Articles: intubation.
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Randomized Controlled Trial Clinical Trial
[Laryngeal edema after extubation. Do corticosteroids play a role in its prevention?].
The role of corticosteroids in the prevention of post-extubation laryngeal oedema was evaluated in a randomized study of 276 patients under mechanical ventilation. Fifty per cent of the patients received methylprednisolone 40 mg intramuscularly and intravenously. ⋯ Thus, the incidence of laryngeal oedema was not modified by corticosteroids. Regular prescription of corticosteroids does not seem to be useful before extubation of patients intubated with large volume, low-pressure balloon tubes.
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Randomized Controlled Trial Clinical Trial
Successful direct extubation of very low birth weight infants from low intermittent mandatory ventilation rate.
It is common practice to use endotracheal continuous positive airway pressure for various time periods up to 24 hours before attempting extubation in infants who are mechanically ventilated. A few studies in newborns have indicated that airway resistance is increased through small endotracheal tubes. This increases the work of breathing and the likelihood of subsequent ventilatory failure. ⋯ All 13 study infants were successfully extubated without significant apnea or respiratory acidosis. Of the 14 control infants, only seven were successfully extubated; six infants had significant apnea and in one infant respiratory acidosis with pH 7.13 and PCO2 65 developed while receiving continuous positive airway pressure (13/13 v 7/14, P less than .005). The seven infants who failed the preextubation trial of continuous positive airway pressure were later extubated from low intermittent mandatory ventilation rates without significant apnea or respiratory acidosis.(ABSTRACT TRUNCATED AT 250 WORDS)
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Case Reports
Subcutaneous emphysema and pneumomediastinum complicating endotracheal intubation--a case report.
A case is reported of a 5-month-old child who developed subcutaneous emphysema and pneumomediastinum following the application of external pressure on the trachea during intubation using a non-kinkable tube with a stylet in situ. Possible aetiological factors and management of such a condition are discussed.
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Succinylcholine is traditionally used as the muscle relaxant of choice for rapid induction sequence intubation. There are, however, many absolute and relative contraindications for the use of succinylcholine necessitating the need for an alternative muscle relaxant. This study was undertaken to evaluate the effectiveness of pancuronium bromide for muscle relaxation in the rapid induction sequence in comparison to succinylcholine. ⋯ The results indicate that in experienced hands pancuronium bromide in a dose of 0.1-0.15 mg/kg is as an effective muscle relaxant for rapid induction sequence intubation as is succinylcholine. It is an acceptable alternative when succinylcholine is contraindicated. Intubating conditions are best 90 seconds after the administration of pancuronium bromide.