Articles: intubation.
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Southern medical journal · Dec 1986
Case ReportsUnrecognized esophageal placement of endotracheal tubes.
Unrecognized esophageal placement of endotracheal tubes during general anesthesia or in apneic unanesthetized patients is not an uncommon occurrence. Allowing this mishap to proceed to asphyxia and catastrophe is inexcusable. If one is uncertain, proper placement can be quickly verified by mouth-to-tube insufflation of a subject's lungs with one's own expired air immediately after intubation. This method of verification may be useful in areas other than the operating room, where intubations are performed for resuscitation or airway control.
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Randomized Controlled Trial Comparative Study Clinical Trial
Tube thoracostomy and trauma--antibiotics or not?
Controversy persists regarding the use of antibiotics in association with t tube thoracostomy for trauma patients. We conducted a prospective randomized study of patients requiring tube thoracostomy for pneumo- and/or hemothorax complicating blunt or penetrating thoracic trauma in an attempt to assess the efficacy of prophylactic antibiotic therapy. Fifty-eight patients were included in the study. ⋯ Cultures demonstrated significant conversion from negative to positive both within each group and between groups. The organism most commonly recovered was S. aureus. Our findings strongly suggest that patients requiring tube thoracostomy for trauma, whether blunt or penetrating, should receive the benefit of systemic prophylactic antibiotic therapy.
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Anesthesia and analgesia · Dec 1986
Priming with atracurium: improving intubating conditions with additional doses of thiopental.
The effects of different intubating doses of atracurium on the time of onset, and the effect of an additional dose of thiopental on intubating conditions, were studied in 72 patients divided into six groups (n = 12 in each). Stratified sampling was used to obtain an even sex distribution. Groups I, III, and V (controls) received atracurium as a single bolus dose of 0.4, 0.5 or 0.6 mg/kg respectively. ⋯ When divided doses of atracurium were given, administration of 2 mg/kg thiopental (in addition to the 5 mg/kg used for induction) before the injection of the intubating dose resulted in improvement of intubating conditions as reflected by statistically significant changes in intubating scores. This result was probably due to the increase by thiopental in the depth of anesthesia. Therefore, when thiopental is given as supplement, the priming technique can be made to provide better conditions for tracheal intubation in less than 90 sec.
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The performance of cricoid pressure was studied in three groups of medical personnel likely to be involved in its application using the cricoid yoke and a test rig. The instrument enabled individuals who had no previous experience in the application of cricoid pressure to achieve results as good as those obtained by experienced anaesthetic staff. Furthermore, the instrument improved the consistency of the applied force in all groups, particularly if cricoid pressure was required for sustained periods of 30 s or more.
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Pulmonary edema due to upper airway obstruction can be observed in a variety of clinical situations. The predominant mechanism is increased negative intrathoracic pressure, although hypoxia and cardiac and neurologic factors may contribute. Laryngospasm associated with intubation and general anesthesia is a common cause of pulmonary edema in children. ⋯ Five of the seven had other risk factors for upper airway obstruction, and in four, the diagnosis of "laryngospasm" could be explained by other factors. Patients with underlying risk factors for upper airway obstruction, such as a forme fruste of sleep apnea or nasopharyngeal abnormalities, appear to be at increased risk for the development of pulmonary edema in the setting of intubation and anesthesia. This form of pulmonary edema usually resolves rapidly without the need for aggressive therapy or invasive monitoring.