Articles: intubation.
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A major problem in the care of premature and other newborn infants is obtaining and maintaining correct position of an endotracheal tube. Improper placement of the distal tip of the endotracheal tube above the larynx or below the carina is a life-threatening hazard that not only impairs ventilation, but also may result in serious pulmonary complications such as lobar atelectasis and air leak. This problem was addressed by testing the hypothesis that a light source at the end of the endotracheal tube could be seen on the neck and chest and that, therefore, the endotracheal tube could be positioned and repositioned without radiologic guidance. ⋯ The illuminated endotracheal tube was used 33 times in 25 infants. This technique has been shown to provide a safe method (not requiring ionizing radiation) for positioning of the endotracheal tube by virtue of external visualization of a circle of light on the surface of the baby. This system will not permit differentiation of tracheal from esophageal intubation.
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During a period of 11 1/2 months, 41 of 217 adult burn patients admitted to the U. S. Army Institute of Surgical Research Burn Center required endotracheal intubation or tracheostomy for management of the airway and/or ventilatory assistance. ⋯ For initial respiratory support, we favor the use of translaryngeal (nasotracheal) tubes for periods up to 3 weeks. Fiberoptic bronchoscopic examination is the most reliable follow-up method for detecting anatomic damage in such patients. Spirometry can be used as a noninvasive screening test and xeroradiograms are helpful in assessing the degree of tracheal stenosis.
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Critical care medicine · Mar 1985
Forward displacement of the larynx for nasogastric tube insertion in intubated patients.
Simple insertion of a nasogastric (NG) tube was successful in only 52 of 100 anesthetized intubated patients. After the larynx was manually pulled forward, the NG tube was successfully inserted in 33 patients. ⋯ The difficulty of NG tube insertion was not correlated with sex, age, weight, or type of endotracheal intubation. Forward displacement of the larynx by manually gripping and lifting the thyroid cartilage is a useful and safe maneuver that facilitates NG tube insertion in anesthetized intubated patients.
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Case Reports
Ankylosis of the temporo-mandibular joint after temporal craniotomy: a cause of difficult intubation.
It is not generally appreciated that surgery in the region of the temporal fossa commonly produces, within a few weeks, a contracture of the temporalis muscle with "pseudo" ankylosis of the jaw. This usually, but not always, resolves within six months. ⋯ Organization of haematoma. It is recommended that active and passive jaw exercises be started early after surgery in the temporal fossa and that such postcraniectomy patients be carefully assessed for jaw ankylosis prior to undertaking anaesthesia.
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Effects on haemodynamics and myocardial oxygenation of endotracheal intubation were examined in 17 patients after halothane induction and 12 after 1 mg X kg-1 of IV morphine. Six patients having each anaesthetic were pretreated with IV propranolol (0.1 mg X kg-1) 45 minutes earlier. Arterial and intracardiac pressures, cardiac output and total coronary sinus blood flow (CSBF), both by thermodilution, were determined plus arterial-coronary differences of oxygen, haemoglobin and lactate. ⋯ More myocardial oxygen was extracted and consumed after intubation, but lactate extraction continued: these data are evidence of adequate oxygen supply. Induction with either halothane or morphine effectively prevented the hypertensive response to intubation. Acute beta blockade led to less increase in heart rate from intubation.