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At least 1,423 records · Page 79Linked to original sources
PubMed2002

Combined electro-acupuncture with liver artery intubation in treatment of massive liver cancer.

OBJECTIVE: To investigate the clinical effectiveness of electro-acupuncture therapy (EAT) in combination with liver artery intubation chemotherapy for massive liver cancer. METHODS: A total of 106 patients were divided into 3 groups. In group A, patients underwent EAT in combination with invasive therapy. In group B, patients received EAT alone. In group C, patients underwent liver artery intubation chemotherapy. In group A and B, subcostal oblique incision was performed to expose liver cancer, and electrodes were inserted into the tumor under direct vision. In group A, liver artery intubation was performed during operation, followed by chemotherapy through the tube. Liver artery intubation chemotherapy was performed only in group C. RESULTS: The effective rate was 73.7% (28/38), 55.6% (20/36) and 28.1% (9/32) in group A, B and C, respectively. CONCLUSIONS: Electro-acupuncture therapy in combination with liver artery intubation chemotherapy achieves best results. It is an effective therapy for massive liver cancer.

Adult↗
PubMed2003

Effect of controlled hyperventilation on the pressor response to laryngoscopy and tracheal intubation.

Pressor response to laryngoscopy and tracheal intubation includes rises in blood pressure and heart rate. This response may be harmful in the presence of cerebral or myocardial diseases. Although different preventive measures have been developed the choice of the agent or method has not been defined clearly. Hypocapnia is commonly used in anesthesia practice for different indications. It depresses the cardiovascular system and lowers the cardiac output. This study investigated the effect of controlled hyperventilation on the pressor response to laryngoscopy and tracheal intubation in three groups of healthy adult patients with different levels of end tidal CO2. The blood pressure and heart rate were recorded during induction of general anesthesia before and after laryngoscopy and tracheal intubation. The pressor responses to laryngoscopy and tracheal intubation in hypocapnic and normocapnic groups were comparable. Moderate degrees of controlled hyperventilation caused relatively more fluctuation in blood pressure during induction of anesthesia. It can be concluded that controlled hyperventilation has no beneficial effect upon the pressor response to laryngoscopy and tracheal intubation.

Adult↗
PubMed1992

A descriptive study of blood in the mouth following routine oral endotracheal intubation.

Oral endotracheal intubation and extubation are two routine procedures performed by anesthesia providers which could lead to breaches of mucosal integrity and slight or moderate bleeding, thereby providing a vector for transmission of a blood-borne disease. This study was designed to determine the incidence of occult or overt blood in the oral and pharyngeal areas during the intubation and extubation periods. A convenience sample of 163 patients from 18 to 70 years of age who underwent an oral endotracheal intubation for general anesthesia were included. Within 15 minutes of endotracheal intubation, the patients were tested at five designated sampling sites for the presence of overt or occult blood. The results demonstrated that blood was present after 34% of the intubations, with 70% of those being positive in the oral/pharyngeal cavity and 52% exhibiting blood on the laryngoscope blade. Upon extubation 72% were positive, with 97% of those being positive at the distal tip of the endotracheal tube. The blood found during both these events was primarily occult. The results suggest that the potential for blood, both overt and occult, to be present in the mouth of patients is significant enough to recommend that all practitioners adhere to the universal barrier precautions to limit their exposure to the transmission of potentially fatal blood-borne viruses.

Adolescent↗
PubMed2004

Language barrier leads to the unnecessary intubation of trauma patients.

Airway evaluation in trauma patients is performed immediately upon patient contact, with communication being a vital component to this exam. Language and communication barriers may lead to the unnecessary placement of an artificial airway with resultant patient risk and elevation of health care costs. The objective of our study was to evaluate potentially preventable intubations in Spanish-speaking patients. A 9-year retrospective review was performed using the National Trauma Registry for The American College of Surgeons (NTRACS) database. We evaluated patients intubated on arrival to the trauma center and remaining intubated for less than 48 hours. Deaths were excluded. Patients who typically speak English were compared with patients who typically speak Spanish. Mechanism of injury (MOI), hypotension during resuscitation (HDR), illicit substance use, alcohol use, mean Glasgow Coma Score (GCS), mean Injury Severity Score (ISS), payer source, and hospital cost were compared. Forty-nine per cent and 38 per cent of Spanish and English speaking individuals, respectively, were intubated for less than 48 hours (P = 0.072). MOI, HDR, ISS, illicit substance use, alcohol use, and payer source were similar. GCS was statistically higher in the Spanish-speaking group (14 vs 12; P = 0.004). Language and communication barriers lead to potentially preventable intubations in trauma patients.

Adult↗
PubMed2004

[Intubation using an illuminating stylet in a patient with a catecholamine-secreting paraganglioma].

Laryngoscopy and tracheal intubation produce intense noxious stimuli and are associated with an adrenergic response that can be deleterious in patients with concomitant diseases. Illuminating stylets effectively aid blind intubation by lighting the trachea, and using such devices has been associated with lower incidences of sore throat, dysphonia, and adverse hemodynamic events in comparison with rigid laryngoscopy. We report the case of a female patient with a catecholamine-secreting vagal paraganglioma. She developed multiple hypertensive episodes that were difficult to control during surgical resection of the tumor. It was decided to perform orotracheal intubation with a Light Wand (Vital Signs, Inc., Totowa, NJ, USA) to avoid oropharyngeal stimulation and to attenuate the hypertension and arrhythmias associated with laryngoscopy in such patients. The procedure was carried out without difficulty on the first attempt, in spite of tracheal displacement. The maximum increases in blood pressure and heart rate were observed 1 minute after intubation and were less than 30% of basal levels. We believe that using this light wand while intubating this patient helped keep the expected hemodynamic response to a minimum during laryngoscopy.

Carotid Body Tumor↗
PubMed2004

[Pulse wave velocity can predict hemodynamic responses to induction of anesthesia and tracheal intubation].

BACKGROUND: The degree of aortic stiffness can be evaluated by noninvasive measurement of pulse wave velocity (PWV). We investigated hemodynamic responses to induction of anesthesia and tracheal intubation, and hypothesized that preoperative measurement of PWV might predict these responses. METHODS: PWV was measured before operation by using automatic PWV measurement device. Patients were anesthetized with fentanyl (1 microg x kg(-1)) and propofol (target controlled infusion at 2.5 microg x ml(-1)), and tracheal intubation was facilitated with vecuronium (1.5 mg x kg(-1)). Hemodynamic data were recorded from the start of anesthesia to 5 minutes after the tracheal intubation. RESULTS: Twenty patients completed the study. There was a significant correlation between PWV and percent changes in systolic blood pressure during anesthesia induction. However, a significant correlation between PWV and percent changes in systolic blood pressure after tracheal intubation was found only in the patients without antihypertensive medications. CONCLUSIONS: Preoperative PWV measurement was useful to predict hemodynamic responses to induction of anesthesia and tracheal intubation.

Adult↗
PubMed2005

A novel method for endotracheal intubation of mice and rats used in imaging studies.

A safe and efficient method for endotracheal intubation was needed to mechanically ventilate mice and rats for various research projects. We developed an easy, reliable, and expeditious method for intubating these rodents. Inexpensive disposable Teflon intravenous catheters are used as endotracheal tubes. Both mice and rats are anesthetized using a combination of injectable and inhalational anesthetics before intubation. A relatively inexpensive custom-designed fiber-optic light guide and battery-powered light source allows visualization of the oropharynx for quick and easy intubation. The fiber-optic light guide has two functions: 1) the light guide transports light from the illuminator to the tip of the fiber for direct visualization of the larynx, and 2) the fiber is used as a stylet to stiffen the Teflon catheter. Direct illumination of the larynx allows its clear visualization and makes the procedure easier and more efficient and, as a result, less traumatic to the animals. This method has been easy to learn, and it allows repeated intubations, even in debilitated or dyspneic animals, for respiratory-gated, noninvasive imaging procedures. With it, we can acquire higher-quality images with fewer motion artifacts than we could before.

Animals↗
PubMed2005

[Effects of landiolol on cardiovascular responses, bispectral index and body movement during endotracheal intubation].

BACKGROUND: We investigated the effects of a novel highly cardioselective short-acting beta-blocker, landiolol, on cardiovascular response, bispectral index and body movement during endotracheal METHODS: Forty ASA class 1 patients were randomly allocated into 2 groups, in a double-blind fashion; 1) 20 patients received landiolol 125 microg x kg(-1) x min(-1) for one minute followed by 40 microg x kg(-1) x min(-1) (landiolol group), and 2) 20 patients received saline (control group). Landiolol or saline was started 6 min after a target controlled infusion of propofol (effect-site concentration 4 microg x ml(-1)). The trachea was intubated 11 min after propofol infusion. Heart rate, mean arterial pressure, and bispectral index were recorded. In addition, the "isolated forearm" technique was used to detect body movement during endotracheal intubation. RESULTS: Maximum changes in heart rate (control; 48% versus landiolol; 19%), mean arterial pressure (51% versus 39%), and bispectral index (31% versus 12%) observed during endotracheal intubation were significantly less in the landiolol group. More patients in the control than in the landiolol group moved after endotracheal intubation (19 versus 11, P<0.05). CONCLUSIONS: Our results suggest that landiolol infusion was effective to attenuate the hemodynamic, arousal and somatic responses to endotracheal intubation.

Adrenergic beta-Antagonists↗
PubMed2005

[Incidence of inappropriate cases for training of emergency medical technicians in endotracheal intubation].

BACKGROUND: Before emergency medical technicians are licensed to perform prehospital endotracheal intubation, they must undergo training in the operating room setting. We investigated the incidence of cases of difficult intubation classified as Cormack & Lehane grade III or IV, because such cases are considered inappropriate for training emergency medical technicians. METHODS: We examined anesthesia records between March 2002 and April 2003, retrospectively. The survey included 585 adult surgical patients with ASA physical status I or II requiring general endotracheal anesthesia. RESULTS: Five anesthesiologists and three doctors from the surgical department performed laryngoscopy during this period. In initial laryngoscopy with a Macintosh blade, the view of larynx was grade I in 436, grade II in 98, grade III in 27 and grade IV in 24 patients. In 68 patients, application of cricoid pressure led to improvement of laryngoscopy grade. The use of McCoy blade was necessary for intubation in 16 patients. Out of 51 patients classified as difficult intubation grade III or IV, 35 were originally not expected to be difficult cases. CONCLUSIONS: Patients with grade I or II view of larynx with a Macintosh blade was only 91%. In order to prepare for unexpected case of difficult intubation, it is necessary to take various measures such as having instructors perform laryngoscopy.

Anesthesia, General↗
PubMed1992

Evaluation of the endotracheal intubating conditions of rocuronium (ORG 9426) and succinylcholine in outpatient surgery.

The time-course of action and tracheal intubating conditions of rocuronium and succinylcholine under intravenous anesthesia with propofol, alfentanil, and nitrous oxide were studied in 30 patients undergoing outpatient surgery. The neuromuscular effects of both drugs were quantified by recording the indirectly evoked twitch response of the adductor pollicis muscle after ulnar nerve stimulation (0.1 Hz, 0.2 ms supramaximal stimuli). Patients were given either 0.6 mg/kg rocuronium (n = 20) or 1 mg/kg succinylcholine (n = 10) intravenously. Sixty seconds after the administration of the muscle relaxant, the trachea was intubated and the intubating conditions were scored by a "blinded" assessor. Intubating conditions were not different (P = 0.34) between the rocuronium and succinylcholine groups. The onset and duration of neuromuscular blockade were shorter with succinylcholine than with rocuronium. The depression of the twitch response to 5% of control value occurred in 0.8 +/- 0.1 min with 1 mg/kg succinylcholine and 1.2 +/- 0.5 min with 0.6 mg/kg rocuronium (P less than 0.01). The recovery of the twitch response to 25%, 75%, and 90% of its control value was shorter after succinylcholine (P less than 0.001) and occurred at 8.1 +/- 2.6, 10.3 +/- 3.9, 11.3 +/- 4.6 and 25.3 +/- 5.0, 33.1 +/- 5.9, 36.1 +/- 6.3 min after succinylcholine and rocuronium, respectively. Also the time required for spontaneous recovery from 25% to 75% of the control twitch response was significantly shorter (P less than 0.001) after succinylcholine (2.2 +/- 1.4 min) than after rocuronium (7.8 +/- 2.1 min). It is concluded that in spite of the pharmacodynamic differences between succinylcholine and rocuronium, the intubating conditions after administration of both compounds are similar and develop at the same rate.

Adult↗
PubMed2005

Induction-intubation response--smokers vs non-smokers--.

BACKGROUND AND OBJECTIVES: Tobacco smoking has been established to be a hazardous activity. Changing social attitude is bringing a decline in tobacco consumption but a significant proportion of patients presenting for surgery still continues to smoke, putting themselves at risk of perioperative complications. We evaluated induction-intubation response in 40 male patients (ASA-I) divided into two groups of 20, each consisting of smokers and non-smokers. METHODS: All patients received standard premedication and general anesthesia. Heart rate, blood pressure and rate-pressure product were measured prior to induction, just before intubation and at 1, 3, 5 and 10 minutes after intubation. Continuous electrocardiography (EKG lead II) monitoring was done. Carboxyhemoglobin and total hemoglobin were estimated at the time of securing venous access. Arterial blood gases were analysed 5 minutes before and after the tracheal intubation. RESULTS: Incidence of arrhythymias (30%) was higher in smokers compared to non-smokers (10%). Mean carboxyhemoglobin (COHb) level in smokers was 3.81 +/- 2.17 gdL(-1) as compared to 2.95 +/- 1.33 gdL(-1) in non-smokers. Four patients who continued to smoke till the day of surgery had higher COHb levels (8.2, 5.9, 6, 8.8 gdL(-1)). PaO2 and PaCO2 levels were comparable in both groups. CONCLUSIONS: During induction-intubation period, heart rate; systolic, diastolic and mean arterial pressure and rate-pressure product showed more pronounced fluctuations in smokers than in non-smokers (p < 0.05).

Adult↗
PubMed2006

[A Kumamoto model of clinical training in tracheal intubation for paramedics].

BACKGROUND: Since July 2004, the Japanese Ministry of Health, Labor and Welfare approved certified paramedics to perform emergency prehospital tracheal intubation. A specialized training system in tracheal intubation has been established in Kumamoto Prefecture. METHODS: The Kumamoto Prefectural Medical Control Organization, a tracheal intubation task force was established: consisting of the departments of Anesthesiology at Kumamoto University and 11 other major hospitals, along with Kumamoto Prefecture and the 14 prefectural fire-departments. This group published the Kumamoto training guidelines and a training system for paramedics. RESULTS: Kumamoto Prefecture appealed for support of paramedic activity on television and in newspapers as public education. The prefectural governor officially asked hospitals to train paramedics. Because 9 of the 14 fire-departments had no regional teaching hospital, trainees were matched with other hospitals by the task force. The task force published a pamphlet to inform surgical patients about tracheal intubation training and to recruit patients as practice volunteers. Anesthesiologists undertook significant roles in making arrangements to facilitate the project at their hospitals, in addition to teaching paramedics prior to surgical procedures. CONCLUSIONS: The Medical Control Organization, Kumamoto Prefecture, anesthesiologists and emergency response personnel worked together successfully to promote the training program for clinical tracheal intubation by paramedics.

Allied Health Personnel↗
PubMedDate not supplied

Intubating conditions with propofol under muscle relaxation with vecuronium bromide. A time-related comparison with thiopental.

In the present study a comparison has been made between intubating condition obtainable after anesthesia induction with Thiopental or Propofol, using Vecuronium Bromide to achieve muscle relaxation. Data were collected about hemodynamic parameters, vocal cords position, coughing or bucking, and involuntary movements. Three-hundred patients, males and females, ASA classes I and II, not premedicated, were included in the study; they all had to undergo surgery requiring tracheal intubation. The patients were divided in six different groups, and in each of them intubation was performed at different times from injection of inducing agents (2-2, 30-3-4-5-6 minutes). Overall results show a lack of satisfying intubating conditions on the extreme of selected times (2 and 5-6 minutes), with no significant difference between Thiopental and Propofol, except for a minimal unlike behaviour in hemodynamics. Therefore, on the basis of our data, as far as intubating conditions are considered, we can conclude that there is no reason to prefer one of the two inducing agents.

Adolescent↗
PubMed2006

[Questions concerning an endotracheal intubation or a tracheotomy in amyotrophic lateral sclerosis].

Amyotrophic lateral sclerosis (ALS) is an illness in which respiratory complications often determine the terminal prognosis. Emergency situations lead one to pose questions concerning an endotracheal intubation or a tracheotomy. A tracheotomy should not be performed during an emergency situation. A tracheotomy necessitates a stable condition and prior reflection. Orotrachael intubation is the method of choice during emergency situations requiring invasive ventilation or airway protection. Intubation during an emergency situation presents specific problems: the lack of knowledge concerning the person and their pre-established desires, the impossibility of evaluating the potential reversibility of an acute pathology, the risk of not being able to wean the patient off the ventilator and the lack of time to gather all the elements necessary for a well-thought out decision. It may be appropriate for emergency personnel to introduce mechanical ventilation and leave the reflection for a later moment, but this approach is not suitable for people in end of life situations in which the person and the family wish to avoid all unreasonable therapeutics. One solution may be to develop among emergency care teams the practice of using non-invasive ventilation and airway clearance techniques as well as developing palliative care knowledge. Orotracheal intubation in an emergency situation presents certain practical difficulties, notably regarding the choice of anesthetics. Preventings situations where emergency intubation may be necessary is probably best obtained by anticipating acute problems, by preparing the ill person, the family and the care givers, by coordinating the potential care providers and by educating emergency personnel in palliative care.

Amyotrophic Lateral Sclerosis↗
PubMed1991

[Effects of clonidine premedication upon hemodynamic changes associated with laryngoscopy and tracheal intubation].

The authors studied 30 patients undergoing general anesthesia in order to evaluate whether oral clonidine premedication could attenuate the hemodynamic changes associated with laryngoscopy and tracheal intubation. Patients were randomly assigned to one of two groups; clonidine group (n = 15) who received oral clonidine of approximately 5 micrograms.kg-1, or control group (n = 15) who received no clonidine. The magnitude of increases in mean blood pressure from baseline values following laryngoscopy and tracheal intubation in the clonidine group was significantly smaller as compared with that in the control group (20 +/- 12 vs. 31 +/- 14 mmHg, mean +/- SD, P less than 0.05). There was also a significant difference between the two groups in the incidence of systolic blood pressure increases above 180 mmHg following laryngoscopy and tracheal intubation (0% vs. 26%, P less than 0.05). However, no significant difference was noted between the two groups in the heart rate responses to laryngoscopy and tracheal intubation. It is concluded that oral clonidine of 5 micrograms.kg-1 as a preanesthetic medication could attenuate the pressor responses associated with laryngoscopy and tracheal intubation.

Administration, Oral↗
PubMed1990

[Plasma catecholamine response to tracheal intubation after midazolam and vecuronium in elderly patients with hypertension].

This study was undertaken to determine whether midazolam alleviates sympathoadrenal response evoked by tracheal intubation in elderly patients with hypertension. Anesthesia was induced with midazolam in a sleep dose followed by vecuronium 0.1 mg.kg-1. Heart rate and blood pressure were recorded before, 1 and 3 minutes after induction with intubation. Free and total catecholamine (CA) in plasma were measured at each time. Dopamine, norepinephrine and epinephrine (EN) were determined using fluorescence derivatization with diphenylethylenediamine by HPLC. Although heart rate and diastolic pressure rose in some degree 1 min after intubation, free and total CA concentrations did not increase during study period. Free and total EN levels decreased significantly 3 min after intubation. The absence of elevation in plasma CA concentrations, especially in free CA, which is physiologically active, would contribute to produce circulatory stability on laryngoscopy and tracheal intubation. However, the mystery of why hyperdynamic state was produced without the increase in CA concentrations remains to be solved, even though it occurred for a short period of time.

Aged↗
PubMed1990

Arterial oxygen desaturation during awake endotracheal intubation.

Five patients requiring general anesthesia but presenting with compromised airways were successfully intubated by blind awake intubation with the aid of regional anesthesia and the use of appropriate sedation. Arterial blood gases were collected at three intervals: presedation, postsedation, and postintubation. Analysis of the blood gases revealed varying degrees of hypoxemia, hypercarbia, and acidosis following deep sedation before intubation. A decrease in oxygen saturation was also observed. Supplemental oxygen is suggested to avoid the effects of arterial desaturation during the sedation process. If oxygen is not administered, the risk of moderate hypoxia associated with blind awake intubation must be considered along with alternative problems including loss of protective reflexes or the inability to ventilate during induction and intubation via a direct technique.

Adult↗
PubMed1990

[Effects of intratracheal lidocaine spray on circulatory responses to endotracheal intubation].

The effect of intratracheal lidocaine spray (0.5, 1.0, 2.0 mg.kg-1) on blood pressure and heart rate changes to endotracheal intubation was evaluated in 20 ASA I-II patients. After thiamylal induction, 15 patients received lidocaine spray with LTA kit. Mean arterial blood pressure and heart rate were recorded for 10 min every 30 sec and analysis of plasma lidocaine concentrations were also performed. In the control group, mean arterial blood pressure increased significantly compared with the pre-anesthetic values for one min, and with all spray groups at one min after intubation. Heart rate increased significantly at 30 sec after intubation only in the control group. Since the plasma lidocaine concentrations at intubation were below 1.5 micrograms.ml-1, we conclude that intratracheal lidocaine spray depresses the circulatory response to intubation by its local surface analgesic effect.

Administration, Inhalation↗