Articles: intubation.
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The passage of a tube through the nose to the epipharynx is potentially dangerous during the nasotracheal intubation because of the possibility of cuff damage, obstruction of the tube, the impossibility of advancing the tube and contamination. It seems therefore useful to protect the cuff e.g. by a finger stall, but using this procedure complications can occur which are reported. A better solution to protect the cuff will be shown.
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The Journal of pediatrics · Aug 1984
Randomized Controlled Trial Clinical TrialNasotracheal intubation in the neonate: physiologic responses and effects of atropine and pancuronium.
Thirty infants with birth weights from 580 to 3450 gm (25 to 40 weeks gestation) were prospectively studied during nasotracheal intubation. The infants were randomized to receive atropine 0.01 mg/kg, atropine 0.01 mg/kg plus pancuronium 0.1 mg/kg, or no medication (controls) prior to intubation. There was a significant decrease in transcutaneous PO2 (27.3 torr, P less than 0.02), associated with significant increases in mean arterial blood pressure (57%, P less than 0.01) and intracranial pressure (mean increase 18.9 cm H2O, P less than 0.01) with intubation in all three groups of infants. ⋯ Pancuronium plus atropine was associated with lesser increases in intracranial pressure and with the least changes in heart rate in response to intubation. There was no significant difference between the groups for changes in systemic blood pressure or transcutaneous PO2. Further studies are required to determine the clinical consequences, if any, of these responses, and the use of pretreatment in the neonate requiring intubation.
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Case Reports
Unrecognized esophageal intubation with both esophageal obturator airway and endotracheal tube.
Two trauma patients with fatal injuries had unrecognized esophageal insertion of an endotracheal (ET) tube despite the presence of an esophageal obturator airway (EOA). Prehospital training must emphasize clinical verification of correct airway placement. ⋯ The EOA does not necessarily guide the ET tube into the trachea. Difficulty removing an EOA after insertion of an ET tube may indicate that both are in the esophagus.