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PubMed1987

[The endocrine stress-reaction to orotracheal intubation and topical anesthesia with lidocaine].

The influence of laryngoscopy and intubation with or without topical lidocaine anesthesia on the endocrine stress response was investigated in six groups of 40 orthopedic surgery patients differing in premedication and technique of lidocaine application (one- or two-step method). Controls were included without lidocaine application. Plasma levels of catecholamines (by HPLC) were measured before induction and 1, 5, and 10 min after intubation, ADH-levels (by RIA) before induction and 5 and 10 min after intubation. In addition, mean arterial pressure (MAP, MAP), HR, and the incidence of coughing and cardiac arrhythmias were observed. The statistical evaluation (analysis of variance with repeated measures on one factor) considered P values of less than 0.05 significant. There was no influence of laryngoscopy and intubation on plasma catecholamine levels during the observation period. A continuous decrease in both levels of epinephrine and norepinephrine was significant. ADH levels showed no significant changes. Lidocaine had no influence on these endocrine parameters. MAP and HR increased after intubation in all groups studied. The increase in HR was less pronounced after lidocaine treatment. Coughing (4 patients) and ventricular dysrhythmia (2 patients) were observed only in patients without lidocaine treatment. In conclusion, no influence of different modes of treatment on the endocrine stress response during intubation became obvious. There was no indication that the cardiovascular symptoms during laryngoscopy and intubation are caused by systemic stress. An explanation may be a direct neural impulse via sympathetic efferents to the heart. On the other hand, topical application of lidocaine did prevent coughing and cardiac irritation, and the increase in HR was attenuated.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Topical↗
PubMed1986

Benefits of orotracheal and nasotracheal intubation in neonates requiring ventilatory assistance.

To investigate differences in orotracheal (OT) and nasotracheal (NT) intubation for ventilatory assistance, we randomly assigned 91 neonates to be intubated via either of the two routes: 46 infants were assigned to the OT group and 45 infants were assigned to the NT group. Inability to intubate the nostril in three neonates, and respiratory or cardiac instability during attempted NT intubation in three neonates, resulted in the assignment of 52 infants to the OT group and 39 infants to the NT group; patients in both groups were of comparable size, sex, and clinical problems. Initial malposition of the endotracheal tube and need to retape, reposition, or replace the tube during the mean duration of intubation of 247 +/- 42 hours for the OT group and 273 +/- 57 hours for the NT group were similar. Daily Gram stains of tracheal aspirates showed that inflammation (greater than or equal to ten polymorphonuclear cells per 400 power fields) was common (51% OT group, 53% NT group). Cultures grew potential pathogens in 37% of the patients from the OT group and 31% of the NT group. There was no difference in the clinical or radiologic incidence of pneumonia. Postextubation problems were comparable: atelectasis, 48% OT and 59% NT; stridor, 15% OT and 26% NT. OT intubation may be preferred for prolonged ventilatory assistance in neonates because of the relative ease of initial intubation.

Female↗
PubMed1995

Endoscopic intubation of oesophago-gastric malignancy.

OBJECTIVE: To determine what percentage of inoperable oesophageal and oesophagogastric malignancies could be successfully intubated for palliation, and to compare Atkinson and Celestin tubes. DESIGN: A consecutive series of 210 patients who had been referred for palliation underwent endoscopy and intubation with the Nottingham introducer. PATIENTS: One hundred and nineteen men and 91 women aged 31-91 (mean age 71) years with inoperable malignant obstruction of the oesophagus or gastro-oesophageal junction were studied. One hundred and five tumours were in the lower third of the oesophagus, 78 in the middle third, 25 in the upper third and seven in the gastric fundus. Four tracheo-oesophageal fistulae resulting from bronchial carcinomas were also successfully intubated. MAJOR OUTCOME MEASURE: Eighty-nine per cent of gastro-oesophageal malignancies were successfully intubated using 120 Atkinson and 67 Celestin tubes. RESULTS: Eleven patients (5.2%) suffered oesophageal perforations during intubation, of whom six died. Nine of the perforations occurred in the first 100 patients treated but only two (2.3%) in the subsequent 87. Seven patients (3.7%) developed aspiration pneumonia, of whom five died. The mean survival time after intubation was 4.5 months (range 0.5-20 months), and 74% of patients required no further procedure. During follow-up, five (4.2%) Atkinson tubes displaced upwards, compared with 12 (17.9%) Celestin tubes (P < 0.01). Eighteen (9.6%) patients had recurrent dysphagia as a result of bolus obstruction and 11 (5.9%) had tumour overgrowth of the tube. CONCLUSION: Palliative intubation of malignant dysphagia is possible in approximately 90% of patients. The mortality associated with the procedure is low (5%) and effective relief of symptoms is achieved, with 74% of patients requiring no further treatment.

Aged↗
PubMed1995

[Comparison of intubating condition under sevoflurane and halothane anesthesia in pediatric patients].

We compared intubating conditions under sevoflurane (group S) and halothane (group H) anesthesia in pediatric patients for otorhinolaryngological surgery. One hundred and six patients were divided randomly into group S (n = 60) and group H (n = 46). Anesthesia was induced with nitrous oxide-oxygen-sevoflurane (GOS, end-tidal sevoflurane concentration; 4.5%) or nitrous oxide-oxygen-halothane (GOF, end-tidal halothane concentration; 1.6%). Intubating conditions were assessed according to the intubation score, which consists of the following three factors; mouth opening, visibility of vocal cord and body movement. Each factor is divided into three grades (0, 1, 2); total scores of 0 correspond to excellent. In comparing the groups with respect to anesthetic induction, group S required 180 sec for disappearance of spontaneous breathing and 660 sec for completion of intubation, while, in group H, the above time intervals were 188 and 676 sec, respectively. We achieved significantly better intubating conditions in group H than group S. There were significantly more cases in group S than in group H in which vocal cord visibility was insufficient. Body movement during intubation was observed in 27% and 26% of patients in group S and H, respectively. In conclusion, halothane anesthesia provides better intubating conditions than sevoflurane anesthesia in slow induction for pediatric patients.

Anesthesia, Inhalation↗
PubMed1994

[Difficult intubation: decision-making algorithms in the main operating suite of the University Hospital Center].

In the setting of an operative suite or in the case of cardio-pulmonary resuscitation, processing algorithms are mandatory for acute crisis situations like the difficult intubation. The following recommendations have been prescribed as applicable for a teaching hospital (CHUV, Lausanne), based on three different possibilities (expected difficult intubation in elective cases, expected difficulties in emergency cases, and unexpected difficulties): awake intubation under topical and local anesthesia, if possible by fibroscopy, for all cases where difficult intubation is expected; steps for unexpected difficult intubation: laryngoscopy with flexible stylettes and special blades, laryngeal mask, trans-tracheal jet-ventilation, rigid tracheo-bronchoscopy by ENT specialist, rescue coniotomy, tracheotomy; tracheal overpressure with transtracheal O2 ventilation in "full stomach" emergency cases; limited number and length of time for intubation trials; keep oxygen inflow during and/or between the intubation attempts; return to spontaneous ventilation as soon as possible. The three algorithms are presented and commented.

Algorithms↗
PubMedDate not supplied

[Evaluation of the hemodynamic and endocrino-metabolic response to tracheal intubation in patients anesthetized with thiopental or propofol].

OBJECTIVES: To compare the effects of thiopental and propofol on hemodynamic and metabolic endocrine response to laryngoscopy and intubation. MATERIAL AND METHODS: We selected two homogeneous groups of 14 healthy patients premedicated with midazolam i.m. (0.07 mg/kg). Induction was with diazepam (0.1 mg/kg), fentanyl (2 micrograms/kg), atropine 0.5 mg and thiopental or propofol (4-6.5 mg/kg and 1.5-2.5 mg/kg, respectively). Parameters recorded were direct arterial pressure, baseline heart rate, and heart rate after induction and at 2 and 5 minutes after intubation. We measured adrenaline (A), noradrenaline (NA), dopamine (Da), glucagon, beta-endorphines, ACTH, cortisol, glucose and amino acids in the baseline and post-intubation blood samples. RESULTS: We observed a significant increase (p < 0.05) in systolic and diastolic arterial pressure after intubation (10% and 22% respectively) in the thiopental group as compared with the propofol group. With both induction agents, heart rate was higher than baseline values at the three times (p < 0.001). In the thiopental group heart rate was higher after intubation than after induction (p < 0.05). Cortisol fell after intubation in the propofol group (p < 0.05); no other hormonal differences were observed. Hyperglycemia (p < 0.0001) was similar for both groups, while in the propofol group there were significant decreases in several amino acids. CONCLUSIONS: Propofol has a greater mitigating effect on the hyperdynamic response to intubation in healthy patients. For the two induction agents we measured no significant differences in stress hormone levels, apart from the drop in cortisol with propofol. We observed a change in energy-producing metabolites.

Adult↗
PubMed1994

Effects of magnesium sulfate pretreatment on succinylcholine-facilitated tracheal intubation.

Magnesium sulfate may prevent increase in serum potassium produced by succinylcholine and cause transient hypotension. The present study was designed to evaluate the effect of magnesium sulfate on heart rate, blood pressure and hyperkalemic response following succinylcholine injection during tracheal intubation. Twenty patients, ASA class I-II, scheduled for elective surgery were equally and randomly allocated to two groups. Heart rate, blood pressure, venous and arterial potassium levels were measured immediately before intubation. Induction was achieved with fentanyl 2 ug/kg and thiopental 5 mg/kg i.v., and intubation was facilitated with succinylcholine 1.0 mg/kg i.v. In the magnesium group (group I), 60 mg/kg of magnesium sulfate was infused intravenously in 1-1.5 min immediately before succinylcholine injection. The control group (group II) received an equal volume of normal saline in the same way. Heart rate, blood pressure, venous and arterial potassium levels were measured at 1, 3, 5 and 10 minutes after intubation. The results showed that magnesium sulfate could attenuate the hypertensive response at 1 minute and the hyperkalemic response at 1 and 3 minutes following succinylcholine-facilitated intubation; the tachycardiac response at 1 minute after intubation could not be reduced by this agent. We concluded that bolus infusion of magnesium sulfate may be of help in reducing the hypertensive response during laryngoscopy and intubation.

Adult↗
PubMed1993

[A modified Macintosh blade for difficult intubation. The mirror blade].

Difficult intubations can occur in cases of anatomical or physiological abnormalities of the face and neck. They are frequently predictable when specific signs are evident preoperatively. There are still occasional unexpected difficulties during conventional laryngoscopy when common blades like the Macintosh and Foregger types are used. During the past 5 decades several authors have proposed many types of laryngoscopes and blades differing in length and shape, as well as various accessories such as guide-wires, prisms, and mirrors. METHOD. We modified a size 3 Macintosh blade by adding a mirror placed tangential to the external curve near the apex. This configuration allows both conventional direct visualisation of the vocal cords and non-direct viewing through the mirror. Insertion of the tube is facilitated using a specially shaped guide-wire. RESULTS. This equipment was used for orotracheal intubation in 20 patients with different degrees of direct laryngeal visibility prior to otolaryngologic endoscopy and surgery under general anaesthesia. Both methods of larynx visualisation were performed and compared. In 1 patient the mirror was not useful because it became fogged. In all the others we could avoid this problem by warming the blade in water. Only in 1 other case was the conventional view better and intubation seemed to be easier than when the mirror was used. In 15 patients the vocal cords were visualised better with the mirror, and intubation was performed by means of the guide-wire with the non-direct technique. In 2 of these cases difficult direct laryngoscopy of grades 3 and 4 according to the Cormack and Lehane classification was found. Four patients were difficult to intubate and neither type of laryngoscopy was ideal. It is notable that a satisfactory view was achieved in the mirror with much less effort. In particular, there was no need to introduce the blade as deeply or raise its apex as much as is usually done. CONCLUSION. The mirror-blade is a suitable device for management of unexpected difficult intubations. Because of its dual availability, it offers both direct and non-direct visualisation of the larynx. Handling of this mirror-blade can be practised extensively, which allows integration of this equipment in the "failed intubation drill". This should be an integral part of the teaching and training of anaesthesia personnel.

Adult↗
PubMedDate not supplied

[Intubation with propofol without neuromuscular blockade. Effect of premedication on fentanyl and lidocaine].

AIMS: Laryngotracheal reflexes, and possibilities of intubations following anaesthetic induction with propofol, with or without premedication and without neuromuscular blockade were evaluated. Hemodynamic parameters were also measured. METHODS: Sixty ASA I-II patients were randomly allocated into 3 groups according to anaesthetic premedication. Group P: (placebo), 2 and 4 ml of saline 0.9%; group F, 4 micrograms/kg of fentanyl and 2 ml of saline 0.9%; group L, 4 micrograms/kg of fentanyl and 1.5 mg/kg of lidocaine 5%. Two point five mg/kg of propofol were administered and 45 seconds later intubation was attempted. Mandibular relaxation, visualization of the glottis, opening of the vocal chords, reflex reactions to laryngoscopy and intubation, time used, blood pressure and heart rate were evaluated. RESULTS: Mandibular relaxation and visualization of the glottis were acceptable in all the patients. The aperture of the vocal chords was enough so as to carry out intubation in 65% (P), 100% (F) (p < 0.05) and 95% (L) (p < 0.05). Laryngeal reactivity significantly decreased (p < 0.001) from 40% (P) to 15% (F) and 10% (L). Tracheal reflexes decreased from 84.6% (P) to 55% (F) (p < 0.01) and 37% (L) (p < 0.001). Blood pressure and heart rate rose with intubation over the basal levels in group P and significantly decreased in groups F and L. CONCLUSIONS: The use of propofol without neuromuscular blockade is inadequate for intubation since laryngotracheal reflexes are not suppressed. Besides, propofol does not prevent hemodynamic reactions. Premedication with fentanyl and/or lidocaine improves the responses not sufficiently to safely perform intubation.

Adult↗
PubMed1995

The use of intranasal nitroglycerin to prevent pressor responses during intubation in general anesthesia--a comparison of various doses.

BACKGROUND: Intranasal nitroglycerin (NTG) was first reported to successfully prevent an increase in arterial blood pressure following laryngoscopy and tracheal intubation by Hill et al. Various different effective dosages of NTG have been reported. Grover et al. indicated 0.75 mg of intranasal NTG to be the most suitable dose. However, no definite conclusion has yet been made. This study was designed to compare the efficacy of four different dosages of intranasal NTG (0.3, 0.5, 0.75, and 1.0 mg) in preventing pressor responses to laryngoscopy and tracheal intubation during the induction of general anesthesia. METHODS: One hundred patients (ASA I or II) scheduled for elective surgery were included. These study subjects were divided into five groups and randomly assigned to four different dosages of intranasal NTG and a placebo. Each group consisted of 20 patients. The NTG solution was administered 1 min before the injection of thiopental. Systolic arterial pressure (SAP), diastolic arterial pressure (DAP), mean arterial pressure (MAP) and heart rate (HR) were recorded before the induction of anesthesia (T1), before laryngoscopy (T2), and at 0, 3, and 5 min after tracheal intubation (T3, T4, and T5 respectively). RESULTS: In patients who received a placebo (control group), there were significant increases in SAP, MAP, HR and rate-pressure-product (RPP) associated with tracheal intubation. Tachycardia was noted in all experimental groups. The increases in MAP associated with tracheal intubation were significantly less in patients who received NTG of 0.5 mg or more but not 0.3 mg. Although 0.5 mg of NTG did attenuate the increases in SAP after tracheal intubation, the increases in SAP of the other three experimental groups were no less than that of the control group. Rate-pressure-product (RPP) values of the experimental groups were noted to be equal to or higher than those of the control group during the period of study. Contrary to the results of the study conducted by Grover et al., 0.75 mg of NTG did not attenuate the pressor responses. CONCLUSIONS: Intranasal NTG does not attenuate the pressor responses to laryngoscopy and tracheal intubation.

Administration, Intranasal↗
PubMed1977

[Laryngeal complications in newborns following intratracheal intubation (author's transl)].

Histological and bacteriological findings in comparison to clinical data concerning intubation for 38 dead premature infants and newborns were studied to elucidate conditions complicating intratrachial intubation at the laryngeal level. The larynx was intact in 3 cases. Slight lesions of mucosa (epithelabrasion, hemorrhage) were found in 13, moderately severe lesions (necrosis of epithelium, ulcers, pseudomembranes) in 11, and severe lesions (deep necrosis, perichondritis with sceletisation) in 10 cases. 1 case showed a stage of regeneration. The narrow passage between the two processus vocales is a site of predilection for tubus-induced lesions, the epithelium bein immediately adjacent to the cartilage. Successful bacteriological demonstration of the infectious agent correlated with the rising degree of mucosal lesions, and increasing duration of intubation. 3 cases, however, already had severe lesions after short-time-intubation. Formal and causal pathogenesis are described. Essential causes are: trauma of intubation, irritation by the tubus in situ, duration of intubation, and infection. Regenerative power of the infantile laryngeal mucosa is strong. Permanent lesions may occur as scarred stenosis. Careful indication, accurate and careful technology of intubation, choice of the smallest possible diameter of tubus, good care for the tubus, and generous prophylaxis against infections are to be demanded.

Hemorrhage↗
PubMed1996

[Effect of intubation timing on the clinical course of polytrauma patients with lung contusions].

UNLABELLED: Aim of the study was to evaluate the influence of early intubation at the scene on the outcome of polytraumatized patients with lung-contusion. METHODS: 377 patients with lung-contusion out of 1031 polytraumatized patients were evaluated in this study. Patients, intubated at the scene were compared with those, who were intubated later. We compared the in-hospital time, the time at the ICU, the pneumonia-rate and the ARDS-rate. Age and injury severity of the compared groups were comparable. RESULTS: In-hospital time and time at the ICU were shorter in the early intubated group than in the later intubated (in-hospital time 34.5 d and 39.4 d, time at the ICU 19.9 d and 23.7 d, resp.). For the time at the ICU the difference is significant. Also a reduction was found in the pneumoniarates (23.7% and 13.2%). The ARDS rate was reduced, too, but both differences were not significant (ppneumonia = 0.053, pARDS = 0.117). The mortality also was not significantly reduced (23.4% and 22.7%, resp.). CONCLUSION: Early intubation at the scene can reduce the inhospital-time, the time at the ICU and the complications. In this way it becomes an important factor of cost-reduction. Therefore early intubation at the scene must become a standard for all patients with lung-contusion.

Adolescent↗
PubMed1997

Effects of sedation, anesthesia, and endotracheal intubation on respiratory mechanics in adult horses.

OBJECTIVE: To determine the effects of endotracheal intubation on respiratory mechanics during xylazine sedation and xylazine-diazepam-ketamine anesthesia in adult horses. ANIMALS: 5 healthy adult horses. PROCEDURE: Measurements were derived from recordings of respiratory gas flow, and transpulmonary and transtracheal pressures. Total pulmonary resistance (RT) was partitioned into upper airway resistance (extrathoracic portion of trachea, larynx, pharynx, nasal cavity, nares; RUA) and lower airway resistance (intrathoracic portion of trachea, bronchi, bronchioles). Baseline measurements were obtained in unsedated horses, after xylazine administration, and following nasotracheal intubation (ID, 18 mm). Measurements were obtained following induction of xylazine-diazepam-ketamine anesthesia and subsequent to endotracheal intubations (ID, 22, 20, and 16 mm). During recovery, horses were nasotracheally intubated (ID, 18 mm). Measurements were obtained upon standing, and repeated after extubation. Data were examined by use of ANOVA with repeated measures. RESULTS: Significant increases in mean work of breathing (W), RT, and RUA observed with xylazine sedation were variably attenuated by nasotracheal intubation. During xylazine-diazepam-ketamine anesthesia, the highest mean values for W, RT, RUA, transpulmonary and transtracheal pressures developed during non-intubation periods. The magnitudes of resistance and pressure values were inversely proportional to the internal diameter of the endotracheal tube. At recovery, values of the W and all measurements of resistances and pressures were significantly increased, compared with presedation values. Extubation resulted in further increases in these measurements. CONCLUSIONS: Work of breathing in horses is substantially increased when RUA is increased during xylazine sedation and xylazine-diazepam-ketamine anesthesia. Endotracheal intubation reduces W by reducing RUA.

Airway Resistance↗
PubMed1997

[Inflation of the endotracheal tube cuff as an aid for blind nasotracheal intubation in patients with predicted difficult laryngoscopy].

HYPOTHESIS AND OBJECTIVES: Inflation of the tracheal tube cuff to facilitate blind nasal intubation as described by Gobarck in 1987 has been shown to be effective for increasing the rate of successful intubation from 45 to 95% in patients with no airway alterations. We aimed to assess the usefulness of this technique in patients with anatomical alterations of the airway, in whom difficult intubation was predicted. PATIENTS AND METHODS: We enrolled 25 patients with airway alterations that made laryngoscopy likely to be difficult and who were scheduled for neoplastic maxillofacial surgery. RESULTS: Twelve patients (48%) were intubated on the first try, 5 (20%) on the second try and 6 (24%) on the third try. We were unable to intubate 2 patients (8%) after three tries, and therefore opted to intubate with a fiberoptic endoscope. CONCLUSIONS: Inflation of the tracheal tube cuff is useful for facilitating nasotracheal intubation in the awake patient.

Adult↗
PubMed1997

[Post-mortem study of laryngotracheal lesions produced by prolonged intubation and/or tracheotomy].

Injuries of the laryngotracheal axis caused by prolonged intubation in critically ill patients raise the issue of the timing of tracheotomy in intubated patients. In 1992 a prospective study was begun in intensive care patients with intubation lasting more than 48 hours. Eight months later, post-mortem data on the laryngotracheal axis of deceased patients was added to our prospective study protocol. The study was closed with 125 cases (52 deceased). The clinical data of 73 surviving patients was compared with that of 18 post-mortem cases. The macroscopic results of the post-mortem study are summarized by grading the lesions according to a personal modification of the Lindholm classification. All cases had laryngotracheal injuries. Only 15% of the lesions were located in the tracheal region. Five cases were classified as grade 2, with an average orotracheal intubation of 9 days, 9 cases as grade 3 with 15 days intubation, and 4 cases as grade 4 with 21 days intubation. We concluded that the severity of laryngotracheal injuries in the early post-mortem exploration was related with the duration of intubation.

Adult↗
PubMed1997

Elective tracheal intubation in cervical spine injuries.

Patients presenting for surgical stabilisation of an unstable cervical spine are at risk of sustaining a further iatrogenic spinal cord injury during intubation of the trachea. Controversy exists regarding the optimal anaesthetic technique for securing the airway. We reviewed the techniques employed for intubating the trachea in our hospital over a five year period. Tracheal intubation was achieved using two different techniques: awake fibre-optic intubation with local anaesthesia, and general anaesthesia via the intravenous or inhalational route with neuromuscular blockade. Forty five patients were included. 16 patients demonstrated a pre-operative neurological deficit. Awake fibre-optic intubation was used in 27 cases, general anaesthesia was employed via the intravenous route in 17 cases and the inhalational route in 1 case. Weighted traction was employed in all cases to immobilize the cervical spine during intubation. There was no new neurological sequelae with any of these techniques. Our study suggests that there is no optimal anaesthetic technique for intubating the trachea in patients with cervical spine injuries and it is noteworthy that in line traction was used in every case.

Adolescent↗
PubMed1976

[Prolonged endotracheal intubation or tracheostomy in children (author's transl)].

Five patients with subglottic tracheal stenosis following prolonged endotracheal intubation are reported. To minimize tracheal stenosis the indications for prolonged intubation should be well defined and tracheostomy considered as an alternative. The incidence of tracheal stenosis following prolonged intubation is stimilar to that following tracheostomy. The risk of stenosis increases with the duration of intubation, the degree of physical trauma to the laryngotracheal mucosa (suction, tube changing, restlessness), infection of the trachea or larynx, and with the age of the child. Prolonged intubation necessitates sedation and intensive care. Tracheostomy has a higher mortality but this and the risk of stenosis depend greatly on the operative technique. Particularly in cases where prolonged intubation increase the risk of tracheal stenosis, the advantages of tracheotomy become evident. Tracheostomised children rarely need sedation, the tracheobronchial tree can be easily and carefully toileted and the changing of the tube is without risk. Neither method is absolutely preferable, but the correct application of both will minimise the complication rate. The indications for each may be summarised as follows: for primary treatment of acute respiratory distress in children prolonged intubation is the treatment of choice. If after 3 days there is no chance of extubation, tracheostomy should be considered but this depends also on the child's age and behaviour, and on the laryngotracheal mucosal reaction. The younger the child the more cautiously should tracheostomy be considered. Children under 2 years of age should only be tracheostomised if there is no alternative.

Age Factors↗
PubMed1992

Changes in coagulation and fibrinolytic activity associated with tracheal intubation.

This study was carried out to clarify the effect of tracheal intubation on the coagulation and fibrinolytic system. It was performed on 20 patients (ASA class 1-2) undergoing elective surgery. Before and after tracheal intubation, hemodynamics, ACTH, cortisol, catecholamines, and several coagulation and fibrinolytic factors were measured. Tracheal intubation was accompanied by significant increases in the blood pressure, heart rate, and norepinephrine level. No changes were observed in fibrinopetide A, fibrinopeptide B(Beta15-42), tissue plasminogen activator antigen, plasminogen, fibrinogen, and Alpha(2) plasmin inhibitor. Patients exposed to long intubation time (>20 seconds) were found to have a significantly higher level of fibrinopeptide A than patients with short tracheal intubation time (</=20 seconds) ( P < 0.05). It therefore can be concluded that the increase in norepinephrine and changes in the hemodynamics following tracheal intubation have no impact on the coagulation and fibrinolytic activity. Also, if the duration of intubation is prolonged, thrombin activity may be promoted.

Journal Article↗