Articles: intubation.
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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.
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The technique of prehospital airway management is determined largely by the level of training and expertise of the prehospital care provider. We report preliminary observations and data in experimental animals and patients using a new airway adjunct--the pharyngeo-tracheal lumen (PTL) airway. The PTL airway employs a two-tube, two-cuff system that is inserted in a "blind" fashion. ⋯ Volumetric efficiency at optimal cuff inflation pressures was 100%, and arterial blood gas values obtained during PTL ventilation were not significantly different from those measured during ventilation with an endotracheal tube at comparable minute ventilations. In six arrest patients undergoing cardiopulmonary resuscitation, arterial PO2 and PCO2 using the PTL airway (176 +/- 105 mm Hg and 36 +/- 12 mm Hg, respectively) were not significantly different from those measured during artificial ventilation with an endotracheal tube (PO2, 162 +/- 124 mm Hg; PCO2, 34 +/- 10 mm Hg). Although the numbers are small, the data suggest that the PTL airway may be an alternative method of emergency airway management when endotracheal intubation cannot be performed.
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The use of a Tiemann curved tip urethral catheter for repeated nasotracheal suction in 120 instances of postoperative pulmonary complications was proved to be more efficient than the use of a regular suction catheter. The curved tip is better adapted to the anatomy of the nasotracheobronchial tract and allows easy selective catheterization of the trachea and major bronchi.