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PubMed2001

Intubating trauma patients before reaching hospital -- revisited.

Endotracheal intubation is widely used for airway management in a prehospital setting, despite a lack of controlled trials demonstrating a positive effect on survival or neurological outcome in adult patients. The benefits, in term of outcomes of invasive airway management before reaching hospital, remain controversial. However, inadequate airway management in this patient population is the primary cause of preventable mortality. An increase in intubation failures and in the rate of complications in trauma patients should induce us to improve airway management skills at the scene of trauma. If the addition of emergency physicians to a prehospital setting is to have any influence on outcome, further studies are merited. However, it has been established that sedation with rapid sequence intubation is superior in terms of success, complications and rates of intubation difficulty. Orotracheal intubation with planned neuromuscular blockade and in-line cervical alignment remains the safest and most effective method for airway control in patients who are severely injured.

Air Ambulances↗
PubMed2005

Human patient simulation is effective for teaching paramedic students endotracheal intubation.

OBJECTIVES: The primary purpose of this study was to determine whether the endotracheal intubation (ETI) success rate is different among paramedic students trained on a human patient simulator versus on human subjects in the operating room (OR). METHODS: Paramedic students (n = 36) with no prior ETI training received identical didactic and mannequin teaching. After randomization, students were trained for ten hours on a patient simulator (SIM) or with 15 intubations on human subjects in the OR. All students then underwent a formalized test of 15 intubations in the OR. The primary outcome was the rate of successful intubation. Secondary outcomes were the success rate at first attempt and the complication rate. The study was powered to detect a 10% difference for the overall success rate (alpha = 0.05, beta = 0.20). RESULTS: The overall intubation success rate was 87.8% in the SIM group and 84.8% in the OR group (difference of 3.0% [95% confidence interval {CI} = -4.2% to 10.1%; p = 0.42]). The success rate on the first attempt was 84.4% in the SIM group and 80.0% in the OR group (difference of 4.4% [95% CI = -3.4% to 12.3%; p = 0.27]). The complication rate was 6.3% in the SIM group and 4.4% in the OR group (difference of 1.9% [95% CI = -2.9% to 6.6%; p = 0.44]). CONCLUSIONS: When tested in the OR, paramedic students who were trained in ETI on a simulator are as effective as students who trained on human subjects. The results support using simulators to teach ETI.

Adolescent↗
PubMed2006

Use of etomidate as an induction agent for rapid sequence intubation in a pediatric emergency department.

OBJECTIVES: Although etomidate is widely used for rapid sequence intubation (RSI), there is no consensus on the optimal induction agent and no prospective pediatric emergency department (ED) study exists. The objective of this study was to assess the effectiveness and safety of etomidate as an induction agent for RSI in the pediatric ED. METHODS: Data on RSI conditions and complications were collected prospectively on patients undergoing RSI in a tertiary pediatric ED from January 2003 to December 2003. ED hemodynamic data and inpatient data were collected retrospectively via chart review. RESULTS: Seventy-seven of 101 patients requiring intubation underwent RSI with etomidate. The mean (+/- SD) age was 8.2 (+/- 6.2) years. All 77 patients were successfully intubated. Intubation condition data were available for 69 of 77 patients (89.6%). Conditions were good in 68 of 69 (99%; 95% confidence interval = 92.2% to 99.9%). The mean (+/- SD) maximal percent decrease in systolic blood pressure was 10% (+/- 13.6%). A greater than 20% maximal percent decrease in systolic blood pressure occurred in 12 of 69 patients (17.4%; 95% confidence interval = 9.3% to 28.4%). There was no relationship between seizures after etomidate administration and prior seizure history (p = 0.25). Corticosteroids were given to 29 of 77 patients post-RSI for varying diagnoses. All eight patients given corticosteroids for shock were in shock at the time of intubation. CONCLUSIONS: In the pediatric ED setting, etomidate as an induction agent provided successful RSI conditions and resulted in varied hemodynamic changes that were especially favorable in those patients presenting in decompensated shock. Hypotension and seizures were uncommon and occurred in patients with confounding diagnoses. Until the significance of a single dose of etomidate on adrenal dysfunction is further clarified, caution should be used in those patients at risk for adrenal insufficiency.

Adolescent↗
PubMed1994

Magnetic orotracheal intubation: a new technique.

We sought to determine the effectiveness of a magnet placed over the thyroid cartilage in the neck to guide an endotracheal tube into the trachea. Forty patients aged 18 to 60 yr with normal airway anatomy (ASA grade I) who required general anesthesia with an endotracheal tube and paralysis for their surgery were chosen and informed consents were obtained. The tip of the epiglottis was exposed with a No. 3 MacIntosh laryngoscope, and a magnet was held over the thyroid cartilage. A catheter with stylet was placed behind the epiglottis allowing the magnet to pull the stylet and catheter close to the glottic opening. The catheter was advanced into the trachea over the stylet and its position was confirmed by auscultating the lungs and by capnography. An extension tube was connected to the catheter, and the endotracheal tube was guided into the trachea over the catheter. The tracheas of 37 patients were intubated on the first attempt with the magnet. The tracheas of the remaining three patients could not be intubated on the first attempt but were successfully intubated without complications on the second attempt. An additional five patients with an anterior larynx whose tracheas could not be intubated with direct laryngoscopy also had tracheal intubation with a magnet. This magnet-guided technique can be used when it is difficult to expose a patient's larynx. It is noninvasive, simple, and can be used without any delay when expensive flexible fiberoptic endoscopes are not readily available. The procedure takes an average of 1 to 2 min.

Adult↗
PubMed2003

Airway management using the intubating laryngeal mask airway for the morbidly obese patient.

UNLABELLED: We studied the effectiveness of the intubating laryngeal mask airway (ILMA) in morbidly obese patients scheduled for bariatric surgery. We included 118 consecutive morbidly obese patients (body mass index, 45 +/- 5 kg/m(2)). After the induction of general anesthesia, the laryngeal view was classified by the first observer according to the method of Cormack and Lehane. The ILMA was then inserted, and the trachea was intubated through the ILMA by a second observer. The rate of successful tracheal intubation with ILMA was 96.3%. The success rate, the number of attempts, and the total duration of the procedure were not different among patients with low-grade (Cormack 1-2) and patients with high-grade (Cormack 3-4) laryngeal views. The time required for insertion of the ILMA was slightly longer in patients with high-grade laryngeal views. Failures of the technique were not explained by the experience of the practitioner or airway characteristics. No adverse effect related to the technique was reported. Results of this study suggest that using the ILMA provides an additional technique for airway management of morbidly obese patients. IMPLICATIONS: The intubating laryngeal mask airway (ILMA) provides an additional technique for airway management of morbidly obese patients. The best choice of the primary technique (laryngoscopy or ILMA) for tracheal intubation of an adult obese patient remains to be determined.

Adult↗
PubMed2003

Cardiovascular responses to endotracheal intubation in patients with acute and chronic spinal cord injuries.

UNLABELLED: Endotracheal intubation usually causes transient hypertension and tachycardia. We investigated whether the cardiovascular responses to intubation change as a function of the time elapsed in patients with spinal cord injury. One-hundred-six patients with traumatic complete spinal cord injury were grouped into acute and chronic groups according to the time elapsed (less than and more than 4 wk after injury) and into those with quadriplegia and paraplegia according to the level of injury (above C7 and below T5): acute quadriplegia, n = 26; chronic quadriplegia, n = 27; acute paraplegia, n = 24; and chronic paraplegia, n = 29. Twenty-five patients with no spinal cord injury served as controls. Systolic arterial blood pressure (SAP), heart rate, and plasma concentrations of catecholamines were measured. The intubation did not affect SAP in either the acute or chronic quadriplegics, but it significantly increased SAP in both acute and chronic paraplegics. Heart rate was significantly increased in all groups; however, the magnitude of change was less in acute quadriplegics than in the other groups. Plasma concentrations of norepinephrine increased in every group but the acute quadriplegics. The magnitude of increase was attenuated in chronic quadriplegics, accentuated in acute paraplegics, and similar in chronic paraplegics when compared with controls. The incidence of arrhythmias did not differ among groups. We conclude that the cardiovascular and catecholamine responses to endotracheal intubation may change as a function of the time elapsed and the level of spinal cord injury. IMPLICATIONS: Cardiovascular and catecholamine responses to endotracheal intubation may differ according to the time elapsed and the level of injury in patients with complete spinal cord injury.

Acute Disease↗
PubMed2005

The short-acting beta1-adrenoceptor antagonists esmolol and landiolol suppress the bispectral index response to tracheal intubation during sevoflurane anesthesia.

In this randomized, double-blind, controlled study, we tested the hypothesis that the short-acting beta(1)-adrenoceptor antagonists esmolol and landiolol suppress hemodynamic changes and bispectral index (BIS) increases, both of which are induced by tracheal intubation under general anesthesia with sevoflurane alone. Forty-five patients were randomly assigned to the control, esmolol, and landiolol groups (n = 15 each). Anesthesia was induced with sevoflurane in oxygen, with an end-tidal concentration maintained at 1 minimum alveolar anesthetic concentration (MAC). Infusion of saline (control group), esmolol (bolus of 1 mg/kg and then 0.25 mg x kg(-1) x min(-1); esmolol group), or landiolol (bolus of 0.125 mg/kg and then 0.04 mg x kg(-1) x min(-1); landiolol group) was started 5 min after the induction of anesthesia and was continued throughout the study. Tracheal intubation was performed 12 min after anesthesia induction. There were no differences in overall changes of mean arterial blood pressure among the three groups, whereas, at 1-5 min after tracheal intubation, heart rate increased in all groups but was significantly slower in the esmolol and landiolol groups than in the control group (P < 0.05). BIS was between 96 and 98 for all patients at baseline and decreased during the induction of anesthesia. There were no differences in BIS among the three groups before laryngoscopy (39 +/- 5, 39 +/- 5, and 38 +/- 4 in the control, esmolol, and landiolol groups, respectively). BIS increased significantly in the control group (54 +/- 10; P < 0.05) 1 min after intubation, whereas it remained unchanged in the esmolol and landiolol groups (45 +/- 10 and 41 +/- 6, respectively). In conclusion, the increase in both heart rate and BIS after tracheal intubation under 1 MAC sevoflurane anesthesia was suppressed by the concomitant administration of either esmolol or landiolol.

Adrenergic beta-1 Receptor Antagonists↗
PubMed2006

Lidocaine does not prevent bispectral index increases in response to endotracheal intubation.

We investigated the effect of IV lidocaine on the hemodynamic and bispectral index responses to induction of general anesthesia and endotracheal intubation. Forty patients (ASA I) were randomly allocated into 2 groups of 20 to receive normal saline or lidocaine 1.5 mg/kg IV 30 s after induction. Ninety seconds later, endotracheal intubation was performed. Systolic blood pressure, heart rate, and bispectral index were measured at baseline, 1 min after induction, at preintubation, and every minute until 5 min after endotracheal intubation. Bispectral index at 1 min after induction and preintubation in the lidocaine group were significantly lower compared with the control group (P < 0.05). Systolic blood pressure increased significantly at 1 and 2 min after intubation in the control group compared with the baseline value (P < 0.05) but did not increase significantly in the lidocaine group. Heart rate increased at 1 to 3 min in both groups (P < 0.05), but there was no significant difference between the two groups. One patient in the control group had recall of the procedure. We conclude that the administration of IV lidocaine (1.5 mg/kg) does not suppress the hypnotic response to endotracheal intubation.

Adult↗
PubMed2006

Guided insertion of the ProSeal laryngeal mask airway is superior to conventional tracheal intubation by first-month anesthesia residents after brief manikin-only training.

In the following pilot study, we compared conventional laryngoscope-guided tracheal intubation (tracheal intubation) and laryngoscope-guided, gum elastic bougie-guided ProSeal laryngeal mask airway insertion (guided ProSeal) for airway management by first-month anesthesia residents after brief manikin-only training. Five first-month residents with no practical experience of airway management were observed performing these techniques in 200 ASA I-II anesthetized, paralyzed adults. Each resident managed 40 patients, 20 in each group, in random order. The number of insertion attempts, effective airway time, ventilatory capability during pressure-controlled ventilation set at 15 cm H2O, airway trauma, and skill acquisition were studied. Data were collected by unblinded observers. Insertion was more frequently successful (100% versus 65%) and effective airway time was shorter (41 +/- 24 s versus 89 +/- 62 s) in the guided ProSeal group (both P < 0.0001). Expired tidal volume was larger (730 +/- 170 mL versus 560 +/- 140 mL) and end-tidal CO(2) lower (33 +/- 4 mm Hg versus 37 +/- 5 mm Hg) in the guided ProSeal group during pressure controlled ventilation (both P < 0.0001). Blood staining was more frequent on the laryngoscope (24% versus 2%; P < 0.0001) in the tracheal intubation group. There was evidence for skill acquisition in both groups. We conclude that laryngoscope-guided, gum elastic bougie-guided insertion of the ProSeal laryngeal mask airway is superior to conventional laryngoscope-guided tracheal intubation for airway management in terms of insertion success, expired tidal volume, and airway trauma by first-month anesthesia residents after brief manikin-only training. The guided ProSeal technique has potential for cardiopulmonary resuscitation by novices when conventional intubation fails.

Adolescent↗
PubMed1985

Paranasal sinusitis: a common complication of nasotracheal intubation in neurosurgical patients.

Sinusitis secondary to nasotracheal intubation has not been reported to occur in neurosurgical patients. Over a 1-year period, 11 patients admitted to the Intensive Care/Trauma Unit at St. Paul Ramsey Medical Center developed this entity. The mean age of these patients was 36 +/- 4 years; 7 were trauma victims, 3 had each had a subarachnoid hemorrhage, and 1 had suffered hypertensive hemorrhage. The patients presented with fever of unknown origin (FUO) and evidence of persistent hypermetabolism without an obvious cause. In 8 cases, the diagnosis was not suspected until mucopurulent nasal discharge was noted. Three additional cases were evaluated for suspected sinusitis before the occurrence of discharge. The mean duration of intubation before the diagnosis of sinusitis was 7.8 +/- 1.5 days. The diagnosis was confirmed by sinus films with a Waters view in 7 cases or by computed tomographic scanning in 4 cases and by bacteriological cultures. Two cases involved only the maxillary sinus on the side of intubation; the rest were polysinusites. The organisms involved included gram-positive and gram-negative species; all were polymicrobial with a single organism predominant. Secondary pulmonary involvement was common, and 4 patients revealed a bacteremia consistent with the major sinus organism. One patient developed septic shock. Treatment involved either orotracheal intubation or tracheostomy. This was curative in all cases. It is concluded that neurosurgical patients nasally intubated are at risk for sinusitis, which can have untoward effects such as septicemia or pulmonary infection. A high degree of suspicion will permit early diagnosis and treatment.

Adult↗
PubMed2001

A method of endoscopic endotracheal intubation in rabbits.

Endotracheal intubation in rabbits is a formidable task and has led to the devising of a new endoscopic method. Sixty New Zealand White rabbits (2.0-3.5 kg) underwent experimental left thoracotomy requiring mechanical ventilation. After anaesthetic induction was achieved, the animal was placed in a supine position. A rigid 30 degrees endoscope was passed through a 4.5 mm endotracheal tube (ET) and then used to advance, under direct vision, through the oropharynx and vocal cords. Once passing the vocal cords, the ET was advanced into the trachea as the endoscope was withdrawn. All animals were successfully intubated within 30 s to 2 min and then ventilated. No complications or deaths occurred during or after intubation, or postoperatively. No instances of oesophageal intubation occurred. All animals survived long-term. Thirty animals underwent necropsy at 10 days and, 30 at 30 days, with no postoperative evidence of orotracheal injury. We have established a new method of endotracheal intubation in rabbits. It is reliable, effective, non-traumatic, safe, and expeditious.

Animal Welfare↗
PubMed1988

Prolonged intubation vs. tracheotomy: complications, practical and psychological considerations.

The charts of 52 adult patients who underwent tracheotomy (49 after intubation) were reviewed to identify early complications of both endotracheal intubation and tracheotomy. The complication rate of endotracheal intubation was 57%, and of tracheotomy, 14%. None of the complications of tracheotomy was serious. Sixty critical-care nurses were surveyed about their attitudes regarding prolonged endotracheal intubation and tracheotomy. A large majority preferred tracheotomy for patients who require airway support, for several reasons. First, they felt that tracheotomy patients were more comfortable and, therefore, required less sedation and restraint. Second, the patients could communicate more effectively. Third, airway care was simplified. Ninety-two percent of nurses stated that they would prefer a tracheotomy for themselves or a loved one if more than 10 days of ventilatory support were required. We conclude that tracheotomy can be performed safely in this group of patients, and that it offers significant practical and psychological benefits compared to prolonged endotracheal intubation.

Aged↗
PubMed2000

Tracheal rupture associated with intubation in cats: 20 cases (1996-1998).

OBJECTIVE: To characterize clinical features of tracheal rupture associated with endotracheal intubation in cats and to evaluate the most appropriate treatment for this condition. DESIGN: Retrospective study. ANIMALS: 20 cats with a history of endotracheal intubation that subsequently developed dyspnea or subcutaneous emphysema. PROCEDURE: Medical records of cats with a presumptive diagnosis of tracheal rupture associated with intubation were reviewed. Clinical and clinicopathologic data were retrieved. RESULTS: Cats were evaluated 5 hours to 12 days after a surgical or medical procedure requiring general anesthesia with intubation had been performed. Fourteen (70%) cats were evaluated after dental prophylaxis. All cats radiographed had pneumomediastinum and subcutaneous emphysema. Eighteen of 19 cats were initially treated medically. Duration of medical treatment for cats that did not have surgery ranged from 12 to 72 hours. Cats that had surgery received medical treatment 3 to 24 hours prior to the surgical procedure. Medical treatment alone was administered to 15 cats that had moderate dyspnea, whereas surgical treatment was chosen for 4 cats that had severe dyspnea (open-mouth breathing despite treatment with oxygen) or worsening subcutaneous emphysema. Eighteen cats had improvement of clinical signs, 1 cat died after surgery, and 1 cat died before medical or surgical intervention. CONCLUSIONS AND CLINICAL RELEVANCE: Most cats with tracheal rupture associated with intubation can be treated medically. Cats with worsening clinical signs (severe dyspnea, suspected pneumothorax, or worsening subcutaneous emphysema) should have surgery performed immediately to correct the defect.

Animals↗
PubMed1995

Risk factors for asthmatic patients requiring intubation. I. Observations in children.

There are significant concerns regarding the increased mortality of patients with asthma. Indeed the paradox of improved pharmacotherapy but worsening prognosis has been explored in depth in several studies including observations in epidemiology, access to medical care, and drug toxicity. Because of our ability to track all admissions to a tertiary-care hospital, we attempted to define the demographic data from a population of asthmatic children admitted for asthma in order to identify risk factors for intubation. We performed a retrospective cohort study of all asthma admissions excluding patients with cystic fibrosis. This study included all asthmatics aged 5-12 years admitted over a 10-year period (1984-1994) to the University of California at Davis Medical Center, Sacramento. A total of 300 such asthma admissions were reviewed, involving 135 girls and 165 boys, mean age 7.7 +/- 2.4 years. Of this group, 166 children were black, 70 were Caucasian, 49 were Hispanic, 14 were Asian, and 1 was an American Indian. By National Heart, Lung, and Blood Institute guidelines, this group included 147 mild, 117 moderate, and 36 severe cases. Thirteen children required intubation for their asthma. Significant risk factors identified for children requiring intubation, compared to those who did not require intubation, were secondhand smoke exposure [odds ratio (O.R.) 22.4; 95% confidence interval (C.I.) 7.4, 68.0], psychosocial problems (O.R. 13.5; 95% C.I. 5.1, 36.0), family dysfunction (O.R. 13.0; 95% C.I. 3.9, 43.9), upper respiratory infection (O.R. 10.2; 95% C.I. 3.4, 28.1), little formal education (O.R. 8.7; 95% C.I. 2.4, 31.6), prior asthma emergency room visit in past year (O.R. 7.2; 95% C.I. 1.9, 27.1), prior asthma hospitalization in past year (O.R. 7.1; 95% C.I. 2.2, 22.2), crowding (O.R. 6.9; 95% C.I. 2.5, 19.1), low socioeconomic status (O.R. 6.5; 95% C.I. 2.1, 20.8), steroid-dependent (O.R. 3.8; 95% C.I. 1.2, 12.1), parental history of allergy or asthma (O.R. 3.4; 95% C.I. 1.1, 10.0), and language barrier (O.R. 3.3; 95% C.I. 1.1, 10.6). Nonsignificant mild risk factors included inhaled cromolyn (O.R. 2.7; 95% C.I. 0.7, 10.0), atopy (O.R. 1.9; 95% C.I. 0.6, 5.9), and prior intubation (O.R. 1.6; 95% C.I. 0.2, 13.1). These risk parameters may be important determinants of baseline risk for asthma deaths and their recognition may have a significant impact on preventive measures.

Asthma↗
PubMed1995

Risk factors for intubation of adult asthmatic patients.

Our object was to describe demographic data from a population of adult asthmatics admitted to a regional tertiary medical center to identify risk factors for intubation. We performed a retrospective cohort study of all asthma admissions (International Classification of Diseases, Ninth Revision, Code 493.9) excluding cases with chronic obstructive pulmonary disease. This included all patients with asthma 20 years and above admitted to the University of California Davis Medical Center, Sacramento, from January 1, 1990 to June 30, 1993. A total of 375 asthma admissions were reviewed. There were 244 women (29 intubated) and 131 men (13 intubated) with a mean age of 40.7 (range 20-72) years. Of this group, 131 people were white, 140 black, 56 Hispanic, 42 Asian, and 6 American Indian. By National Heart, Lung, and Blood Institute Guidelines, there were 101 mild, 181 moderate, and 93 severe cases. Significant risk parameters identified for intubation were psychosocial problems [odds ratio (O.R.) 9.3; 95% confidence interval (C.I.) 6.8, 12.7], low socioeconomic group (O.R. 2.9; 95% C.I. 1.5, 5.8), little formal education (O.R. 5.4; 95% C.I. 2.8, 10.2), atopic allergy (O.R. 11.7; 95% C.I. 5.7, 23.7), duration of asthma > or = 15 years (O.R. 2.6; 95% C.I. 1.3, 5.3), previous intubation (O.R. 14.0; 95% C.I. 7.6, 25.6), upper respiratory infection (O.R. 4.0; 95% C.I. 2.2, 7.5), hospital admission for asthma within the last year (O.R. 5.3; 95% C.I. 2.7, 10.4), emergency room visit within the last year (O.R. 8.8; 95% C.I. 3.9, 20.1), and steroid dependency (O.R. 5.5; 95% C.I. 3.0, 10.2).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Palliative intubation of malignant oesophageal strictures.

A 6-year experience (1981-1987) of palliative intubation of irresectable malignant oesophageal strictures is reported in 110 patients with a mean age of 70.3 (range 41-90) years. Pulsion intubation was performed on 71 patients, 11 (15.5%) of whom died, and traction intubation on 39 with 6 (15.4%) deaths. Seven deaths resulted from instrumental perforation, but six other patients survived perforation and left the hospital in satisfactory condition. Mean in-patient stay was 8 (range 1-26) days. Non-fatal tube-related complications were more common in pulsion intubation, but was found to be highly effective in relieving dysphagia, with shortened hospital stay (mean 6 days) and acceptable morbidity and mortality rates. These results indicate the trend towards, and the increased safety of, pulsion intubation.

Aged↗
PubMed1998

Improvement of gas exchange by apneic oxygenation with nasal prong during fiberoptic intubation in fully relaxed patients.

To evaluate the effect of apneic oxygenation with a nasal prong during fiberoptic orotracheal intubation (FOI) in fully relaxed patients, 46 patients, who underwent tympanomastoidectomy under general anesthesia whose intubation lasted more than 3 but less than 4 minutes, were studied. Changes of arterial oxygen tension (PaO2), arterial carbon dioxide tension (PaCO2) and vital signs were measured every minute. Twenty-three patients who underwent FOI in apneic state without oxygen administration (Group I), showed similar increases in heart rate (HR) and mean arterial pressure (MAP) to the other 23 patients who received 5 L/min of apneic oxygenation (Group II) with nasal prong. PaCO2 increased less and PaO2 decreased less in Group II at 3 minutes. In summary, apneic oxygenation during fiberoptic orotracheal intubation in fully relaxed patients is useful because it could delay the onset of hypoxia and hypercarbia, thereby providing extra time for intubation. And attempts to intubate a fully relaxed patient could probably be kept at least under 3 minutes.

Anesthesia, General↗
PubMed1995

Intubation of weight-selected chicks with soybean oil or residual yolk: effect on early growth and development.

Experiments were conducted to study the role of residual yolk on growth and development of chicks during the 1st wk after hatch. Surgical removal of the yolk sac at hatch reduced early body weight gains. Intubating chicks with a mixture of soybean meal and soybean oil or with residual yolk obtained from chicks at hatch increased body weights and enhanced development of the liver and pancreas. Whereas intubation with residual yolk reduced absorption of yolk sac contents, absorption was similar for chicks that consumed mash ad libitum or were intubated with the soybean meal-soybean oil diet. After cessation of yolk intubation, absorption of residual yolk resumed. Removal of the yolk sac decreased amylase and lipase activity in the pancreas. In the intestinal chyme, activity of amylase, trypsin, and chymotrypsin was reduced by yolk sac removal. Intubation with yolk increased enzyme activity (amylase excepted) in the pancreas or intestinal chyme only in chicks that had their yolk sacs removed. There was evidence that contents of the yolk sac did not enter the intestine via the yolk stalk, but were absorbed directly via the blood.

Aging↗