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PubMed1986

[Reduction of circulatory reactions to intratracheal intubation--the effect of meptazinol].

A controlled, randomized, double blind assessment of the efficacy of meptazinol 3 mg kg-1 in reducing the circulatory responses to tracheal intubation was carried out in 20 ASA class I patients. After thiopentone 4 mg kg-1, meptazinol 3 mg kg-1 (ten patients) or saline (ten patients), and suxamethonium 1.5 mg kg-1 tracheal intubation was carried out, and the changes in pulse rate and arterial blood pressure compared between the groups and with control values. Significance was assessed at the 5% level (Student's t-test and paired t-test). Patients who received saline exhibited a rise in pulse rate, significant 1 and 2 min after intubation, and a significant rise in mean arterial pressure for 5 min after intubation. Patients who received meptazinol exhibited no significant rise in pulse rate, but a significant fall in pulse rate occurred from 5 min onwards. Mean arterial pressure rose significantly for 4 min after intubation but the rise was significantly less than that seen in the saline group. Suppression of spontaneous ventilation or movement in 50% of the group lasted for 7 min and 9 min after induction of anaesthesia in the control group and meptazinol treated group respectively. Meptazinol 3 mg kg-1 modifies the circulatory responses to tracheal intubation, preventing the tachycardia and reducing the hypertension, and causes a short delay in the onset of spontaneous respiration or movement.

Adult↗
PubMed1984

A suitable substitute for 4% cocaine before blind nasotracheal intubation: 3% lidocaine-0.25% phenylephrine nasal spray.

To assess the efficacy of potential substitutes for cocaine as a topical anesthetic before nasal intubation, the authors performed a double-blind study comparing the hemodynamic effects of blind nasotracheal intubation in 75 patients receiving one of three nasal sprays: 4% cocaine (C), a mixture of 3% lidocaine in 0.25% phenylephrine (L-P), and 0.25% phenylephrine alone (P). Three minutes after 0.5 ml of one of the solutions was sprayed into each nostril, anesthesia and paralysis were induced with thiopental (5 mg/kg) followed by succinylcholine (1 mg/kg); immediately after induction, mean arterial pressure (MAP) and heart rate (HR) were recorded. After blind nasotracheal intubation was accomplished, MAP and HR were recorded for 5 min while anesthesia was maintained with 70% N2O in O2. In patients receiving L-P, mean MAP during the 5 min after intubation decreased 2.3 +/- 2.2 mm Hg (mean +/- SEM); this was significantly different from the increase of 6.2 +/- 1.7 and 8.5 +/- 2.0 mm Hg in MAP after intubation of patients receiving C and P, respectively (P less than 0.005). Although mean HR decreased during the 5 min after intubation in all groups, this decrease was significantly greater (9.6 +/- 1.4 beats/min) in patients receiving L-P than in those receiving C (3.1 +/- 1.6 beats/min) or P (0.1 +/- 1.7 beats/min) (P less than 0.005). Changes in HR and MAP were similar in patients receiving C and P. There was no significant difference in the incidence or severity of epistaxis among the three groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia, Local↗
PubMed1983

[Difficult intubation in Pierre-Robin children, a new method: the retromolar route].

The Pierre-Robin-children show a micro- and retrognathia of the lower jaw with the consequence of dorsal and cranial displacement of the basioglossal. It is well known that this can lead to serious difficulties in endotracheal intubation. As far as we know intubation via retromolar route has never been described at length. It has never been mentioned in the case of Pierre-Robin-children as an alternative to the unsuccessful classical method. This paper describes the problems intubation in these children and deals with the corresponding prophylactic measures of most importance before intubating. It describes in detail the technique of homolateral retromolar intubation - axis straight and distance shorter - and gives helpful guidelines that lead to a straight intubation axis in spite of anatomical abnormalities: pressure on the cricoid, pushing the larynx to the side, hyperextending, adjusting the degree of flexion, pushing or rotating the head to the other side or appropriate bending the end of the tube with a stylet.

Anesthesiology↗
PubMed1983

[Intubation injuries of the larynx and trachea--etiology, forms, therapy and endoscopic control for prevention].

Severe intubation injuries of the larynx and trachea are usually caused by prolonged intubation, particularly if the primary intubation was difficult. Due to the persisting, time-consuming therapeutic problems, tracheal and laryngeal stenoses are among the most-feared sequelae of long-term intubation. Therefore many laryngologists reject endotracheal intubation for prolonged respiratory support and recommend an early tracheostomy. Advances in respiration techniques and in the development of tissue-compatible tubes with low pressure cuffs permit, in our opinion, prolonged intubation if this is controlled by repeated endoscopic examination to recognize lesions at an early, still reversible, stage.

Anesthesiology↗
PubMed1983

[Clinical studies on the effect of various drugs on cardiocirculatory behavior during the induction phase of intubation anesthesia].

In a randomized study on 150 patients (ASA 1) undergoing induction of anaesthesia, the effects of Fentanyl (0.1 mg), the combination of Fentanyl (0.1 mg) and Droperidol (5 mg) (Innovar, Thalamonal) and Atropine (0.01 mg/kg b.w.) alone on cardiocirculatory parameters were studied. Induction and intubation were carried out with Thiopentone and Succinylcholine. All patients were aged between 18 and 50 years. In addition to continuous ECG recording of standard leads I-III, blood pressure measurements (Riva-Rocci), capillary blood gases and serum potassium were estimated at regular intervals. Prior to intubation Atropine caused arrhythmias in 10% and during intubation in 40%, half of which occurred repeatedly. In comparison, the control group showed arrhythmias in only 28% at intubation time. The median value of the rate pressure products rose before intubation time to levels of almost 20,000 units whereas the control group reached the same high product only during intubation. Cardiac rhythm proved most stable using Fentanyl, the systolic, diastolic and mean blood pressure changes were significantly lower than in those groups without an additional analgesic. With Fentanyl and Atropine the increase of all haemodynamic parameters was less pronounced than in the control group given Atropine only. Comparison of the Fentanyl groups showed only a significantly lower arterial mean pressure when Atropine was given, the other parameters were similar. Using Innovar alone, 4 cases of severe and 1 of mild rhythm disturbances appeared, while with Innovar plus Atropine only 2 cases of mild and 1 of repeated extrasystoles occurred. In the Atropine-free groups, the addition of Innovar only caused a lesser increase in the heart rate, while the remaining parameters did not differ.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1982

[A scanning electron microscopic study of the tracheal mucosa damage after long-term translaryngeal intubation (author's transl)].

Tracheal mucosa tissue obtained by tracheotomy from 23 patients who had been intubated between 4 to 20 days was examined in the scanning electron microscope. In spite of different intubation periods almost identical tissue defects with extensive areas of epithelial degeneration reaching as far as the basal lamina were found. In contrast, patients with short-term intubation, i.e. during intubation anaesthesia, showed no mucosal changes in the areas studied. The expected damage in the lower trachea caused by the cuff of the intubation tube is described and the dangers of prolonged intubation are discussed.

Female↗
PubMed1982

[Pyeloureteral plastic operation with or without ureteral intubation].

Application of ureteral splint in corrective operations of the pyeloureteral segment represents still a problem to be discussed, arising diverse opinions regarding its effectiveness. A number of authors consider ureteral intubation as a necessary condition in plastic surgery of pyelone and ureter. Another group of authors reject it and consider it to be unnecessary and even dangerous, due to the possibility of it to cause additional infection and unnecessary traumas due to the splint. In this paper the author presents the postoperative early and late complications, as well as the final results of 34 corrective operations of the pyeloureteral segment, carried out with intubation, and 34 other operations without application of ureter intubation. By comparison of the obtained results it has been concluded that: (1) urinary fistula as an early complication is also possible in the case of operation with splint: (2) postoperative infection is slightly smaller and preoperational existing infection rapidly decreases in the case of operations without splint: (3) postoperational calculosis and stenosis at the place of operation were observed in higher percentage in operations with splint: (4) postoperational hospitalization period was longer for patients operated with splint compared to those operated without splint: and (5) the percentage of successful operations, regardless the stage of pyelocalics dilatations, was higher for operations without intubation of ureter. Based upon these information and the X2 test results author of this paper considers pyeloureteral intubation in pyeloureteral plastics unnecessary, except in extraordinary cases, such as secondary correction of pyeloureteral segment, heavy peripyeloureteritis, narrow and fibrose ureter, multiple and other stenosis, uncertain anastomosis and danger of necrosis at the edges of anastomose where intubation is still required.

Humans↗
PubMed1995

Evaluation of different induction techniques for tracheal intubation.

Conditions for tracheal intubation and the hemodynamic changes associated with different intravenous anesthetic induction techniques were studied in seventy-two ASA I patients randomly assigned to one of six groups (G). Anesthesia was induced with I.V. propofol 2.5 in G 1, 3, 5 or with thiopental 5 mg/kg (G2, 4, 6). In G 1-4, the standard sequence of administering muscle relaxant was used. G 1 and 2 received succinylcholine 1 mg/kg after induction, and one min later laryngoscopy and orotracheal intubation attempted. G3 and 4 received 0.5 mg/kg atracurium and intubation attempted 3 min later. In G 5 and G 6 the "timing principle" was used; atracurium 0.5 mg/kg was given first followed by propofol and thiopental, and one minute after the induction agent intubation attempted. There was no statistically significant difference in the intubating conditions between the six groups of patients studied. Similar to succinylcholine timing technique with atracurium and propofol or thiopental reliably provided excellent or good intubating conditions in two minutes.

Adolescent↗
PubMed1995

[Light stylet--an alternative when intubation is difficult].

Using a light stylet, it is possible to perform oro- and nasotracheal intubation without the need of visualizing the larynx or extending the patient's neck. This makes the light stylet a valuable alternative when conventional intubation with a laryngoscope is difficult or impossible. Intubation with the light stylet is easy to learn, is relatively atraumatic, has an acceptable success rate and is fast enough to compete with laryngoscopic intubation. The equipment is inexpensive. We describe successful intubation with the light stylet in four patients. Two had unstable neck fractures, one had previously been difficult to intubate, and one had trismus.

Aged↗
PubMed1995

[Difficult intubation: a prospective evaluation of the Mallampati and Wilson tests].

This prospective study aimed to evaluate in 849 patients the Mallampati and Wilson scores for predicting a difficult intubation. All scheduled patients were included. Induction and tracheal intubation were carried out as usual. Intubation was deemed to have been difficult if any special procedure had been required (external compression excepted); difficult laryngoscopy was defined as grade 3 or 4 on the Cormack-Lehane scale. In accordance with these criteria, less than 36% of patients with difficult intubation or laryngoscopy were detected, with a high false positive rate (more than 75%) but a good negative predictive value (more than 90%). This study was not concordant with the results of the original studies. However, data from literature show a great variability of results between studies. Many factors may contribute to this variability: differences between samples of patients, evaluation of Mallampati or Wilson scale, protocols of induction and intubation or characterization of difficult intubation. This study suggests a poor reliability of the two tests.

Humans↗
PubMed1994

[Complications and late sequelae after nasotracheal intubation].

A total of 379 patients admitted to the Intensive Care Unit (ICU) for mechanical ventilation were prospectively investigated for lesions of the nose, nasal cavity, ears and larynx during and after nasotracheal intubation. One to two years later, the surviving patients were questioned to investigate late persisting sequelae. During intubation and up to five days following extubation, inflammatory changes and ulceration of the nostrils or nasal septum were found in respectively 76 (20%) and 110 (29%) patients. There were bleedings from the nasal cavity in 67 (19%) and fractures of the conchae in 40 patients (11%). Hoarseness was noted in 135 patients (42%). Inflammatory changes and ulcerations of the nostril and nasal septum were correlated to the duration of intubation. Among the 281 patients included in the follow-up study, 100 (35%) had symptoms from the nose and nasal cavity. Sixty-five (24%) had symptoms related to the ears, 56 (20%) to the maxillary sinus, 81 (29%) to the voice and 90 (32%) to the throat. Increasing duration of intubation was found to be correlated to persisting symptoms from the larynx. Former ulcerations of the nose were associated with a tendency toward nasal bleeding. To avoid as many complications as possible from the nose and nasal cavity, we recommend orotracheal intubation. As late sequelae from the larynx increase with the duration of intubation, perhaps tracheostomy should be performed earlier than is general practice today, but that has to be proven in forthcoming studies.

Adolescent↗
PubMed1994

Rapid-sequence orotracheal intubation with rocuronium: a randomized double-blind comparison with suxamethonium--preliminary communication.

Eighty ASA I-III patients were randomly assigned to four groups. Group I patients received rocuronium 0.6 mg kg-1 immediately prior to thiopentone, while patients in group II received the same dose immediately after the induction agent. In groups III and IV a priming dose of rocuronium 0.04 mg kg-1 was administered prior to induction. Group III patients received rocuronium immediately prior to thiopentone. In group IV, suxamethonium 1.5 mg kg-1 was administered immediately after thiopentone. Intubation conditions were scored by a blinded investigator. An intubation time of > 60 s was defined as a failure. All patients could be intubated within 60 s. Priming with rocuronium did not improve intubation conditions. Total intubation scores > 6 occurred significantly more often in group II (P < 0.01 vs. all other groups). A single bolus dose of rocuronium 0.6 mg kg-1 (2 x ED95) administered immediately prior to thiopentone 6 mg kg-1 offers the same intubation conditions as suxamethonium 1.5 mg kg-1.

Adult↗
PubMed1994

The safety of emergency neuromuscular blockade and orotracheal intubation in the acutely injured trauma patient.

BACKGROUND: This study was done to determine the safety and success of orotracheal intubation with planned neuromuscular blockade in patients who are severely injured. The study was performed at Carle Foundation Hospital, designated Level I trauma center located in east central Illinois. STUDY DESIGN: A retrospective review of the trauma registry and medical records of all patients requiring emergency airway control from September 1, 1987 to September 30, 1991 was performed. Two hundred twenty-nine patients who were critically injured were reviewed, the mean injury severity score was 29 (range of 3 to 75), the mean revised trauma score was 9 (range of 3 to 12), the mean Glasgow Coma Scale was 9 (range of 3 to 15), and the mean age was 31 years (range of one to 94 years). RESULTS: Indications for intubation included hemodynamic instability or altered level of consciousness (66.4 percent), or both, combative or uncooperative behavior (33.2 percent), and need to secure airway for transport (0.4 percent). Two hundred twenty-three (97.4 percent) patients were successfully intubated. Six (2.6 percent) patients required cricothyroidotomy and one (0.4 percent) patient was aspirated during intubation. Eight (3.5 percent) patients had cervical spine injuries but had no complications from orotracheal intubation. In the combative group, 32 (42 percent) patients had significant head injuries and 17 (22 percent) had other potentially life-threatening injuries. CONCLUSIONS: Orotracheal intubation with planned neuromuscular blockade and in-line cervical traction is a safe, effective method for airway control in patients who are severely injured. This technique is also indicated to expedite therapy in combative, uncooperative patients because of the high incidence of significant life-threatening injuries to the brain and other organs.

Adolescent↗
PubMedDate not supplied

Determination of oral temperature accuracy in adult critical care patients who are orally intubated.

OBJECTIVE: To determine whether sublingual temperatures are accurate in adult critical care patients with an oral endotracheal tube in place. DESIGN: Repeated measures quasi-experimental. SETTING: University-affiliated tertiary care center in Western Canada. SUBJECTS: Convenience sample of 33 adults (24 men, 9 women) with a mean age of 63 years undergoing scheduled open heart surgery and serving as their own controls. PROCEDURES: Oral, rectal, and ambient temperatures were measured twice at a one-half hour interval the evening before surgery when subjects were not intubated and three times over an 8-hour period after surgery and after intubation. Pulmonary artery (core) temperature served as a reference and was measured along with endotracheal tube content temperature of the intubated subjects. RESULTS: Descriptive and inferential statistics were used to analyze the data. Results of the study supported the accuracy of oral temperatures in critically ill patients who were intubated. Mean oral temperature measurements were neither statistically (p > 0.05) nor clinically (+/- 0.14 degrees C) significantly different from mean pulmonary artery temperature at any of the three measurement times after intubation and a mean difference of 0.01 degrees C (0.17 SD) was noted. This was not significantly affected by endotracheal tube content temperature (p > 0.05). Significantly high correlations between oral and pulmonary artery (r = 0.92 to 0.96) temperature measurements also were revealed. A significant difference (p = 0.0001) in rectal minus oral temperature discrepancy between subjects with and without an endotracheal tube was noted. CONCLUSION: Sublingual and pulmonary artery temperature measurements of adult critical care patients who were orally intubated consistently showed close agreement during a thermally dynamic 8-hour period after open-heart surgery.

Adult↗
PubMed1993

Rapid sequence induction and tracheal intubation with vecuronium--with or without a priming dose.

The purpose of this study was to determine whether prior administration of a small, sub-paralytic dose of nondepolarizing muscle relaxant, vecuronium, would have a better intubating condition than a single bolus dose when vecuronium was used as the muscle relaxant during rapid sequence induction and tracheal intubation. Six groups of 15 patients each (ASA class I or II) were involved in this study. Anesthesia was induced with fentanyl 2-3 micrograms/kg and thiopental 4-5 mg/kg. In group 1, 2 and 3, the patients were given the same priming dose of 0.1 mg/kg. Four min later, different doses of vecuronium were given to each group: 0.09 mg/kg (Gp1), 0.14 mg/kg (Gp2), and 0.19 mg/kg (Gp3). In group 4, 5 and 6, no priming vecuronium was given and the intubating doses given to each group were as follow: 0.1 mg/kg (Gp4), 0.15 mg/kg (Gp5) and 0.2 mg/kg (Gp6). At the end of a 60 sec, the percentage of patient with excellent intubating condition were 46.6%, 66.6%, 86.6%, 20%, 40% and 80% respectively for group 1, 2, 3, 4, 5 and 6 respectively. The percentage with good intubating condition were 46.6%, 33.4%, 13.4%, 46.6%, 53.2%, and 20% for group 1, 2, 3, 4, 5 and 6 respectively. The percentage of poor intubating condition were 6.8% in group 1, 33.4% in group 4, 6.8% in group 5 and 0% in group 2, 3, 6. All patients receiving a priming dose could sustain head lift for 5 sec and did not complain any respiratory discomfort 3 min after the priming dose.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Predicting difficult laryngoscopy for tracheal intubation: an approach to airway assessment.

Tracheal intubation by direct laryngoscopy is an essential skill for physicians working in the operating room, emergency room or intensive care unit settings. While tracheal intubation can usually be accomplished with ease by direct laryngoscopy, it is sometimes difficult or impossible because of coexisting disease or abnormal physical features. When recognized before attempts at tracheal intubation, virtually all difficult airways can be secured by the selected use of specialized tracheal intubation techniques, although many of these methods require special training, experience, assistance and equipment. When a difficult airway is unrecognized before attempts at intubation the results can be catastrophic because the personnel and equipment necessary for utilizing the specialized tracheal intubation techniques may not be immediately available and the patient's spontaneous respiratory efforts may have been eliminated by anesthetics or muscle relaxants. Thus, identifying patients who are likely to harbor an airway that cannot reliably be secured by simple direct laryngoscopy is an important skill for all acute or critical care physicians. There is an extensive research data base describing historical information, physical examination findings and radiographic features that are associated with the difficult airway. Reviewed collectively, one of the most important underlying concepts suggested by this body of research literature is that the difficult airway is a product of many anatomic and pathologic variables. A surprisingly wide variety of historical, physical examination and radiographic features associated with difficult direct laryngoscopy have been described. A rational approach to airway assessment, therefore, naturally includes a detailed history, a careful physical examination and inspection of relevant x-rays whenever time permits. As outlined in Table 5, there are specific questions to address that may warn the physician about possible airway difficulty. A number of airway assessment schemes based on physical examination findings have been proposed and tested. These schemes vary in their complexity and their clinical convenience. The simpler schemes fail to address the multifactorial nature of the problem, while the more complex systems are clinically impractical. Schemes combining the distance of the thyromental space and the visibility of the oropharyngeal structures, such as that proposed by Frerk, are perhaps the most practical and reliable of the methods proposed to date. Clearly, no one scheme is ideal. At present, preintubation airway evaluation remains a poorly quantified gestalt estimate of the chances for difficulty based on a complex juxtaposition of historical information and physical findings.(ABSTRACT TRUNCATED AT 400 WORDS)

Humans↗
PubMedDate not supplied

[Tracheotomy or intubation, alternatives in the treatment of respiratory insufficiency during infectious diseases in childhood].

Tracheostomy and endotracheal intubation are complementary methods in the management of acute respiratory failure (ARF). One hundred patients (n = 100) were treated at the Intensive Care Unit for Infants and Children, University Hospital of Infectious Diseases "Dr. Fran Mihaljević" Zagreb, from 1987 to 1991. They mostly suffered from severe infectious diseases in the course of which ARF developed. Endotracheal intubation was performed in 95/100 patients, while tracheostomy was done in 11/100 patients. In the majority of subjects the course of the disease required mechanical ventilation (96%). Complications connected with tracheostomy or intubation developed in 49% of the intubated patients and in 100% of the patients with tracheostomy. 17% mortality rate among our patients was neither the result of tracheostomy or intubation nor of the respiratory support but of the adverse course of the disease and consecutive complications characteristic for newborns and infants. Most of our patients developed ARF as a result of inefficient gas transfer, particularly those suffering from central nervous system infection. Nasotracheal intubation appeared to be the method of choice in the treatment of ARF in infancy and childhood, while tracheostomy is only the supplement of substitute when particular indications are present. In most of our patients (83%) those methods contributed to the positive outcome of ARF treatment.

Acute Disease↗
PubMed1993

[Fiberoptic intubation in patients with rheumatic diseases].

In a retrospective evaluation of 3,301 cases of intubation anaesthesia in patients with rheumatic diseases, 165 endotracheal fiberoptic intubations were analyzed. These represent 5% of the overall intubations. The practical approach to fiberoptic endotracheal intubation on sleeping, spontaneously breathing patients is described, and special aspects and complications are emphasized. For patients who cannot be intubated "conventionally" the method of fiberoptic endotracheal intubation represents a safe and harmless alternative with a high rate of success and requiring not more than a reasonable amount of time.

Anesthesia, General↗