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PubMed1990

[Sinusitis caused by nasotracheal intubation].

Sinusitis following nasotracheal intubation (NTI) is an almost overlooked complication. The pathogenesis is believed to be development of oedema of the nasal mucosa due to irritation by the tube in the nasal cavity. The size of the tube is probably not important, whereas the duration of intubation is of major importance. The infection is often caused by Gram-negative microorganisms. The frequency is found to be 0.3% in short term intubation (less than 5 days) and 40.4% in long term intubation (greater than 5 days). In neurosurgical patients treated with NTI sinusitis is found in 52% and 100% of the patients. In adults the indications for prolonged NTI instead of orotracheal intubation and early tracheostomy should be considered carefully. If fever or sepsis develops in patients treated with NTI, investigations for sinusitis should be included in the search for focus. When sinusitis has developed, the tube should be removed, and the patient tracheostomised. If this treatment fails, surgical drainage should be performed.

Humans↗
PubMed1987

Palliative intubation of the tracheobronchial tree.

Sixteen patients with far-advanced neoplastic lesions in the trachea and main-stem bronchi were studied. Ten of them were admitted to the ward in extremely poor general condition with marked cyanosis and dyspnea at rest. Palliative intubation was undertaken with two types of tubes: a Neville tracheal prosthesis and a Tracheoflex tracheostomy tube. Both types of tubes had to be specially prepared, as they had originally been designed for other purposes. The tubes were placed in the stenotic sections of the trachea and, depending on anatomical relations, within the right or left main bronchus as well. Intubation of the bronchus in the case of changes involving only the trachea was necessary to properly position and fasten the tube in the bronchial tree and to prevent displacement of the prosthesis inside the trachea. In two patients the esophagus was intubated as well. An improvement in the general condition of all patients was observed. Intubation resulted in reexpansion of a completely collapsed lung in two patients. The longest time of intubation was 9 months. The method is simple, and every physician experienced in endoscopy can use it. The results obtained encourage its further and wider application.

Adult↗
PubMed1989

[Pneumothorax, subcutaneous emphysema and mediastinal emphysema in transnasally intubated patients].

A 41-year-old woman was admitted to our clinic because of an acute subdural hematoma. After an emergency operation her neurological status improved with an increase in the Glasgow Coma Scale score from 6 to 11. On the second postoperative day she developed frequent episodes of clonic convulsive seizures localized in the face and the left upper extremity, and her level of consciousness deteriorated. Next day she was transnasally intubated for respiratory management, but no mechanical ventilation was required. While she was undergoing the CT scanning 5 days after intubation, respiratory arrest and cyanosis developed all of a sudden, and her face and neck became swollen. The chest x-ray revealed a marked subcutaneous emphysema, mediastinal emphysema and bilateral pneumothorax. CT at that time showed a diffuse low density area in the right hemisphere, and a marked midline shift returned. She did not regain consciousness and died 12 days after the incident. At autopsy an ulcer was observed in the wall of the trachea, where the tip or the cuff of the transnasal tracheal tube was supposed to be present. No perforation, however, was there. Case 2: A 75-year-old woman was admitted to our hospital because of SAH. In hospital course she was also transnasally intubated and required no mechanical ventilation. When she was undergoing the CT scanning 3 days after intubation, she developed subcutaneous and mediastinal emphysema similarly to case 1. Although it is reported to be not a rare complication in patients on a mechanical ventilator, subcutaneous emphysema or pneumothorax is extremely rare in those intubated patients with spontaneous respiration. The mechanism of these complications in these cases is briefly discussed.

Adult↗
PubMed1989

The effect of advancing age on the sympathetic response to laryngoscopy and tracheal intubation.

The effect of aging on the hemodynamic and sympathetic response to tracheal intubation was evaluated in 27 patients aged 18 to 80 years, ASA Class I and II, given atropine 0.4 mg and diazepam 10 mg as premedication and thiopental, 4.0 mg/kg, and succinylcholine 100 mg for anesthesia induction. Laryngoscopy and tracheal intubation was performed 60 seconds after induction. The elderly had significantly less chronotropic response to intubation 2, 3, 4, and 5 minutes after induction so that the maximum increase in heart rate above awake values was negatively correlated with age (R = -0.66, P less than 0.001). Baseline systolic blood pressure (SBP) and mean BP increased significantly with age (R = 0.81, P less than 0.001 and R = 0.76, P less than 0.001, respectively) but age was not significantly related to increases in SBP and mean BP following intubation. Baseline plasma norepinephrine (NE) levels increased with age ( R = 0.51, P less than 0.01). Following intubation, mean plasma NE concentrations were significantly higher in elderly patients than young patients, despite the diminished heart rate response. Heart rate (HR) per pg/ml of NE, a measure of cardiac sensitivity to beta stimulation, was therefore significantly less 2, 3, and 4 mins after induction in elderly patients than in younger patients. To determine if this alteration in cardiac sensitivity to endogenous catecholamines was reflected by changes in beta receptor function on lymphocytes, beta receptor density and the proportion of receptor binding agonist with high affinity (%RH) were measured. No significant correlation between beta-receptor affinity for agonist, %RH, or receptor density was found with age, HR, or HR per pg/ml NE.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

[Clinical use of long-term nasotracheal intubation].

Clinical data are presented on prolonged (3 to 63 days) nasotracheal intubation in 159 patients performed for controlled lung ventilation and for maintenance of upper respiratory ways patency in spontaneous respiration. The advantages and disadvantages of nasotracheal intubation as compared to tracheostomy and orotracheal intubation are analysed. The indications for delayed tracheostomy, ways of prevention of complications of prolonged nasotracheal intubation and a method for maintenance of intubation tube patency are suggested.

Adolescent↗
PubMed1989

Intravenous magnesium sulfate inhibits catecholamine release associated with tracheal intubation.

The effects of pre-treatment with 60 mg/kg body weight magnesium sulfate intravenous on cardiovascular responses and catecholamine release associated with tracheal intubation were measured in 15 normal patients and in 15 saline solution pre-treated controls. Magnesium pre-treatment increased heart rate by 13 +/- 3.9 beats/minute. After intubation, heart rate was unchanged in the magnesium group at 107.3 +/- 3.6 beats/minute but increased in the control group to 120.9 +/- 4.6 beats/minute (P less than 0.05). Systolic blood pressure increased after intubation from 106.8 +/- 3.1 to 121.0 +/- 4.4 mm Hg in patients given magnesium and from 106.4 +/- 3.12 to 145.1 +/- 5.6 mm Hg in the control group (P less than 0.05). Norepinephrine levels increased from 297.3 +/- 20.9 pg/ml to a peak of 532.5 +/- 30.1 pg/ml 2 minutes after intubation in the magnesium group. In controls, norepinephrine levels increased from 273.3 +/- 39.1 mg/ml to 944.6 +/- 68.7 pg/ml (P less than 0.05 for differences between groups). Epinephrine levels were unchanged from baseline after magnesium but in controls increased from 113.9 +/- 19.5 to 279.6 +/- 92.3 pg/ml (P less than 0.05). We conclude that magnesium sulfate attenuates the catecholamine mediated responses after tracheal intubation.

Adult↗
PubMed1986

[Vecuronium in crash intubation].

A prospective controlled study was conducted to compare the efficacy of vecuronium and succinylcholine for the crash-induction technique. Following precurarisation with 0.02 mg/kg vecuronium and 0.1 mg fentanyl (group A and B) or NaCl 0.9% and 0.1 mg fentanyl (group C) preoxygenation via face mask was maintained until the patients reported heavy eye-lids or weariness or the precurarization-time attained 120 s. The patients then received 5 mg/kg thiopentone followed by 1.5 mg/kg succinylcholine (group B) or 0.08 mg/kg vecuronium (group A) resp. 0.1 mg/kg vecuronium (group C) directly before the thiopentone. Rapid intubation and scoring of the intubation condition was performed by an anaesthetist who was unaware of the grouping. The intubation time was defined as the interval from the end of the injection of the drugs until cuff-inflation of the tracheal tube. All patients in group A and B could be intubated within 60 s, in contrast to only 15 patients in group C (p less than 0.05). The intubation conditions in the succinylcholine group and in the vecuronium group with divided doses showed no significant differences, while in group C the conditions were significantly worse. The modified crash-induction technique with vecuronium in divided doses could become beneficial in patients with contraindications of the use of succinylcholine who are at risk of aspiration.

Anesthesia↗
PubMed1988

[Joseph O'Dwyer--a pioneer in endotracheal intubation and pressure respiration].

The oro- and nasotracheal intubation has been developed into one of the most important techniques in anaesthesiology. Originally, intubations were carried out for overcoming acute diphteric airway obstruction in children. As late as the end of the 19 century, the only life saving chance was to perform tracheotomy. Although the technique for this operation at that time was well developed, it was very often impossible to save the life of those moribund patients. The famous American paediatrician Joseph O'Dwyer re-initiated the technique of intubation and his excellent results became great success and promoted world-wide use, although it was a well-known procedure at that time. His intubation method - also called the O'Dwyer-Method-was first published in the N. Y. Medical Journal as "Intubation of the Larynx" 100 years ago. Working together with the surgeon George Fell, O'Dwyer designed an apparatus, for artificial respiration. As Fell-O'Dwyer Apparatus it was widely used in cases of asphyxia, - even in those caused by overdosage of anaesthetics. Further developments of the apparatus permitted positive pressure ventilation and the combination with a funnel for narcotics increased the repertory of anaesthesiological possibilities.

History, 19th Century↗
PubMed1988

[Endoscopic concept and fiberoptic technic in monitoring long-term intubation].

An endoscopic procedure has been developed to enable constant monitoring of the mucous membrane of the larynx and trachea. The examination can be divided into four stages. 1. Transnasal inspection. 2. Transtubal inspection. 3. Partial, endoscopically controlled extubation. 4. Endoscopically controlled re-intubation. The advantage of this newly developed technique using a flexible fiberoptic endoscope is that complete extubation is not necessary in patients who are under artificial respiration and subject to long-term intubation. In long-term intubation without artificial respiration care must be taken to provide the best possible means of sedation. Endoscopic monitoring of this kind guarantees the following: 1. Early determination of intubation damage to larynx and trachea. 2. Exact control of the position of the tube, rendering X-ray identification unnecessary. 3. Examination of the bronchial system. 4. A final check on the above-mentioned critical points during complete extubation after long-term intubation. Regular examination by this atraumatic method provides an early diagnosis of any mucosal damage caused by tubes. The recommendation that a secondary tracheotomy should be carried out after 48 h, and at the latest after a week, can no longer be supported, provided the necessary modern anaesthetic equipment and management is available.

Bronchi↗
PubMed1988

Effects of tracheal intubation on laryngeal acoustic waveforms.

To assess the feasibility of noninvasive detection of laryngeal injury after tracheal intubation through acoustic waveform measurements, we studied the effects of intubation on "time-expanded" acoustic waveforms of the larynx in 16 patients given general anesthesia, 9 with and 7 without tracheal intubation. Recordings of several utterances were obtained by means of a microphone and an accelerometer attached to the skin at the midpoint of the suprasternal notch. Recordings were taken the day before induction of general anesthesia, 20 minutes after extubation, and 2 and 4 days after extubation. Waveforms of the recordings were subsequently assessed visually for features different from those of normal phonation as determined in preliminary studies. Waveforms in several of the recordings taken soon after extubation showed marked intraperiod and interperiod irregularities. These abnormalities improved and disappeared over the following 4 days. No changes were observed in the acoustic waveforms of seven patients given general anesthesia without tracheal intubation. The analysis of time-expanded acoustic waveforms of the larynx indicates that this technique has considerable potential as a sensitive, noninvasive technique that helps to evaluate the effects of tracheal intubation on laryngeal function, a technique that warrants further study and evaluation.

Adult↗
PubMed1988

Effects of aerosolized and/or intravenous lidocaine on hemodynamic responses to laryngoscopy and intubation in outpatients.

A randomized, double-blind study was carried out on 40 unpremedicated, ASA I-II adult surgical outpatients to assess the effects of aerosolized lidocaine, intravenous lidocaine, both, or neither, on circulatory responses to laryngoscopy and intubation. Lidocaine (4 mg/kg) or saline was given by nebulizer in the holding area beginning at -15 minutes. The patient underwent a standardized induction of anesthesia that included IV curare (3 mg) and O2 by facemask at minute 2, followed by IV thiopental (5 mg/kg) and succinylcholine (1.5 mg/kg) at minute 5. Lidocaine (2 mg/kg) or saline was given by IV push at minute 4. Laryngoscopy was begun at 5 minutes and continued for 45 seconds before intubation. Heart rate and systolic, diastolic, and mean blood pressures were automatically recorded at 1-minute intervals from 0 to 11 minutes. The four treatment groups included: group 1, aerosolized and IV saline; group 2, aerosolized saline, IV lidocaine; group 3, aerosolized lidocaine, IV saline; and group 4, aerosolized and IV lidocaine. There were no differences among the four treatment groups (n = ten per group) in any of the four hemodynamic variables before laryngoscopy and intubation. Within each group, after intubation all four hemodynamic variables increased significantly over the corresponding baseline values for that group. However, the maximum values attained after intubation did not differ significantly among the four treatment groups for any of the four hemodynamic variables, whether those maxima were expressed as absolute values or as a percentage of baseline.(ABSTRACT TRUNCATED AT 250 WORDS)

Aerosols↗
PubMed1988

Rapid sequence induction with oral endotracheal intubation in the multiply injured patient.

The charts of 1798 consecutive admissions at this level one trauma center to evaluate the practice of emergency airway control were reviewed. A total of 335 patients required endotracheal intubation, 320 oral endotracheal, 12 nasotracheal, and three surgical. A technique of rapid sequence induction (RSI) with oral endotracheal intubation was the method of airway control in 260 spontaneously breathing patients. Prior cervical spine evaluation was not obtained. In all instances airway control was prompt and accurate. There were no hemodynamic nor neurologic complications secondary to RSI or oral endotracheal intubation. It is believed that RSI with oral endotracheal intubation is a reasonable alternative to nasotracheal intubation in the spontaneously breathing patient.

Emergencies↗
PubMed1986

[History of intubation].

The Arabian doctor Avicenna (980-1037) described the first orotracheal intubation in dyspnoea. The history of peroral endotracheal intubation actually begins in the 18th century. At that time obstetricians and lifesavers used breathing tubes. In 1880 Macewen preoperatively intubated a patient to prevent the aspiration of blood during extirpation of a tumour from the base of the tongue. Regular peroral intubation to keep the respiratory tract clear during narcosis was first applied by Franz Kuhn in 1900; unfortunately, the pioneer himself did not live to see his method become a routine procedure. It was only as late as 1945, that endotracheal intubation became part of hospital practice at our clinic.

History, 16th Century↗
PubMed1987

[Fiber optic orotracheal intubation].

Fiberoptic intubation is widely accepted in the management of a "difficult airway". In the majority of these cases the underlying anatomical findings require a nasal approach. We report a case of fiberoptic intubation where nasal passage was not possible. Orotracheal fiberoptic intubation was easily performed using a Williams oral airway and a Patil-Syracuse face mask. We recommend this technique for those cases where fiberoptic intubation is indicated but contraindications to the transnasal route apply and an "asleep-intubation" is desired.

Airway Obstruction↗
PubMed1987

[Experiences in small intestine intubation in pediatric surgery].

An account is given in this paper of intestinal intubation, the most promising approach at present to postoperative ileus. Reference is made to causes and to preventive methods used in the past. Classical techniques and their variants are described, with peculiarities being mentioned together with possible complications. Positive results have enlarged the list of intraabdominal diseases in which cases intubation should be justified. Fifteen children died out of 55 with intestinal intubation. However, those deaths could not be attributed to intubation, since no ileus was recordable on post-mortem from any of these cases. They were rather attribute to pre-existence of general damage or to postoperative complications which had unfavourable effects primarily on prematurely born children, newborns, and infants up to one month of age. Hence, intestinal intubation may be considered to be the most effective and least risky approach to the control of mechanical or combined paralytico-mechanical ileus.

Child↗
PubMed1986

Conditions for endotracheal intubation after atracurium and suxamethonium.

Intubating conditions following 2 different dosage levels of atracurium, a new non-depolarising muscle relaxant was compared with suxamethonium. The dosage levels of atracurium were 0.5 mg/kg and 0.7 mg/kg while the dosage of suxamethonium chloride was 1 mg/kg. A total of 60 patients with 20 patients in each of the three groups were studied. Premedication was with oral diazepam 10 mg. Anesthesia was induced with fentanyl 1 microgram/kg and thiopentone 5 mg/kg and intubation performed in all cases by the same operator. Excellent intubation conditions were obtained in all patients within 60 seconds in the suxamethonium group, 90 seconds in the atracurium 0.7 mg/kg group, and 120 seconds in the atracurium 0.5 mg/kg group. No side effects were observed and there was circulatory stability. It is concluded that atracurium in a dose of 0.7 mg/kg allows more rapid intubation than the 0.5 mg/kg dose. It is however not as rapid as suxamethonium which remains the drug of choice when very rapid intubation is crucial.

Adult↗
PubMed1985

Intravenous lidocaine as a suppressant of coughing during tracheal intubation.

Effects of intravenously administered lidocaine on cough suppression during tracheal intubation under general anesthesia were evaluated in two studies. In study 1, 100 patients received either a placebo or 0.5, 1.0, 1.5, or 2.0 mg/kg lidocaine intravenously 1 min before tracheal intubation. All visible coughs were classified as coughing. The incidence of coughing decreased as the dose of lidocaine increased. A dose of 1 mg/kg or more of intravenous lidocaine suppressed the cough reflex significantly (P less than 0.01). Coughing was suppressed completely by 2 mg/kg of intravenous lidocaine. In study 2, 108 patients received 2 mg/kg lidocaine intravenously or a placebo 1, 3, 5, 7, 10, or 15 min before intubation. The same criteria for determining whether a patient did or did not cough during tracheal intubation were used as in study 1. The incidence of coughing decreased significantly (P less than 0.01) when 2 mg/kg of lidocaine was injected intravenously between 1 and 5 min before our attempting intubation. Cough reflex was suppressed completely by plasma concentrations of lidocaine in excess of 3 micrograms/ml.

Adolescent↗
PubMed1984

Peroral pulsion intubation of malignant esophageal strictures using a fiberoptic technique.

Palliative peroral pulsion intubation of malignant esophageal strictures in 44 patients with incapacitating dysphagia is reviewed. Intubation, using a fiberoptic endoscope, the Nottingham introducer, and a modified Celestin tube was performed, usually under intravenous sedation. Intubation was successful in 93 per cent and provided satisfactory relief of dysphagia. Six deaths (14%) were the result of intubation, three from esophageal perforation, two from aspiration pneumonia, and one from hemorrhage. The overall hospital mortality was 23 per cent. Six patients required reintubation for proximal or distal migration of the prosthesis. Although mean survival was short (3.2 months), esophageal intubation by this technique is relatively safe, minimizes hospitalization, and offers reasonable palliation in most patients.

Adult↗