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At least 1,405 records · Page 78Linked to original sources
PubMed2005

Nalbuphine prevents haemodynamic response to endotracheal intubation.

OBJECTIVE: To determine the efficacy of nalbuphine in preventing the increase in heart rate and mean arterial pressure in response to laryngoscopy and orotracheal intubation. DESIGN: A comparative trial. PLACE AND DURATION OF STUDY: Department of Anaesthesia, Pakistan Naval Hospital Shifa, Karachi, Pakistan, from January 2001 to January 2002. PATIENTS AND METHODS: Forty healthy patients having general anaesthesia for elective surgery, were selected by convenient sampling to receive either saline [group I (control group); n= 20] or nalbuphine 0.2 mg/kg; (group II; n = 20) as a bolus dose, 5 minutes before laryngoscopy. Double blinding was done as the patient as well as the researcher was not aware of which study drug was being given. Heart rate (HR) and mean arterial pressure (MAP) were measured before induction of anaesthesia (time 1), just after intubation (time 2), then after every minute upto 5 minutes (time 3-7) and after 10 minutes of intubation (time 8). Twenty percent rise in heart rate (HR) and mean arterial pressure (MAP) was considered as significant. Data were analyzed by using SPSS version 10. Student's t-test was used for the significance of parameters at p < 0.05 and analysis of variance test (ANOVA) was interpreted for group analysis of the parameters. RESULTS: There was a significant increase (p <0.05) in heart rate (53.4%) in group I after intubation at time 2 compared with baseline at time 1, as compared to group II (15.5%). The HR gradually decreased during time 3 to 8 but still remained slightly higher than group II. MAP also increased significantly (p <0.05) in group I, at time 2 (43.6%) compared with baseline at time 1 as compared to group II (10.5%). The MAP also gradually decreased during time 3 to 8 but remained on slightly higher level than group II. CONCLUSION: Nalbuphine 0.2 mg/kg prevented a marked rise in heart rate and mean arterial pressure associated with laryngoscopy and orotracheal intubation.

Adult↗
PubMed1981

Emergency endotracheal intubation by respiratory care personnel in a community hospital.

We designed and implemented a program to train respiratory therapy personnel to perform emergency endotracheal intubation in a community hospital. During a one-year study period, 143 emergency intubations were attempted by physicians, nurse anesthetists, and respiratory therapy personnel. Respiratory therapy personnel attempted 74 intubations, with 13 complications, for a complication rate per attempt of 18%. Physicians and nurse anesthetists attempted 69 intubations, with 39 complications, for a complication rate of 57%. We conclude that trained respiratory care personnel can safely and effectively secure an airway via endotracheal intubation under emergency circumstances in our institution.

Hospital Bed Capacity, 100 to 299↗
PubMed1999

[Conditions of intubation and neuromuscular block induced by mivacurium: comparison with succinylcholine].

OBJECTIVE: To compare the clinical conditions for intubation and neuromuscular parameters after a high dose of mivacurium (0.25 mg/kg; 3 x SD95) administered in 30 s to those obtained after use of the usual dose of succinylcholine (1 mg/kg). PATIENTS AND METHODS: Eighty-two patients, 37 in the succinylcholine group and 45 in the mivacurium group, were studied. Intubating conditions were assessed on a scale of 3 to 12 points analyzing ease of laryngoscopy, relaxation of vocal cords and presence of cough 60 seconds after administration of the drug. Neuromuscular parameters were acceleration of the thumb induced by supramaximal train-of-four stimulation of the cubital nerve. Heart rate and non-invasive mean blood pressure were recorded throughout surgery. Cutaneous flush was looked for after administration of the relaxant. RESULTS: Time to onset of effect (159 s versus 82 s) and times to recovery after mivacurium were significantly longer than with succinylcholine. Mivacurium afforded excellent/good conditions for intubation in 95.6% of cases, with a neuromuscular blockade at intubation of 52.68%. No significant hemodynamic changes or side effects were observed. CONCLUSIONS: Given the moderate conditions of intubation achieved at 60 s, mivacurium can not be recommended as a relaxant in situations that require a rapid induction sequence. In elective surgery, 0.25 mg/kg of mivacurium can, however, be considered an alternative to succinylcholine.

Adolescent↗
PubMed1999

Effects of early postnatal alcohol exposure on learning in the developing rat: replication with intubation method of delivery.

Early postnatal exposure to alcohol during early development produces deficits in learned persistence, as reflected in the partial reinforcement extinction effect (PREE) in weanling rats, and deficits memory-based learning, as shown by patterned single alternation (PSA) discrimination learning in preweanling rats. We report a partial replication of these effects using the intubation method instead of artificial rearing. Rat pups were intubated once per day with 4.5 g/kg/day alcohol in a milk-based diet or control diet on postnatal days (PNDs) 4 to 9, and then assessed for the PREE on PNDs 20 and 21 or PSA learning on PNDs 17 and 18. Compared with previous artificial rearing reports, the intubation method produced healthier and heavier pups, and yielded a consistently lower and less variable blood alcohol levels. Even with the lower alcohol levels, intubation with alcohol eliminated the PREE. Intubation with alcohol had a weaker but still detrimental effect on PSA learning. These results suggest that alcohol exposure during development can produce behavioral deficits in the absence of the more severe effects on brain and body growth typically associated with fetal alcohol syndrome.

Animals↗
PubMed1999

Visual estimation of onset time at the orbicularis oculi after five muscle relaxants: application to clinical monitoring of tracheal intubation.

UNLABELLED: The onset time of neuromuscular blockade at the adductor pollicis (AP) is different among neuromuscular blocking drugs, but these discrepancies had never been studied at the orbicularis oculi (OO). The purpose of this study was to verify if the differences in onset time observed at the AP still existed at the OO and to score the intubating conditions using monitoring at the OO after five muscle relaxants. The study included 172 adults aged 18-75 yr. Anesthesia was induced with fentanyl and propofol. Atracurium (0.5 mg/kg), mivacurium (0.20 mg/kg), rocuronium (0.6 mg/kg), succinylcholine (1.0 mg/kg), or vecuronium (0.08 mg/kg) was injected by random allocation. Time to complete disappearance of the response at the OO was assessed visually after train-of-four stimulation of the facial nerve. Laryngoscopy was then performed, and intubating conditions were determined on a scale of 1-4. Results were based on 150 patients. Onset time at the OO was (mean +/- SD): succinylcholine (57 +/- 17 s) < mivacurium (99 +/-19 s) = rocuronium (99 +/- 47 s) < atracurium (129 +/-33 s) = vecuronium (135 +/- 38 s) (P < 0.05). Overall intubating conditions were excellent (84%), good (14%), poor (1.3%), impossible (0.7%), and were similar among the five groups. We conclude that differences in onset time of muscle relaxants observed at the AP were also found at the OO. Visual estimation of the response at the OO correctly predicted good-to-excellent intubating conditions in more than 90% of cases for all the currently available muscle relaxants. IMPLICATIONS: Onset time of neuromuscular blockade, as estimated visually at the orbicularis oculi, depends on the muscle relaxants given. Regardless of the relaxant used, intubating conditions at loss of orbicularis oculi are acceptable.

Adolescent↗
PubMed1999

[The use of bronchial fibroscopy for difficult intubations in maxillofacial surgery].

BACKGROUND: Evaluation of difficulties and modalities of tracheal intubation in maxillofacial surgery. METHODS DESIGN: retrospective study. SETTING: maxillofacial operation room. 2152 patients who underwent elective maxillofacial surgery during a five-year time, from 1994 to 1998. Indications and alternative modalities of tracheal intubation through fiberoptic bronchoscope in eight patients (0.37%) with preoperatively evaluated difficult intubation due to temporomandibular ankylosis (3 patients), burns sequelae (1 patient), craniofacial congenital malformations (2 patients), unstables fractures of the cervical spine (2 patients), are discussed. Fiberoptic bronchoscope was used through nasotracheal route under topical nasal and laryngeal anaesthesia, combined with appropriate benzoanalgesia, in order to maintain spontaneous breathing. Proper positioning of tracheal tube was directly checked by fiberoptic bronchoscope, through visualization of the tracheal carina. RESULTS: In seven patients tracheal intubation was easily performed without complications in less than 20 minutes. In the eight patients the time spent was 35 minutes, due to important nasal bleeding, which caused a change of the nostril. CONCLUSION: Among the alternative methods of elective tracheal intubation, previously evaluated as difficult or impossible using conventional laryngoscopy, the use of fiberoptic bronchoscope seems to be safest and easiest to use, although not the cheapest.

Adult↗
PubMedDate not supplied

[Comparison between the rubber Carlens tube and the polyvinylchloride Robertshaw tube for endobronchial intubation].

The aims of the study were to compare prospectively two double-lumen endobronchial tubes (DLTs): red rubber Carlens and left polyvinylchloride Robertshaw DLT with regard to difficulties in intubation and complications during one-lung ventilation. Sixty-two adult patients were randomly intubated with Carlens tube (31 patients) or Robertshaw tube (31 patients). Correct placement of DLTs was assessed using clinical signs and in some patients in the Robertshaw group fiberoptic bronchoscope was used. In the group intubated with the Carlens tube there were significantly more difficulties in passing the tube through the larynx (4 out of 31 patients), compared with the Robertshaw group (not a single patient). There was no difference in the number of patients with difficulties in placing the tube in the left main bronchus; however, the nature of the problem was more complex with the Carlens tube. The frequency of all the complications as well as the occurrence of the most common complications--hypoxemia and increased peak airway pressure, was not different between the groups. In both groups hypoxemia was related to the right side of the operation. Fiberoptic bronchoscope was used in 18 out of 31 patients intubated with the Robertshaw tube. Its use was not correlated with decreased incidence of complications compared to intubation in which tube position was assessed by clinical signs only.

Adult↗
PubMed2000

[Cardiovascular response to tracheal intubation in patients with intracranial tumor. Comparative study between urapidil and lidocaine].

OBJECTIVES: To compare the effects of urapidil and lidocaine on cardiovascular response to laryngoscopy and tracheal intubation in patients with brain tumors. PATIENTS AND METHODS: Prospective, randomized double-blind study of 40 ASA II-III patients undergoing elective surgery for supratentorial tumor resection. The patients were assigned to two groups of 20 to receive an intravenous bolus of 1.5 mg/kg of lidocaine or 0.4 mg/kg urapidil before laryngoscopy and intubation. Anesthetic induction was performed with 0.03 mg/kg midazolam, 3 micrograms/kg of fentanyl, 5 mg/kg of thiopental and 0.2 mg/kg of vecuronium. Anesthesia was maintained with N2O/O2 (60%/40%) and isoflurane (0.5% expired). The following variables were recorded: mean blood pressure, heart rate and arterial oxygen saturation (SpO2) at baseline and 1, 2 and 3 min after induction and at 1, 2, 3, 4, 5 and 10 min after laryngoscopy and tracheal intubation. RESULTS: The two groups were comparable with respect to age, sex, weight, height and baseline hemodynamics. No statistically significant differences in hemodynamic variables were found between the two groups. Mean blood pressure in the postintubation period stayed near baseline and heart rate increased significantly after laryngoscopy and tracheal intubation in both groups. SpO2 decreased 7 min after administration of urapidil and stayed lower throughout the study period and was statistically different from SpO2 in the lidocaine group. All changes described were within clinically normal ranges. CONCLUSIONS: In patients undergoing neurosurgery to remove a supratentorial tumor, both lidocaine and urapidil reduce the pressor response to laryngoscopy and tracheal intubation at the doses given in this study. However, neither was able to prevent the increase in heart rate.

Adult↗
PubMed2000

[Successful fiberoptic intubation for a patient with lingual tonsillar hyperplasia].

Hypertrophied lingual tonsils are rare, but may cause difficulty or inability in tracheal intubation during induction of general anesthesia. A 39-yr-old woman was scheduled for resection of symptomatic hypertrophied lingual tonsils. In this patient, we examined two methods of oro-tracheal intubation either with rigid laryngoscopy or flexible fiberoscopy using trans-nasal fiberopic monitoring. Direct laryngoscopy failed to expose the trachea because of large hypertrophied tissue, and fiberoscopic intubation was also difficult since a large mass hindered acquiring a suitable view. However, transnasal fiberoscopic monitoring could guide the orotracheal fiber into the trachea for intubation. When an anesthesiologist can predict the abnormality of lingual tonsils, this combination might be recommended for difficult airway and intubation.

Adult↗
PubMed2000

Effect of bolus dose of remifentanil on haemodynamic response to tracheal intubation.

A randomized placebo-controlled double-blinded study was conducted in 40 ASA 1 and 2 patients to determine the dose response of remifentanil in attenuating the haemodynamic response to tracheal intubation. Patients were allocated to one of four groups: placebo, remifentanil 1 microgram.kg-1, remifentanil 2 micrograms.kg-1 and remifentanil 4 micrograms.kg-1. A propofol target-controlled infusion was started at 4 micrograms.ml-1 and incrementally titrated to loss of verbal contact. Muscle relaxation was provided by cisatracurium. The study drug was given three minutes later over 30 seconds, and 90 seconds later the patient's trachea was intubated under direct laryngoscopy. Baseline noninvasive blood pressure and heart rate recordings were made prior to starting target-controlled infusion, then at one-minute intervals after loss of verbal contact for the duration of the study. Demographic data and target-controlled infusion rate at intubation was similar for the groups. Following intubation, heart rate increased by 15% in the placebo group, 10% in 1 microgram.kg-1 group, with no changes in 2 micrograms.kg-1 and 4 micrograms.kg-1 groups. Systolic blood pressure following intubation increased by 30% in the placebo group, 10% in the 1 microgram.kg-1 group and remained unchanged in the 2 micrograms.kg-1 and 4 micrograms.kg-1 groups. Remifentanil 1 microgram.kg-1 attenuated the rise in heart rate and systolic blood pressure. Remifentanil 2 micrograms.kg-1 blocked the haemodynamic response completely: no further benefit was shown from increasing the dose to 4 micrograms.kg-1.

Adult↗
PubMed2000

Effects of ephedrine on the onset time of neuromuscular block and intubating conditions after cisatracurium: preliminary results.

We studied the effects of intravenous ephedrine on the onset time and the intubating conditions 2 min after a bolus dose of cisatracurium (0.15 mg kg-1). Thirty patients anaesthetized with sufentanil and propofol were randomly divided in 2 groups to receive either ephedrine (70 micrograms.kg-1) or saline, 5 s before propofol. Cisatracurium was administered after loss of consciousness. Neuromuscular block was assessed at the adductor pollicis using accelography. Tracheal intubation was performed 2 min after cisatracurium injection and rated as excellent, good, poor or bad. At intubation, neuromuscular block (% height of control T1) was greater in patients receiving ephedrine (36.1 +/- 25.8% vs 57.9 +/- 25.1%) (mean +/- SD). The frequency of excellent intubating conditions was higher after ephedrine (86.6%) than after saline (40.0%). The onset time of cisatracurium was shorter after ephedrine (167 +/- 64.8 s vs 234.9 +/- 63.1 s). Thus, a low dose of ephedrine given before induction of anaesthesia improves the intubating conditions 2 min after 0.15 mg kg-1 cisatracurium and this effect likely relates to a quicker onset of neuromuscular block.

Adult↗
PubMed2001

[Do all patients with mandibular hypoplasia present difficulty in endotracheal intubation?].

On 7 patients with Pierre-Robin syndrome (PR), 8 patients with first and second brachial arch syndrome (BA) and 7 patients with Treacher Collins syndrome (TC), we examined retrospectively the number of patients whom anesthesiologists found difficult to perform laryngoscopy and intubation, the number of attempt necessary for proper insertion of the tracheal tube, the number of patients in whom the endotracheal intubation with laryngoscopy was given up and the time necessary for endotracheal intubation. We compared these with those from 22 control patients. Our results suggest that the difficult laryngoscopy and intubation are more frequent in TC. On the other hand, most of PR and BA may not present difficulty in intubation.

Child↗
PubMed1999

[Bolus administration of esmolol for preventing the haemodynamic response to tracheal intubation: a multicentre clinical study].

OBJECTIVE: To explore the dose-response relation and the safety of esmolol administered as a single i.v. bolus prior to the induction of anesthesia for preventing the haemodynamic response to tracheal intubation. METHODS: 1,830 patients from 20 centres were randomly divided into three groups: E1 group, receiving esmolol at a dose of 1 mg/kg; E2 group, at 2 mg/kg and E0 group, receiving 0.9% NaCl. Heart rate, systolic and diastolic, and mean artery blood pressures (MAP) were measured following the induction and 1 to 10 minutes following the intubation. RESULTS: The patients in the E0 group had greater HR and MAP values after anesthesia induction and tracheal intubation than the patients in the E1 and E2 groups (P < 0.05-0.01). The E1 group had higher HR than the E2 group (P < 0.05-0.01). The incidence of tachycardia after intubation was higher in the E0 group (63.8%) than in the E1 group (34.7%) and the E2 group (22.6%) (P < 0.01). The proportion of hypotention and bradycardia was higher in the two treatment groups than the E0 group (P < 0.01), but no severe adverse event was observed. CONCLUSION: A 1-2 mg/kg bolus of esmolol is effective and safe for preventing the haemodynamic response to tracheal intubation. The clinical and side-effects are all dose-related.

Adolescent↗
PubMed2001

Orotrachial intubation in darkness using night vision goggles.

OBJECTIVE: Securing the airway of a wounded soldier while operating in a light-restricted combat environment may be required of forward-deployed military medical personnel. The best method of obtaining such an airway has not been addressed. In this pilot study, the objective was to examine the use of endotracheal intubation using an infrared filtered laryngoscope and night vision goggles. METHODS: The investigators performed endotracheal intubation, using an infrared filter light source laryngoscope, on patients undergoing elective surgical procedures. All intubations took place in a completely darkened operating room. RESULTS: Twenty-one patients (91.3%) were intubated successfully as defined in the study. No adverse outcomes or complications occurred. CONCLUSIONS: This study demonstrates that endotracheal intubation can be performed using a laryngoscope with an infrared filter and night vision goggles with a high success rate in a select population in a darkened environment.

Adolescent↗
PubMedDate not supplied

Disturbances in the function of cardiovascular system in patients following endotracheal intubation and attempts of their prevention by pharmacological bloackade of sympathetic system.

The author recorded arterial blood pressure by direct method and ECG in 94 patients during laryngoscopy and intubation. A rise of the mean arterial blood pressure was observed from 104 to 153 mm Hg together with the appearance of ventricular premature beats in patients with normal arterial blood pressure and without arhythmia before the procedure. Superficial analgesia of the pharynx, larynx and trachea failed to prevent the rise of arterial pressure during intubation. The procedure of superficial analgesia connected with intubation caused also a rise in the arterial blood pressure and arrhythmia. Blockade of beta adrenergic receptors reduced the intensity of these disturbances, while blockade of alpha adrenergic receptors increased them. Blockade of the sympathetic ganglia by controlled infusion of trimethaphan (Arfonad) allowed the arterial pressure to be controlled during intubation thus preventing sudden rises and the development of arrhythmia. The author suggests that a sudden rise in the arterial blood pressure during endotracheal intubation may cause rupture of aortic or intracranial aneurysms. The rise of arterial blood pressure precedes the appearance of ventricular premature beats caused by stimulation of the pharynx, larynx and trachea.

Analgesia↗
PubMed2003

[The usefulness of the processed nasal airway for fiberscope guided nasotracheal intubation].

BACKGROUND: The fiberscopy has become an essential tool for tracheal intubation. As we realized that nasal airway acts like a conduit to guide a fiberscope toward the larynx, we have devised a unique nasal airway named "Osaka airway" which is suitable for fiberoptic naso-tracheal intubation. This airway has two pre-cut line from the head to the tip which can be peeled off easily after the insertion of fiberscope. To verify this advantages, we measured the length of nares-vocal cords and assessed the fiberoptic visibility of vocal cords under the aid of nasal airway. METHODS: At the end of operation, 54 patients were extubated and nasal airway was inserted to measure the length of nares-vocal cords and to observe vocal cords and epiglottis. Then, in another series, two beginners conducted fiberoptic intubation on several cases with the aid of Osaka airway. RESULTS: The length of nares-vocal cords of male was 20.2 +/- 1.0 S.D.cm, and that of female 17.3 +/- 1.1 S.D.cm. The length correlated with the body height. In 34 patient, we could see vocal cords just below the airway tip. Two beginners could complete the intubation within 2 min in almost all cases. CONCLUSION: Osaka airway was a help for fiberoptic naso-tracheal intubation for beginners.

Adult↗
PubMed2003

Lidocaine: the optimal timing of intravenous administration in attenuation of increase of intraocular pressure during tracheal intubation.

BACKGROUND: This study was designed to examine the optimal timing of intravenous lidocaine in attenuation of increase of intraocular pressure in response to laryngoscopy and tracheal intubation during induction of anesthesia. METHODS: One hundred and thirty five adult patients of ASA class I, aged between 20-35 years, undergoing surgical procedures irrelevant to ophthalmology were enrolled for study. Patients were randomly assigned to one of five groups. In group II, III, IV and V the patients received intravenous injection of lidocaine (2 mg/kg), 1, 3, 5, 10 min before tracheal intubation, respectively. Group I in which patients did not receive lidocaine served as the control group. RESULTS: In patients of groups I, IV and V, the intraocular pressure increased significantly after intubation, whereas in those of groups II and III, the intraocular pressure did not. All patients in the five groups showed concomitantly a surge of blood pressure, but the magnitude of increase was smallest in group III in comparison with the other groups. The values of systolic and diastolic pressures 1 min after intubation were significantly less in groups III and IV than in the control group. CONCLUSIONS: In healthy patients aged between 20 and 35 the most optimal time of administration of intravenous lidocaine to attenuate the increase of intraocular pressure seemed to be the space between 1 to 3 min before laryngoscopy and tracheal intubation.

Adult↗
PubMed2003

Comparison of two methods for predicting difficult intubation in obstetric patients.

Preoperative airway assessment for prediction of difficult laryngoscopy and intubation was done using the modified Mallampati test and Wilson risk sum score in three hundred and seventy two obstetric patients undergoing elective as well as emergency Cesarean section under general anesthesia. 25 (6.7%) patients had laryngoscopy grade III or IV of whom 24 (6.4%) patients were difficult at tracheal intubation. Mallampati class III or IV predicted 15 of the 23 patients while Wilson risk sum score > or = 2 predicted 9 of the 14 patients in whom tracheal intubation was difficult. As a screening test for prediction of difficult intubation Wilson risk sum score was less sensitive (36%) but had almost same specificity (98.5%) and positive predictive value (64%) in comparison to modified Mallampati test (62.5%, 97.7% and 65% respectively). When used as a predictor of difficult laryngoscopy sensitivity, specificity and positive predictive value for modified Mallampati test were 60%, 97.6% and 65% respectively and for Wilson risk sum they were 36%, 98.5% and 64% respectively, but when both tests were combined as predictors (with either of tests positive) sensitivity improved to 100% while specificity was marginally decreased to 96.2% and positive predictive value (64.8%) remained almost the same. There was no significant association between age and laryngoscopy grade III or IV but there was significant (P < 0.01) relationship with weight and external laryngeal manipulation. The advantage of the above tests lies in, incorporating them into the preoperative protocol, rather than using them as sole predictors of difficult laryngoscopy and intubation.

Adolescent↗