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PubMedDate not supplied

[Complications after prolonged intubation in patients with head trauma].

In this study, 72 patients with head injury, hospitalized in the Intensive Care Unit (ICU) were analyzed. All of them required prolonged intubation. Every patient was initially intubated. Thirty (41.7%) of them underwent tracheotomy and 56 (77.8%) demanded mechanical ventilation. The patients were divided into three groups with respect to their treatment: 1. Patients intubated up to five days--27 (37.5%); 2. Patients intubated more than five days--45 (62.5%); 3. Tracheotomized patients--30 (41.7%). Tracheotomy was done between the fifth and the twenty-sixth day following the intubation. Laryngotracheal complications occurred in 47% of the patients from the second group and 23% from the third group. The patients in the first group developed no complications. Pulmonary infections prevailed in the second group. We conclude that early postinjury tracheotomy is associated with a lesser incidence of complications than prolonged intubation in neurosurgical patients.

Adolescent↗
PubMed1996

[Sore throat after tracheal intubation].

This study was performed to determine the incidence of sore throat 24 h after tracheal intubation in 1,268 patients ASA I or II, who had undergone elective surgery. A data form was completed. Nosing were age, sex, type of surgery, anaesthetic drug, muscle relaxant, number of intubation attempts, duration of intubation, and presence of sore throat. The incidence of sore throat was 15.06%. It was significantly higher in females than in males (19.29% vs 11.66%; P < 0.01). There was a significant difference between those patients who received fentanyl and those who received pethidine (P < 0.05). There was also a greater incidence after thyroid surgery (P < 0.01). There was no correlation between sore throat and variables such as age, muscle relaxant, narcotic drug, number of intubation attempts, or duration of intubation. Lidocaine jelly and the appropriate analgesic drug reduce the incidence of sore throat following tracheal intubation.

Adolescent↗
PubMed1996

A comparison of lidocaine, fentanyl, and esmolol for attenuation of cardiovascular response to laryngoscopy and tracheal intubation.

BACKGROUND: Laryngoscopy and tracheal intubation are known to increase sympathetic activity that may be detrimental to patients with pre-existing ischemic or hypertensive heart diseases. In order to alter the hyperdynamic consequences resulting from intubation during induction of general anesthesia, we chose esmolol, an ultra-short acting cardioselective beta-adrenergic blocker, to attenuate the cardiovascular responses during tracheal intubation in patients undergoing elective surgery. The efficacy of esmolol in this regard was carefully evaluated. METHODS: Eighty ASA physical status class I or II patients undergoing elective, non-cardiac procedures were included in a randomized, single-blinded study consisting of 4 groups with each group receiving a designated drug: group A received normal saline as control, while group B, group C and group D received lidocaine 2 mg/kg, fentanyl 3 micrograms/kg and esmolol 2 mg/kg, respectively. Monitoring included EKG, pulse oximetry, capnometry and arterial pressure. All patients were premedicated with diazepam 0.1 mg/kg 30 min before induction of general anesthesia. Each designated drug was given upon induction of anesthesia (time zero). Anesthesia was induced with thiopental 5 mg/kg and succinylcholine 1.5 mg/kg, and maintained with N2O, 1% isoflurane in 50% O2 and vecuronium. Intubation was carried out 3 min after the designated drug was given. Heart rate (HR) and systolic arterial blood pressure (SBP) were obtained every min for 10 min after induction. Either chi-square test or analysis of variances (ANOVA) was used for statistical comparison. A p value less than 0.05 was considered statistically significant. RESULTS: There was no difference in the demographic data among the four groups. After intubation, the incidence of tachycardia (HR > 100/min) was found in 3 of 20 (15%) patients in esmolol group, significantly lower than 17 of 20 (85%) patients in the control group, 15 of 20 (75%) patients in lidocaine group, and 11 of 20 (55%) patients in fentanyl group, respectively (p < 0.05). The incidence of hypertension (SBP > 180 mmHg) was found in 4 of 20 (20%) patients in esmolol group, significantly lower than 16 of 20 (80%) patients in control group and 14 of 20 (70%) patients in lidocaine group, respectively (p < 0.05), but not in 8 of 20 (40%) patients in fentanyl group. Besides, the incidence of hypertension in fentanyl group (40%) was significantly lower than control group (80%; p < 0.05), but not in lidocaine group (70%). CONCLUSIONS: Results of this study showed that only esmolol could reliably offer protection against the increase in both HR and SBP, low dose of fentanyl (3 micrograms/kg) prevented hypertension but not tachycardia, and 2 mg/kg lidocaine had no effect to blunt adverse hemodynamic responses during laryngoscopy and tracheal intubation.

Adrenergic beta-Antagonists↗
PubMed1996

The comparative potency of intravenous nicardipine and verapamil on the cardiovascular response to tracheal intubation.

BACKGROUND: Two different types of calcium channel blockers (namely nicardipine and verapamil) have been used widely in clinical practice. However, no clinical studies have previously been performed to ascertain the relative potency of intravenous verapamil and nicardipine in the attenuation of cardiovascular response to tracheal intubation. METHODS: We assessed the optimal dose and relative potency of verapamil and nicardipine in the attenuation of hemodynamic response to tracheal intubation in 135 healthy patients. Control group (Group D received normal saline i.v. Patients in Groups II-V received nicardipine 0.005, 0.01, 0.03 and 0.06 mg/kg i.v., respectively. Patients in Groups VI-IX received verapamil 0.03, 0.05, 0.1 and 0.15 mg/kg i.v., respectively. Anaesthesia was induced with propofol (2.5 mg/kg) and muscle relaxation was facilitated by vecuronium (0.2 mg/kg, i.v.). One min after induction, tracheal intubation was performed. Mean arterial pressure (MAP) was measured at 1 min interval from 10 min before induction to 15 min after induction. RESULTS: The ED50 with 95% confidence interval of nicardipine and verapamil for the attenuation of 50% mean arterial pressure (MAP) increase after tracheal intubation were 14.55 micrograms/kg (8.25-25.67) and 75.4 micrograms/kg (58.7-96.95), respectively. The ED50 with 95% confidence interval of verapamil for the reduction of the 50% heart rate (HR) increase post tracheal intubation was 57.4 micrograms/kg (18-182.2). No differences were found in the frequency of perioperative arrhythmia, post-operative hypotension, postoperative emesis, dizziness, muscle weakness and muscle soreness within two hours following surgery, when compared control with experimental groups (p > 0.05). CONCLUSIONS: These results suggest that verapamil and nicardipine attenuate the hypertensive response to tracheal intubation without significant adverse effects in healthy patients. The dose ratio (ED50 nicardipine and ED50 verapamil for MAP) with 95% confidence interval was revealed to be 2.3 (1.82-7.41).

Adult↗
PubMedDate not supplied

[Intubation granulomas of the lacrimal ducts in patients with silicone implants].

The results of 315 endonasal operations on the lacrimal duct with long intubation are analyzed. The most incident complication of long intubation of the lacrimal duct is formation of intubation granulomas, which are most often localized in the inferior lacrimal canaliculus; their etiology is sometimes allergic--they form as a response of adjacent tissues to the material of the intubation tube, and the findings of our recent histological study prove it. The diagnosis of intubation granulomas is easy in the majority of cases. The treatment consists in removal and obligatory adequate total and local antiallergic therapy decelerating the growth and relapses of granulomas. After removal of the intubation tube the growth of granulations ceases and a fine cicatrix forms.

Dacryocystorhinostomy↗
PubMed2001

The intubating laryngeal mask airway in severe ankylosing spondylitis.

PURPOSE: To evaluate the use of inhalational induction followed by intubation through the intubating laryngeal mask (ILM) for patients with severe ankylosing spondylitis undergoing elective surgery who prefer airway management under anesthesia. METHODS: Nine patients undergoing a total of 11 procedures were enrolled in the study. Fentanyl 2 microg*kg(-1), midazolam 0.035 mg*kg(-1) and sevoflurane in oxygen 100% were used for induction. The ILM was inserted when the end-tidal sevoflurane concentration reached 3%. After an effective airway was established, atracurium 0.5 mg*kg(-1) was given. A polyvinyl chloride tube in the reversed position using a blind technique was used to intubate the trachea. RESULTS: The ILM provided an effective airway on 11/11 occasions at the first attempt. Intubation was successful at the first attempt on 7/11 occasions, at the second attempt on 2/11 and at the third attempt in 1/11. Intubation failed in one patient. The mean (range) minimal oxygen saturation was 99.4% (97-100%). There were no problems with ILM removal. CONCLUSION: Inhalational induction followed by ILM insertion and blind intubation is a reasonable option in patients with severe ankylosing spondylitis undergoing elective surgery who prefer airway management under anesthesia.

Adult↗
PubMed2000

[Remifentanil-propofol for bronchoscopic fiber optic intubation under capnographic control].

UNLABELLED: We report a case of a 41-years-old woman presenting for revision of a secondary reconstructive procedure using the modified Tagliacozzi upper arm flap after subtotal maxillectomy. Because of the pedicle flap the upper arm was fixed in a pre-facial position and so fiberoptic intubation was required. After routine pre-anesthetic preparations and topical anesthesia of the nares and nasopharynx a CO2 measuring catheter as well as a O2 catheter to administer 100% oxygen was inserted deeply into the left naris. At that time, a continuous infusion of 0.05 microgram/kg/min remifentanil and 2 mg/kg/h propofol was started. After 4 min, fiberoptic intubation was performed through the right nare without any technical difficulties in conscious sedation of the patient. During the entire fiberoptic intubation SaO2 was constant at 100% and capnogram tracings with etCO2 values ranging from 31 to 33 mmHg were displayed on the monitor. At the end of this second surgical procedure with fixed pre-facial upper arm position the patient was uneventfully extubated fully awake. For the time period of fiberoptic intubation the patient had complete amnesia. CONCLUSION: With the use of nasal capnography and capnometry in addition to simultaneous O2 administration during fiberoptic intubation under extreme conditions excellent analgosedation with propofol and remifentanil could be provided without compromising our patients' safety. The presented CO2 measuring and O2 administering device represents a simple and cheap expansion of standard anesthetic monitoring during fiberoptic intubation.

Adult↗
PubMed2001

The combination of a fiberoptic stylet and a McCoy laryngoscope facilitates tracheal intubation in difficult airway cases.

PURPOSE: Fiberoptic stylets are considered useful for difficult airway management. In the present study, we assessed the usefulness of a fiberoptic stylet when the stylet was used with a Macintosh or a McCoy laryngoscope. METHODS: Twenty-four patients, whose airways were graded as Cormack grade III, were studied. We compared the times required for tracheal intubation when the fiberoptic stylet was used with a Macintosh direct laryngoscope and when it was used with a McCoy laryngoscope. Cormack grade III was subdivided into IIIa (with distance between the epiglottis and the posterior wall of the pharynx) and IIIb (with no distance between the epiglottis and the posterior wall of the pharynx), according to the view of the vocal cords by the laryngoscope. RESULTS: The intubation time in grade IIIb patients, who were intubated by the concurrent use of the fiberoptic stylet and the McCoy laryngoscope (28 +/- 4 s), was not significantly different from that in grade IIIa patients (28 +/- 10 s). The intubation time in grade IIIb patients, who were intubated by the concurrent use of the fiberoptic stylet and the Macintosh laryngoscope (52 +/- 8 s), was significantly longer than that in grades IIIa (28 +/- 10 s; P < 0.01) or IIIb with the McCoy laryngoscope (28 +/- 4 s; P < 0.01). CONCLUSION: The combination of a new handy fiberoptic stylet and a McCoy laryngoscope facilitated tracheal intubation of patients whose airway had no distance between the epiglottis and the posterior wall of the pharynx in laryngoscopic vocal cord view.

Journal Article↗
PubMed2003

Submental Orotracheal Intubation: An Alternative to Tracheotomy in Transfacial Cranial Base Surgery.

This retrospective study evaluated the safety and efficacy of submental intubation not only for trauma treatment but also for oncological cranial base surgery. The medical records of 24 patients who underwent submental intubation from 1996 to 2002 were reviewed. There were 6 procedures for craniofacial trauma, 12 transmaxillary approaches to the clivus for clivus chordomas, and 6 transmaxillary approaches to the cranial base for chondrosarcomas. Time required for intubation, accidental extubation, postoperative complications, and the healing of intraoral and submental scars were evaluated. The submental orotracheal intubation was completed successfully in all patients. No accidental extubations or tube injuries occurred. The mean time required for intubation was 5 minutes. The only complication was one case of superficial infection of the submental wound. The intraoral and submental accesses healed with minimal scarring in all patients. Submental orotracheal intubation is a useful and safe technique for airway management of craniomaxillofacial traumas and during transfacial approaches to the cranial base. It avoids the complications associated with tracheostomy. It also permits considerable downward retraction of the maxilla after a Le Fort I osteotomy and is associated with good clival exposure. Furthermore, it does not interfere with maxillomandibular fixation at the end of the surgery.

Journal Article↗
PubMed1999

The intubating laryngeal mask airway compared with direct laryngoscopy.

We have compared the ability of naïve intubators to intubate the trachea using a laryngoscope and an intubating laryngeal mask airway (ILMA) after receiving basic training, in a randomized, prospective, crossover study in 60 patients. Ventilation of the lungs via the ILMA was also compared with ventilation with a face mask. There was no significant difference in successful intubation between the techniques (38 of 89 with the ILMA and 33 of 93 with direct laryngoscopy; ns). In patients in whom participants failed in their intubation attempts with the ILMA, investigators achieved success in 89% (16 of 18). Satisfactory ventilation was more common with the ILMA (50 of 51) than with the face mask (43 of 60) (P = 0.0001). A total of 98% (89 of 91) of ILMA were inserted successfully, with a mean insertion time of 19.6 s, and 78% (69/89) of these insertions were achieved in less than 26 s. The ILMA may be useful for emergency oxygenation and ventilation, but these results do not support its use for intubation by those not trained in advanced airway management and ILMA use.

Adult↗
PubMed2004

Unanticipated difficult intubation.

PURPOSE OF REVIEW: While there are many predictors of difficult laryngoscopic intubation, they all have a low positive predictive value. Therefore, unanticipated difficult laryngoscopic intubation will likely occur in our day-to-day practice. This review discusses recent developments in alternative airway devices and techniques in addressing these difficulties. RECENT FINDINGS: There is emerging evidence to suggest that new supraglottic devices are useful rescue appliances, particularly for unanticipated difficulties in laryngoscopic intubation. Other new intubating devices, including the Glidescope, may also play an important role in the management of patients with unanticipated difficult or failed laryngoscopic intubation. SUMMARY: The evidence to date does not always arm us with the ability to predict a difficult laryngoscopic intubation. Therefore, it is imperative that we equip ourselves with devices and techniques that will help us to maintain effective oxygenation and ventilation in a safe manner in the face of such failure.

Journal Article↗
PubMed1988

[Onset of the effect and intubation conditions following atracurium, verocuronium and suxamethonium].

1. The onset of neuromuscular blockade following i.v. injection of atracurium 0.3, 0.4, or 0.5 mg/kg; vecuronium 0.08 or 0.1 mg/kg; and succinylcholine 1.0 mg/kg was studied in 205 adult patients during induction of anesthesia by means of the compound action potential (EMG) of the hypothenar muscle, which was indirectly stimulated via the ulnar nerve above the wrist, using the Datex Relaxograph. At the same time, the intubation conditions at 0.5, 1, 2, or 3 min after injection were assessed using a scoring system (Crul 1983) related to ease of laryngoscopy, movement of vocal cords and coughing, and reflex movements of the extremities. 2. Neuromuscular blockade and intubation conditions 2 min after administration of atracurium 0.3 mg/kg were 60 +/- 10% and 8.7 +/- 0.3; after 0.4 mg/kg 74 +/- 4% and 10.3 +/- 0.3; and after 0.5 mg/kg 86 +/- 5% and 11.8 +/- 0.2. After 0.08 mg/kg vecuronium 76 +/- 3% and 7.4 +/- 0.5 were recorded and after 0.1 mg/kg 85 +/- 6% and 10.5 +/- 0.4. Motor blockade 1 min after succinylcholine was 98 +/- 2% and intubation conditions scored 11.3 +/- 0.3. Relating intubation conditions to neuromuscular blockade yielded a close correlation and surprisingly good or very good intubation conditions (score more than 10) at a motor blockade of 80% (resp. 20% transmission). 3. Although succinylcholine is still the muscle relaxant with the most rapid onset of action, the new drug atracurium seems to satisfactorily facilitate tracheal intubation within an acceptably short time interval of 2 min after injection.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia, Endotracheal↗
PubMed1993

First alveolar-arterial oxygen gradient (AADO2) in mechanical ventilation as a predictor for duration of intubation in respiratory distress syndrome.

From January 1988 to May 1992, 33 premature infants (inborn, gestational age less than 35 weeks), put on respirator therapy (before six hours of age) due to severe respiratory distress syndrome (RDS), were studied to examine if the first alveolar-arterial oxygen gradient (AaDO2) after initiating mechanical ventilation could be used as a predictor of intubation duration. They were divided into three groups: nine cases without associated diseases or severe complications who were successfully extubated (group I), 10 cases with associated diseases or severe complications who were successfully extubated (group II), and 14 cases where death occurred before extubation (group III). After intubation, the relationship between the first AaDO2 and the intubation duration thereafter was examined. A significant correlation between AaDO2 and the number of days of intubation was demonstrated only in group I (r = 0.93, p < 0.001). Among the groups, the means of the gestational ages, Apgar scores, data of the first arterial blood gas sample and ventilator settings after intubation, and AaDO2 were not statistically different. The results suggest that the first AaDO2 cannot be used to predict mortality and morbidity, but it can be used as a predictor of the number of days of intubation in surviving RDS infants without associated diseases or severe complications. If a surviving patient with RDS is not extubated by the expected date, one should search for possible associated diseases or severe complications.

Blood Gas Analysis↗
PubMed1993

The oral motor development of low-birth-weight infants who underwent orotracheal intubation during the neonatal period.

OBJECTIVE: To investigate the potential development of oral motor problems following prolonged orotracheal intubation in low-birth-weight infants. DESIGN: Prospective observational. SETTING: Tertiary-care hospital. PATIENTS: Fifty-one low-birth-weight infants and 10 full-term infants divided into three groups--group 1 with 15 low-birth-weight infants (< or = 1250 g) who had been intubated for more than 1 week; group 2 with 36 low-birth-weight infants who had been intubated for 1 week or less; and group 3 with 10 full-term control infants. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: Oral motor assessments of nutritive sucking were compared at corrected ages of term and 3 months. The results showed that low-birth-weight infants with prolonged intubation had significantly poorer sucking abilities at both term and 3 months. The number of days of oxygen use and the postnatal age (weeks) at which nipple feeding was begun were the most powerful predictors of sucking ability at term (P < .001), whereas the number of days of orotracheal intubation and gestational age at birth were the most powerful predictors of sucking ability at 3 months (P < .001).

Apgar Score↗
PubMed1989

Comparison of end-tidal carbon dioxide, oxygen saturation and clinical signs for the detection of oesophageal intubation.

The reliability of various methods for detecting oesophageal intubation was assessed by means of a single blind study in rats. Both oesophagus and trachea were simultaneously intubated. The presence or absence of various clinical signs was noted during tracheal or oesophageal ventilation and arterial blood gases and end-tidal CO2 were measured. Oesophageal ventilation for one minute was associated with significant decreases (P less than 0.001) in pH, PaO2 and SaO2 and a significant (P less than 0.001) increase in PaCO2. Although mean PaO2 decreased by 70 per cent and mean SaO2 decreased by 31 per cent, 43 percent of rats failed to demonstrate a decrease in SaO2 below 85 per cent. Oxygen saturation was the least reliable method for detecting oesophageal intubation (sensitivity = 0.5, specificity = 0.9, positive predictive value (PPV) = 0.8). Chest movement was the most reliable clinical sign for detecting oesophageal intubation (sensitivity = 0.9, specificity = 1.0, PPV = 1.0). Oesophageal rattle was the second most reliable clinical sign (PPV = 0.9). Moisture condensation in the tracheal tube (PPV = 1.0) and abdominal distension (PPV = 0.9) were judged to be the least reliable because each had a high false negative rate of 0.3. The most reliable method for the early detection of oesophageal intubation in rats was end-tidal, CO2 (sensitivity 1.0, specificity = 1.0, PPV = 1.0). In addition, end-tidal CO2 when used in conjunction with the four clinical signs improved the reliability of these signs.

Abdomen↗
PubMed1984

Paramedic orotracheal intubation: a feasibility study.

In order to determine whether paramedics could be effectively trained in the skill of orotracheal intubation, 11 paramedics were entered into a pilot study. All paramedics received the same limited didactic, cadaver, and in vivo clinical preparation. Over a six-month period, intubation was attempted on 33 patients in a variety of field situations. Intubation was successful in 28 cases with no reported complications. Subsequently, training has been expanded to a large number of paramedics, and the experience with intubation now includes a total of 128 patients and an overall success rate of 86%. It is concluded that paramedics can safely and effectively perform orotracheal intubation in a variety of adverse field conditions.

Adolescent↗
PubMed1989

Capnographic waveforms in esophageal intubation: effect of carbonated beverages.

Capnography is a useful tool in differentiating tracheal from esophageal intubation. It may be an especially useful tool in emergency airway management by rescue squads or in the emergency department. However, in clinical practice the question has arisen as to whether prior ingestion of carbonated beverages can generate false-positive capnographic evidence of endotracheal intubation when in fact esophageal intubation has occurred. To answer this question, we compared the difference between tracheal and esophageal capnographic waveforms in dogs in the setting of recent ingestion of carbonated beverages. Esophageal capnographic recordings from three of five dogs undergoing esophageal ventilation were strikingly positive for exhaled carbon dioxide; however, the waveforms were significantly different from waveforms of tracheal ventilation. We conclude that esophageal intubation, after recent ingestion of carbonated beverages, may give false-positive waveforms suggestive of tracheal intubation. Rapidly diminishing CO2 concentrations, however, help differentiate esophageal from tracheal ventilation in this setting.

Animals↗
PubMed2002

Out-of-hospital pediatric intubation by paramedics: the San Diego experience.

To evaluate pediatric endotracheal intubations by our paramedics, we performed a retrospective review of a prehospital computer database, quality assurance reviews, and prehospital run sheets for all patients under 15 years of age who had an endotracheal tube (ETT) placed. During the 4.5-year study period, 324 pediatric patients had intubation attempts by field paramedics, of which 264 (82%) were successful and three were reported esophageal and unrecognized by the paramedic. Two of these esophageal placements were noted on arrival at the hospital, and one upon turn-over of patient care to a nurse of an aeromedical service. All three intubations were deemed esophageal with direct laryngoscopy, and the patients had been in cardiopulmonary arrest status prior to the intubation. Of the 264 patients who had ETT placed, 99% were endotracheal, while only 1% were unrecognized esophageal. We conclude that pediatric endotracheal intubation by out-of-hospital paramedics in an established EMS system has a low occurrence of unrecognized esophageal placements.

California↗