Articles: intubation.
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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.
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Anesthesia and analgesia · Aug 1981
Effect of propranolol on circulatory responses to induction of diazepam-nitrous oxide anesthesia and to endotracheal intubation.
The present study evaluated the hemodynamic effects produced by the intravenous infusion of diazepam (0.5 mg/kg over 10 minutes) and the simultaneous inhalation of 50% nitrous oxide in oxygen administered to 19 patients with coronary artery disease who were receiving chronic propranolol therapy (106 +/- 67 mg/day). In addition, hemodynamic changes produced by direct laryngoscopy and intubation of the trachea were measured. Data during the induction of anesthesia were compared to measurements obtained in a previously reported group of similar patients anesthetized in the same manner but not receiving propranolol. ⋯ These changes were transient, returning to control values within 3 minutes after intubation. Patients with awake resting HR less than 70 beats per minute had greater increases in HR and RPP at 1 minute than did patients with resting HR greater than 70 beats per minute (p less than 0.05). This suggests that propranolol even in doses adequate to produce significant slowing of HR in awake patients does not ensure protection against increases in HR and MAP associated with laryngoscopy and intubation of the trachea.