Articles: intubation.
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Anesthesia and analgesia · Aug 1982
Randomized Controlled Trial Clinical TrialLow-dose fentanyl blunts circulatory responses to tracheal intubation.
The effect of fentanyl, 8 micrograms/kg, used as an adjunct to thiopental for induction of anesthesia, on the circulatory response to tracheal intubation was investigated in 36 patients undergoing major vascular surgery. Patients were randomly assigned to receive either thiopental, 6 mg/kg, alone (N = 18), or thiopental, 3 mg/kg, along with fentanyl, 8 micrograms/kg (N = 18), for induction of anesthesia. ⋯ Increases in systolic blood pressure, diastolic blood pressure, and pulmonary capillary wedge pressure with intubation were also significantly greater following administration of thiopental than following fentanyl-thiopental. Doses of fentanyl that are low enough to cause little postoperative respiratory depression significantly blunt postintubation hypertension when used as an adjunct to thiopental.
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Case Reports
Inadvertent endobronchial intubation with nasogastric tube. Occurrence after head and neck surgery.
Inadvertent endobronchial intubation with nasogastric tubes is hazardous. Massive aspiration can be fatal after nasogastric feeding. In this study, methods of blind nasogastric tube insertion and conventional techniques of confirming the site of the tube are discussed. We stress that direct laryngoscopy either during or immediately after placement or a chest roentgenogram should be considered in the case of nasogastric feeding after major head and neck surgery.
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Randomized Controlled Trial Comparative Study Clinical Trial
Tracheal damage after endotracheal intubation: comparison of two types of endotracheal tubes.
Twenty-eight patients who required endotracheal intubation for open-heart surgery were randomly allocated to one of two types of endotracheal tube. The tracheal mucosa was examined with a fibreoptic bronchoscope at the time of extubation, usually 24 hours after operation. The degree of oedema, inflammation, and ulceration was scored by the bronchoscopist, who also photographed the whole length of the trachea. ⋯ Both observers found significantly less mucosal damage with the low-pressure, high-volume type of cuff than with the traditional high-pressure, low-volume type. This difference may be related to the differences in lateral wall pressures exerted by the two types of cuff. The low-pressure type of cuff may be preferable in patients requiring prolonged endotracheal intubation.
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Critical care medicine · Jul 1982
Predictive value of stridor in detecting laryngeal injury in extubated neonates.
We evaluated 73 consecutively extubated neonates for evidence of acute laryngeal injury from intubation. Hoarseness and stridor were graded by a clinical scoring system. ⋯ All patients with stridor had moderate or major injury, as did 38% of patients without stridor. Stridor was quite specific for detecting moderate or major injury but did not identify the type of injury.
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Randomized Controlled Trial Clinical Trial
Postoperative sore throat related to tracheal tube cuff design.
Recent reports of the incidence of postoperative sore throat following anaesthesia with tracheal intubation have claimed that low volume high pressure cuffs are preferable to those with high volume and low pressure. In this study similar methods were used for evaluating postoperative sore throat. Randomly selected tracheal tubes were used in 56 patients undergoing elective abdominal surgery, followed by direct questioning about sore throat on the first postoperative day. ⋯ Therefore the validity of this method for evaluating the influence of cuff design must be questioned. Postoperative sore throat is a symptom caused by many factors, such as the intubation procedure and the use of stylets or lubricants. The incidence of postoperative sore throat does not necessarily reflect damage caused by the tracheal tube cuff.