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At least 1,333 records · Page 74Linked to original sources
PubMed1994

Early intubation in severely injured patients.

In a prospectively studied trauma population from 1986 to 1991 the influence of early intubation (EI) within 2 h after the accident on post-traumatic (multiple) organ failure (M)OF was compared with delayed intubation (DI) in 131 patients with multiple injuries (Injury severity score (ISS) 37). Indications for intubation were unconsciousness following severe head injury in 45 cases (45 EI, 0 DI), major chest trauma (AIS > or = 3) in 40 (31 EI, 9 DI) and the severity of injuries (no head or chest trauma, but ISS > 24) in 40 patients (30 EI, 10 DI). One hundred and six trauma victims (81%) have been intubated early and 19 patients (14.5%) required intubation and artificial ventilation later in the course, whereas 6 subjects (4.5%) could manage spontaneous breathing. The pattern of injured body regions and respiratory parameters on admission showed no remarkable difference in the two groups, but the severity of injury was significantly higher (p < 0.001) in the EI group (ISS 39) compared with the DI patients (ISS 29). Due to a significantly worse haemodynamic condition of the EI patients on admission, they showed significantly higher volume requirements throughout the resuscitation period. All patients were treated to a standard resuscitation protocol. Sixty-seven per cent of the EI patients developed at least one OF, 45% respiratory failure (RF), 28% multiple organ failure (MOF) and 15% died. The DI group showed almost the same incidence of RF (42%) and other OF (63%) and an even higher (n.s.) incidence of MOF (37%) and mortality rate (26%). Corresponding to the significantly lower injury severity of the DI group, the observed OF and mortality rates are inappropriately high in comparison with the incidence of OF and death in the EI group. We conclude that EI of multiple injured patients within 2 h after trauma along with ventilatory support--even in alert patients without major chest trauma or signs of cardiocirculatory or respiratory insufficiency, but a known or suspected ISS > 24--may help to reduce post-traumatic organ failure and improve outcome.

Adolescent↗
PubMed2002

Role of rapid sequence induction for intubation in the prehospital setting: helpful or harmful?

Use of rapid sequence induction for intubation was introduced to the prehospital environment in the hope of enhancing patient outcome by improving early definitive airway management. Varying success has been achieved in both air and ground transport emergency medical services systems, but concern persists about the potential to cause patients harm. Individual emergency medical services systems must determine the need for rapid sequence induction for intubation and their ability to implement a rapid sequence induction for intubation protocol effectively with minimal adverse events. Therefore, the value of rapid sequence induction for intubation is dependent on each emergency medical services system design in their ability to establish personnel requirements and ongoing training, expertise in airway management skills, medical direction and supervision, and a quality assurance program. If these principles are strictly adhered to, rapid sequence induction for intubation may be safely used as an advanced airway management technique in the prehospital setting.

Adult↗
PubMed2002

Esophageal intubation with duodenoscope in the presence of pharyngeal pouch by a guidewire and catheter-guided technique.

Esophageal perforation can occur during blind intubation with a side-viewing duodenoscope during endoscopic retrograde cholangiopancreatogram (ERCP) in patients with pharyngeal or esophageal anomalies. We describe a case of difficult intubation during an ERCP due to an asymptomatic and unsuspected pharyngeal pouch (Zenker's diverticulum). The side-viewing duodenoscope was withdrawn once resistance was encountered during intubation, and a forward-viewing gastroscope was inserted carefully under direct vision to evaluate the upper esophagus. After the diagnosis was made, intubation of the duodenoscope was performed by exchanging scopes over a guidewire. Subsequent ERCP with sphincterectomy and stone removal was uneventful. We caution that a side-viewing duodenoscope should be withdrawn once resistance is encountered during blind intubation during ERCP. Our technique minimizes patient discomfort and is rapid and easy to perform. In addition, no extra device such as an overtube is required.

Aged↗
PubMed2004

Emergency physicians and rapid sequence intubation: a survey of Scottish teaching hospitals.

OBJECTIVES: Emergency definitive airway management is a fundamental skill for physicians in the emergency department. The aim of this survey was to determine the perceived confidence in the assessment and control of the emergency airway, including rapid sequence intubation, among physicians in Scottish teaching hospital emergency departments. METHODS: A postal survey of senior and middle-grade physicians in seven Scottish teaching hospital emergency departments. RESULTS: The response rate was 78% (47/60). A total of 98% of physicians rated their confidence at assessing the difficult airway as 'reasonable' to 'very high'; 79% were confident concerning their ability to administer drugs to facilitate emergency intubation; 47% had used drugs for emergency intubation within the month preceding the survey, and 72% had done so within the 6 months before the survey. Consultants were more confident than trainees, as were those possessing the Fellow of the Royal College of Anaesthetists qualification or a Diploma in Anaesthetics (UK). Those possessing the Fellowship of the Royal College of Anaesthetists qualification had all performed a rapid sequence intubation within the past month. CONCLUSION: Physicians in Scottish teaching hospital emergency departments have high levels of self-rated confidence in assessment and their ability to secure the emergency airway utilizing drugs to facilitate emergency intubation. Consultants and those with anaesthetic qualifications are more confident than trainees and those without such a qualification.

Clinical Competence↗
PubMed2004

Possible risk factors associated with moderate or severe airway injuries in children who underwent endotracheal intubation.

OBJECTIVE: To analyze the role of risk factors associated with moderate or severe airway injuries in children who underwent endotracheal intubation. DESIGN: Prospective cohort study. SETTING: Pediatric intensive care unit. PATIENTS: All patients who required endotracheal intubation during a 25-mo period (October 1999 through October 2001). Exclusion criteria were death before extubation and weight of <1250 g. INTERVENTIONS: Airway endoscopy at extubation and reevaluation for those reintubated. MEASUREMENTS: Relative risks and 95% confidence intervals were calculated in the univariate risk factor analysis (age, sex, organ failure, difficult intubation, tube size, reintubation, tube changes, and duration of intubation). p Values were calculated from the chi-square test with Yates' correction or for trend, and a value of <.05 was considered significant. To define which of the main variables were independently associated with the outcomes of interest, we used logistic stepwise forward modeling. The Mantel-Haenszel method was used for the stratified analysis between the two independently associated variables. RESULTS: The study population consisted of 215 patients (61 newborns and 154 children). Moderate lesions occurred in 24.2% of patients, and severe lesions in 10.7% of patients. Risk factors associated with moderate or severe injury in a univariate analysis were age, sex, organ failure, reintubation, tube changes, and longer duration of intubation. According to Mantel-Haenszel stratified analysis results, reintubation and tube changes were the only variables independently associated with the outcomes. CONCLUSIONS: We concluded that to prevent morbidity secondary to airway injury, efforts should be directed to avoid reintubation and tube changes in the concerned scenario.

Adolescent↗
PubMed1975

Intubating conditions with AH 8165 and suxamethoniun.

Intubating conditions after AH 8165, 1times25 mg/kg, have been compared with those after suxamethonium 1 mg/kg in 240 patients. Patients were matched for physical fitness and intubating conditions were studied in different groups at 30, 45, 60 and 75 seconds after the relaxant. At all times suxamethonium produced a higher incidence of good relaxation of the vocal cords and the incidence of excellent overall intubating conditions was significantly higher with suxamethonium. It proved impossible to intubate eleven patients with AH 8165 at the chosen time but all patients receiving suxamethonium could be intubated.

Aza Compounds↗
PubMed1977

Rapid intubation with fazadinium. A comparison of fazadinium with suxamethonium and alcuronium.

The speed of onset and intubation conditions have been compared for suxamethonium 1 mg/kg, alcuronium 0-32 mg/kg and fazadinium 1 mg/kg and 1-25 mg/kg. Fazadinium 1 mg/kg was not significantly different in times to intubation from suxamethonium although the latter gave a highly significant greater number of patients with excellent conditions. The higher dose of 1-25 mg/kg fazadinium did not give significantly better intubating conditions than the lower dose. Although the times to intubation for the two dose levels of fazadinium did not differ statistically, the higher dose was significantly slower in onset than suxamethonium. Alcuronium was slower than either suxamethonium or fazadinium 1 mg/kg in producing satisfactory conditions. The nondepolarizing drug, fazadinium, may be a useful neuromuscular blocking agent in emergency cases where rapid intubation is required and when it is wished to avoid possible or probable adverse effects from the depolarising drug suxamethonium.

Adolescent↗
PubMed1984

Comparison of intubating conditions with atracurium, vecuronium and pancuronium.

A blind trial, comparing time of onset of satisfactory conditions for tracheal intubation with atracurium 0.6 mg/kg, vecuronium 0.1 mg/kg and pancuronium 0.1 mg/kg is described. Intubation was attempted at 30-second intervals in 60 patients, randomly allocated to receive one of the above muscle relaxants. Patients receiving atracurium 0.6 mg/kg could be intubated from 30 to 120 seconds. Patients receiving either vecuronium 0.1 mg/kg or pancuronium 0.1 mg/kg were able to be intubated between 60 and 240 seconds. The results showed a statistically significant earlier onset of satisfactory intubating conditions with atracurium than with vecuronium or pancuronium in these doses but no difference between vecuronium and pancuronium.

Adolescent↗
PubMed1984

Atracurium for intubation in man. A clinical and electromyographic study.

Atracurium is a new competitive neuromuscular blocking agent. We prospectively studied intubating conditions 2.5 minutes after atracurium doses of 0.4 or 0.5 mg/kg. For comparison, we evaluated conditions 1 minute after suxamethonium 1.0 mg/kg, there being 10 patients in each group. The same anaesthetist evaluated conditions during laryngoscopy and intubation in all patients. Intubating conditions were excellent in 33% of patients receiving atracurium 0.4 mg/kg and 60% of those receiving atracurium 0.5 mg/kg after 2.5 minutes; conditions were excellent in 80% of patients 1 minute after suxamethonium. The incidence of successful intubation on the first attempt was 67%, 90%, and 100%, respectively, in the three groups. Atracurium may be a suitable alternative to suxamethonium when speed of intubation is not critical.

Adolescent↗
PubMed1984

Reducing the haemodynamic responses to laryngoscopy and intubation. A comparison of alfentanil with fentanyl.

The effects of alfentanil and fentanyl on controlling the haemodynamic responses to laryngoscopy and intubation have been compared. Five groups of ten patients were studied. Induction was with thiopentone 4 mg/kg. Thirty seconds later group 1 received 1 ml/20 kg saline, group 2 received 15 micrograms/kg alfentanil, group 3 received 30 micrograms/kg alfentanil and group 4 received 5 micrograms/kg fentanyl one minute before induction. Suxamethonium was given 60 seconds after induction and intubation of the trachea was performed 150 seconds after the start of induction. Heart rate and mean arterial pressure were recorded every minute throughout and compared with pre-induction control values. Control patients (group 1) showed significant increases associated with tracheal intubation in all haemodynamic variables. No increases were noted in groups receiving 30 micrograms/kg alfentanil or 5 micrograms/kg fentanyl. The heart rate, but not blood pressure, increased with intubation after 15 micrograms/kg alfentanil. The mean time to movement in 50% of the control patients was 7 minutes. In those given 15 and 30 micrograms/kg alfentanil it was 11 and 12 minutes respectively. In those given 5 micrograms/kg fentanyl it was greater than 15 minutes. Alfentanil is shown to reduce the cardiovascular responses to laryngoscopy and intubation and the effect appears to have a shorter duration than that of fentanyl.

Adjuvants, Anesthesia↗
PubMed1988

Effects of beta-adrenoceptor antagonism on the cardiovascular and catecholamine responses to tracheal intubation.

The catecholamine and cardiovascular responses to laryngoscopy and tracheal intubation were studied in 20 patients who underwent elective gynaecological surgery and who were allocated randomly to receive either practolol 10 mg or saline intravenously prior to induction of anaesthesia. Anaesthesia was induced with fentanyl and thiopentone; atracurium was administered and the lungs were ventilated artificially with 67% nitrous oxide in oxygen. Tracheal intubation was performed when muscle relaxation was adequate. Arterial pressure, heart rate, plasma noradrenaline and adrenaline concentrations were measured before and after tracheal intubation. A significant increase in catecholamine concentrations occurred in both groups in response to tracheal intubation but the magnitude of the increase in adrenaline was greater in the practolol group. There were no significant differences in arterial pressure or heart rate changes between the groups. We conclude that pretreatment with practolol is of no value in the attenuation of the hypertensive response to direct laryngoscopy and tracheal intubation in previously normotensive patients.

Adult↗
PubMed1988

Intra-ocular pressure changes during induction of anaesthesia and tracheal intubation. A comparison of thiopentone and propofol followed by vecuronium.

Intra-ocular pressure was measured during induction of anaesthesia with propofol (n = 40) or thiopentone (n = 40) followed by vecuronium to facilitate tracheal intubation which was carried out 3 minutes after the administration of relaxant. The average induction doses were 2.15 and 4.83 mg/kg for propofol and thiopentone, respectively. Half the patients in each group received a supplementary dose of the same induction agent (propofol 1.0 mg/kg or thiopentone 2.0 mg/kg) (corrected) prior to intubation. Both propofol and thiopentone produced a significant reduction in intra-ocular pressure which decreased further after administration of vecuronium as well as the second smaller dose of the induction agents. Intra-ocular pressure prior to intubation was lower in the two propofol groups in comparison to the corresponding thiopentone groups. Intubation was associated with an increase in intra-ocular pressure but it still remained significantly below the baseline values except in the group given one dose of thiopentone. Supplementary doses of induction agents before intubation attenuated the increase in intra-ocular pressure. Propofol was significantly more effective in this respect and this group showed the lowest intra-ocular pressure throughout the study period. However, administration of propofol resulted in a 30% incidence of pain on injection and a decrease in systolic arterial pressure of more than 30% in about half the patients.

Adolescent↗
PubMed1990

Successful difficult intubation. Tracheal tube placement over a gum-elastic bougie.

A randomised study was carried out to assess the effect of tracheal tube rotation on the passage of a tube over a gum-elastic bougie into the trachea in 100 patients. The effect of the presence or absence of a laryngoscope on successful tube placement was also assessed. A grade 3 difficult intubation was simulated in patients with a laryngoscope. There was a significant difference in the rates for successful first-time intubation in those patients with tube orientation of -90 degrees (with the bevel facing posteriorly) as compared with a tube orientation of 0 degrees (the normal orientation with the bevel facing left). The unsuccessful first-time intubations with a 0 degree orientation were frequently converted to successful intubations with the -90 degrees position at a second attempt. The presence of a laryngoscope in the mouth while rail-roading a tube over the bougie also made a significant difference to the rate of successful first-time intubations. The most successful method was to leave the laryngoscope in the mouth and rotate the tube to -90 degrees.

Adolescent↗
PubMed1992

An evaluation of the gum elastic bougie. Intubation times and incidence of sore throat.

This study was designed to evaluate the routine use of a gum elastic bougie for tracheal intubation. The median time to intubation with the gum elastic bougie while simulating an 'epiglottis only' view was only 10 s longer than the time taken during conventional intubation with an optimum view. Three of the patients required a gum elastic bougie-assisted intubation after attempts at conventional visual intubation had failed. There was no significant difference in the incidence of postoperative sore throat and hoarseness between the two groups. We recommend that anaesthetists should use the gum elastic bougie whenever a good view of the glottis is not immediately obtained.

Evaluation Studies as Topic↗
PubMed1993

Intermittent thiopentone for teaching fibreoptic nasotracheal intubation.

A technique for teaching fibreoptic nasotracheal intubation is described. Fifty patients presenting for elective dental surgery received thiopentone by intermittent injection for induction and maintenance of anaesthesia whilst a trainee anaesthetist attempted to visualise the vocal cords using an intubating fibrescope. During endoscopy patients spontaneously breathed oxygen-enriched air and passage of the tracheal tube was facilitated by suxamethonium. Arterial blood pressure, heart rate and arterial oxygen saturation were monitored continuously. Time from loss of eyelash reflex to successful intubation was 113 (90) (35-480) s (mean (SD) (range)). Changes in arterial blood pressure and heart rate were similar to those described in previous studies of tracheal intubation. Haemoglobin oxygen saturation remained above 95% in 43 patients, and above 93% in 46 patients; the lowest saturation recorded was 91%. Intermittent thiopentone provides good conditions for teaching fibreoptic nasotracheal intubation whilst maintaining arterial blood pressure and oxygen saturation.

Adolescent↗
PubMed1993

A technique of awake fibreoptic intubation. Experience in patients with cervical spine disease.

We report our experience of 58 patients undergoing awake fibreoptic intubation for cervical spine surgery. Topical anaesthesia was administered using a 'spray as you go' technique. The tracheas of 57 patients were intubated successfully. The mean time from starting topical anaesthesia to intubation was 16.1 min (SEM 1.0). The procedure was associated with cardiovascular stability, a low incidence of severe cough and had a high patient acceptance. There was a low failure rate amongst trainees. The minimum mean arterial oxygen saturation was 92.9% (SEM 1.1). There was no relationship between the time taken to intubation and the episodes of desaturation or the grade of laryngeal visibility at direct laryngoscopy. This method of producing topical anaesthesia for awake fibreoptic intubation is recommended.

Adolescent↗
PubMed1994

Cervical spine movement during orotracheal intubation: comparison of the Belscope and Macintosh blades.

This study was designed to compare the degree of cervical spine movement during laryngoscopy and tracheal intubation using the Belscope and Macintosh laryngoscope blades. Twenty ASA 1 and 2 patients scheduled for elective surgery requiring tracheal intubation were studied. Following induction of anaesthesia and muscle relaxation, a neutral cross-table lateral cervical spine X ray was taken. Laryngoscopy was then performed in each patient using both the Belscope and Macintosh blades. After visualisation of the vocal cords and tracheal intubation the cervical spine X ray was repeated. Movement of the cervical spine was evaluated by tracing bony landmarks on each film and then superimposing the neutral and intubating films. We were unable to demonstrate a difference in the amount of cervical spine movement comparing the two blades. Using the Belscope blade, intubation took longer (median 18 s) than the Macintosh blade (median 12 s, p < 0.01) and was unsuccessful in two patients despite adequate visualisation of the vocal cords.

Adolescent↗
PubMed1994

Teaching fibreoptic intubation. Effect of alfentanil on the haemodynamic response.

A technique for teaching fibreoptic orotracheal intubation in patients under general anaesthesia is described and evaluated. A standard general anaesthetic was administered to 60 patients presenting for elective gynaecological surgery. Patients were randomly assigned to receive either alfentanil 10 micrograms.kg-1 or a placebo, and to be intubated either by a consultant experienced in the use of the fibreoptic bronchoscope or by an inexperienced trainee under instruction. Heart rate, arterial pressure and oxygen saturation were monitored continuously. The time to achieve tracheal intubation in the trainee group was significantly prolonged (p < 0.001), but no patient developed arterial desaturation. The hypertensive response to fibreoptic intubation was suppressed in those patients who received alfentanil (p < 0.001). The increase in heart rate was not suppressed, but was attenuated when these patients were compared with those who had received the placebo (p < 0.001). Alfentanil 10 micrograms.kg-1 minimises the haemodynamic response when teaching fibreoptic orotracheal intubation under general anaesthesia.

Adolescent↗