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PubMedDate not supplied

Examination of the hypopharynx predicts ease of laryngoscopic visualization and subsequent intubation: a prospective study of 665 patients.

STUDY OBJECTIVE: To determine (a) whether the ability to visualize a patient's airway preoperatively correlates with the ability to visualize his or her larynx during laryngoscopy and (b) whether the presence of certain anatomic characteristics allows anesthetists to predict difficult laryngoscopic visualization and intubation. DESIGN: Observational. Patients were categorized into two groups: those who had one or more physical characteristics to alert an anesthetist to the possibility of difficult intubation (obesity, overbite, short neck, or decreased neck/jaw mobility) and those with none of these characteristics. SETTING: University-affiliated hospital. PATIENTS: Six hundred sixty-five patients scheduled for general anesthesia and requiring endotracheal intubation. Patients were between the ages of 18 and 88 years, with body weight ranging from 21 kg to 141 kg. INTERVENTIONS: Preoperatively, the anesthetist obtained the best view of the hypopharynx by having the patient extend the tongue and phonate. The airway was then categorized into one of three classes by the ability to see the tonsillar pillars and uvula (Class A, best view--all four tonsillar pillars and uvula seen; Class B, part of the pillars and uvula seen; Class C, worst view--pillars not seen and uvula partially or not seen). After induction, the same anesthetist graded laryngeal visibility into one of four groups depending on his ability to see the patient's epiglottis and vocal cords. MEASUREMENTS AND MAIN RESULTS: Patients with one or more clinical clues were more likely to have poor visualization of the hypopharynx and, in turn, poor laryngoscopic visualization of the glottis. Patients who had a Class A airway tended to have easy laryngoscopic visualization and were relatively easy to intubate. Conversely, patients with no clinical clues and a Class C airway had poor glottic exposure. CONCLUSIONS: Our study confirms work showing that the ability to visualize structures of the hypopharynx is a good predictor of subsequent glottic visualization during laryngoscopy and of ease of intubation.

Adolescent↗
PubMedDate not supplied

Attenuation of hypertensive response to tracheal intubation with nitroglycerin.

STUDY OBJECTIVE: To evaluate the efficacy and safety of intravenous (IV) nitroglycerin in attenuating the hypertensive response to laryngoscopy and intubation as a new application of the drug. DESIGN: Controlled, randomized, double-blind study. SETTING: University hospital. PATIENTS: Thirty normotensive patients (ASA physical status I) undergoing elective surgery were divided into three groups of ten patients each. INTERVENTIONS: Anesthesia was induced with thiopental sodium 5 mg/kg i.v., and tracheal intubation was facilitated with vecuronium 0.2 mg/kg i.v. During anesthesia, ventilation was assisted or controlled with 1% enflurane and 50% nitrous oxide in oxygen. Either 1.5 micrograms/kg of nitroglycerin, 2.5 micrograms/kg of nitroglycerin, or saline (control) was administered IV simultaneously with the start of laryngoscopy (lasting 30 seconds), which was attempted 2 minutes after administration of thiopental sodium and vecuronium. MEASUREMENTS AND MAIN RESULTS: Patients receiving saline showed a significant increase in mean arterial pressure and rate-pressure product associated with tracheal intubation. These increases following tracheal intubation were significantly reduced in nitroglycerin-treated patients compared with those in the control group (p < 0.05). CONCLUSION: A single, rapid IV dose of nitroglycerin is a simple, practical, effective, and safe method to attenuate the hypertensive response to laryngoscopy and tracheal intubation.

Adult↗
PubMed1995

Nebulized bupivacaine attenuates the heart rate response following tracheal intubation.

STUDY OBJECTIVE: To determine whether nebulized bupivacaine attenuates the acute hemodynamic response to laryngoscopy and intubation. DESIGN: Prospective, randomized, placebo-controlled study. SETTING: Operating room at a university medical center. PATIENTS: 40 health ASA physical status I and II patients scheduled for minor surgical procedures. INTERVENTIONS: Patients were randomized to receive 4 ml of a nebulized solution of either saline (n = 20) or 0.75% bupivacaine (n = 20) 15 minutes before induction of anesthesia. On completion of the aerosol treatment, fentanyl 1.5 micrograms/kg was given intravenously (i.v.), and 3 minutes later anesthesia was induced with thiopental sodium 5 mg/kg i.v. and succinylcholine 1.5 mg/kg i.v.. Laryngoscopy was begun 60 seconds after induction, and the trachea was intubated at 90 seconds. Anesthesia was maintained with 50% nitrous oxide in oxygen following intubation, and 1% isoflurane was administered at 180 seconds. MEASUREMENTS AND MAIN RESULTS: Heart rate (HR) and blood pressure were recorded automatically every 30 seconds for 5 minutes. Bupivacaine significantly attenuated HR (p < 0.05) but not the hypertensive response to laryngoscopy and intubation. CONCLUSION: Nebulized 0.75% bupivacaine was only partially effective in blunting the hemodynamic response to tracheal intubation.

Adult↗
PubMed1995

Comparative effects of lidocaine, esmolol, and nitroglycerin in modifying the hemodynamic response to laryngoscopy and intubation.

STUDY OBJECTIVE: To compare the safety and efficacy of lidocaine, esmolol, and nitroglycerin in modifying the hemodynamic response to laryngoscopy and intubation. DESIGN: Randomized, placebo-controlled, double-blind study. SETTING: University-affiliated VA medical center. PATIENTS: 40 ASA physical status I and II patients undergoing electric surgery with general endotracheal anesthesia. INTERVENTIONS: Anesthesia was induced with thiopental sodium 5 mg/kg, and intubation was facilitated with vecuronium 0.15 mg/kg. Isoflurane (0.5% to 1%) and 50% nitrous oxide in oxygen were used for maintenance of anesthesia. In addition, patients received one of the following four study drugs intravenously (i.v.) prior to laryngoscopy: Group 1 (control) = saline 5 ml; Group 2 = lidocaine 1.5 mg/kg; Group 3 = esmolol 1.4 mg/kg; Group 4 = nitroglycerin 2 micrograms/kg. MEASUREMENTS AND MAIN RESULTS: Mean arterial pressure (MAP) and heart rate (HR) were recorded every minute for 20 minutes following induction of anesthesia. Following laryngoscopy and intubation, MAP increased significantly in all four treatment groups (control 49% +/- 19%, lidocaine 55% +/- 26%, esmolol 25% +/- 11%, nitroglycerin 45% +/- 21%) compared with preinduction baseline values. In the esmolol-pretreated patients, the increase in HR was significantly lower (20% +/- 3%) compared with the nitroglycerin (37% +/- 8%), lidocaine (52% +/- 8%), and control (29% +/- 4%) groups. CONCLUSIONS: Lidocaine 1.5 mg/kg i.v. and nitroglycerin 2 micrograms/kg i.v. were ineffective in controlling the acute hemodynamic response following laryngoscopy and intubation. Esmolol 1.4 mg/kg i.v. was significantly more effective than either lidocaine or nitroglycerin in controlling the HR response to laryngoscopy and intubation (p < 0.05). Esmolol also was significantly more effective than lidocaine in minimizing the increase in MAP (25% vs. 55%).

Adrenergic beta-Antagonists↗
PubMed2005

Intubation without premedication may worsen outcome for unconsciousness patients with intracranial hemorrhage.

To clarify the influence of an intubation maneuver with or without premedication for an intracranial hemorrhage in an unconsciousness patient, we retrospectively analyzed 70 patients who had received intubation for unconsciousness and in whom a nontraumatic intracranial hemorrhage was found by CT over a 6-year period. They were divided into 2 groups, consisting of a drug group (n=15), wherein drugs were used before intubation, and control group (n=55), wherein no drugs were used before were intubation. The physical findings on admission, CT findings, Glasgow Outcome Score (GOS) at 3 months from admission were analyzed between the groups. There were no significant differences in the backgrounds of the subjects between the groups. The GOS in the control group was significantly higher than in the drug group (P<.001). In cases of intubation for unconscious patients who may have intracranial hemorrhaging, premedication is considered associated with a more favorable outcome.

Analgesics, Opioid↗
PubMed2004

[Disposable material for tracheal intubation: pilot study using Penlon Crystal blades and Penlon Lary Gard sheaths].

OBJECTIVE: The risk of cross infection due to non-conventional infectious agents has led to the development of single-use disposable medical material. For laryngoscopy, two attitudes have been proposed: the use of disposable blades or disposable translucide cover sheaths with steel blades. Practice studies assessing the quality of these devices are scarce, leaving the physician to his own experience. STUDY DESIGN: Open pilot study assessing satisfaction of the users during tracheal intubation. PATIENTS AND METHODS: Hundred patients of general surgery requiring tracheal intubation underwent laryngoscopy in routine condition with disposable blades (Penlon Crystal) or disposable cover sheaths (Penlon Lary Gard) with steel blades. The users gave a general appreciation of the device and specific comments on the easiness of insertion of the blade, intensity of light and its focus, quality of glottic exposure, easiness of tracheal tube insertion, and solidity of the device. RESULTS: With both devices, intubation was impossible in 6% of the patients. The users considered that intubation was performed in comfortable conditions with both devices. Dim light was noticed with Crystal blade. CONCLUSION: In case of use of disposable material, both devices seem to be close in terms of quality of intubation.

Adolescent↗
PubMed2003

Indication for and technical refinements of submental intubation in oral and maxillofacial surgery.

INTRODUCTION: In maxillofacial injuries, a choice has often to be made between different ways of intubation when surgical access to both the nasal and the oral cavities is necessary. Submental intubation is an interesting alternative to tracheotomy, especially when short-term postoperative control of the airway is foreseeable, and as control of the dental occlusion is complete, and access to the nose and mouth is undisturbed. MATERIAL: This kind of intubation has been used in our department in 25 cases since 1997. All patients had fractures disturbing the dental occlusion plus either an associated fracture of the skull base, or a displaced nasal fracture. RESULTS: There was no intra-operative complication, average intubation duration was 1.5 days. Post-operative complications consisted of one case with hypertrophic scarring and two cases of abscess formation in the floor of the mouth. All these completely healed following local conservative treatment. CONCLUSION: Submental intubation demands certain technical skills but it is simple, rapid and may avoid tracheotomy in selected patients.

Abscess↗
PubMed2006

Submental endotracheal intubation in concurrent orthognathic surgery: a technical note.

INTRODUCTION: Achieving the necessary occlusion for orthognathic surgery is not possible with conventional oral intubation since the tube interferes with the occluding teeth. Sometimes nasotracheal intubation is impossible due to developmental malformations requiring repair. Also, the oral or nasotracheal tube may interfere with the operation or may be damaged during the procedure. In 1986, Hernandez Altemir described a method of submental endotracheal intubation. His intentions were to avoid tracheostomy in maxillofacial trauma cases where short-term intermaxillary fixation was required. PATIENTS: Between January 2000 and May 2003, 13 patients were operated on, using submental intubation. Eight of these (three females and five males) had surgery for orthognathic malformations. METHODS: The Hernandez Altemir technique was modified to ease the procedure: a sterile nylon guiding tube and the '222 rule' incision were introduced. Eight cases with concurrent complex orthognathic surgery, using this modified technique are reported in this paper. RESULTS: There were no operative or postoperative complications related to the procedure. CONCLUSION: The technique is easy to use, rapid and free of complications compared to 'alternative' intubation methods (tracheostomy, retromolar location of tube, etc.). Submental scarring is acceptable. It is recommended for orthognathic procedures in selected cases.

Adolescent↗
PubMed2005

Seldinger-assisted videotelescopic intubation (SAVI): a common sense approach to the difficult pediatric airway.

OBJECTIVES: To describe the Seldinger-assisted videotelescopic intubation (SAVI) technique, a complementary method for aiding in difficult pediatric intubations that uses common equipment available to the practicing otolaryngologist. STUDY DESIGN: Technique description. METHODS: Detailed description of technique for use of a pediatric laryngoscope with video-assisted endotracheal tube (ETT) covered rigid tracheoscopy controlled intubation in difficult pediatric airways. RESULTS: In our practice, SAVI is vital in establishing a secure airway in the difficult-to-intubate child. After insertion of a laryngoscope, an appropriate sized endotracheal tube is delivered through the glottis under direct video-visualization from a rigid telescope using a variation of the well-established Seldinger technique. The telescope serves as the stable ETT stylet that also provides panoramic visualization. The ETT slides over the telescope to provide a secure airway directly visible to all in the operating room. Benefits of the SAVI technique to previously described video-assisted intubations with flexible or specially designed endoscope devices include decreased cost, employment of previously existing endoscopy skills, the benefit of rigid delivery of the endotracheal tube as well as innate versatility to a multitude of clinical situations. CONCLUSIONS: The SAVI technique offers an additional practical clinical solution to the difficult pediatric airway. Although ultimately establishing the airway depends on the skills of the operator, the SAVI technique has saved multiple lives by using common equipment through a common-sense approach. EBM RATING: D.

Child↗
PubMedDate not supplied

Comparison of etomidate and midazolam for prehospital rapid-sequence intubation.

OBJECTIVE: This study compares etomidate with midazolam for prehospital rapid-sequence intubation (RSI). METHODS: The authors conducted a retrospective review of consecutive intubations at a university-based air medical program from January 1995 to December 2000. Exclusion criteria were patients not undergoing RSI, age <15 years, and incomplete chart data. Outcome measures included intubation success, incidence of hypotension, and percentage of change in heart rate (HR) and systolic blood pressure (SBP). RESULTS: The intubation success rate was 110 out of 112 (98%) with etomidate, and 96 out of 97 (99%) with midazolam. Mean ages, patient gender distributions, and initial SBPs and HRs did not differ between the two groups. The mean dose of etomidate was 24 mg, the mean percentage of change in HR was -1% (95% confidence interval [CI], -6 to 4), and the mean percentage of change in SBP was 2% (95% CI, -3 to 7). The mean dose of midazolam was 3.5 mg, the mean percentage of change in HR was 1% (95% CI, -5 to 7), and the mean percentage change in SBP was 3% (95% CI, -3 to 9). The number of hypotensive episodes with etomidate (7 out of 74) compared with midazolam (3 out of 56) did not differ significantly (Fisher's exact test, p=0.51). CONCLUSION: Intubation success rate was very high with both etomidate (98%) and midazolam (99%). There was no statistically significant mean percentage of change in SBP or HR with either agent. The authors found a low incidence of hypotension with both agents, although the mean dose of midazolam used was considerably less than typically recommended for induction.

Academic Medical Centers↗
PubMed2006

Predictors of hospital outcome and intubation in COPD patients admitted to the respiratory ICU for acute hypercapnic respiratory failure.

BACKGROUND: Mortality rate, the possible factors affecting mortality and intubation in patients with acute exacerbation of chronic obstructive pulmonary diseases (COPD) and hypercapnic respiratory failure (RF) are yet unclear. OBJECTIVE: To identify the possible factors affecting mortality and intubation in COPD patients. DESIGN: A prospective study using data obtained over the first 24h of respiratory intensive care unit (RICU) admission. Consecutive admissions of 656 patients were monitored and 151 of them who had acute exacerbation of COPD and hypercapnic RF were enrolled. SETTING: University hospital, Department of Chest Diseases, RICU. RESULTS: Mean age was 65.1 years. The mean APACHE II score was 23.7. Eighty-seven patients (57.6%) received mechanical ventilation (MV) via an endotracheal tube for more than 24 h. Twenty-two patients received non-invasive ventilation (NIV). Fifty patients died (33.1%) in hospital during the study period. The mortality rate was 52.9% in patients in need of MV. In the multivariate analysis, the need for intubation, inadequate metabolic compensation for respiratory acidosis, and low (=bad) Glasgow Coma Score (GCS) were determined as independent factors associated with mortality. The low GCS (OR: 0.61; CI: 0.48-0.78) and high APACHE II score (OR: 1.24; CI: 1.11-1.38) were determined as factors associated with intubation. CONCLUSION: The most important predictors related to hospital mortality were the need for invasive ventilation and complications to MV. Adequate metabolic compensation for respiratory acidosis at admittance is associated with better survival. A high APACHE II score and loss of consciousness (low GCS) were independent predictors of a need to intubate patients.

Adult↗
PubMed2000

Still photography versus videotaping for documentation of cecal intubation: a prospective study.

BACKGROUND: Documentation of cecal intubation is important for credentialing and continuous quality improvement. However, convincing cecal photographs can be difficult to obtain. The aims of the study were to determine (1) the anatomic variations and photographic factors associated with convincing cecal photographs; (2) whether a prospective attempt to capture specific features resulted in more convincing photographs; and (3) how a prospective attempt at capturing convincing cecal features during still photography compares with videotaping as a method of documenting cecal intubation. METHODS: A single examiner evaluating 165 consecutive patients photographed the entire cecum from just distal to the ileocecal valve, the appendiceal orifice, the ileocecal valve orifice, and in the last 110 consecutive cases, the terminal ileum, if it could be intubated. The photographs were then scored by 8 experts according to how convinced they were that cecal intubation had occurred. Features associated with high and low scores were determined, and 50 additional consecutive patients were photographed with a specific effort to capture these features, along with videotaping of the cecum. These photographs and videotapes were then scored by 7 of the 8 experts on a scale of 1 to 5, with 5 representing "definitely the cecum." RESULTS: There was marked variation in scores of still photographs among reviewers. A combination of photographs produced the highest mean score and the highest percentage of scores that were either "probably" or "definitely" of the cecum. The photograph of the cecum from just distal to the ileocecal valve was most convincing and the terminal ileum photograph was least convincing. In the 50 cases in which an attempt was made to capture specific features, mean scores improved for the overall cecal photograph by 0.10, the appendiceal orifice by 0.23, the ileocecal valve lips by 0.20, and the terminal ileum by 0. 19. The cecum, appendiceal orifice, valve lips, and terminal ileum photographs for the last 50 patients were scored higher than those from the first 165 patients by 4, 4, 4, and 5 reviewers, respectively. Videotapes were consistently convincing (overall mean score 4.78 out of 5) and were scored more convincing than the combination of still photos from the final 50 cases by 6 of 7 reviewers. CONCLUSIONS: Still photography of the cecum can be improved somewhat by attempting to capture specific cecal features. However, because of anatomic variation among normal individuals, still photography remains inconsistently convincing. A combination of photographs is most convincing. Videotaping of the cecum is consistently convincing and would appear to serve effectively as a means of documenting cecal intubation rates for the purposes of continuous quality improvement and credentialing.

Cecum↗
PubMed2005

A prospective study of factors that determine cecal intubation time at colonoscopy.

BACKGROUND: For outpatient colonoscopy, the time required to intubate the cecum is variable. The aim of this study was to determine factors associated with cecal intubation time. METHODS: A total of 693 consecutive outpatient colonoscopies performed from January to October 2002 at a tertiary care medical center were studied prospectively. Data gathered included time required to reach the cecum; patient age, gender, and body mass index; history of abdominal surgery; quality of bowel preparation; presence/absence of diverticula; and endoscopist experience. RESULTS: Complete data were available for 587 patients. Mean age was 59 years, 48% were men, and mean body mass index was 28. Median cecal intubation time was 9 minutes. Linear regression analysis was performed. Cecal intubation time is prolonged by the following factors: older patient age, female gender, lower body mass index, poor bowel preparation, and lower endoscopist annual case volume. CONCLUSIONS: This large, prospective study identified 5 factors that prolong the time required for cecal intubation at colonoscopy. These factors may be used to individualize scheduling of colonoscopy according to the time required.

Adult↗
PubMedDate not supplied

The frequency of total colonoscopy and terminal ileal intubation in the 1990s.

We examined the frequency of total colonoscopy and terminal ileal intubation in a training setting using modern videoendoscopic equipment and techniques with examinations supervised or done by the two authors. The cecum was considered reached if the endoscopic report included a description of the cecal landmarks visualized and if electronic images documenting these landmarks were obtained. One of us also routinely attempted terminal ileal intubation for documentation purposes, allotting a minute or two for the purpose. In cases of chronic diarrhea and possible inflammatory bowel disease, a more prolonged attempt was made to visualize the terminal ileum. Among 418 consecutive colonoscopies, the cecum was reached in 96% of cases. If cases of malignant obstruction were excluded, the success rate improved to 97%. When routinely attempted, the terminal ileum was intubated and inspected in 74% of cases (excluding cases of malignant obstruction). In cases in which terminal ileal intubation and inspection was deemed necessary, the success rate was 91%. We conclude that total colonoscopy can be accomplished in the 1990s in excess of 90% of cases and can be documented by high-quality photographs that can be attached to the procedure report. High rates of successful total colonoscopy should be attainable even in training programs. Routine intubation of the terminal ileum can be performed to provide further objective proof of the extent of colonoscopy and to allow the endoscopist to develop and maintain the skill. A skilled, practiced endoscopist can inspect the terminal ileum in about 90% of cases in which such examination is needed.

Adult↗
PubMed1999

Rapid sequence intubation of the pediatric patient. Fundamentals of practice.

Rapid-sequence intubation and rapid sequence induction of general anesthesia are synonyms and refer to the technique of choice for tracheal intubation in many pediatric patients in the emergency department. The principles of safe practice and basic standards of care uniformly apply to all clinical situations in which the technique is performed. RSI has two basic technical components: induction of general anesthesia and direct laryngoscopy with tracheal intubation. The technique is a prescribed protocol that can be modified slightly by the clinical circumstances. RSI is designed to rapidly create ideal intubating conditions, attenuate pathophysiologic reflex responses to direct laryngoscopy and tracheal intubation, and reduce the risk for pulmonary aspiration. Optimal performance requires appropriate training and knowledge, technical skill, and sound medical judgment. Medical and airway evaluation, careful patient selection, recognition of the need for consultation or safer alternatives, thorough familiarity with appropriate drug management, and attention to detail are essential for minimizing the risk for adverse complications. RSI with a rapid injection of preselected dosages of an anesthetic induction agent and muscle relaxant is the pharmacologic technique of choice. Premedication should not be routinely used. Anticipation, recognition, and management of complications are inherent to the competent delivery of all medical care. The unanticipated difficult airway is arguably the most severe complication of RSI, and all individuals performing the technique must prepare in advance a specific plan for this scenario. As with all such skills or procedures, a quality assurance program is important to monitor care, and individuals practicing RSI need to take appropriate steps to maintain competence.

Anesthetics↗
PubMed2001

Early postnatal ethanol intubation blunts GABA(A) receptor up-regulation and modifies 3alpha-hydroxy-5alpha-pregnan-20-one sensitivity in rat MS/DB neurons.

Previously we found postnatal binge-like ethanol exposure using an artificial-rearing method in the rat delayed developmental up-regulation of GABA(A) receptors (GABA(A)Rs) in both medial septum/diagonal band (MS/DB) and cerebellar Purkinje neurons. In the present study, the impact of ethanol on developing GABA(A)Rs in MS/DB neurons was further tested under conditions not requiring anesthesia or maternal deprivation. Nursing rat pups received ethanol (4.5-5.25 g/kg/day) on postnatal days (PD) 4-9, which was administrated manually by oral intragastric intubation. This treatment caused dose-dependent blunting of peak GABA(A) receptor whole cell currents in acutely dissociated MS/DB cells on PD 12-15. The threshold with oral intubation was slightly higher than previously observed for artificial-rearing (4.9 vs. 4.5 g/kg/day). The previously observed reduced sensitivity of GABA(A)Rs to Zn(2+)-inhibition after ethanol was not found with the intubation model. In studies only carried out using the intubation method, 3alpha-hydroxy-5alpha-pregnan-20-one (3alpha-OH-DHP) caused an allosteric concentration-dependent potentiation of currents activated by non-saturated concentrations of GABA. A bicuculline sensitive direct activation of GABA(A)Rs also occurred with higher concentrations of 3alpha-OH-DHP alone. Ethanol intubation up-regulated allosteric neurosteroid potentiation with low concentrations of GABA, but did not change direct agonist actions of 3alpha-OH-DHP. Finally, 3alpha-OH-DHP did not prime ethanol insensitive GABA(A)Rs to become sensitivity to acute ethanol potentiation. These results indicate ethanol consistently blunts postnatal GABA(A) receptor up-regulation across early postnatal binge-type ethanol exposure models and may increase positive modulation of GABA(A) receptors by endogenous neurosteroids.

Age Factors↗
PubMed1997

Management of infantile subglottic hemangioma: laser vaporization, submucous resection, intubation, or intralesional steroids?

The infantile subglottic hemangioma can be treated in various ways. The results of the treatment used in the Sophia Children's Hospital, intralesional steroids and intubation (IS + I), are discussed and compared with the results of other current treatment methods: CO2 laser vaporization, submucous resection and intubation alone. A total of 18 infants were treated for subglottic hemangioma in our hospital: ten with IS + I alone, five were first treated with systemic therapy and later with IS + I alone and three with various therapies. IS + I was effective in 14 of the 15 patients, one patient was lost from follow up. The remaining three infants were treated with (combinations of) various therapies, because IS + I failed or was not tried. Two patients were finally cured, one still has a tracheotomy. Of other current therapies, CO2 laser vaporization is reported to be effective. In all 30% of the infants treated in Boston Children's Hospital with CO2 laser needed a tracheotomy. Moreover subglottic stenosis is a serious complication. Submucous resection is often successful. It may be complicated by subglottic stenosis and in some cases, depending on the localization of the hemangioma, it may be contraindicated. Intubation alone is less effective than intubation combined with intralesional steroids. Management of subglottic hemangioma in Sophia Children's Hospital is primarily intralesional steroids and intubation and secondarily submucous resection or tracheotomy. CO2 laser vaporization is seldom applied because of the risk of subglottic stenosis.

Female↗
PubMed1985

Intratracheal aerosolized etidocaine to attenuate cardiovascular and cough responses to laryngoscopy and intubation.

Forty-five ASA I or II patients scheduled for elective surgery were randomized into one of three groups. Patients in Group 1 (n = 15) received no intratracheal aerosol at laryngoscopy. Patients in Group 2 (n = 15) and Group 3(n = 15) received 50 mg and 75 mg, respectively, of intratracheal aerosolized etidocaine at laryngoscopy. Cardiovascular and respiratory responses were observed at laryngoscopy and intubation and for the first ten minutes following laryngoscopy and intubation (with anesthesia provided by IV thiopental and nitrous oxide [70%] in oxygen). The magnitude and duration of blood pressure and heart rate increases caused by laryngoscopy and intubation were significantly less in the etidocaine-treated patients than in the controls (P less than .05). The incidence of coughing after intubation also was decreased significantly in the etidocaine-treated patients (P less than .05). Etidocaine did not, however, decrease the incidence of arrhythmias after intubation.

Acetanilides↗