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At least 37 records · Page 2Linked to original sources
PubMed1992

Routine omission of nasogastric intubation after gastrointestinal surgery.

The need for routine nasogastric-tube decompression after gastrointestinal surgery has been challenged repeatedly for several years. To determine whether nasogastric intubation can be omitted routinely, 101 consecutive patients who underwent gastrointestinal surgery were managed prospectively without nasogastric tubes. Excluded were patients with complete bowel obstruction and those who required prolonged endotracheal intubation. These patients were compared with 101 retrospective controls who had nasogastric decompression routinely. There were four protocol violations in the prospective group (nasogastric tubes were left in place postoperatively) and one in the retrospective group (no nasogastric tube postoperatively), leaving 97 and 100 patients, respectively, for follow-up. The mean duration of hospitalization in comparable patients was 10.6 days in patients without decompression and 11.9 days in those with routine decompression. Subsequent nasogastric-tube insertion was required in nine patients who did not undergo routine decompression, compared with two patients who had routine decompression. There were no statistically significant differences in the rates of anastomotic leaks, wound disruptions and pulmonary or other complications between the two groups. The authors conclude that nasogastric decompression can be safely omitted as a routine part of postoperative care after gastrointestinal surgery.

Digestive System Surgical Procedures↗
PubMed1985

Intestinal decompression: preliminary study in the horse.

A technique of nasoduodenal (N-D) intubation and intestinal decompression was developed and used in the horse to explore the prevention of gastric and intestinal distention after abdominal surgical operation. Three styles of tubes (2 single-lumen tubes and 1 double-lumen tube) were positioned in the duodenum of 12 mature horses (10 experimental and 2 clinical) during laparotomy (without enterotomy), and an iatrogenic occlusion at the small intestine was created and later released in the 10 experimental horses. The 2 clinical horses had an exploratory laparotomy to correct a natural obstruction of the small intestine. After each horse recovered from surgical manipulation, suction was used to keep fluids from accumulating in the cranial part of the gastrointestinal tract. In 5 of the 12 horses, the most simple N-D tube was positioned successfully and functioned properly. Three of the 5 horses which were fasted before surgical manipulation (to obtain an empty stomach) survived without postsurgical complications. Volume of reflux material was measured. Clinical data, such as periods of comfort during decompression without giving analgesics, were recorded. Necropsies were done on 10 of the 12 horses (9 experimental and 1 clinical). Although already tested in 2 clinical horses, use of the N-D tube remains experimental, and the N-D tube functioned only in horses which were fasted before surgical manipulation. Perfection of a safe and dependable means of emptying the equine stomach of its solid ingesta before gastrointestinal intubation is done, is the next step in affording greater clinical application of the N-D tube for gastrointestinal decompression.

Animals↗
PubMed1989

The effect of a new synthetic cholinergic compound (aclatonium napadisilate) on interdigestive motility and pancreatic function in humans.

To investigate the effect of aclatonium napadisilate (Ac), a synthetic cholinergic compound, on human interdigestive gastrointestinal function, six healthy volunteers underwent gastrointestinal intubation for measurement of duodeno-jejunal motor activity and pancreatic enzyme secretion. Each subject was studied twice on two separate days and received either aclatonium (300 mg) or placebo intraduodenally in randomized order. Aclatonium significantly increased the overall length of the cycle of interdigestive motor complex (IMC) by a mean of 34% (p less than 0.05) without stimulating the phases of increased motor activity. Aclatonium slightly, but significantly increased output of lipase during phase II of the IMC (p less than 0.05), whereas outputs during phase I and III were not significantly changed. We conclude that aclatonium in a dose of 300 mg has only weak cholinergic effects on motility and exocrine pancreatic secretion in healthy humans during the interdigestive state.

Acetylcholine↗
PubMed1982

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.

Aged↗
PubMed1989

Esophageal stethoscope. Another possible cause of vocal cord paralysis.

Hoarseness after endotracheal intubation can result from compression of the anterior branch of the recurrent laryngeal nerve as it passes behind the thyroid cartilage to innervate the lateral cricoarytenoid muscle. This usually occurs when the cuff of the endotracheal tube lies in the larynx instead of the trachea. When a nasogastric tube is positioned in the midline, resultant postcricoid inflammation can result in vocal cord immobility. This may result from neuropraxia of the posterior branch of the recurrent laryngeal nerve that innervates the posterior cricoarytenoid and interarytenoid muscles, or inflammatory spasm of the interarytenoid muscles themselves. We present a case of vocal cord paralysis after general anesthesia that may have been caused by an esophageal stethoscope. The mechanism for vocal cord immobility could be similar to that of a midline nasogastric tube with resultant postcricoid inflammation. We describe measures that can be taken to prevent vocal cord paralysis after intubation of the larynx or esophagus.

Adult↗
PubMed1996

Penetration of antibiotics in diseased antral mucosa.

OBJECTIVES: To investigate extracellular concentrations of antibiotics in inflammatory diseased sinus mucosa in critically ill patients and to find out whether there were any correlations between the concentrations of antibiotics in extracellular tissue and the presence of bacterial infection. DESIGN: Prospective case series. Sinoscopic findings were used as the criterion standard. SETTING: The general and the neurosurgical intensive care units of a tertiary care hospital. PATIENTS: Critically ill patients, nasotracheally intubated or tracheotomized, who received ventilator treatment (> 7 days) and antibiotic therapy. INTERVENTIONS: Bilateral sinoscopies were performed; antral secretions were collected for bacterial cultures; and serum and tissue samples were obtained for bioassay of antibiotic concentrations. RESULTS: The concentrations of all antibiotics found in extracellular fluid were lower than those found in serum samples. CONCLUSION: Measurable extracellular tissue concentrations of antibiotics were found in the antral mucosa, demonstrating that inflammatory maxillary sinus disease does not impede the antibiotic penetration of the mucosa or antibiotic activity in the extracellular tissue.

Adult↗
PubMed1976

Esophageal perforation in the neonate. A review of the literature.

The clinical and roentgenographic findings in traumatic esophageal perforation in the newborn are specific enough to enable a diagnosis to be made rapidly. A case of this entity is discussed and the literature on this subject is reviewed. This case demonstrates that the diagnosis can be strongly suspected from the findings on the chest roentgenogram and confirmed by performing an esophagram.

Diagnosis, Differential↗
PubMed1993

The oral motor development of low-birth-weight infants who underwent orotracheal intubation during the neonatal period.

OBJECTIVE: To investigate the potential development of oral motor problems following prolonged orotracheal intubation in low-birth-weight infants. DESIGN: Prospective observational. SETTING: Tertiary-care hospital. PATIENTS: Fifty-one low-birth-weight infants and 10 full-term infants divided into three groups--group 1 with 15 low-birth-weight infants (< or = 1250 g) who had been intubated for more than 1 week; group 2 with 36 low-birth-weight infants who had been intubated for 1 week or less; and group 3 with 10 full-term control infants. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: Oral motor assessments of nutritive sucking were compared at corrected ages of term and 3 months. The results showed that low-birth-weight infants with prolonged intubation had significantly poorer sucking abilities at both term and 3 months. The number of days of oxygen use and the postnatal age (weeks) at which nipple feeding was begun were the most powerful predictors of sucking ability at term (P < .001), whereas the number of days of orotracheal intubation and gestational age at birth were the most powerful predictors of sucking ability at 3 months (P < .001).

Apgar Score↗
PubMed1978

Tracheoesophageal fistula caused by cuffed tracheal tube. Successful treatment by tracheal resection and primary repair with four-year follow-up.

A tracheoesophageal fistula secondard to prolonged nasogastric intubation and ventilatory assistance via a cuffed tracheostomy tube developed in a 27-year-old woman who had sustained a traumatic injury. The fistula grew progressively larger despite removal of the tubes, thus demonstrating the inherent poor prognosis associated with the untreated lesion. Since the cuff necessarily damages the trachea circumferentially at the same level, closure of the fistula and circumferential excision and reconstruction of the damaged tracheal wall were performed with an excellent result up to four years after the repair. This would be the preferred procedure when the patient can be weaned off the respirator and when the general condition and the size of the fistula allow such a definitive one-stage approach.

Abortion, Spontaneous↗
PubMed2004

Nasal versus oral route for placing feeding tubes in preterm or low birth weight infants.

BACKGROUND: Enteral feeding tubes for preterm or low birth weight infants may be placed via either the nose or mouth. Nasal placement may compromise respiration. However, orally placed tubes may be more prone to displacement, local irritation, and vagal stimulation. OBJECTIVES: To assess the available evidence from randomised controlled trials concerning the effects of nasally placed compared with orally placed feeding tubes on growth and development, and the incidence of adverse consequences in preterm or low birth weight infants. SEARCH STRATEGY: We used the standard search strategy of the Cochrane Neonatal Review Group, including electronic searches of the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 2, 2004), MEDLINE (1966 - April 2004), EMBASE (1988 - April 2004), and CINAHL (1982- April 2004), conference proceedings, and previous reviews. SELECTION CRITERIA: Randomised or quasi-randomised controlled trials that compared the use of the nasal versus oral route for placing feeding tubes in preterm or low birth weight infants. DATA COLLECTION AND ANALYSIS: We extracted data using the standard methods of the Cochrane Neonatal Review Group, with separate evaluation of trial quality and data extraction by each author, and analysis of data using relative risk, risk difference and mean difference. MAIN RESULTS: We found only one eligible trial. Forty-two infants participated in the study. This primary aim of the trial was to assess the effect of oral versus nasal placement of feeding tubes on the incidence of apnea and periodic breathing in preterm infants. The trial did not report data on the pre-specified primary outcomes for this review (growth and development). REVIEWERS' CONCLUSIONS: There are insufficient data available to inform practice. A large randomised controlled trial is required to determine if the use of nasally placed feeding tubes compared with orally placed feeding tubes improves growth and development, without increasing adverse consequences in preterm or low birth weight infants.

Enteral Nutrition↗
PubMed1994

Toxicity of an anthraquinone violet dye mixture following inhalation exposure, intratracheal instillation, or gavage.

Anthraquinone dyes are utilized by the military in colored-smoke grenades. During production, workers in munitions plants may be exposed to fugitive emissions of these dyes or mixtures thereof. The effects of a prototype violet dye mixture (VDM) consisting of Disperse Red 11 (DR11), [1,4-diamino-2-methoxy-anthraquinone] and Disperse Blue 3 (DB3) [1-methylamino-4-hydroxyethylamino-anthraquinone] on F344 male and female rats have been investigated. Acute 1-day inhalation exposures (6 hr) to VDM were conducted at 1000, 300, 100, 70, 40, and 10 mg/m3, with an additional exposure to 40 mg/m3 6 hr/day for 5 days; 4.22 +/- 2.1 microns (MMAD +/- delta g). Lung burdens of dye, general histopathology, and/or liver function were evaluated at 0, 3, and 7 days postexposure. Unexpected lethality due to severe liver damage was observed with acute exposures of > or = 300 mg/m3 and in the 5-day 40 mg/m3 exposures. Centrilobular degeneration and necrosis of liver cells was concentration-dependent with inhalation of VDM > or = 40 mg/m3. In addition, nasal olfactory epithelium exhibited degeneration and necrosis with acute exposures > or = 10 mg/m3. Lung instillations at 250, 500, and 1000 micrograms of the VDM revealed no lung or liver toxicity. Because per os exposure due to preening was suspected as a major exposure route, a gavage study with the VDM and its two component dyes DR11 and DB3 (800 mg/kg) was undertaken. One day following gavage with DR11 or DB3, serum enzymes indicative of liver toxicity (LDH, SGPT, SDH, and ICDH) were slightly elevated (1-6x control). However, rats gavaged with VDM had serum enzyme levels 10-100x control by Day 1 after gavage, indicating acute liver toxicity. Activities of liver enzymes involved in xenobiotic and glutathione metabolism were also acutely affected. All of the dyes caused various degrees of induction of glucose-6-phosphate dehydrogenase, glutathione reductase, glutathione peroxidase, and nonprotein sulfhydryls. The enzymes involved in xenobiotic metabolism (glutathione S-transferase, NADPH cytochrome-c reductase, and P450) were also elevated by the two component dyes, in contrast to their significant depression with VDM treatment. The similarity between the liver and olfactory epithelium effects of these compounds and the lack of pulmonary tissue effects is not fully understood, but the interaction of the individual dyes as VDM emphasizes the need to assess chemicals such as the anthraquinones as their likely-to-be-encountered mixtures.

Administration, Inhalation↗