial
An investigation of the features of the pre-term infant palate and the effect of prolonged orotracheal intubation with and without protective appliances.
The features of premature low birth weight infant palates were examined. Babies of less than 32 weeks gestation at birth were compared with 30 who had required orotracheal intubation for ten or more days. ⋯ Prolonged orotracheal intubation was shown to be associated with narrowing, deepening and some anterior elongation of the developing palate. The protective appliance was shown to reduce the extent of these changes and provided an additional means of orotracheal tube support.
-
An infant with Goldenhar's syndrome is presented in whom two-stage plastic surgery was undertaken. The first operation, at the age of 5 months, necessitated a retrograde technique for tracheal intubation while in the second, at 10 months of age, conventional intubation was possible. The discussion highlights those refinements that promote a successful outcome when retrograde intubation is indicated, particularly in infants.
-
Despite the fact that endotracheal intubation is a skill essential for clinicians of varied specialties, the procedure is not without risk, especially when practiced in an emergency setting, particularly the field environment. Of all complications, none is more serious than unrecognized esophageal intubation. Clinical experience with a method of guided orotracheal intubation using a rigid-wire lighted stylet prompted us to develop a technique to confirm correct intratracheal placement of an endotracheal tube using a new flexible lighted stylet designed for nasotracheal intubation. ⋯ The level of experience or training bore no relationship to the ability of the intubator to identify correct placement. We conclude from the study that this technique is a rapid and reliable method of confirming correct placement of endotracheal tubes. The use of this method could reduce, if not eliminate, unrecognized esophageal intubation in the field, emergency department, the critical care unit, and the operating room.