Articles: intubation.
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Endotracheal intubation has proven to be a relatively safe and effective means of securing the airway in neonates. Some concern remains, however, regarding airway management in critically ill infants who require assisted ventilation for extended periods. Among the various risk factors associated with the complication of acquired subglottic stenosis in neonates, the one most frequently cited has been "prolonged" intubation, although opinion varies regarding the definition of this term. ⋯ The incidence of subglottic stenosis for infants whose duration of intubation ranged from 3 to 50 days was 0.4% (1/245). Infants with birth weights less than 1,500 g appeared more susceptible to the development of intubation-related laryngeal injury. The conclusion of this study is that endotracheal intubation is an appropriate means of long-term airway management in neonates hospitalized in a pediatric intensive care unit, providing other known risk factors are minimized.
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Clinical Trial Controlled Clinical Trial
Esmolol for control of increases in heart rate and blood pressure during tracheal intubation after thiopentone and succinylcholine.
Esmolol, an ultra-short-acting cardioselective beta-adrenergic blocker, was investigated in a double-blind prospective protocol for its ability to control haemodynamic responses associated with tracheal intubation after thiopentone and succinylcholine. Thirty ASA physical status I patients received a 12-minute infusion of esmolol (500 micrograms X kg-1 X min-1 for four minutes, then 300 micrograms X kg-1 X min-1 for 8 minutes) or saline. Five minutes after the start of the drug/placebo infusion, anaesthesia was induced with 4 mg X kg-1 thiopentone followed by succinylcholine for tracheal intubation. ⋯ Increases in HR, SAP and RPP after intubation were approximately 50 per cent less in patients given esmolol compared to patients given placebo. There were highly significant differences in HR (p less than 0.0001), and RPP (p less than 0.0005) and significant differences in SAP (p less than 0.05) when the maximal esmolol post-intubation response was compared to the maximal placebo response. Infusion of esmolol in the dose utilized in this study significantly attenuated but did not completely eliminate cardiovascular responses to intubation.
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The two new uses for the nasopharyngeal airway include facilitation of nasogastric intubation and nasotracheal intubation. First this technique takes advantage of the nasopharyngeal airway's unique ability to traverse the nasopharynx atraumatically and serve as a conduit for the smaller nasogastric tube. This technique also utilizes the nasopharyngeal airway to dilate the nasopharyngeal passage atraumatically, thus facilitating the passage of an endotracheal tube during nasotracheal intubation.
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The inside and outside diameters of all endoscopes and tracheotomy tubes in the endoscopy suite were systematically measured. These measurements were correlated with the manufacturer's stated size and comparisons noted. ⋯ As a result, the proper choice of a tracheotomy tube or endoscope for a patient's size and age may be confusing. A chart was developed and included in order to allow quick and accurate recognition of tracheotomy tube and endoscope sizes across product lines to aid in the proper selection of tracheotomy tubes and endoscopic equipment.