Articles: intubation.
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It has been suggested that the size of the base of the tongue is an important factor determining the degree of difficulty of direct laryngoscopy. A relatively simple grading system which involves preoperative ability to visualize the faucial pillars, soft palate and base of uvula was designed as a means of predicting the degree of difficulty in laryngeal exposure. The system was evaluated in 210 patients. The degree of difficulty in visualizing these three structures was an accurate predictor of difficulty with direct laryngoscopy (p less than 0.001).
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To determine the effect of intravenous lidocaine on the intraocular pressure (IOP) response to laryngoscopy and intubation, twenty unpremedicated children, ages one to ten years were studied. After administration of either intravenous sterile water (control) (n = 10) or preservative-free lidocaine (1.5 mg X kg-1) (n = 10), anaesthesia was induced with pancuronium (0.15 mg X kg-1), thiopentone (5 mg X kg-1), and atropine (0.02 mg X kg-1), and maintained with halothane, nitrous oxide and oxygen. The trachea was intubated one minute after administration of thiopentone. ⋯ At each measurement (except time 0), IOP was significantly greater in the control group than in the lidocaine group (p less than 0.05). Heart rate and systolic blood pressure did not increase significantly in either group after intubation. We conclude that intravenous lidocaine (1.5 mg X kg-1) significantly attenuates the IOP response to laryngoscopy and intubation in children anaesthetized with pancuronium, thiopentone, and atropine.
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Randomized Controlled Trial Comparative Study Clinical Trial
Endoscopic sclerosis and esophageal balloon tamponade in acute hemorrhage from esophagogastric varices: a prospective controlled randomized trial.
A prospective randomized controlled clinical trial was performed in 43 consecutive histologically proved cirrhotic patients with endoscopically proved actively bleeding esophageal varices. Twenty-two were randomly selected to have esophageal tamponade with the Sengstaken-Blakemore tube, and 21 were selected to have endoscopic sclerosis of the esophageal wall. The two groups were similar in demographic, clinical and laboratory data. ⋯ Within 30 days, six patients (27%) in the Sengstaken-Blakemore tube group had died compared to 2 (10%) in the endoscopic sclerosis group which is statistically significant (p less than 0.01) in favor of endoscopic sclerosis. The frequency of complications was similar in the two groups. Endoscopic sclerosis patients received serial endoscopic sclerosis after bleeding had been stopped during the whole period of follow-up.(ABSTRACT TRUNCATED AT 250 WORDS)
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This study determined which variables affected endotracheal tube "leak" pressures in 80 surgical patients, two weeks to 11 years of age, intubated with uncuffed tracheal tubes. We defined "leak" pressure as the inspiratory pressure needed to cause an audible escape of gas around the endotracheal tube. "Leak" pressure was measured after varying either head position, tracheal tube depth within the trachea, fresh gas flow rate, or degree of neuromuscular block. "Leak" pressure increased progressively from 16.9 +/- 1.3 cmH2O with complete patient paralysis to 30.6 +/- 1.4 cmH2O following 100 per cent recovery of neuromuscular function. ⋯ Thus, there may be marked variability in "leak" pressure, depending on head position and degree of neuromuscular blockade. Keeping the patient fully paralyzed with the head in a neutral position provides a reliable and consistent method for measuring "leak" pressures.