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At least 127 records · Page 7Linked to original sources
PubMed2003

Clinical test to confirm tracheal intubation: a new method to confirm endotracheal intubation in the absence of capnography.

BACKGROUND AND OBJECTIVE: Advancing an uncut endotracheal tube into the right main bronchus produces unilateral breath sounds. We wanted to test the validity of using this method to distinguish oesophageal from tracheal intubation. METHODS: Forty-two patients were randomized into two groups. The first group was randomized to receive an endotracheal tube that was advanced into the right main bronchus. The second group of patients had their tracheas intubated as normal and then a second endotracheal tube was placed in the oesophagus. Blinded observers were then asked to decide by auscultation if the patients had unilateral breath sounds or not and if they were bronchial and therefore to decide if endotracheal intubation had occurred. RESULTS: Ninety-one per cent of patients (95% CI 0.71-0.99) intubated in the right main bronchus were correctly identified by unilateral breath sounds confirming the usefulness of this test. CONCLUSIONS: Advancing an endotracheal tube into the right main bronchus and auscultation of unilateral breath sounds is a useful way of confirming tracheal intubation.

Adolescent↗
PubMed2001

Fibreoptic nasal intubation in children with anticipated and unanticipated difficult intubation.

The establishment of a tracheal airway with direct laryngoscopy can be either a very difficult or an impossible task in children with congenital or acquired facial malformations. Out of 46 patients categorized as difficult tracheal intubation, fibreoptic laryngoscopy was used successfully in 44 children anaesthetized by mask with sevoflurane and oxygen or by an intravenous infusion of propofol and mask oxygenation. There were two failures (4.3%). One was due to excessive bleeding and secretions produced by the multiple attempts to intubate with direct laryngoscopy and the other failure in a patient with Pierre Robin syndrome and very small nasal passages that precluded the introduction of the endoscope. Fibreoptic laryngoscopy was successful in 37 cases (80.4%) on the first attempt to intubate and in seven (15.2%) on a second or third attempt. We conclude that fibreoptic laryngoscopy in anaesthetized children with difficult anticipated or unanticipated tracheal intubation in trained hands is a safe technique that can be lifesaving. Therefore, we urge all anaesthesia trainees to become proficient in fibreoptic tracheal intubation.

Adolescent↗
PubMed2000

The intubating laryngeal mask airway does not facilitate tracheal intubation in the presence of a neck collar in simulated trauma.

Tracheal intubation must be performed with great care in the multiply injured patient when it must be assumed that the cervical spine may be damaged. Use of conventional direct laryngoscopy usually requires removal of the neck collar and manual in-line stabilization of the head and neck. The intubating laryngeal mask (ILMA) has been designed to facilitate tracheal intubation in the neutral position. We used the ILMA to intubate the trachea in 10 patients wearing a neck collar and with cricoid pressure applied in a simulated trauma scenario. The ILMA was difficult to insert and ventilation proved difficult. In only two patients was intubation successful. These problems were probably caused by the neck collar strap under the chin lifting up and tipping the larynx anteriorly. On the basis of these findings, ILMA use in a subject wearing a neck collar cannot be recommended.

Adult↗
PubMed2006

Comparative evaluation of different doses of propofol preceded by fentanyl on intubating conditions and pressor response during tracheal intubation without muscle relaxants.

BACKGROUND: The aim of our study was to determine the optimal dose of propofol preceded by fentanyl for successful tracheal intubation and to see its effectiveness in blunting pressor response in children aged 3-10 years. METHODS: This prospective, double blind, randomized study was conducted on 60 ASA grade I and II children, between 3 and 10 years undergoing elective surgery who were divided into three groups of 20 each. The children received different doses of propofol (group I, 2.5 mg x kg(-1); group II, 3.0 mg x kg(-1); group III, 3.5 mg x kg(-1)) preceded by a fixed dose of fentanyl (3.0 microg x kg(-1)) 3 min earlier. The tracheal intubating conditions were graded based on scoring system devised by Helbo-Hensen et al. with Steyn modification which includes five criteria; ease of laryngoscopy, degree of coughing, position of vocal cords, jaw relaxation, and limb movement and graded on a 4-point scale. Heart rate (HR), mean arterial pressure (MAP), and oxygen saturation changes were also noted. RESULTS: Tracheal intubating conditions were acceptable in 25% of the patients in group I, while significantly higher (P < 0.001) in group II (80%) and in group III (90%). The pressor response was not effectively blunted in group I (17% increase in HR), while effectively blunted in groups II and III. A fall in cardiac output was seen in group III indicated by a decrease in MAP (16%) and HR (11%). No airway complications were noted. CONCLUSIONS: Propofol 3 mg x kg(-1) (group II) preceded by fentanyl 3 microg x kg(-1) is the optimal dose combination in our study. It provides acceptable intubating conditions in 80% patients, blunts pressor response to intubation without significant cardiovascular depression.

Anesthesia, General↗
PubMed2002

Reflex responses to insertion of the intubating laryngeal mask airway, intubation and removal of the ILMA.

We studied 21 patients (ASA 1 or 2) to investigate the skin vasomotor reflex (SVmR) and haemodynamic responses to insertion of an intubating laryngeal mask airway (ILMA), tracheal intubation using the ILMA and removal of the ILMA. Anaesthesia was induced with fentanyl, midazolam, vecuronium and nitrous oxide. A size 4 ILMA was inserted using the standard technique, and a silicone reinforced tracheal tube (7.5 mm, ID) was passed through it. After confirming successful intubation, the ILMA was removed using the stabilizing rod. The three procedures were performed at approximately one-minute intervals. Insertion of the ILMA, intubation and removal of the ILMA all significantly reduced the skin blood flow on the ring finger in all patients. The mean amplitudes of the SVmR were 0.46 (SD 0.29), 0.54 (0.32) and 0.68 (0.21) respectively. The magnitude of the SVmR and the haemodynamic changes induced by removal of the ILMA were significantly larger than those accompanying the other two procedures. Use of the ILMA for intubation and removal of the ILMA produces three stimuli and the removal of the ILMA produces the greatest response.

Adult↗
PubMed2003

Awake nasotracheal fiberoptic intubation: patient comfort, intubating conditions, and hemodynamic stability during conscious sedation with remifentanil.

Awake nasotracheal fiberoptic intubation requires an anesthetic management that provides sufficient patient comfort, adequate intubating conditions, and stable hemodynamics. Short-acting and easily titratable analgesics are excellent choices for this maneuver. In this study, our aim was to determine an appropriate dosage regimen of remifentanil for awake nasotracheal fiberoptic intubation. For that reason, we compared two different dosage regimens. Twenty-four patients were randomly assigned to receive remifentanil 0.75 micro g/kg in bolus, followed by a continuous infusion of 0.075 micro g x kg(-1) x min(-1) (Group L), or remifentanil 1.5 micro g/kg in bolus, followed by a continuous infusion of 0.15 micro g x kg(-1) x min(-1) (Group H). All patients were premedicated with midazolam 0.05 mg/kg IV and glycopyrrolate 0.2 mg IV. Both dosage regimens ensured patient comfort and sedation. Discomfort did not differ between groups. Patients in Group H were sedated more profoundly. Hemodynamic stability was maintained with both remifentanil doses. Intubating conditions were adequate in all patients and comparable between the groups. The large dosage regimen did not result in any additional benefit compared with the small dosage. For awake nasotracheal fiberoptic intubation, we therefore recommend remifentanil 0.75 micro g/kg in bolus followed by continuous infusion of 0.075 micro g x kg(-1) x min(-1), supplemented with midazolam 0.05 mg/kg.

Adolescent↗
PubMed1986

Pretreatment technique for fast intubation with vecuronium: intubation conditions and unwanted effects.

In eighty patients 15 micrograms kg-1 of vecuronium was given 3 minutes before induction of anesthesia and 50 micrograms kg-1 was given at the time of induction. The trachea was intubated 60 seconds after the second dose. A wide spread of twitch depression was found. The 80 patients were divided into 4 groups retrospectively with respect to the degree of neuromuscular blockade during intubation. Tracheal intubation was performed when the mean twitch depression was 48.8 +/- 11.8 (SD)% and the conditions were satisfactory in 89% of the cases. Intubating conditions were different significantly between the four sub-groups (p less than 0.01). Ptosis occurred in 77 patients, diplopia in 13 patients and dyspnea in 2 patients between the first injection of vecuronium and induction of anesthesia. The administration of vecuronium in divided doses gives satisfactory intubating conditions in the majority of the patients, but close observation between the priming dose and the induction of anesthesia is mandatory. The method is not considered suitable for obese and is probably not indicated in severely ill patients.

Adolescent↗
PubMed1992

Cardiovascular responses to fiberoptic intubation: a comparison of orotracheal and nasotracheal intubation.

We compared the cardiovascular responses between nasal and oral intubation with a fiberoptic bronchoscope under the combination of neuroleptic analgesia (NLA) and topical anesthesia. The 16 patients studied were divided into 2 groups: the nasal intubation group (N group: 8 patients) and the oral intubation group (O group: 8 patients). There were significant changes in systolic, diastolic and mean arterial pressures in the N group and in the pressure rate quotient in the O group. Diastolic arterial pressure and heart rate were significantly higher in the N group than in the O group before induction of general anesthesia. The rate pressure product (RPP) was significantly higher in the N group than in the O group at some points during the procedure. The individual RPP in both groups was relatively stable except for one patient in the N group, who had a marked increase in RPP during the procedure. We conclude that, under the combination of NLA and topical anesthesia, the cardiovascular responses to oral fiberoptic intubation are less severe than those to the nasal approach. The oral approach is recommended, especially in patients with coronary artery disease, taking into consideration of the cardiovascular responses to fiberoptic intubation.

Journal Article↗
PubMedDate not supplied

Nasotracheal intubation in a child with Treacher Collins syndrome using the Bullard intubating laryngoscope.

Tracheal intubation may be difficult or impossible in children with Treacher Collins syndrome. Nasotracheal intubation may be required for appropriate repair of cleft palate in these patients. This report describes the use of the Bullard intubating laryngoscope to facilitate nasotracheal intubation in a child with severe mandibulofacial dysplasia.

Anesthesia, Inhalation↗
PubMed2000

Use of the intubating laryngeal mask for airway management and light-guided tracheal intubation in the lateral position.

Sudden accidental loss of the airway during surgery is potentially hazardous especially when the patient is lying in any position which prevents easy intubation of the trachea. We describe two patients lying in the lateral position who required urgent airway management and endotracheal intubation. In both cases endotracheal intubation was achieved successfully using a light-guided technique--with a prototype illuminated flexible catheter--through an intubating laryngeal mask airway.

Adult↗
PubMedDate not supplied

Patient status and time to intubation in the assessment of prehospital intubation performance.

UNLABELLED: Assessment of paramedic endotracheal intubation (ETI) performance often does not account for varied clinical conditions or the time required to complete the procedure. OBJECTIVE: To demonstrate the utility of patient status and time to intubation (TTI) for evaluating prehospital ETI performance. METHODS: Paramedic charts were reviewed for the period January-December 1998. Patient clinical status was defined as cardiac arrest (absence of perfusing rhythm) or non-cardiac arrest (presence of perfusing rhythm). Method, route, and success of ETI were noted. The TTI was determined as the elapsed time from on-scene arrival to securing of the endotracheal tube. Time elapsed from on-scene arrival to emergency department arrival was noted for instances of failed ETI. Statistical analysis was performed using chi-square and survival analysis (Kaplan-Meier estimator). RESULTS: Computer records were available for 26,026 patient contacts. Of 893 documented ETI attempts, 771 (86%) were successful. The ETI success rate was significantly higher (p<0.001) for cardiac arrests (551 of 591, 93.2%) than for non-cardiac arrests (220 of 302, 72.9%). Median TTIs were 5 minutes (95% CI: 5, 5) for cardiac arrests and 17 minutes (95% CI: 14, 20) for non-cardiac arrests; this difference was significant (p<0.001). For non-cardiac arrests, ETI success was significantly (p = 0.002) higher for orotracheal intubation (OTI) (168 of 214, 78.5%) than for nasotracheal intubation (NTI) (52 of 88, 59.1%). Median TTIs were 15 minutes (95% CI: 13, 17) for OTI and 25 minutes (95% CI: 23, 27) for NTI; this difference was significant (p = 0.002). For non-cardiac arrests, the difference i

Delaware↗
PubMedDate not supplied

Inverse intubation: an important alternative for intubation in the streets.

One of the highest priorities for prehospital emergency personnel is airway management. Several rescuer positions for intubation on the ground have been published. Only recently, the inverse intubation method as an additional approach for intubation in the out-of-hospital setting has received further attention. Using four case reports, situations in which inverse intubation may be an important tool for successful airway management are discussed. Other uses of the method are listed.

Accidents, Traffic↗
PubMed1999

Malposition of the epiglottis after tracheal intubation via the intubating laryngeal mask.

The intubating laryngeal mask has been reported to be a successful method of tracheal intubation although advancement of the tracheal tube via the laryngeal inlet into the trachea cannot be seen. Damage to the larynx or other tissues may occur during blind passage of a tracheal tube. We report a case in which the tracheal tube, advanced blindly, tucked the epiglottis into the laryngeal inlet, resulting in oedema of the epiglottis. This case illustrates the potential for airway obstruction after extubation when using the intubating laryngeal mask as a blind intubation guide.

Epiglottis↗
PubMed1993

A split laryngeal mask as an aid to training in fibreoptic tracheal intubation. A comparison with the Berman II intubating airway.

Thirty patients were randomly allocated to one of two groups in order to compare the use of a split laryngeal mask airway with the Berman II airway as aids to training in fibreoptic laryngoscopy. In both groups anaesthesia was induced with propofol and maintained with isoflurane in N2O/O2 (FIO2 = 0.5). The fibreoptic laryngoscope was guided towards the larynx using the split laryngeal mask airway in group 1 and the Berman airway in group 2. The tracheas of all patients were successfully intubated at the first attempt and no patient's peripheral oxygen saturation decreased below 92%. Two min after intubation mean heart rate was significantly greater in group 1 (101 beat.min-1) than in group 2 (84 beat.min-1) (P < 0.05). The split laryngeal mask is a useful aid to training in fibreoptic intubation and may allow better airway control than the Berman II intubating airway.

Adolescent↗
PubMed2000

The intubating laryngeal mask airway: effect of handle elevation on efficacy of seal, fibreoptic position, blind intubation and airway protection.

We conducted three studies to test the hypothesis that elevation of the intubating laryngeal mask (ILM) handle increases efficacy of seal, changes fibreoptic position, prevents aspiration of regurgitated fluid and improves intubation. In study 1, the ILM was inserted into 20 paralysed, anaesthetized patients and 20 cadavers. Oropharyngeal leak pressure and fibreoptic position were measured at an intracuff pressure of 0, 60 and 120 cm H2O with 0, 20 and 40 N of elevation force. In study 2, the oesophageal pressure at which regurgitation and aspiration occurred was measured in 20 cadavers with the ILM at the above intracuff pressures and elevation forces and 10 cadavers without the ILM (controls). In study 3, ease of blind intubation (first attempt only) was determined in 20 paralysed, anaesthetized patients at 0 and 40 N elevation force. In study 1, there was a significant increase in oropharyngeal leak pressure with increasing elevation force at an intracuff pressure of 0 and 60 cm H2O. There were no changes in fibreoptic position. Oropharyngeal leak pressure and fibreoptic position were similar between patients and cadavers. In study 2, oesophageal pressure for regurgitation and aspiration was usually greater for the ILM than controls (all: P < 0.05. Aspiration and regurgitation usually occurred at the same oesophageal pressure. In study 3, blind intubation was more successful at 0 N than 40 N (15/20 v 8/20, P = 0.03). We conclude that elevation of the ILM handle has little clinical utility other than as a temporary measure to improve the efficacy of the seal.

Adult↗
PubMedDate not supplied

Endoscopically assisted balloon dacryocystoplasty and silicone intubation versus silicone intubation alone in adults.

PURPOSE: To compare the success rate of endoscopically assisted balloon dacryocystoplasty (DCP) and silicone intubation (DCP-SI) with endoscopically assisted silicone intubation alone (SI) in adults with incomplete nasolacrimal duct (NLD) obstruction. METHODS. In a retrospective nonrandomized comparative case series, 62 eyes of 55 adult patients with incomplete NLD obstruction underwent endoscopic probing and either SI (n=39 eyes) or DCP-SI (n=23 eyes) under general anesthesia. The last follow-up examination included diagnostic probing and irrigation if there was not success. Success was defined as disappearance of the symptoms and failure as partial improvement or absence of improvement at last follow-up. RESULTS: Patients ranged from 20 to 85 years of age (mean: 60.93, SD: 15.60). Tubes were removed between 6 and 20 weeks (mean: 7.49, SD: 2.25) postoperatively. Follow-up ranged from 6 to 63 months (mean: 14.60, SD: 10.33). Success rate of the eyes with SI (21/39, 53.84%) and DCP-SI (14/23, 60.86%) were not statistically different (p=0.60). Complications included slight nasal and canalicular bleeding in almost all eyes in both groups which was easily controlled, slit punctum in four eyes with bicanalicular intubation (4/50, 8%), and monocanalicular tube lost in three eyes prematurely. CONCLUSIONS: Success rate of endoscopic DCP-SI had no statistically significant difference from silicone intubation alone in treatment of incomplete NLD obstruction in adults.

Adult↗
PubMed2004

[Morphologic trachea alterations in intubated patients in function of intubation time].

This is a descriptive analytic study which aimed to describe the morphologic alterations of the trachea in intubated patients with cannulas of high-residual volume and low-pressure cuff, maintained on mechanical ventilation with lower pressure inside the "cuff" than the tracheal capillary pressure (20-30 mmHg) in function of intubation time. The study population consisted of 23 adult patients admitted at an Intensive Care Unit, who were intubated for periods ranging from 27 to 317 hours and died, needing necropsy to identify the cause of deaths. The observed alterations were limited to the tracheal mucous membrane, affecting only the epithelium tissue and the lamina propria. Intubation time was a determinant factor to aggravate tracheal wall injuries.

Adolescent↗
PubMed1998

Tracheal intubation through the intubating laryngeal mask in a patient with a fixed flexed neck and deviated larynx.

Insertion of the conventional laryngeal mask is more difficult or impossible when the patient's head and neck are in either the neutral or flexed position. The intubating laryngeal mask is best inserted when the patient's head is supported by a pillow, without placing the head and neck into the Magill position; therefore, insertion of this modified mask may be less difficult than the conventional mask in the patient with a flexed neck. We report a case of successful insertion of the intubating laryngeal mask and subsequent tracheal intubation through the mask using a fibre-optic bronchoscope, in a patient with a flexed neck in whom tracheal intubation using several methods had been difficult previously.

Adult↗