Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Intubation”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 703 records · Page 39Linked to original sources
PubMed2002

Fentanyl is more effective than remifentanil at preventing increases in cerebral blood flow velocity during intubation in children.

PURPOSE: Controlling the cerebral and systemic hemodynamic responses to laryngoscopy and tracheal intubation may play a role in determining clinical outcome in pediatric neurosurgical patients. This study compared the effects of remifentanil and fentanyl on cerebral blood flow velocity (CBFV) and hemodynamic profile during laryngoscopy and tracheal intubation in children under sevoflurane anesthesia. METHODS: Sixty healthy children aged two to six years undergoing dental surgery under general anesthesia were enrolled. Each child was randomly assigned to receive a remifentanil or fentanyl infusion, at a rate of 0.75, 1.0, or 1.5 microg x kg(-1) x min(-1) after induction of anesthesia with 2% sevoflurane. Middle cerebral artery blood flow velocity was measured by transcranial Doppler (TCD) sonography. Once a baseline set of hemodynamic variables and TCD measurements were recorded, the opioid infusion was started. Measurements were taken at two-minute intervals, starting four minutes prior to laryngoscopy until four minutes following naso-tracheal intubation. RESULTS: Remifentanil caused a more significant decrease in mean arterial pressure and CBFV prior to tracheal intubation than did fentanyl (P < 0.001). During laryngoscopy and for two minutes following tracheal intubation, CBFV increased in all remifentanil groups (P < 0.05), whereas it remained stable in all fentanyl groups. CONCLUSION: This study suggests that fentanyl was more effective than remifentanil at preventing increases in CBFV during and immediately following laryngoscopy and tracheal intubation in children undergoing sevoflurane anesthesia. Fentanyl also seemed to provide a more stable hemodynamic profile prior to laryngoscopy and tracheal intubation when compared to remifentanil.

Blood Flow Velocity↗
PubMed2004

Gargling with povidone-iodine reduces the transport of bacteria during oral intubation.

PURPOSE: Nosocomial pneumonia remains a common complication in patients undergoing endotracheal intubation. This study examined the transport of bacteria into the trachea during endotracheal intubation, and evaluated the effects of gargling with povidone-iodine on bacterial contamination of the tip of the intubation tube. METHODS: In the gargling group, patients gargled with 25 mL of povidone-iodine (2.5 mg.mL(-1)). In the control group, patients gargled with 25 mL of tap water. Before tracheal intubation, microorganisms were obtained from the posterior wall of the patient's pharynx using sterile cotton swabs. After anesthesia, all patients were extubated and bacteria contaminating the tip of the tracheal tube were sampled and cultured. RESULTS: Before orotracheal intubation, all 19 patients who gargled with tap water (control group) had bacterial colonization on the posterior walls of the pharynx. This group included five patients who had methicillin-resistant staphylococcus aureus (MRSA) in their nasal cavity preoperatively and MRSA was also detected in the pharynx of four patients. Bacterial colonization was observed in all 19 patients who gargled with povidone-iodine (gargling group) and four patients carried MRSA in their nasal cavity, although no MRSA was detected in the pharynx. In the control group, all the patients had bacterial colonization at the tip of the tube after extubation. Additionally, MRSA was detected in two of the four patients. In the gargling group, povidone-iodine eradicated general bacteria and MRSA colonies in the pharynx before intubation and at the tip of the tube after extubation. CONCLUSION: Gargling with povidone-iodine before oral intubation reduces the transport of bacteria into the trachea.

Anti-Infective Agents, Local↗
PubMed1991

Acute epiglottitis in the adult: is intubation mandatory?

Acute epiglottitis (AE) in the adult results in inflammation of the supraglottic structures and carries the potential for complete airway obstruction. There is disagreement in the medical literature as to the appropriate management of the airway in the adult with AE. Some authors advocate intubation in all patients while others propose more selective intervention, intubating the trachea only in those patients presenting with airway compromise. We reviewed our institutional experience with 21 patients over the last seven years admitted with a proven diagnosis of AE. Six patients presented with respiratory distress, three in severe distress with symptoms and signs of upper airway obstruction. The three patients in severe distress were taken to the operating room, in two the tracheas were intubated and one underwent tracheostomy after failed intubation. All other patients were monitored but their tracheas were not intubated. The majority of the patients were monitored for 24 hr in the ICU before transfer to wards. No patient initially monitored required tracheal intubation for progression of disease. There were no deaths. Recommendations for the care of the airway in the adult with AE based on our experience and a review of approximately 1000 cases reported in the last ten years are presented. It is our opinion that adults presenting without respiratory symptoms may be safely monitored in an intensive care setting given that provision is made for tracheal intubation or tracheostomy should respiratory distress become evident.

Acute Disease↗
PubMed2006

[Perforation of the hypopharynx as a rare life-threatening complication of endotracheal intubation].

BACKGROUND: Endotracheal intubation is regarded as the gold standard technique to secure the airway with a low complication rate, however, perforating tracheal or esophageal injuries are rare but severe complications. MATERIALS AND METHODS: Two cases of hypopharyngeal perforation after intubation are presented and discussed. RESULTS: While intubation of the first patient was anticipated to be difficult, the second patient did not present any risk factors. One patient developed a typical clinical pattern of difficult swallowing, soft tissue emphysema of the neck, pyrexia, and leukocytosis. The other initially showed minor symptoms but increasing difficulties in swallowing led to the diagnosis of a retropharyngeal abscess. A subsequent acute airway obstruction required emergency invasive airway access. In both cases surgical intervention in combination with antibiotic therapy resulted in complete healing. CONCLUSIONS: Physicians performing endotracheal intubation or dealing with patients after intubation, should be aware of the clinical symptoms because only early diagnosis and therapy can prevent development of mediastinitis. In "cannot intubate-cannot ventilate" situations, wide bore transtracheal airway access under local anaesthesia and spontaneous breathing should have priority and temporary tracheotomy should also be considered. To prevent hypopharyngeal injury a thorough evaluation of the "difficult airway" and the atraumatic performance of direct laryngoscopy and endotracheal intubation are mandatory.

Aged↗
PubMed2002

Comparison of three different methods to confirm tracheal tube placement in emergency intubation.

OBJECTIVES: Verification of endotracheal tube placement is of vital importance, since unrecognized esophageal intubation can be rapidly fatal (death, brain damage). The aim of our study was to compare three different methods for immediate confirmation of tube placement: auscultation, capnometry and capnography in emergency conditions in the prehospital setting. DESIGN AND SETTING: Prospective study in the prehospital setting. PATIENTS AND INTERVENTIONS: All adult patients (>18 years) were intubated by an emergency physician in the field. Tube position was initially evaluated by auscultation. Then, capnometry was performed with infrared capnometry and capnography with infrared capnography. The examiners looked for the characteristic CO(2) waveform and value of end-tidal carbon dioxide (EtCO(2)) in millimeters of mercury. Determination of final tube placement was performed by a second direct visualization with laryngoscope. Data are mean +/- SD and percentages. MEASUREMENTS AND RESULTS: Over a 4year period, 345 patients requiring emergency intubation were included. Indications for intubation included cardiac arrest ( n=246; 71%) and non-arrest conditions ( n=99; 29%). In nine (2.7%) patients, esophageal tube placement occurred. The esophageal intubations were followed by successful endotracheal intubations without complications. The capnometry (sensitivity and specificity 100%) and capnography (sensitivity and specificity 100%) were better than auscultation (sensitivity 94% and specificity 83%) in confirming endotracheal tube placement in non-arrest patients ( p<0.05). Capnometry was highly specific (100%) but not sensitive (88%) for correct endotracheal intubation in patients with cardiopulmonary arrest (capnometry versus auscultation and capnometry versus capnography, p<0.05). CONCLUSION: Capnography is the most reliable method to confirm endotracheal tube placement in emergency conditions in the prehospital setting.

Auscultation↗
PubMed2003

Hemodynamic and bispectral index responses to tracheal intubation during isoflurane or sevoflurane anesthesia.

PURPOSE: The effects of volatile anesthetics on change in the bispectral index (BIS) due to tracheal intubation are unclear. We investigated hemodynamic and BIS responses to intubation during isoflurane or sevoflurane anesthesia. METHODS: After obtaining Institutional Review Board approval and informed consent, we randomly allocated 40 patients of American Society of Anesthesiologists (ASA) physical status I to receive either isoflurane (ISO group; n = 20) or sevoflurane (SEV group; n = 20). The patients were anesthetized with thiamylal and were ventilated with 100% oxygen, using a mask. The inspired concentrations of isoflurane and sevoflurane were gradually increased and maintained at end-tidal anesthetic concentrations of 2 minimum alveolar concentration (MAC) during the study period. Tracheal intubation was performed 15 min after the end-tidal anesthetic concentrations had reached 2 MAC. Mean arterial pressure (MAP), heart rate (HR), and BIS were recorded before induction, at the loss of consciousness, before laryngoscopy, and at 1, 3, and 5 min after intubation. RESULTS: Anesthesia with 2 MAC volatile anesthetics increased HR in the ISO group, and decreased MAP in the SEV group. The BIS value decreased from 95 +/- 3 and 96 +/- 2 before thiamylal to 39 +/- 9 and 38 +/- 10 before intubation in the ISO and SEV groups, respectively. MAP and HR were significantly increased in both groups 1 and 3 min after intubation, but BIS remained unchanged. CONCLUSION: Anesthesia with 2 MAC of isoflurane and sevoflurane was effective to suppress the change in BIS due to intubation but was not sufficient to prevent changes in hemodynamic responses.

Adult↗
PubMed2005

Landiolol attenuates the cardiovascular response to tracheal intubation.

PURPOSE: The objective of this prospective study was to compare the cardiovascular responses with or without landiolol to the induction of general anesthesia and tracheal intubation. METHODS: Twenty-two patients were randomly allocated to receive a loading dose of landiolol 125 microg kg(-1) min(-1) for 1 min followed by an infusion at 40 microg kg(-1) min(-1) for 4 min, or placebo. Four minutes after landiolol or placebo was started, propofol and succinylcholine were administered. Laryngoscopy and tracheal intubation were performed 1 min after the administration of succinylcholine. Heart rate and blood pressure were measured noninvasively every minute. RESULTS: A significant attenuation of the heart rate and blood pressure response were seen in the landiolol group for 3 min after intubation. Heart rate and systolic blood pressure in the landiolol group were decreased for 2 min before intubation and just before intubation compared with baseline, respectively. CONCLUSION: Continuous administration of landiolol before tracheal intubation results in the attenuation of cardiovascular response for tracheal intubation.

Adrenergic beta-Antagonists↗
PubMed1992

Palliative intubation for dysphagia in patients with carcinoma of the esophagus.

One hundred seven consecutive patients seen over a 6-year period with dysphagia secondary to advanced primary carcinoma of the esophagus underwent intubation. One hundred five patients underwent pulsion intubation. In 2 patients pulsion intubation was not possible, and laparotomy and traction intubation was performed. For the intubated group there were 65 men and 40 women (ratio, 1.6:1), with a mean age of 71.3 +/- 10.5 years (range, 36 to 92 years). Of the 105 patients who had pulsion intubation, a perforation developed in 11 (10.5%), which was responsible for the death of 4 patients (3.8%). A further 3 patients died of malignant cachexia, which resulted in an overall mortality of 6.7%. Late complications included tube displacement (4 patients; 3.8%) and tube obstruction (32 patients; 30.5%). Tube obstruction was due to advancement of malignant disease in 26 patients (81.2%) and food bolus impaction in the remaining 6 patients (18.8%). Pulsion intubation for advanced carcinoma of the esophagus can be performed with a low morbidity and early mortality. However, there is a substantial long-term morbidity of tube obstruction in almost a third of survivors.

Adenocarcinoma↗
PubMed1993

Nosocomial herpes simplex virus infection associated with oral endotracheal intubation.

BACKGROUND: To determine by culture the frequency of herpes simplex virus reactivation complicating oral endotracheal intubation. Additionally, clinical appearance and recognition of patient infection by attendant health care workers were studied. Last, evidence of any occupational acquisition of herpes simplex virus infection was sought. METHODS: In a prospective, non-randomized study, three serial viral cultures were taken of oro-facial or mucosal sites on the day of oral endotracheal intubation and in the subsequent 3rd and 5th or 7th days from 51 consecutive adults undergoing oral endotracheal intubation in a suburban community hospital. Clinical variables including appearances of lesions and therapeutic interventions were noted during serial assessments by study authors. Employee health records were reviewed for evidence of health care worker occupational herpes simplex virus infection associated with these cases. RESULTS: Of 51 patients, 4 were culture positive on the day of oral endotracheal intubation. Of the remaining 47 patients, serial cultures during the first week post intubation revealed herpes simplex virus in 25 (53.2%) patients. Of cohort variables studied, a history of prior oral herpes simplex virus was significantly associated with a subsequent positive viral culture for herpes simplex virus (relative risk, 2.29; 95% confidence interval, 1.48 to 3.56). Typical or atypical lesions were visible in only 52% of the herpes simplex virus culture-positive cases. No occupational transmission of herpes simplex virus was detected. Tape-securing practices appeared to contribute to the morbidity of herpes simplex virus eruptions. CONCLUSIONS: Nosocomial reactivation of herpes simplex virus infection complicated oral endotracheal intubation in our patient population in approximately one half of the patients who were intubated for more than 48 hours during the first week after the procedure. Clinically, the infection was recognizable in only one half of the virus culture-positive cases. Increased awareness of this infection is needed by health care workers, patients, and families. More information is needed on optimal therapy and prevention.

Aged↗
PubMed1992

Paramedic intubation training in a pediatric operating room.

The authors conducted a prospective study to assess the performance of paramedics with prior adult endotracheal intubation experience in pediatric intubation in the operating room of a teaching hospital. Nineteen paramedic students were observed attempting endotracheal intubation on a total of 57 anesthetized pediatric patients undergoing scheduled surgical procedures. The average age of patients was 5.1 years (range, 6 months to 15.2 years). Average duration of intubation attempts was 22.7 +/- 10.7 seconds, with a success rate on first attempt of 74%. Only minor complications occurred, and were limited to intubation attempts of greater than 45 seconds duration in four cases (6%), and patient oxygen saturation less than 90% in one case (2%). The study suggests that paramedics may be successfully incorporated into a hospital's clinical training program, and can receive closely supervised experience in pediatric endotracheal intubation without compromising patient care. Such training may increase the willingness of paramedics to attempt emergent prehospital endotracheal intubation of children, as well as increase their success with this potentially life-saving procedure.

Adolescent↗
PubMedDate not supplied

Clinical characteristics of paramedics' performance of endotracheal intubation.

Paramedics intubated 358 of 383 (93.5%) patients over a nine-month period. There were 85 survivors. The intubators used the curved-blade laryngoscope in 304 patients (79.5%). Two of 25 (8.0%) patients who were not successfully intubated lived; 83 of 358 (23.2%) successfully intubated patients survived. Clinically significant complications occurred in 32 patients (8.9%) who were successfully intubated. Paramedics encountered adverse conditions in 126 patients (32.9%). Presenting cardiac rhythm was recorded. There were no significant differences in intubation success rate between survivors and nonsurvivors or as a function of cardiac rhythm. This retrospective study further documents the ability of paramedics to successfully perform endotracheal intubation. The high success rate supports training with live subjects. Further studies of cause and impact of complications, correlation of success with increased survival, and alternative techniques are essential for effective EMS system medical control.

Allied Health Personnel↗
PubMed1996

[Prevention of increase of blood pressure and intracranial pressure during endotracheal intubation in neurosurgery: esmolol versus lidocaine].

OBJECTIVES: To compare the preventive effects of esmolol and lidocaine on the increase in mean arterial pressure (MAP) and intracranial pressure (ICP) during endotracheal intubation in neurosurgery. STUDY DESIGN: Comparative, randomised, double-blind study. PATIENTS: Twenty-two patients, physical status ASA I or II, undergoing neurosurgery, and randomised into two groups (esmolol group and lidocaine group). METHODS: After induction of anaesthesia with thiopentone, vecuronium, fentanyl and isoflurane, one group received iv esmolol 1.5 mg.kg-1 and the other iv lidocaine 1.5 mg.kg-1, 130 sec before endotracheal intubation. The MAP measured with a radial catheter, the ICP obtained with a lumbar subarachnoid catheter and the cerebral perfusion pressure (CPP, calculated from MAP and ICP) were assessed before induction of anaesthesia, before esmolol or lidocaine injection, and before intubation, during the maximal change in MAP, as well as 2 and 5 minutes after intubation. RESULTS: The time course of MAP, ICP and CCP were similar throughout the study in the two groups, with a significant decrease (P < 0.05) of the CPP from 92 +/- 12 to 62 +/- 8 mmHg after esmolol, and from 96 +/- 12 to 68 +/- 15 mmHg after lidocaine. Following intubation, CPP increased significantly (P < 0.05) to 99 +/- 23 mmHg after esmolol and to 99 +/- 17 mmHg after lidocaine. The ICP increased also significantly (P < 0.05) after intubation from 11 +/- 6 to 17 +/- 10 mmHg in the esmolol group, and from 10 +/- 6 to 16 +/- 9 mmHg in the lidocaine group. CONCLUSIONS: Esmolol or lidocaine as an iv bolus of 1.5 mg.kg-1 before laryngoscopy and intubation do not completely prevent the increase in MAP and ICP.

Adrenergic beta-Antagonists↗
PubMed1990

Sufentanil and succinylcholine for rapid-sequence anesthetic induction and tracheal intubation: hemodynamic and hormonal responses.

Rapid-sequence induction and tracheal intubation are used in the management of patients at risk of aspiration. Patients with coronary artery disease (CAD) are at additional risk of adverse hemodynamic responses to intubation. The hemodynamic and hormonal responses to intubation with sufentanil, 7 micrograms/kg, and succinylcholine, 1.5 mg/kg, were studied in patients with CAD and good left ventricular function (ejection fraction greater than or equal to 0.4) who were undergoing elective coronary artery bypass grafting. Tracheal intubation occurred 60 seconds after administration of sufentanil and succinylcholine. Heart rate, systemic and pulmonary arterial pressures, pulmonary artery occlusion and central venous pressures, and cardiac outputs were measured at various time intervals before and after induction of anesthesia. Systemic vascular resistance and cardiac index were calculated. Arterial blood samples were drawn before and after anesthetic induction for the determination of catecholamine concentrations in serum. Rapid-sequence administration of sufentanil and succinylcholine resulted in a moderate decrease (24%) in mean arterial pressure from 95 to 72 mm Hg, and the mean arterial pressure remained less than the control value at 1, 3, and 5 minutes after intubation. Systemic vascular resistance also decreased (23%) after administration of sufentanil and returned to control values 5 minutes after intubation. There were no changes in cardiac index until 5 minutes after intubation, at which time it decreased (18%) from 2.8 to 2.3 L/min/m2.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Effects of prostaglandin E1 on the cardiovascular response to tracheal intubation.

STUDY OBJECTIVE: To evaluate the efficacy of prostaglandin E1 in attenuating the hypertensive response to laryngoscopy and intubation. DESIGN: Controlled, comparative, and randomized study. SETTING: Induction of anesthesia for elective surgery at a university hospital. PATIENTS: Thirty normotensive patients (ASA physical status I) undergoing elective surgery divided into three groups. Each group consisted of ten patients. INTERVENTIONS: Anesthesia was induced with thiopental sodium 5 mg/kg intravenously, and tracheal intubation was facilitated with vecuronium 0.2 mg/kg. Either 0.3 micrograms/kg of prostaglandin E1, 0.6 micrograms/kg of prostaglandin E1, or saline (control) was injected 15 seconds before starting direct laryngoscopy (within 30 seconds), which was attempted 2 minutes after administration of thiopental sodium and vecuronium. MEASUREMENTS AND MAIN RESULTS: Patients receiving saline showed a significant increase in mean arterial pressure and rate-pressure product associated with tracheal intubation. These increases following tracheal intubation were significantly less in prostaglandin E1-treated patients than in the control group (p less than 0.05). CONCLUSIONS: A single rapid intravenous administration of prostaglandin E1 is a practical pharmacologic and safe method to attenuate the hypertensive response to tracheal intubation. The use of 0.6 micrograms/kg of prostaglandin E1 as a supplement during induction is recommended for reducing the pressor response to intubation on the basis of rate-pressure product and mean arterial pressure following intubation as an index.

Alprostadil↗
PubMedDate not supplied

The effect of an intermediate dose of labetalol on heart rate and blood pressure responses to laryngoscopy and intubation.

STUDY OBJECTIVE: To evaluate the efficacy of an intermediate dose of labetalol (0.4 mg/kg) for attenuation of heart rate (HR) and blood pressure (BP) responses to laryngoscopy and intubation. DESIGN: Randomized, double-blind, placebo-controlled study. SETTING: Inpatient gynecology service at a university medical center. PATIENTS: Two groups of 18 patients each undergoing elective surgery under general anesthesia. INTERVENTIONS: Patients received either 0.4 mg/kg of labetalol or an equal volume of normal saline 5 minutes prior to laryngoscopy and intubation. MEASUREMENTS AND MAIN RESULTS: HR and BP were measured upon arrival in the operating room (OR) (baseline) and at 1 minute intervals thereafter for 4 minutes prior to intubation and through 10 minutes following intubation. The labetalol group had a significantly lower HR from induction through 1 minute following intubation. Intragroup differences in HR were greatest immediately following laryngoscopy and intubation (33% increase above baseline for the placebo group vs 1% for the labetalol group, p less than 0.05). At the same time, a significant increase in mean arterial pressure (MAP) from baseline was noted in both groups (29% for the placebo group vs 23% for the labetalol group), but the difference between the groups was not significant. CONCLUSIONS: An intermediate dose of labetalol blunted the HR response to laryngoscopy and intubation during rapid-sequence induction in healthy patients but had a minimal effect on BP.

Adult↗
PubMedDate not supplied

Blind oral intubation: the development and efficacy of a new approach.

STUDY OBJECTIVE: To develop an approach to blind oral intubation. With the aid of a fiberoptic laryngoscope and stylet within an endotracheal tube, a video camera, a monitor, and a recorder to correlate the effects of various manipulations of the airway on access to the trachea, a suitable approach was devised. We then evaluated its efficacy. DESIGN: Randomized, prospective comparison of regimens. SETTING: Inpatient surgery at a university-affiliated teaching hospital. PATIENTS: One hundred adult patients with no known abnormalities of the upper airway by history or on physical examination, scheduled to undergo elective surgery, and without evidence of major cardiac disease or need for a rapid-sequence induction of anesthesia. INTERVENTIONS: Fifty patients in each of two groups were given fentanyl 5 micrograms/kg intravenously (IV), followed 2 minutes later by thiopental sodium 5 mg/kg and succinylcholine 2 mg/kg. Patients in Group 1 (the controls) were orally intubated via direct laryngoscopy using a Macintosh #3 blade. Patients in Group 2 (the experimentals) were intubated orally with the approach developed without the use of a laryngoscope. Intubations were deemed successful if they were performed within 1 minute after the mouth was opened. MEASUREMENTS AND MAIN RESULTS: All the patients in Group 1 were successfully intubated within 1 minute, while 49 of the 50 patients in Group 2 were successfully intubated within 1 minute. CONCLUSIONS: Blind oral tracheal intubation can be successfully performed in a safe and effective manner after appropriate teaching of the technique.

Adult↗
PubMed1995

A study of radiologic imaging techniques and airway grading to predict a difficult endotracheal intubation.

STUDY OBJECTIVES: To study whether a detailed radiographic examination of neck and upper airway can help identify normal looking patients in whom endotracheal intubation may be difficult; determine whether such parameters as identified by magnetic resonance imaging (MRI) can also be identified in a soft tissue radiograph; and to study the correlation between oropharyngeal appearance, based on Mallampati's classification, and laryngoscopic findings in a large number of patients requiring endotracheal intubation. DESIGN: Prospective. SETTING: University medical center. PATIENTS: 20 adult patients in whom an unanticipated difficult endotracheal intubation was encountered, and a control group of 20 patients in whom endotracheal intubation was easily accomplished. INTERVENTIONS: Difficult-to-intubate patients were identified according to prospectively established criteria. Control subjects, in whom the trachea was easily intubated, were matched for age, gender, height, weight, and oropharyngeal appearance. MEASUREMENTS AND MAIN RESULTS: In all 40 study patients, a soft tissue radiograph and an MRI scan of the neck were obtained. We measured 21 parameters from both radiographic studies. There were no significant differences between the two groups in 20 of 21 measured parameters on MRI scans and soft tissue radiographs. Only one measurement--the distance between the uppermost visible part of the airway and the posterior pharyngeal wall (measured from MRI scans only)--between the two groups achieved statistical significance. The values recorded from MRI and soft tissue radiographs were not significantly different. Airway grading system first suggested by Mallampati had a fair correlation with laryngoscopy findings associated with a difficult endotracheal intubation. CONCLUSIONS: No significant difference between the two groups could be identified on soft tissue radiography or MRI scans.

Adult↗
PubMed1996

Efficacy and safety of divided dose administration of mivacurium for a 90-second tracheal intubation.

STUDY OBJECTIVE: To compare the safety and effectiveness of 0.25 mg divided doses of mivacurium chloride to succinylcholine for a 90-second tracheal intubation. DESIGN: Randomized, double-blind, multicenter study in two groups. SETTING: Operating rooms at four university medical centers. PATIENTS: 200 healthy ASA status I and II adult patients scheduled for elective surgery with general anesthesia and endotracheal intubation. INTERVENTIONS: Patients were premedicated with 1 to 2 mg midazolam and 2 micrograms/kg fentanyl. Anesthesia was induced with 2 mg/kg propofol. Group A received 0.25 mg/kg mivacurium given as a divided dose (0.15 mg/kg followed in 30 seconds with 0.1 mg/kg). Group B (control) received 1.5 mg/kg succinylcholine (SCh) preceded two minutes earlier by 50 micrograms/kg d-tubocurarine (dtc). MEASUREMENTS AND MAIN RESULTS: Tracheal intubation grading, train-of-four response of the adductor pollicis, heart rate (HR), and mean arterial blood pressure (MAP) were measured and evaluated. Chi-square analysis was performed for comparison between Group A and Group B with respect to the frequency distribution of intubation using the scores excellent, good, and poor and not possible (combined). Group B had a significantly higher excellent score of intubation than Group A, 84% versus 56% (p < 0.0001). No significant difference was found between the two groups when the scores excellent and good were combined (Fisher's Exact test, p = 0.28). The changes in MAP and HR were similar for the two groups. CONCLUSIONS: When Sch is not desirable, mivacurium 0.25 mg/kg given as a divided dose provides good to excellent intubation conditions 90 seconds after the initial dose without significant changes in MAP or HR. It can be an appropriate alternative for short surgical procedures. It must be emphasized that this conclusion does not apply to rapid-sequence induction-intubation.

Adolescent↗