Articles: intubation.
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For a two-month period, 71 nasotracheal intubations done in the emergency department or inpatient units at Detroit General Hospital were studied. Sixty-five of 71 intubations, or 91%, were successful. Mild or moderate complications occurred in 15 of 71 patients, and consisted of mild or moderate bleeding. ⋯ Retropharyngeal perforation may be a more common complication of nasotracheal intubation than realized. The major technical error is failure to appreciate that loss of flow of air from the tube, once the tube has passed the turbinates, means that the lumen of the tube is abutting the pharyngeal mucosa. Even slight pressure at this point can lead to retropharyngeal perforation.
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Letter Case Reports
An infrequent cause of pulmonary atelectasis during mechanical ventilation.
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Anesthesia and analgesia · Feb 1981
Randomized Controlled Trial Comparative Study Clinical TrialEarly extubation versus prophylactic ventilation in the high risk patient: a comparison of postoperative management in the prevention of respiratory complications.
To evaluate whether prophylactic ventilation during the early postoperative period diminishes pulmonary complications, 35 high risk, elderly patients undergoing major, elective abdominal aortic reconstruction were prospectively randomized into either an early extubation group or a prophylactic ventilation group. The 17 patients assigned to the prophylactic ventilation group received mechanical ventilation by assist/control mode until 8 a.m. of the first postoperative day. The 17 patients assigned to the early extubation group were extubated after the operation as soon as they could maintain a pH of 7.35, with a spontaneous respiratory rate of less than 30. ⋯ Intrapulmonary shunt and oxygen delivery were not significantly different between the groups at any time during the study period. There was no mortality or significant morbidity in either group. These findings suggest that in high risk surgical patients, prophylactic ventilation, per se, may not diminish respiratory complications or improve gas exchange.
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Letter Case Reports
The use of the fibre-optic bronchoscope for the passage of a double lumen tube.