Articles: intubation.
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Comparative Study
Evaluation of two methods used to stabilize oral endotracheal tubes.
This study examined the effects of using an oral endotracheal tube holder versus conventional taping for stabilization of oral endotracheal tubes. Twenty-five patients were studied for 4 days, while 5 remained in the study 3 days. Each of the 30 patients had each of the two methods of stabilization in place for at least 1 day. ⋯ Skin breakdown was also observed less frequently with the tube holder. Overall, nursing staff had a higher level of acceptance of the tube holder as the method of choice for stabilization of an oral endotracheal tube. Patient perceptions of the system were not evaluated because of the degree of illness of the patients.
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Case Reports
Fibreoptic bronchoscopy for tracheal and endobronchial intubation with a double-lumen tube.
A 68-year-old patient was scheduled for a thoracotomy. A double-lumen endobronchial tube was requested by the surgeon to facilitate operating conditions. Initial attempts at intubation by conventional methods were unsuccessful. ⋯ The patient's larynx was easily visualized and the bronchoscope was passed into the trachea. The double lumen tube was then advanced over the bronchoscope and correctly positioned. Shortening a double-lumen tube allows the use of a fibreoptic bronchoscope to aid in tracheal intubation in a patient whose larynx is difficult to visualize by conventional methods.
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Randomized Controlled Trial Comparative Study Clinical Trial
Effect of topical lignocaine on the sympathoadrenal responses to tracheal intubation.
The catecholamine and cardiovascular responses to laryngoscopy and tracheal intubation have been studied in 30 patients undergoing elective gynaecological surgery, allocated randomly to one of three groups: group 1 received 4% lignocaine 160 mg using a Forrester Spray; group 2 received 4% lignocaine 160 mg by "Laryng-o-jet"; group 3 received an equal volume of saline administered by Forrester Spray. In all three groups, there were similar and statistically significant increases in mean arterial pressure and plasma adrenaline and noradrenaline concentrations 1 min after intubation, with diminution of these responses by 5 min after intubation. There were no differences between the three groups at any stage, which suggests that topical anaesthesia of the mucosa of the upper airway, as performed conventionally, is ineffective as a means of ameliorating the pressor and catecholamine responses to routine laryngoscopy and intubation.
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Intubation of a patient with an obstructive friable tumor mass in the hypopharynx can be difficult. A technique for solving our most difficult cases evolved after all current methods had been tried. This technique combines the use of a tubular laryngoscope and a hollow wand (or guide), through which O2 can be delivered into the trachea as the endotracheal tube is advanced past the obstructing lesion. Existing techniques are also discussed.