Articles: intubation.
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J. Thorac. Cardiovasc. Surg. · Oct 1981
Case ReportsUse of the silicone tracheal T-tube for the management of complex tracheal injuries.
This paper reports on the use of the silicone Montgomery T-tube for the management of 18 patients with complex tracheal injuries. Our use of the tube was as follows: prior to definitive resection, as a better alternative to tracheostomy tube, while we were awaiting the most appropriate time for resection; at the time of resection, as an adjunct to segmental subglottic resection, used to stent residual abnormal laryngeal mucosa: following tracheal resection for uncertain or unsatisfactory healing: as sole treatment, when resection was deemed unsuitable or inappropriate. ⋯ In contrast to a tracheostomy tube, the T-tube provides respiration through the the nasopharynx, so that humidification and phonation are maintained. It is generally trouble free, requires little if any maintenance, and can remain in place for a year or more when necessary.
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From July 1975 to September 1979, 6 patients were treated with truly prolonged endotracheal intubation; the duration ranged from 55--155 days. Only patients who survived after extubation and were discharged from the hospital were included in this study. Of the 6 patients, 4 were still alive as of November 1980, 23 patients died from causes not related to the intubation. ⋯ In none of these cases was the patient's death related to the intubation. The authors believe that the risk of long-term intubation has been reduced significantly by the use of nasotracheal tubes and to the newer tube materials, which are completely biocompatible, and to improved techniques of cuff inflation. Complications to tracheostomy are less frequent, but often more serious, than complications of long-term nasotracheal intubation.
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Randomized Controlled Trial Comparative Study Clinical Trial
Intubating conditions with ORG NC45. A preliminary study.
The case of tracheal intubation using two doses of the new steroid neuromuscular blocking compound ORG NC45 (Norcuron) 0.1 and 0.15 mg/kg was compared with a standard dose of pancuronium 0.1 mg/kg at 60, 90 and 120 seconds. The results did not reveal any statistically significant benefit of the new drug within 2 minutes of administration over the control.
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Laryngeal complications secondary to nasogastric intubation have been reported rarely in recent literature. Recent experience with three patients who developed laryngeal injuries related to nasogastric tubes prompted retrospective, experimental, and prospective studies to determine the mechanism of laryngeal injury. A review of the literature, as well as the clinical findings in our three patients, point to midline tube placement and the subsequent development of cricoid chondritis as the underlying etiology. ⋯ Six percent of the patients had nasogastric tubes in the midline. Patients who have nasogastric tubes in place for more than three days or have a severe amount of discomfort should have an x-ray film to determine position of the tube. Midline tubes should be removed or replaced.
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In 205 patients undergoing surgery of the nose, throat of dental surgery, a gauze pack was used fixed into the tracheal tube, remaining during surgery above the vocal cords. Advantages in adults as well as children are discussed: laryngoscopy has to be performed only once, a free operating field is secured for the surgeon in that throat, the tube cannot be inserted too far into the trachea and the pack cannot be forgotten in the pharynx. The only disadvantage noticed so far was that in about 10% of the patients intubation was somewhat more difficult for the less experience anaesthetist.