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At least 145 records · Page 8Linked to original sources
PubMed1989

Comparison of tracheal intubating conditions and neuromuscular blocking profiles after intubating doses of mivacurium chloride or succinylcholine in surgical outpatients.

Thirty ASA physical status I or II outpatients scheduled to undergo short procedures (less than 1 hr in duration) requiring tracheal intubation received either 1.0 mg/kg succinylcholine or 0.20 mg/kg (2.5 x ED95) or 0.25 mg/kg (3 x ED95) mivacurium. A N2O/O2/narcotic anesthetic technique was utilized and the ulnar nerve was stimulated with subcutaneous electrodes placed at the wrist. Tracheal intubation was attempted in all patients either 2 min after mivacurium or 1 min after succinylcholine. Intubation conditions were not different between the succinylcholine and mivacurium groups or between the two mivacurium groups. The onset and duration of neuromuscular blockade were shorter with succinylcholine than with mivacurium. Suppression of the T1 response to 90% of baseline occurred in 0.9 min with 1.0 mg/kg succinylcholine and at 2.2 and 1.5 min respectively, with 0.20 mg/kg and 0.25 mg/kg mivacurium. Initial recovery of the T1 response occurred at 6.4 min after 1.0 mg/kg succinylcholine and 12.7 and 13.6 min respectively after 0.20 mg/kg and 0.25 mg/kg mivacurium. Subsequent to initial recovery from the intubating dose of relaxant, infusions of mivacurium or succinylcholine were administered to maintain approximately 95% block. The mean infusion rates were 6.6 micrograms.kg-1.min-1 mivacurium and 41.2 micrograms.kg-1.min-1 for succinylcholine. Spontaneous recovery from neuromuscular blockade occurred more quickly after succinylcholine than after mivacurium: the time from cessation of infusion to recovery of T1 to 95% of baseline was 6.5 min in patients given succinylcholine and 16.7 min in patients given mivacurium. When reversal was in order, residual mivacurium-induced blockade was readily antagonized by 0.045 mg/kg neostigmine.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1996

[Modified technique of Waters for retrograde intubation. Apropos of a case of difficult intubation].

The authors describe a case of impossible intubation by classical means in an obese 37-yr old woman, affected with encephalopathy, hydrocephalus and severe psychomotor retardation. After failure of intubation by classical methods using a flexible introducer, the patient was intubated by Waters retrograde technique using an epidural catheter passed through the thyrocricoid membrane and recovered in the mouth. Following this guide the endotracheal tube passed the glottis fairly easily with the help of a flexible "mouse tail-ended" introducer (C-Mettro, Cook, 19.0.80) inserted into the same tube to facilitate alignment of distal tube and trachea. The authors conclude that the combination of epidural catheter and flexible introducer may facilitate the retrograde technique performance; they consider this technique to be an interesting alternative when endotracheal intubation is difficult or impossible by usual methods.

Adult↗
PubMed1996

[Mouth mask method for fiberoptic tracheal intubation in difficult intubations].

We tried 72 fiberoptic tracheal intubations (FTI) using a mouth mask in difficult intubation cases. In this method, ventilation is performed via only the mouth using a mask applied over the mouth (mouth mask) and FTI can be done via a nostril with no hindrance from the mask in anesthetized patients. We have been using an infant or child type Seal Mask (Gibeck Respiration) for the mouth mask or a specially made mouth mask. An oral airway is usually inserted and the nostril of one side is plugged with cotton. FTI is performed by another anesthesiologist. An endotracheal (ET) tube capped with a rubber diaphragm is passed through another nostril, and a fiberscope is inserted through the ET tube. The subsequent technique is the same as that of the usual FTI for awake patients. Intubations were successful in all cases except 2; in one, ventilation was impaired even with oral airway in place, and in the other, bleeding in upper airway due to jaw injury from traffic accident hindered the sight of the scope. Mouth mask method for FTI is safe, useful and practical in difficult intubations with little discomfort to the patient.

Adolescent↗
PubMed1988

A method of detecting oesophageal intubation or confirming tracheal intubation.

A method of testing the location of an endotracheal tube, in the trachea or oesophagus, was subjected to trial. The test involves drawing back on the plunger of a 50 ml syringe connected with airtight fittings to the endotracheal tube connector, with the endotracheal tube cuff deflated. The ability to withdraw 30 ml of air confirms tracheal intubation. When marked resistance to withdrawal of the plunger occurs and on release the plunger rebounds to its original position the oesophagus has been intubated. The method was 100% accurate in fifty intubations, 25 tracheal and 25 oesophageal. The technique has been in routine use by one author for several years without giving an incorrect answer and enthusiastic use by other authors is producing the same result.

Adult↗
PubMed1995

Clinical application of modified Anyang type 2 esophageal intubation instrument--a new esophageal intubation method.

The preliminary experience in the clinical use of Anyang Type 2 esophageal intubation instrument, designed by ourselves, in 11 patients with severe esophageal obstruction due to advanced carcinoma of the esophageal was reported. The diagnosis of all 11 cases was confirmed by barium-meal roentgenography. After intubation, all the patients could take liquid or soft diet by mouth. There was no operative mortality and the patients survived 2 to 14 months (mean 5.7 months). All of them could take food by mouth before death. The clinical application proved that the intubation has been a safe and suitable management.

Adult↗
PubMed2006

[Transorbital fiberoptic intubation: a predictable difficult intubation in cephalic surgery].

Management of the difficult adult airway is a crucial problem in anaesthesia. It is the first cause of anaesthetic mortality and morbidity. We report here the case of a patient who could only be intubated through the orbital cavity. We discuss our technique of intubation compared to the other rare procedures described in the literature. We also focus on our anaesthetic protocol and the interest of preserving spontaneous ventilation for intubation. Use of short acting anaesthetic drugs can help to achieve such conditions.

Adenocarcinoma↗
PubMed2006

Subcutaneous emphysema and pneumomediastinum after translaryngeal intubation: tracheal perforation due to unsuccessful fiberoptic tracheal intubation.

A 77-year-old man was scheduled to undergo a cervical lymph node biopsy under general anesthesia. Although awake, nasotracheal fiberoptic intubation was initially planned because of an anticipated difficult airway, the attempt was unsuccessful. Orotracheal intubation was subsequently performed under direct laryngoscopy without difficulty. After initiating positive pressure mechanical ventilation, subcutaneous and mediastinal emphysema developed. The cause of this emphysema was considered to be tracheal perforation after an unsuccessful attempt at fiberoptic tracheal intubation.

Aged↗
PubMed1998

Fibreoptic intubation using the cuffed oropharyngeal airway and Aintree intubation catheter.

A cuffed oropharyngeal airway has recently been introduced which has larger internal dimensions than a comparable Guedel airway. This allows a ventilation/exchange bougie, the Aintree Intubation Catheter, mounted on a fibreoptic laryngoscope to pass through it. Its 15-mm connector and pharyngeal cuff suggested the possibility of using a Rüsch sealed-port angle piece to allow ventilation through the oropharyngeal airway during fibreoptic laryngoscopy. This study investigated using this equipment to intubate the trachea through the cuffed oropharyngeal airway in paralysed patients, whilst maintaining ventilation manually with a Bain system. In 20 patients, airway control was satisfactory throughout and tracheal intubation was accomplished without complications. The cuffed oropharyngeal airway was easy to manipulate to improve a suboptimal fibreoptic view of the larynx. This may give it an advantage over the laryngeal mask airway when used as a ventilation/intubation conduit.

Adolescent↗
PubMed1999

Use of the flexible intubating fibrescope for tracheal re-intubation in a patient with difficult extubation.

Difficulty in tracheal extubation was experienced in a patient following major maxillofacial surgery for reconstruction of the maxilla using bone grafts and a microvascular free flap. With the aid of an intubating flexible fibrescope, the cause of the difficulty was identified as a stitch accidentally transfixed through the tracheal tube. Tracheal re-intubation was required to facilitate surgical exploration to remove the stitch and the proximal end of the tube. The tip of an Olympus LF-2 intubating fibrescope was successfully negotiated in the trachea alongside the original tube with its cuff deflated. This allowed safe and speedy railroading of a new tube immediately after the distal end of the original tube was removed.

Adult↗
PubMed2000

Awake tracheal intubation with the intubating laryngeal mask in a patient with diffuse idiopathic skeletal hyperostosis.

Diffuse idiopathic skeletal hyperostosis, otherwise known as Forestier's disease or ankylosing hyperostosis, is a relatively common condition that is distinguished from ankylosing spondylitis by the relative preservation of spinal function and the characteristic 'candle flame' lipping of the vertebrae. We report a patient with this condition and a well-recorded history of impossible intubation who presented for emergency laparotomy. The patient was intubated awake using the intubating laryngeal mask and sedation and anaesthesia were provided by a target-controlled infusion of propofol.

Anesthesia, Intravenous↗
PubMed2000

Comparison of laryngeal mask and intubating laryngeal mask insertion by the naïve intubator.

Seventy-five inexperienced participants were timed inserting the laryngeal mask airway (LMA) and the intubating laryngeal mask (ILM) in one of five cadavers. Adequacy of ventilation was assessed on a three-point scale depending on chest expansion and air leak. Participants were also asked to intubate the trachea via the ILM. The ILM was inserted faster than the LMA (P < 0.05) with a greater proportion achieving adequate ventilation after their first attempt (P < 0.05). Tracheal intubation via the ILM was completed successfully by 67% (52 of 75) of participants. In a questionnaire, participants stated that the ILM was easier to use and the preferred device in an emergency. The results suggest that inexperienced practitioners should use the ILM rather than the LMA for emergency ventilation.

Cadaver↗
PubMed2002

The use of the intubating laryngeal mask endotracheal tube with intubating devices.

IMPLICATIONS: Despite adequate visualization of the vocal cords using specialized airway devices, anatomical factors and the physical characteristics of the tube may cause difficulty when performing endotracheal intubation. The endotracheal tube designed for use with the intubating laryngeal mask airway may facilitate intubation in these circumstances.

Aged↗
PubMed2000

Simplified rat intubation using a new oropharyngeal intubation wedge.

Our new oropharyngeal intubation wedge made from a plastic 3-ml syringe has been used successfully for the expansion of the oropharyngeal cavity and visualization of vocal cords for endotracheal intubation in the rat. All the animals we used tolerated the intubation and ventilation procedures in a series of experiments. After the proper setting of the respirator, vital signs were maintained within normal range. The postmortem examination and measurements in the upper airway confirmed that the endotracheal tube was properly sited and also demonstrated the precise size of the device that should be used. The main advantages of this method include low cost, simplicity, and reliability. Furthermore, because no expensive, elaborate, difficult-to-operate, or hard-to-get special equipment is needed, this technique can be used in every laboratory.

Animals↗
PubMed1993

[Laterosubmental tracheal intubation. An alternative method to nasal-oral intubation or tracheostomy in single-step treatment of panfacial multiple fractures or osteotomies].

In single-step surgery of panfacial fractures or conversion osteotomies of the visceral cranium, nasal as well as oral intubation or tracheal intubation via tracheostomy is necessary. If complicated tracheostomy is not done, intraoperative nasal-oral repositioning of the tube is required. In order to avoid the risks of repositioning the endotracheal tube or tracheostomy, we suggest a new alternative method called laterosubmental tracheal intubation. After a laterosubmental fistula is created at the base of the mouth, directly behind the anterior mandibular dentition, the tube is guided through the oral floor, lateral to the muscles and the salivary duct, and fixed extraorally. The advantages of this method are: no more intraoperative repositioning of the endotracheal tube and no need for tracheostomy, thus eliminating the risks and side effects, as well as tracheal scarring, and free accessibility of the operative field.

Facial Bones↗
PubMed1998

[Usefulness of the intubating laryngeal mask airway for cases with predicted difficult intubation].

We evaluated the usefulness of the intubating laryngeal mask airway (ILMA) in patients who were predicted to have possible difficult airway. Patients with possible difficult airway were defined as those with limited head extension, Mallampati's classification of grade IV, thyro-mental distance < 4 cm, or Cormack grade III-IV on the laryngoscopy. The control group was consisted of the patients without these conditions or impaired mouth opening. Insertion of the ILMA was successfully performed in all patients of both groups. In the group of possible difficult airway, 83% of patients were intubated through the ILMA successfully, and in the control group, 86%. We conclude that the ILMA may become an additional tool in patients with difficult intubation.

Adult↗