Articles: intubation.
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A new method for nasotracheal intubation of infants and young children is described. This method offers a smooth, reliable, and rapid means of entry into these children's airways in a safe and efficient manner in a wide variety of cardiorespiratory illnesses. This technique should be reserved for well-trained physicians with adequate equipment and experience. It is an optional technique for intubation that should be available in all modern general and children's hospitals throughout the country.
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The complications observed in twelve patients undergoing guided blind nasotracheal intubation are presented. The commonest was minor bleeding, followed by difficulty in hooking the cannula out of the nostril. These complications are minor enough to justify the more frequent use of the technique in patients with intubation problems.
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During cuffed intubation, damage to the trachea is least likely when the lateral wall pressure exerted by the cuff does not exceed the mean capillary perfusion pressure of the mucosa. A study was carried out of eight different types of endotracheal tubes. At the seal point the traditional red rubber tube and the armoured latex and Softway tubes exerted pressures above the mean systemic arterial pressure. ⋯ The Lanz tube, however, with its over-pressure safety balloon, maintained a lateral wall pressure below the mean capillary perfusion pressure even when inflated considerably beyond the seal point. Endotracheal cuffs are often overinflated in clinical practice. Since cuff-induced tracheal damage is most influenced by the lateral wall pressure, these results suggest that the use of Lanz-type tubes should be mandatory in intensive care units or when a cuffed tracheostomy tube is required and they should also be considered for use in more routine anaesthetic practice.