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 757 records · Page 42Linked to original sources
PubMed2000

Determination of sevoflurane alveolar concentration for tracheal intubation with remifentanil, and no muscle relaxant.

The sevoflurane alveolar concentration needed for tracheal intubation with remifentanil was studied in 26 adult patients premedicated with 100 mg hydroxyzine. Anaesthesia was induced with sevoflurane in oxygen. The concentration was determined by Dixon's up-and-down method. The first patient was tested at 4.5%. One minute after obtaining the preselected value, remifentanil 1 microg.kg-1 was injected for 60 s followed by an infusion of 0.25 microg.kg-1. min-1. Ventilation was then manually assisted for 2 min and tracheal intubation was attempted. Tracheal intubation conditions and responses to intubation were noted. Heart rate and mean arterial pressure were recorded before induction, before remifentanil injection, and before and 3 min after tracheal intubation. The concentration for acceptable intubating conditions was 2.5 +/- 0.7%. From logistic regression, ED50 and ED95 were 2.0% (95% CI 1.3-2.5) and 3.2% (95% CI 2.6-5.6), respectively. With sevoflurane 2.5%, heart rate and mean arterial pressure decreased by 18% and 15%, respectively, after remifentanil administration and increased slightly after tracheal intubation.

Adolescent↗
PubMed2001

Fibreoptic views through the laryngeal mask and the intubating laryngeal mask.

BACKGROUND AND OBJECTIVE: The intubating laryngeal mask (intubating laryngeal mask airway) was designed to facilitate blind intubation. Its value as an adjunct to fibreoptic laryngoscopy has not been evaluated. This study compares the intubating laryngeal mask airway with the standard laryngeal mask airway as conduits for fibreoptic laryngoscopy. METHODS: The fibreoptic view of the laryngeal inlet was graded via both devices in 60 anaesthetized patients. The fibreoptic view through the intubating laryngeal mask airway was assessed after the central epiglottic elevator bar had been lifted out of the field of vision by an 8-mm Euromedical tracheal tube, which was inserted to a depth of 18 cm. The fibreoptic view from the aperture bars of the laryngeal mask was recorded. RESULTS: The vocal cords were viewed less frequently through the intubating laryngeal mask airway (52%) than through the laryngeal mask airway (92%) [difference = 40% (95% CI = 26% to 54%), P < 0.0001]. CONCLUSION: The view of the laryngeal inlet is better through the laryngeal mask airway than through a tracheal tube inserted to 18 cm in the intubating laryngeal mask.

Adolescent↗
PubMed2001

Small doses of remifentanil or sufentanil for blunting cardiovascular changes induced by tracheal intubation: a double-blind comparison.

BACKGROUND AND OBJECTIVE: To compare the effects on cardiovascular changes induced by tracheal intubation when small doses of either remifentanil or sufentanil are used in the presence of midazolam. METHODS: Thirty normotensive, ASA physical status I-II patients, receiving general anaesthesia for major abdominal surgery, received an intravenous midazolam premedication (0.05 mg kg-1) 10 min before induction. They were randomly allocated to receive in a double-blind fashion an intravenous bolus of either (a) remifentanil given as a bolus dose 1 microgram kg-1 (n = 15), or else (b) sufentanil 0.1 microgram kg-1 infused over 60 s (n = 15). In each instance this loading dose was followed by a continuous intravenous infusion (0.1 microgram kg-1 min-1 or 0.01 microgram kg-1 min-1 of remifentanil or sufentanil, respectively). General anaesthesia was induced with propofol (2 mg kg-1), followed by atracurium besilate (0.5 mg kg-1) to facilitate tracheal intubation. Following intubation, the lungs were mechanically ventilated with a 60% nitrous oxide in oxygen mixture and a 1% inspired sevoflurane. RESULTS: Arterial pressure and heart rate were recorded before induction of anaesthesia (baseline), immediately before intubation, immediately after tracheal intubation and every minute for the first five minutes thereafter. No differences in systolic and diastolic arterial pressures were observed between the two groups. At the end of the study period, systolic and diastolic pressures slightly decreased from preinduction values in both groups. Four patients in the remifentanil group (26%) and five patients in sufentanil group (33%) showed at least one systolic pressure value < 90 mmHg during the study period (P = not significant); however, the observed decreases in systolic pressure were transient and did not require treatment. Heart rate values were not affected by tracheal intubation in either group. CONCLUSIONS: In healthy normotensive patients without cardiovascular disease the use of a relatively small dose of either remifentanil or sufentanil after standard midazolam premedication results in a similar and clinically acceptable effectiveness in blunting the cardiovascular changes induced by tracheal intubation.

Adjuvants, Anesthesia↗
PubMed2005

Selective left bronchial intubation and left-lung isolation in infants and toddlers: analysis of a new technique.

OBJECTIVES: The purpose of this study was to analyze and compare a new technique for left bronchial intubation and left-lung isolation in infants and toddlers without the help of bronchoscopes. METHODS: In this prospective, unique comparative study, 3 different techniques for left mainstem bronchus intubation and left-lung isolation using a Fogarty catheter as a bronchial blocker were conducted in 11 children under age 4 who required left-lung isolation for left-lung surgery. A new technique for Fogarty catheter insertion and balloon inflation for proper positioning and avoiding displacement during lung handling was used. The first technique was a blind introduction to the left bronchus of the endotracheal tube (ETT) with the head turned to the right and the tube turned to the left at 180 degrees . The second one was to introduce the preshaped Fogarty catheter to the left bronchus. The third one was to intubate the left bronchus using the new technique of a preshaped ETT. RESULTS: No left bronchial intubation could be achieved with the first technique. Left bronchial intubation and isolation were achieved in 2 of 11 by the second technique and 10 of 11 using the third technique. No bulb displacement occurred in any of these during lung handling. CONCLUSION: The new technique of left bronchial intubation with a preshaped endotracheal tube was simple, safe, and easily accomplished. A Fogarty catheter can be positioned properly without the aid of a smaller bronchoscope once the left bronchus is intubated. Balloon displacement can be avoided completely if the left lung is collapsed properly and completely before the final balloon inflation.

Balloon Occlusion↗
PubMed1996

[Intubation damage to the larynx. Manifestations, comments on pathogenesis, treatment and prevention].

BACKGROUND: A variety of lesions can be seen in the larynx subsequent to an intubation anaesthesia or treatment with a respirator. The larynx may already be injured by introducing an endotracheal tube. The inserted tube must necessarily chafe the laryngeal mucosa. Many studies are concerned with individual manifestations [5-10,14,16,17,20]. The following article gives an overview of the intubation lesions of the larynx observed by us and offers comments on pathogenesis and prevention. PATIENTS: 161 patients with severe lesions subsequent to an intubation or treatment with a respirator were seen at the ENT Department of the University of Marburg Hospital from 1973 to 1995. TYPES OF LESIONS CAUSED BY INTUBATION: Basing on the pathomechanisms, we can classify the lesions as follows: inflammatory reactions, lesions of the larynx caused during intubation, lesions caused by chafing by the tube or by the sealing sleeve. CONCLUSIONS: Considering the large number of performed intubations, lesions of the larynx occur rarely. However, in view of the possible sequels, it would be advisable if an experienced laryngologist would perform a careful endoscopic examination of the larynx and trachea at least after every forced or prolonged intubation and especially after every treatment with a respirator.

Adolescent↗
PubMed1998

The need for delivery room intubation of thin meconium in the low-risk newborn: a clinical trial.

The delivery room management of meconium-stained amniotic fluid remains controversial. We attempted to determine if intubation of the low-risk newborn with thin meconium affects the incidence of respiratory symptoms. Exclusion criterion included moderate or thick meconium, fetal distress, neonatal depression, or prematurity. Eligible infants were randomized to either an intubation (group I) or to a nonintubation group (group II). The outcome was the presence of respiratory symptoms. Patients were studied from May 1994 to June 1997. There were 8967 births during this period: 7.9% (708/8967) were delivered through meconium. Thin meconium was noted in 50.3% (356/708) of all births. 24/356 infants with thin meconium were excluded for medical criterion. One hundred sixty-three infants were medically eligible but could not be randomized due to lack of consent, late arrival of the team, or obstetrician request. These were placed into intubation (group I B) and nonintubation (group II B) groups. Seventy-seven infants were randomized into group I and 92 infants into group II. From the intubation groups I and I B, one required supplemental oxygen and was weaned to room air in 7 hr. From the nonintubation groups II and II B, two infants required oxygen, weaning to room air in 11 and 46 hr. Comparing birth weight, gestational age, sex, mode of delivery and 5-min Apgar, there were no significant differences. However, the intubation groups had significantly lower 1-min Apgar scores. There was no airway morbidity reported in the intubation groups. In the infant with thin meconium and an otherwise low-risk pregnancy, we were unable to demonstrate a difference in respiratory symptoms with intubation and intratracheal suctioning.

Airway Obstruction↗
PubMed2003

Patient safety in emergency airway management and rapid sequence intubation: metaphorical lessons from skydiving.

Concern about patient safety and failed rapid sequence intubation has led to an increased awareness of potentially difficult laryngoscopy situations and algorithms promoting techniques in awake patients. Given the low overall incidence of failed laryngoscopy, however, prediction of difficult laryngoscopy has poor positive predictive value and uncertain clinical utility, especially in emergency settings. Non-rapid sequence intubation approaches have comparatively lower chances of intubation success, require more time, and are associated with more complications. As a specialty, emergency medicine has adopted rapid sequence intubation as the mainstay of emergency airway treatment for many appropriate reasons; the problem that must be addressed is how patient safety can be ensured while what is an inherently dangerous procedure is performed. A novel way to conceptualize patient risk and safety issues in rapid sequence intubation is to examine how inherent risk is managed in skydiving. Metaphorical lessons from skydiving that are applicable to rapid sequence intubation include (1) a redundancy of safety; (2) a methodic approach to primary chute deployment; (3) use of backup chutes that are fast, simple, and easy to deploy; (4) attention to monitoring; and (5) equipment vigilance. This article reviews how each of these lessons apply metaphorically to rapid sequence intubation, wherein the primary chute is laryngoscopy, the backup chute is rescue ventilation, and monitoring involves pulse oximetry.

Emergencies↗
PubMedDate not supplied

A randomized comparison of rescuer positions for intubation on the ground.

OBJECTIVE: To examine the ease of endotracheal intubation on the ground for various rescuer positions. METHODS: Six female and 18 male emergency medical technicians were asked to intubate a Laerdal Megacode Trainer placed on the ground. Rescuers assumed the following positions in random order: prone, sitting, kneeling at the mannequin's head, and straddling the chest. The authors measured times 1) for changing from mask ventilation to assuming intubation position and 2) from touching the laryngoscope to putting it down. Incidences of esophageal tube placement and clicks (possible tooth damage) were noted. The rescuers rated their satisfaction with each position on a six-point scale (1 = very good, 6 = insufficient). Total intubation times of the other three positions were compared with that for prone by rank order test for paired observations. Handling, esophageal positions, and clicks of the other three positions were compared with those for prone by sign test for paired observations. A Bonferroni correction (factor 12) was applied. RESULTS: Mean total intubation times (in seconds) were 11.8 +/- 3.3 for prone, 13.9 +/- 4.7 for sitting, 11.4 +/- 4.5 for kneeling, and 16.2 +/- 5.8 for straddling. The difference between straddling and prone was statistically significant (p < 0.005). For handling, the results were for prone 3.0 +/- 1.4, for sitting 3.1 +/- 1.1, for kneeling 2.2 +/- 0.6, and for straddling 2.8 +/- 1.4. Esophageal positions occurred for prone 1, for sitting 1, for kneeling 2, and for straddling 3. Clicks were counted for prone 2, for sitting 1, for kneeling 1, and for straddling 0. CONCLUSIONS: All tested positions provide satisfactory conditions for intubation on the ground. The straddling position requires statistically, but not clinically, significantly more time for intubation than does prone and may be an important backup position if access from behind the patient's head is impossible.

Adolescent↗
PubMed1988

Modification by alfentanil of the haemodynamic response to tracheal intubation in elderly patients. A dose-response study.

Fifty-five elderly patients undergoing elective ophthalmological surgery were randomly allocated to four groups. Following the induction of anaesthesia with thiopentone (given over 2 min) and the administration of atracurium 0.6 mg kg-1, patients received alfentanil 400, 600, 800 or 1000 micrograms. Intubation of the trachea was performed 90 s later. Heart rate was monitored continuously and systolic arterial pressure was measured at 1-min intervals for 3 min before induction, and both variables were monitored until 10 min had elapsed after tracheal intubation. In each of the groups there was a significant decrease in systolic arterial pressure and a significant increase in heart rate on induction of anaesthesia. In those patients who received either 400 or 600 micrograms of alfentanil, arterial pressure increased immediately after tracheal intubation, whereas in those receiving alfentanil 800 or 1000 micrograms, arterial pressure decreased immediately after tracheal intubation, and when measured 10 min after intubation. It is suggested that alfentanil 600 micrograms (10 micrograms kg-1) constitutes the optimal dose with which to obtund the haemodynamic response to tracheal intubation in elderly patients, and to minimize cardiovascular depression after tracheal intubation.

Adjuvants, Anesthesia↗
PubMed1991

Effects of pindolol on the cardiovascular response to tracheal intubation.

Laryngoscopy and tracheal intubation often cause hypertension, tachycardia and arrhythmias, which may be exaggerated during rapid-sequence induction of anaesthesia. We have studied the efficacy of pindolol in attenuating the cardiovascular responses to laryngoscopy and intubation in patients receiving pindolol 2 micrograms kg-1 or 4 micrograms kg-1 3 min before induction of anaesthesia in a double-blind design. The data were compared with those in a control group receiving saline. Each group consisted of 10 patients undergoing elective surgery. Anaesthesia was induced with thiopentone 5 mg kg-1 i.v. and tracheal intubation was facilitated with vecuronium 0.2 mg kg-1. Patients receiving saline showed a significant increase in mean arterial pressure and heart rate associated with tracheal intubation. These increases after tracheal intubation were reduced in pindolol 4 micrograms kg-1 treated patients compared with those in the control group (P less than 0.05). Pindolol 2 micrograms kg-1 attenuated tachycardia in response to intubation but did not affect hypertension. These data suggest that a bolus injection of pindolol 4 micrograms kg-1 is a simple, practical and effective method for attenuating cardiovascular responses to laryngoscopy and tracheal intubation.

Adult↗
PubMed1993

Haemodynamic and catecholamine responses to induction of anaesthesia and tracheal intubation: comparison between propofol and thiopentone.

We have studied the haemodynamic changes, QT intervals and catecholamine responses to induction of anaesthesia and tracheal intubation in 24 ASA I patients allocated randomly to receive either propofol 2.5 mg kg-1 or thiopentone 5 mg kg-1 over 60 s. After disappearance of the eyelash reflex, the lungs were ventilated with 100% oxygen for 3 min. The trachea was intubated after administration of vecuronium. With thiopentone, heart rate (HR) was greater than with propofol before intubation (P < 0.05). During induction, systolic (SAP) and diastolic arterial pressure (DAP) decreased more with propofol than with thiopentone. The QT interval was prolonged only during induction with thiopentone. In both groups, HR, SAP, DAP and the QT were increased in response to intubation (P < 0.001). The SAP and QT interval responses to intubation were significantly greater with thiopentone than with propofol (P < 0.05). One patient in the thiopentone group with a significantly prolonged QT interval had episodes of bigeminy and ventricular tachycardia. In both groups, concentrations of noradrenaline in mixed venous plasma increased after intubation (P < 0.001). Concentrations of adrenaline increased after intubation only in the thiopentone group (P < 0.001).

Adolescent↗
PubMed1993

Tracheal intubation in a mannikin: comparison of the Belscope with the Macintosh laryngoscope.

Tracheal intubation carries a risk of accidental oesophageal intubation; this is increased with inexperienced trainees, and in patients with a difficult airway. The recent introduction of an angulated laryngoscope, the Belscope, may permit a better view of the vocal cords and increase the accuracy of orotracheal intubation. To determine how easy it is to learn to use the Belscope compared with the traditional Macintosh laryngoscope, a group of medical students attempted to intubate a mannikin which had been modified to simulate a difficult intubation. Time to intubation was fast with both laryngoscopes, although faster with the Macintosh, but the Belscope produced an unexpected greater incidence of failed intubation.

Anesthesiology↗
PubMed1998

Preoperative assessment for difficult intubation in general and ENT surgery: predictive value of a clinical multivariate risk index.

Several clinical multifactorial indexes have been described for predicting difficult laryngoscopy or intubation, or both, mostly in general surgery, and less frequently in ENT surgery. The objective of this study was to develop and validate a single clinical index for prediction of difficulty in tracheal intubation in both ENT and general surgery. We studied a population of 1200 consecutive ENT and general surgical patients. Clinical criteria were tested using univariate and multivariate analysis. Difficult intubation was defined as requiring unusual techniques. Logistic regression identified seven criteria as independent predictors of difficult tracheal intubation; previous history of difficult intubation; pathologies associated with difficult intubation; clinical symptoms of pathological airway; inter-incisor gap and mandible luxation; thyromental distance; head and neck movement; and Mallampati's modified test. Point values were assigned to each of these factors in proportion to regression coefficients representing the relative weight of each predictive intubation difficulty factor, the sum comprising the score. The best predictive threshold was chosen using a receiver operating characteristic curve. We then prospectively studied and validated the score in a population of 1090 consecutive ENT and general surgery patients. The sensitivity and specificity of the predictions were 94% and 96% in general surgery, 90% and 93% in non-cancer ENT surgery, and 92% and 66% in ENT cancer surgery, respectively.

Adolescent↗
PubMed1998

Video-intuboscopy: a new aid to routine and difficult tracheal intubation.

Video-intuboscopy gives a video display of the view from the tip of the tracheal tube during conventional laryngoscopy, and was developed particularly to assist the immediate management of unexpected difficult intubation. A lightweight, malleable video-optical intubation stylet transmits the view from the stylet tip onto a monitor. It is inserted in the tracheal tube before starting anaesthesia, and the view from the tracheal tube tip enables the anaesthetist to verify tracheal tube position in the trachea. During difficult intubation the video view is used to guide the tracheal tube into the trachea. When used to allow confirmation of tracheal placement, the system did not interfere with conventional intubation procedures. The method showed the subglottic airway, gave immediate confirmation of tracheal tube position, and aided teaching and supervision. The method was used to guide intubation in two patients with unanticipated grade 3 laryngoscopic views. Intubation was simple, rapid and atraumatic, without the need for head, neck or laryngeal manipulation. Tracheal placement was instantly confirmed using the video view from the stylet tip. Clinical studies are required to define the value of this new intubation technique.

Anesthesia, General↗
PubMed1998

Effect of remifentanil on the auditory evoked response and haemodynamic changes after intubation and surgical incision.

We have observed the effect of intubation and incision, as measured by the auditory evoked response (AER) and haemodynamic variables, in 12 patients undergoing hernia repair or varicose vein surgery who received remifentanil as part of either an inhaled anaesthetic technique using isoflurane or as part of a total i.v. technique using propofol. Anaesthesia was induced with remifentanil 1 microgram kg-1 and propofol, neuromuscular block was achieved with atracurium 0.6 mg kg-1 before intubation, and anaesthesia was maintained with a continuous infusion of remifentanil in combination with either a continuous infusion of propofol or inhaled isoflurane. The AER and haemodynamic variables were measured before and after intubation and incision. The effects of intubation and incision on the AER and haemodynamic variables were not significantly different between the remifentanil-propofol and remifentanil-isoflurane groups. However, the study had a low power for this comparison. When the data for the two anaesthetic combinations were pooled, the only significant effects were increases in diastolic arterial pressure and heart rate immediately after intubation; these were not seen 5 min after intubation. There were no cardiovascular responses to incision. There were no significant changes in the AER after intubation or incision.

Analgesics, Opioid↗
PubMed2002

Optimal rocuronium dose for intubation during inhalation induction with sevoflurane in children.

BACKGROUND: We studied 120 children aged 2-7 yr in a prospective, randomized, assessor-blinded fashion to define the optimal rocuronium dose which provides a 95% probability of acceptable intubation conditions (ED95TI) during inhalation induction with sevoflurane. METHODS: After inhalation induction with 8% sevoflurane in 60% nitrous oxide and 40% oxygen, and loss of the eyelash reflex, we administered rocuronium (0.1, 0.15, 0.22, 0.3, or 0.6 mg kg-1) or placebo. We quantified neuromuscular function by stimulation of the ulnar nerve at 0.1 Hz to produce contraction of the adductor pollicis muscle using accelerometry. Intubation conditions were assessed 2 min after test drug injection. The optimal rocuronium dose was defined as the lowest dose, which allowed acceptable intubation conditions in 95% of children (ED95TI). RESULTS: Two minutes after injection of placebo or rocuronium, intubation conditions were acceptable in 35, 45, 80, 90, 95, and 100% of children, respectively. Rocuronium 0.07 [CI 0.02-0.11], 0.24 [0.19-0.31], and 0.29 [0.23-0.38] mg kg-1 provided 50, 90, and 95% probability of acceptable intubating conditions. When thumb acceleration was depressed by 50% or more, intubating conditions were considered acceptable in 97% of children. Recovery of the train-of-four ratio to 0.8 averaged 12 (7), 16 (7), 24 (7), 24 (8), and 50 (22) min after the respective dose of rocuronium. CONCLUSIONS: During inhalation induction with 8% sevoflurane in 60% nitrous oxide, rocuronium 0.29 mg kg-1 (ED95) optimizes intubation conditions for surgery of short duration.

Androstanols↗
PubMed2004

Randomized, controlled trial of the double setup tracheal tube during fibreoptic orotracheal intubation under general anaesthesia.

BACKGROUND: Impingement of the tracheal tube (ETT) on upper airway structures during railroading over the fibreoptic bronchoscope (FOB) occurs commonly. Potential complications of impingement include prolonged intubation time, leading to arterial desaturation, failed intubation and laryngeal trauma. The objective of this randomized, controlled trial was to assess the effect of the double setup ETT (a paediatric ETT is placed inside an adult ETT) on the incidence of impingement during orotracheal fibreoptic intubation. METHOD: Two hundred patients were randomized to have a single ETT or double setup ETT. After induction of anaesthesia, fibreoptic orotracheal intubation was performed. The degree of impingement of the ETT during advancement over the FOB was assessed using a standardized scoring system based on the manoeuvres required to overcome the impingement. RESULTS: The incidence of impingement was lower using the double setup ETT compared with the single ETT (18 vs 93%, P<0.001). The double setup ETT also reduced the incidence of impingement requiring more than a simple 90 degrees counterclockwise rotation to achieve intubation (3 vs 14%, P=0.01) and reduced the median intubation time (31 vs 35 s, P=0.046). CONCLUSIONS: The double setup ETT is effective in reducing ETT impingement and in reducing intubation time. We did not find an association between ETT impingement and arterial desaturation.

Adolescent↗
PubMed2004

Target concentrations of remifentanil with propofol to blunt coughing during intubation, cuff inflation, and tracheal suctioning.

BACKGROUND: The target blood concentrations of propofol and remifentanil, when used in combination, required to blunt the cough response to tracheal intubation, cuff inflation, and tracheal suctioning without neuromuscular blocking agents are not known. METHODS: In a randomized prospective study, 81 patients were enrolled to determine which of three target remifentanil blood concentrations was required to blunt coughing during intubation, cuff inflation, and tracheal suctioning. Anaesthesia was achieved with propofol at a steady effect-site concentration of 3.5 microg ml(-1). The target blood remifentanil concentrations were 5, 10, or 15 ng ml(-1). These concentrations were maintained for 12 min before intubation. RESULTS: There was no cough response to intubation in more than 74% of patients and no significant difference in the incidence of coughing with intubation between the three groups. Significant difference in coughing, diminishing with increasing remifentanil target concentration, was observed with cuff inflation (P=0.04) and tracheal suctioning (P=0.007). Bradycardia and hypotension was more frequent with the remifentanil target concentration of 15 ng ml(-1). Tracheal suctioning resulted in more coughing than intubation (P=0.01) or cuff inflation (P=0.004). CONCLUSION: Target remifentanil blood concentrations of 5, 10, and 15 ng ml(-1) associated with a 3.5 microg ml(-1) propofol target blood concentration provided good intubating conditions and absence of cough about 75% of the time. Higher target remifentanil concentrations were associated with less coughing during tracheal tube cuff inflation and tracheal suctioning.

Adolescent↗