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 955 records · Page 53Linked to original sources
PubMed1998

Laryngeal injuries after short- versus long-term intubation.

Forty-five patients were seen over a 5-year period with laryngeal injuries following endotracheal intubation (ETI). The mean duration of ETI was 5.6 days (2 hours to 37 days). Patients intubated for less than 24 hours were most likely to present with a vocal fold immobility or an anterior glottic web. Long-term intubation was associated with the development of subglottic stenoses and granulomas. Patients with vocal fold immobility were seen more often after ETI for surgical reasons and had a significantly higher incidence of previous intubation and tobacco usage. Subglottic stenoses were seen in younger patients intubated for medical reasons and associated with nasogastric tubes and longer periods of intubation.

Adult↗
PubMed2002

Effects of combining midazolam and barbiturate on the response to tracheal intubation: changes in autonomic nervous system.

STUDY OBJECTIVE: To investigate the effects on the autonomic nervous system of anesthesia induction with a combination of midazolam and barbiturate using plasma catecholamine concentration and heart rate (HR) variability in comparison with the induction with barbiturate alone. DESIGN: Prospective study. SETTING: Operating room of a university hospital. PATIENTS: 40 ASA physical status I and II patients aged 30 to 70 years, who were scheduled for general anesthesia. INTERVENTIONS: Anesthesia was induced with 0.1 mg/kg midazolam followed by 3 mg/kg thiopental sodium (Midazolam-Barbiturate group) or thiopental 5 mg/kg (Barbiturate group) with 6 L/min oxygen. MEASUREMENTS: Arterial blood pressure (BP), HR, HR variability, and plasma concentrations of epinephrine and norepinephrine were measured. MAIN RESULTS: Blood pressure and HR increased in response to tracheal intubation in both groups, but the increase was significantly larger in the Barbiturate group. In the Barbiturate group, the high-frequency component (HF) in HR variability increased significantly during intubation, whereas in the Midazolam-Barbiturate group, HF decreased continuously. The low-frequency component (LF)/HF ratio increased in both groups, with significantly higher values noted in the Barbiturate group. Plasma epinephrine concentrations decreased before intubation and increased in response to tracheal intubation in the Barbiturate group. Finally, plasma norepinephrine concentrations increased in response to tracheal intubation only in the Barbiturate group. CONCLUSIONS: Anesthesia induction with a combination of midazolam-thiopental was effective in reducing hemodynamic and cardiac autonomic nervous system responses to tracheal intubation in comparison with the conventional induction with thiopental alone.

Adult↗
PubMed1997

Is intravenous lidocaine an effective adjuvant for endotracheal intubation in children undergoing induction of anesthesia with halothane-nitrous oxide?

STUDY OBJECTIVE: To evaluate the efficacy of intravenous (i.v.) lidocaine in suppressing the cough reflex and increases in intraocular pressure (IOP), heart rate (HR), and mean arterial pressure (MAP) elicited by endotracheal intubation. DESIGN: Prospective, randomized, placebo-controlled, blinded study. PATIENTS: 60 ASA physical status 1 premedicated children aged 2 to 6 years undergoing induction of anesthesia with halothane-nitrous oxide (N2O) for surgery to correct strabismus. INTERVENTIONS: Patients were randomly divided into two groups of 30 each. The control group (C) received saline and the treatment group (L) received 2 mg/kg i.v. lidocaine 90 seconds prior to endotracheal intubation. MEASUREMENTS AND MAIN RESULTS: Awake HR and MAP; IOP, HR, and MAP 45 seconds prior to endotracheal intubation, immediately after endotracheal intubation, and 1 minute later, were recorded. Coughing was noted at endotracheal intubation. Lidocaine prevented coughing and a significant increase in IOP. Although significant increases in HR and MAP were observed in both groups (comparing preintubation and postintubation values), these increases were significantly less in the L group compared with the C group. CONCLUSIONS: In healthy premedicated children, aged 2 to 6 years, who are undergoing induction of anesthesia with halothane-N2O, 2 mg/kg of lidocaine given 90 seconds prior to laryngoscopy effectively suppresses the cough reflex and increase in IOP secondary to endotracheal intubation and attenuates increases in HR and MAP.

Adjuvants, Anesthesia↗
PubMed1997

Lightwand intubation of infants and children.

STUDY OBJECTIVE: To examine factors contributing to successful lightwand (lighted stylet) intubation of infants and children. DESIGN: Prospective observational study. SETTING: University hospital. PATIENTS: 125 children under age 10 years presenting for elective surgery. INTERVENTIONS: Prototype lightwands specifically designed for pediatric patients were used. Intubations were done by anesthesia residents with little or no prior lightwand experience. All attempts were recorded on videotape. In a subgroup of 14 patients, an endoscopic view of the lightwand was also recorded with a flexible nasopharyngoscope. MEASUREMENTS AND MAIN RESULTS: 125 patients with a mean age of 3.0 years (+/- 2.4 years SD; range: 3 weeks to 9 years) were enrolled. 83.2% were intubated using the lightwand, including 75.5% (34 of 45) of infants weighing less than 10 kg. Of the 21 failed intubations, 8 were due to an inappropriately large endotracheal tube, as recognized during direct laryngoscopy; 4 were due to other reasons discussed; and 9 (persistent vallecular or esophageal entry) could not be explained from videotape analysis. Factors contributing to successful intubation included: (1) use of a shoulder roll and slight head extension; (2) conscientious alignment of airway axes; (3) anterior jaw lift to elevate the epiglottis; and (4) gentle handling of the lightwand to avoid displacing soft tissue. Inability to advance the lightwand despite correct glow is caused by entrapment in the vallecula, hang up of the lightwand on the aryepiglottic folds, subglottic narrowing, or vocal cord closure. CONCLUSIONS: Lightwand intubation in children uses both tactile and visual cues regarding the location of the endotracheal tube tip. Attention to detail results in a high level of success among novice users of the pediatric lightwand. Endoscopic and external videotaping gave us a means of monitoring the progress of mechanical skills among novice users.

Child↗
PubMed2001

Esophageal perforation: life threatening complication of endotracheal intubation.

OBJECTIVE: To raise awareness of this complication of tracheal intubation, to emphasize the gravity due to delayed diagnosis, and to advocate a surgical treatment. METHODS: Between April 1980 and January 2000, 97 patients were treated for esophageal perforation in our department. We reviewed the cases of perforation occurring after attempted tracheal intubation. Each case is presented. Discussion is focused on diagnosis and treatment. RESULTS: Esophageal perforation occurred after attempted endotracheal intubation in five cases among 58 iatrogenic perforations. There were four women and one man (mean age 72 years). In all cases, it was for a planned operation. Intubation was performed by a single lumen tube in three cases and a double lumen tube in two cases. Presenting symptoms were acute in one case and insidious in four cases. Free interval before diagnosis and treatment was long in all but one case, with an average of 179 h (range 5--432). Two patients suffered from septic shock when they were transferred. All patients were operated on. Two patients died. CONCLUSION: Post intubation esophageal perforation is one of the most life threatening esophageal perforation. Delayed diagnosis is the first cause of gravity. Prevention of this complication begins with recognition of a potentially difficult intubation. Good outcome follows from rapid diagnosis and early surgical treatment.

Aged↗
PubMed1991

Air medical tracheal intubation: establishing a threshold for this QA indicator.

Endotracheal intubation is a critical skill necessary in a number of situations encountered by air medical personnel. The purpose of this study was to establish a threshold for the quality assurance indicator of successful tracheal intubation in a physician-staffed air medical system. The records of all patients transported by a physician-staffed air medical system over a 36-month period were reviewed. One hundred and forty-three patients had endotracheal intubation attempted. Blind nasotracheal intubation attempts were successful in 71% of those in whom it was attempted, while the overall intubation success rate was 92%. Based on this study and the existing literature, a threshold of 90% is recommended for the quality assurance indicator of successful tracheal intubation in physician-staffed air medical systems.

Aircraft↗
PubMedDate not supplied

Intubation quality assurance thresholds.

INTRODUCTION: Quality assurance (QA) and continuous quality improvement (CQI) are valued activities within health-care organizations. Quality assurance indicators as guidelines for quality practice usually are established intuitively. The purpose of this study was to determine an appropriate threshold for successful intubation in patients transported by air and to examine factors impacting this success rate. SETTING: Fifteen rotor-wing programs from across the United States participated. METHOD: The study was a prospective descriptive design. A total of 369 flight crew members agreed to participate, and intubations were attempted on 862 patients during the 12-month study. RESULTS: Intubations were attempted on 862 patients and were successful in 788 (91.4%) of the patients. Of the patients not successfully intubated, 14 received supplemental oxygen only, 25 were supported with bag-valve-mask, 26 received a surgical cricothyroidotomy and for nine patients it was unknown what form of airway support was provided. CONCLUSION: Factors impacting successful intubation include cardiac arrest, use of neuromuscular blockade, use of sedatives and facial trauma. Data from the study support a threshold for successful intubation of between 90% and 95%.

Air Ambulances↗
PubMed1987

The incidence of nosocomial pneumonia following urgent endotracheal intubation.

The risk of nosocomial pneumonia following emergency or urgent endotracheal intubation was studied prospectively. Pneumonia developed in 35 of 78 (45%) patients within three days of intubation. No differences in age, sex, underlying illness, respiratory infection, or antibiotic use were found between those with or without pneumonia. There were also no differences in the frequency of complications occurring during intubation. Patients developing pneumonia tended to have the same organisms isolated from the sputum at the time of intubation and at the time of diagnosis of pneumonia (9 of 20 were identical, 5 differed by a single organism). Sputum cultures taken at the time of intubation were helpful in predicting the subsequent pathogens in patients who developed pneumonia. There were no differences in mortality between patients with (29%) and without (28%) pneumonia. Emergency endotracheal intubation appears to contribute to the overall incidence of nosocomial pneumonia.

Aged↗
PubMed2005

Comparative study of intubating conditions at the first minute with suxamethonium, rocuronium and different priming techniques of rocuronium.

BACKGROUND AND OBJECTIVE: To evaluate orotracheal intubation conditions after 1 min. PATIENTS AND METHODS: A prospective randomized study with 376 adult American Society of Anesthesiologists (ASA) Grade I-III patients. Each patient received propofol, fentanyl and either suxamethonium (1 mg kg(-1)) or rocuronium. The intubating dose of rocuronium (2 x ED95) was preceded 4 min earlier by saline, or a 0.1 x ED95 priming dose of rocuronium, atracurium, cis-atracurium, vecuronium or mivacurium. Intubating conditions were graded as excellent, good or poor with respect to laryngoscopy, vocal cord position and movement and reaction to intubation and/or cuff inflation. RESULTS: There were significant differences (P < 0.05) in laryngoscopy between suxamethonium and rocuronium primed with saline, atracurium or cis-atracurium. With respect to vocal cord position and movement during intubation, rocuronium without priming differed significantly from all other groups and for reaction to insertion of tracheal tube and/or cuff inflation. Rocuronium without priming differed significantly from all other groups except for rocuronium primed with itself. The mivacurium group showed more signs of pre-curarization than other groups (P < 0.05). There were significant differences between rocuronium alone and the other groups when final intubating conditions were compared. CONCLUSIONS: Priming rocuronium with 0.1 x ED95 of vecuronium, rocuronium, atracurium or cis-atracurium is a safe technique and did not increase risk of pre-curarization in healthy patients.

Adjuvants, Anesthesia↗
PubMed2006

Gabapentin reduces cardiovascular responses to laryngoscopy and tracheal intubation.

BACKGROUND AND OBJECTIVE: We have compared the effects of gabapentin on arterial pressure and heart rate at induction of anaesthesia and tracheal intubation in a randomized double-blind study. METHODS: Ninety normotensive patients (ASA I) undergoing elective surgery were divided into three groups of 30 patients each. Patients received oral placebo (Group I), 400 mg of gabapentin (Group II) or 800 mg of gabapentin (Group III) 1 h prior to surgery in the operating theatre. After induction of anaesthesia heart rate and mean arterial pressure were recorded at baseline 1, 3, 5, 10 and 15 min after intubation. RESULTS: Patients receiving placebo and 400 mg gabapentin showed a significant increase in blood pressure and heart rate associated with tracheal intubation compared to baseline levels and Group III. There was significant decrease in heart rate and arterial pressure in Group III after intubation 1, 3, 5 and 10 min (P < 0.001, P < 0.001, P < 0.05 and P < 0.05, respectively) compared to Groups I and II. CONCLUSION: Given 1 h before operation gabapentin 800 mg blunted the arterial pressure and heart rate increase in first 10 min due to endotracheal intubation. Oral administration of gabapentin 800 mg before induction of anaesthesia is a simple and practical method for attenuating pressor response to laryngoscopy and tracheal intubation after standard elective induction.

Administration, Oral↗
PubMedDate not supplied

Emergent intubation and CT scan pathology of blunt trauma patients with Glasgow Coma Scale scores of 3-13.

INTRODUCTION: Widely accepted guidelines for use of pharmacologic agents for prehospital intubation have not been fully developed. Toward the goal of formulating specific guidelines, this study sought to determine how well the Glasgow Coma Scale (GCS) score stratifies the need for emergent intubation (within 30 minutes of emergency department arrival or in the prehospital setting). METHODS: A one-year, retrospective review of the charts of blunt trauma patients with presumed head injury who presented to the emergency department of a Level 1 trauma center with a GCS score of less than or equal to 13 was performed. A total of 120 patients met the inclusion and exclusion criteria. RESULTS: A significant number of patients presenting with a GCS score of less than or equal to 9 required emergent intubation. A significant minority of patients presenting with a GCS score of 10-13 required emergent intubation (20%) or had intracranial pathology on head CT scan (23%), and the majority of patients from this subgroup did not require subsequent intubation. Alcohol or substance intoxication and communication barriers such as deafness and language difficulties limited the clinical examination. CONCLUSIONS: Patients with a presenting GCS score of less than or equal to 9 represent candidates for the use of pharmacologic agents to facilitate aggressive airway control by well-trained and supervised emergency medical technicians (EMTs). Emergent intubation of patients with a GCS score of 10-13 is problematic. Patients with a presenting GCS score of 10-13 must be evaluated individually and closely monitored.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2003

Retrograde intubation with a Mini-Trach II kit.

BACKGROUND: Retrograde intubation has been accepted internationally as a viable alternative for managing the difficult airway. Various techniques have been described to perform this procedure, however, difficulties have arisen on account of problems with suboptimal materials. We therefore describe a retrograde intubation technique using the knife and stiff plastic introducer from a Mini-Trach II set from Portex Ltd (Kent, UK). METHODS: The cricothyroid membrane was identified and using the knife from the mini-trach set, incised longitudinally. The plastic introducer was inserted through the incision and maneuvered out through the mouth providing a guide over which the endotracheal tube was threaded. The technique was evaluated on 20 cadavers and thereafter used in four patients. RESULTS: Mean intubation time in the 20 cadavers was 6.7 s (range 3-10) from incision to removal of the guide. Also, the technique was used successfully in four patients in whom anterograde attempts failed. In one of these patients the retrograde intubation was life saving. CONCLUSION: Retrograde intubation with a stiff curved plastic introducer was rapid and easy in cadavers and in four patients. In emergency situations where conventional intubation fails it may be life saving.

Aged↗
PubMed2002

Orotracheal fibreoptic intubation for rapid sequence induction of anaesthesia.

We assessed whether flexible fibreoptic-guided orotracheal intubation could be rapidly and successfully achieved during a simulated rapid sequence induction in 30 anaesthetised and paralysed patients. Rapid sequence induction was simulated by applying practised cricoid pressure. Using a flexible fibreoptic laryngoscope with camera and closed circuit television, an anaesthetist experienced with the technique performed orotracheal endoscopy and intubation with a cuffed 7.0-mm Portex tracheal tube through a VBM Bronchoscope Airway. Fibreoptic intubation was successful at the first attempt in 28 patients (93%); two patients required two attempts. Mean (SD) time from removal of the facemask from the patient's face to the appearance of carbon dioxide in the expired breath after intubation was 111 (46) s (median 100 s; range 54-195 s). There were one or more difficulties in 13 patients (43%). These difficulties were largely avoidable and included problems with fibreoptic equipment, the Bronchoscope Airway, copious secretions, cricoid pressure or railroading of the tracheal tube. Flexible fibreoptic-guided orotracheal intubation may have a place in the management of failed intubation during a rapid sequence induction.

Adolescent↗
PubMed2001

The effect of different doses of propofol on tracheal intubating conditions without muscle relaxant in children.

BACKGROUND AND OBJECTIVE: Situations may occur in anaesthetic practice where the use of neuromuscular blocking drugs is unsuitable or contraindicated. We investigated the use of propofol given 5 min after fentanyl to permit endotracheal intubation in children. METHODS: We studied the intubating conditions and cardiovascular parameters in 60 ASA I and II children. Intravenous midazolam (0.1 mg kg(-1)) was given as premedication 5 min before the induction of anaesthesia. The children received different doses of propofol (group I, 2.5 mg kg(-1); group II, 3.0 mg kg(-1); group III, 3.5 mg kg-1) preceded by fentanyl (3.0 microg kg(-1)) given 5 min earlier. No neuromuscular blocking agents were administered. The intubating conditions were assessed using a four-point scoring system based on the degree of difficulty of laryngoscopy, the position of vocal cords and the intensity of coughing. RESULTS: Tracheal intubating conditions were adequate in 20% of the patients in group I, in 75% of the patients in group II and in 80% of the patients in group III (P < 0.05 for group I vs. groups II and III). Haemodynamic changes were not significantly different between the groups. CONCLUSIONS: Propofol (3.0 mg kg(-1)) preceded by fentanyl (3.0 microg kg(-1)) was adequate for the induction of anaesthesia in children and provided adequate tracheal intubating conditions without significant haemodynamic changes. This method represents a useful alternative technique for tracheal intubation when neuromuscular blocking drugs are contraindicated or should be avoided.

Anesthetics, Intravenous↗
PubMed1998

Anaesthetic induction time for tracheal intubation using sevoflurane or halothane in children.

The current study was designed to determine the anaesthetic induction time required for tracheal intubation (TimeEI) with equipotent inspired concentrations of 5% sevoflurane and 2.5% halothane in oxygen. TimeEI that prevents 50% and 95% of patients from coughing and gross purposeful muscular movements after intubation was defined as TimeEI50 and TimeEI95, respectively. Thirty-six patients aged 1-7 years were enrolled in the study. Anaesthesia was induced via mask and when TimeEI attained a predetermined value, intubation was performed using an uncuffed tube. Each TimeEI at which tracheal intubation was attempted was predetermined according to the up-and-down method. When intubation was accomplished without gross purposeful muscular movements, it was considered a smooth intubation. Determination with this method revealed that TimeEI50 and TimeEI95 for the sevoflurane/halothane groups were 147/214 s and 194/255 s, respectively. In conclusion, it is possible to determine TimeEI using an inspired sevoflurane concentration of 5% and halothane 2.5% in oxygen. The technique with 5% sevoflurane seems more practical for paediatric anaesthesia induction in busy clinical situations.

Anesthetics, Inhalation↗
PubMed1998

Evaluation of intubating conditions with rocuronium and either propofol or etomidate for rapid sequence induction.

We have assessed the effect of two induction agents on tracheal intubating conditions after rocuronium 0.6 mg.kg-1 in unpremedicated patients undergoing simulated rapid sequence induction. Following pre-oxygenation, anaesthesia was induced with propofol up to 2.5 mg.kg-1 (n = 35) or etomidate 0.3 mg.kg-1 (n = 36), and further increments as required. After loss of verbal contact, cricoid pressure was applied and rocuronium was injected. Laryngoscopy was performed at 45 s and intubation attempted at 60 s after rocuronium had been given. Ninety-four per cent of patients in the propofol group had clinically acceptable (good or excellent) intubating conditions compared to only 75% in the etomidate group (p = 0.025). Owing to coughing, one patient in the etomidate group could not be intubated on the first attempt. A greater pressor response also followed intubation after induction with etomidate. We conclude that etomidate and rocuronium alone cannot be recommended for intubation at 60 s under rapid sequence induction conditions.

Adolescent↗
PubMed1999

Influence of induction of anaesthesia on intubating conditions one minute after rocuronium administration: comparison of ketamine and thiopentone.

We compared the effect of thiopentone and ketamine on intubating conditions after rocuronium 0.6 mg.kg-1 in two groups of patients (n = 16 each), aged 21-44 years, undergoing elective surgery. Premedication consisted of alprazolam 1 mg by mouth 1 h before surgery. All patients received midazolam 2 mg intravenously 2 min before intravenous administration of thiopentone 5 mg.kg-1 or ketamine 2.5 mg.kg-1. Muscle relaxation was provided by rocuronium 0.6 mg.kg-1. One minute after rocuronium administration, tracheal intubation was performed within 15 s by a skilled anaesthetist blinded to the treatment group assignment. Intubating conditions were graded as excellent, good, fair or poor on the basis of jaw relaxation, position of vocal cords and diaphragmatic response. Neuromuscular transmission was assessed at the adductor pollicis muscle using a TOF-GUARD monitor. Excellent and good intubating conditions were obtained in 100% of patients in the ketamine group and in 50% of patients in the thiopentone group (p = 0.002). Jaw relaxation was similar in both groups but vocal cord conditions were better and the diaphragmatic response less marked in the ketamine group compared with the thiopentone group (p = 0.002). The degree of neuromuscular block [% decrease of T1, mean (SD)] at the time of intubation was similar: 51.8 (25)% (ketamine group) and 54.3 (23.1)% (thiopentone group). We conclude that ketamine 2.5 mg.kg-1 provides better intubating conditions than thiopentone 5 mg.kg-1 1 min after administration of rocuronium 0.6 mg.kg-1.

Adult↗
PubMed2001

Comparison of the effects of intravenous alfentanil and esmolol on the cardiovascular response to double-lumen endobronchial intubation.

We compared the effect of alfentanil 10 microg.kg-1 and esmolol 1.5 mg.kg-1 on the cardiovascular responses to laryngoscopy and double-lumen endobronchial intubation in two groups of 20 ASA 2-3 patients undergoing pulmonary surgery, in a randomised double-blind study. Arterial pressure and heart rate decreased after induction of anaesthesia and increased after intubation in both groups (p < 0.05) but remained at or below baseline values, and changes were comparable in both groups. Plasma catecholamine concentrations decreased after induction of anaesthesia in both groups (p < 0.05). Epinephrine concentrations increased in the esmolol group after intubation (p < 0.05) but remained below baseline in the alfentanil group (p < 0.05). Norepinephrine concentrations increased significantly in both groups after intubation but were higher in the esmolol group (p < 0.05). Although both esmolol 1.5 mg.kg-1 and alfentanil 10 microg.kg-1 similarly attenuated the arterial pressure and heart rate response to endobronchial intubation, plasma catecholamine concentrations increased in the esmolol group to values greater than previously reported after tracheal intubation.

Adrenergic beta-Antagonists↗