Articles: intubation.
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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 Arabian doctor Avicenna (980-1037) described the first orotracheal intubation in dyspnoea. The history of peroral endotracheal intubation actually begins in the 18th century. ⋯ Regular peroral intubation to keep the respiratory tract clear during narcosis was first applied by Franz Kuhn in 1900; unfortunately, the pioneer himself did not live to see his method become a routine procedure. It was only as late as 1945, that endotracheal intubation became part of hospital practice at our clinic.
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Historical Article
[The history of endotracheal anesthesia, with special regard to the development of the endotracheal tube].
Endotracheal anaesthesia is today the form of general anaesthesia most often applied. It represents more than 80% of the total in hospitals with different surgical specialties. ⋯ At the beginning of our century all preconditions had been given for a widespread and safe performance of endotracheal anaesthesia. The most important stages in the development of this form of anaesthesia are as follows: 1869: First endotracheal anaesthesia in human by use of a tracheotomy cannula by Friedrich Trendelenburg. 1880: First orotracheal intubation anaesthesia by William Macewen. 1894: Positive pressure ventilation following morphine intoxication by George Fell and Joseph O'Dwyer. 1895: Description of direct laryngoscopy by Alfred Kirstein. 1901: Franz Kuhn "Die perorale Intubation".
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Establishment of airway patency is a crucial procedure necessary for every emergency physician. Because no one method of airway management is appropriate for every emergency, emergency physicians must be skilled in several different types and familiar with the various equipment needed for each.