Articles: intubation.
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In order to determine whether paramedics could be effectively trained in the skill of orotracheal intubation, 11 paramedics were entered into a pilot study. All paramedics received the same limited didactic, cadaver, and in vivo clinical preparation. ⋯ Subsequently, training has been expanded to a large number of paramedics, and the experience with intubation now includes a total of 128 patients and an overall success rate of 86%. It is concluded that paramedics can safely and effectively perform orotracheal intubation in a variety of adverse field conditions.
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We report a case of a 78-year-old woman, previously in good health, who was endotracheally intubated and brought to the emergency department following sudden cardiac arrest. Physical examination revealed absent breath sounds over the right hemithorax, and a portable chest radiograph demonstrated left mainstem bronchus intubation. Although right mainstem bronchus intubation is a common complication of endotracheal intubation, left mainstem bronchus intubation is rare.
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Comparative Study Clinical Trial Controlled Clinical Trial
Rate of onset of good intubating conditions, respiratory depression and hand muscle paralysis after vecuronium.
The development of neuromuscular blockade of the adductor pollicis muscle following vecuronium 0.1, 0.15 and 0.2 mg kg-1, was compared with the development of intubating conditions and respiratory paralysis. From this relationship, the optimal time after injection required for ideal tracheal intubation was calculated for the three doses of vecuronium. The effects of these doses of vecuronium on the onset, the duration of action and rate of recovery were studied. ⋯ Suxamethonium 1.5 mg kg-1 (preceded by gallamine 20 mg 2 min earlier), produced excellent conditions in under 1 min. Hypopnoea occurred when the peripheral neuromuscular blockade was about 20-40% established with vecuronium or 50% established with pancuronium. Increasing the dose of vecuronium from 0.1 mg kg-1 to 0.2 mg kg-1 prolonged significantly the duration of action (from 21 to 48 min) but did not shorten significantly the onset time nor prolong the rate of recovery.
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The volume and pressure of a tracheal tube cuff inflated with air increases during nitrous oxide anaesthesia. The study was designed to investigate the changes of tracheal tube cuff pressure during nitrous oxide anaesthesia following inflation of the cuff with air or saline in 10 mongrel dogs who were anaesthetised with nitrous oxide and their lungs artificially ventilated. ⋯ On microscopic examination of the trachea, only the air group had glandular inflammation, dilatation and destruction. Therefore, it appears that if saline is used to inflate tracheal tube cuffs, there will not be an increase in cuff volume and pressure during nitrous oxide anaesthesia.