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PubMed1983

Capnography facilitates blind nasotracheal intubation.

Continuous capnography recordings were made during blind nasotracheal intubation of 17 patients breathing spontaneously. The carbon dioxide analyzer (CD 300, Datex Helsinki) was connected to the open proximal end of the endotracheal tube. In addition to the auscultatory findings, capnography gave valuable information about the position of the endotracheal tube during the entire intubation procedure. The low and peaked CO2 waves recorded from the nasopharynx tended to become higher and more flat-topped as the larynx was approached. When the tip of the endotracheal tube erroneously glided behind the larynx (12 of the 17 cases) this was promptly revealed by absence of CO2 in the recording. On the other hand, entrance of the tube into the trachea could always be rapidly detected as typical flat-topped CO2 waves were seen in the capnogram. Thus capnography facilitates orientation during blind nasotracheal intubation and rapidly detects accidental oesophageal intubation. The capnographic recording also is a valuable and reliable additional sign and document of correct endotracheal intubation.

Auscultation↗

PubMed1984

[Uncommon injuries of the larynx following intubation. Recurrent paralysis, torsion and luxation of the cricoarytenoid joints].

19 laryngeal injuries are reported. 16 were secondary to orotracheal intubation and 3 were sequelae of gastroscopy, laryngoscopy and a nasogastric tube. In 6 patients, the trauma followed prolonged nasotracheal intubation, 10 cases followed a single endotracheal intubation. The main symptom was hoarseness. In 6 cases dislocation of an arytenoid cartilage was diagnosed, in 1 case a vocal cord paresis and in the other cases contusion or distortion of the arytenoid joint. In the cases of subluxation the arytenoid cartilage was dislocated posterolaterally, with the cord in the abducted position. For treatment we recommend closed reduction and injection of Cortison-Crystal-suspension into the joint. The outcome is good after single endotracheal intubation, but bad in prolonged nasotracheal intubation because of ankylosis of the cricoarytenoid joint.

Adult↗

PubMed1984

The role of intestinal intubation in obstruction of the small intestine due to carcinoma of the ovary.

A total of 165 episodes of obstruction of the small intestine associated with carcinoma of the ovary were evaluated retrospectively to define the role of intestinal intubation. Patients with prolonged tube suctioning (greater than 48 hours) had a significantly higher operative mortality than patients operated upon immediately without prior intubation or after short term intubation of no longer than 48 hours (p less than 0.05). When controlled for risk factors, such as age, tumor status, ascites and amount and type of prior therapy, the difference between the groups was no longer significant (p greater than 0.1). Another variable of importance was the response to tube suction as documented by serial plain roentgenograms of the abdomen. Prolonged tube suction did not result in increased morbidity compared with short term intestinal intubation (p greater than 0.1) if decompression of the small intestine was accomplished within 48 hours of admission. Nonoperative therapy by intestinal intubation rarely relieves small intestinal obstruction caused by carcinoma of the ovary. It may, however, relieve distension of the small intestine proximal to the obstruction, thus preventing anatomic and metabolic changes that contribute to poor outcome when surgical treatment for relief of the obstruction is delayed.

Aged↗

PubMed1983

Effect of gastrointestinal intubation on the passage of a solid meal through the stomach and small intestine in humans.

The effect of a gastrointestinal tube on the passage of a radiolabeled solid meal through the stomach and small intestine was investigated in 22 healthy volunteers using the gamma camera and breath hydrogen analysis. Gastric emptying was significantly retarded in 12 subjects, who had an intestinal tube in situ compared with 10 control subjects, who were not intubated (t 1/2 = 1.5 +/- 0.1 vs. 1.2 +/- 0.1 h; p less than 0.02). On the other hand, colonic filling was significantly accelerated in the intubated subjects (onset: 1.2 +/- 0.2 vs. 2.9 +/- 0.4 h; p less than 0.001; t 1/2: 4.1 +/- 0.3 vs. 5.6 +/- 0.5 h; p less than 0.001). Values for small bowel residence were significantly reduced in the intubated subjects (5.3 +/- 0.5 vs. 6.5 +/- 0.6 food hours; p less than 0.001). Paired studies, carried out in an additional 11 normal subjects, confirmed that small bowel transit time was significantly shortened during intestinal intubation in the same individuals (2.0 +/- 0.3 vs. 3.6 +/- 0.4 h). These results suggest that intubating the gastrointestinal tract may profoundly affect its function.

Adult↗

PubMed1983

[Intubation or tracheotomy in severe subglottic laryngitis].

A retrospective study to assess safety of nasotracheal intubation for subglottic laryngitis in children was conducted in 44 cases treated in the Intensive Care Unit of Hôpital Bretonneau, France between 1971 and 1981. Intubation had been performed in 40 children, and immediate tracheotomy in the other 4. The course of the affection was favorable in 37 (92,5%) of intubated children, secondary tracheotomy being necessary in only 3 cases. A mean duration of 84 hours of intubation was sufficient in 24 children, a total mean duration of 180 hours being required in the 13 other cases. The catheter employed in the 3 tracheotomized children with morbilous laryngitis was too large, and laryngeal stenosis developed in 2 of them. These findings demonstrate that when a catheter of correct size (1/2 size below that indicated by the weight and age of the child) is employed, nasotracheal intubation for severe subglottic laryngitis is a safe procedure.

Acute Disease↗

PubMed1978

Effect of gastric intubation of the gastric loss of serum albumin.

In a group of 18 inpatients, the catabolism of serum albumin rate, in percentage of intravascular albumin pool, was measured during two successive periods of 7 days. In the first experimental period, we did no intubation, while during the second, a tube was kept in the stomach, with an overnight intragastric perfusion of an isotonic solution of sodium bicarbonate. With the same batches of labelled albumin, we measured the serum albumin catabolism, in a similar way, in a group of 19 normal subjects, for two weeks, without gastric intubation. The difference in the rate of serum albumin catabolism, during the first and second period, is positive and amounts to +0.547 percent +/- 0.214 (mean +/- SEM) in the intubated group, and +0.765 percent +/- 0.207 in the control group. The weaker decrease in catabolism rate during the second period in the intubated group, as compared to the control group, is not statistically significant (t = 0.731). We conclude that continuous intubation of the stomach for 7 days does not increase the catabolism rate of serum albumin. Therefore, it should not significantly increase the loss of albumin in the gastric lumen.

Animals↗

PubMed1980

Neonatal nasotracheal intubation: an evaluation.

A retrospective review of 100 surviving infants, all requiring nasotracheal intubation in the neonatal period for greater than 24 hr. was performed to assess the morbidity of this form of airway management. Seventy infants needed only one intubation, 22 were intubated twice and 8 infants required 3 intubations. No infant had evidence of laryngeal or tracheal sequelae, either in the immediate newborn period or on follow-up. Nasotracheal intubation by an experienced practitioner with appropriate tube fixation and toilet coupled with the use of low pressure ventilation and a consistent extubation routine will result in very low long-term tracheal morbidity in the neonate.

Evaluation Studies as Topic↗

PubMed1995

[Influence of epidural anesthesia on the halothane MAC-intubation in emergence in infants and children].

The alveolar anesthetic concentration level at which the patient first shows movement when emerging from anesthesia is defined as MAC-intubation in emergence in infants and children. Twenty one patients of ASA physical status 1, were studied to determine the halothane MAC-intubation in emergence. The patients were divided into two groups; a general anesthesia alone group and a general anesthesia plus epidural anesthesia group. After endotracheal intubation without muscle relaxant, bupivacaine (0.25% with 200,000 epinephrine, 0.75 ml.kg-1) was injected into the lumbar epidural space in the epidural anesthesia group (n = 11). Each group was maintained at 1.0% end-tidal halothane concentration with oxygen under spontaneous respiration in the perioperative period. After the end of surgery, end-tidal halothane concentration, respiratory rate (RR), and ETCO2 were measured at the time halothane was discontinued and at the time of patient's first movement. The time from the discontinuation of halothane to the first body movement was recorded. The halothane MAC-intubation in emergence without epidural anesthesia was 0.26 +/- 0.03% (mean +/- SE) and that of the epidural anesthesia was 0.18 +/- 0.02% (P < 0.05). The time from the discontinuation of halothane to the first body movement tended to be longer without epidural anesthesia. RR and ETCO2 did not differ between the two groups of patients. The halothane MAC-intubation in emergence in the general anesthesia alone group was 0.26%, and adding epidural anesthesia decreased this concentration to 0.18%.

Anesthesia Recovery Period↗

PubMed1995

[Effect of early intubation on the reduction of post-traumatic organ failure].

In a prospective multiple trauma study lasting from 1986 to 1991 the influence of early intubation (EI) within 2 h after the accident on posttraumatic (multiple) organ failure (M)OF was compared with that of delayed intubation (DI) in 131 patients with multiple injuries (ISS 37). The indications for intubation were unconsciousness following severe head injury in 45 cases (45 EI, 0 DI), major chest trauma (AIS > or = 3) in 40 (31 EI, 9 DI) and other severe injuries (no head or chest trauma, but ISS > 24) in 40 patients (30 EI, 10 DI). One hundred and six trauma victims (81%) were intubated early and 19 patients (14.5%) required intubation and artificial ventilation in the later course, whereas in 6 subjects (4.5%) spontaneous respiration was adequate. The pattern of injured body regions did not differ substantially between the two groups, but the severity of injury was significantly greater (p < 0.001) in the EI group (ISS 39) than in the DI patients (ISS 29). Among the EI patients, 67% developed at least one OF, 45% respiratory failure (RF), and 28% multiple organ failure (MOF); 15% died. The DI group showed almost the same incidence of RF (42%) and other OF (63%), and even a higher (n.s.) incidence of MOF (37%) and mortality rate (26%). In view of the significantly less severe injuries in the DI group, the observed OF and mortality rates are inappropriately high compared with the incidence of OF and death in the EI group.(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗

PubMed1995

[Lack of effect of i.v. lidocaine on cardiovascular responses to laryngoscopy and intubation].

A randomized open study was carried out on 36, ASA I-II adult surgical patients to assess the effect of intravenous lidocaine and fentanyl on circulatory responses to laryngoscopy and intubation. The three treatment groups include: group L, intravenous lidocaine 1.5 mg.kg-1 2 minutes before laryngoscopy, group F, intravenous fentanyl 4 micrograms.kg-1, and group C, no treatment. Induction, preceded by preoxygenation was performed by intravenous vecuronium for precurarisation, followed by thiopental 4-5 micrograms.kg-1 and succinylcholine 1.5 mg.kg-1. Before induction of anesthesia, there were no significant differences among the three groups in mean arterial pressure (MAP), heart rate (HR) and rate pressure product (RPP). After laryngoscopy and intubation, the three hemodynamic variables increased significantly from control values in group L and group C. The maximum values attained after intubation did not differ significantly between the two groups for any of the variables. In group F, these hemodynamic variables showed no significant changes after laryngoscopy and intubation and were significantly less than those in group F and group C. Intubating conditions were better in the fentanyl group than in the lidocaine group.

Adult↗

PubMed1995

Emergency intubation with the Combitube in two cases of difficult airway management.

The airway was managed successfully in two cases of difficult intubation using the Combitube, a new device for emergency intubation, which combines the functions of an oesophageal obturator airway and a conventional endotracheal airway. One patient could not be intubated due to lockjaw; in the other patient, the vocal cords could not be seen because of continued vomiting. The cases illustrate the benefit of the Combitube during emergency intubation for different problems and its effectiveness as an alternative to traditional intubation techniques.

Aged↗

PubMed1994

[Fiberscopic intubation under general anesthesia for children with Goldenhar syndrome].

Goldenhar syndrome is characterised by an eye abnormality such as epibulbar dermoid and lipoma, associated with ear, mandibular, and/or vertebral anomalies. It is well documented that difficult intubation in patient with this syndrome may be expected because of mandibular hypoplasia and limitation of neck movement resulting from vertebral anomalies. We report anesthetic management of two children with Goldenhar syndrome, 9 and 14-year-old. By preoperative examination, two children were expected to be difficult in intubating trachea. We used our newly developed mask adapter which enabled us to perform fiberoptic bronchoscopy-aided tracheal intubation under general anesthesia under controlled ventilation. By using this adapter, under sevoflurane/nitrous oxide anesthesia with vecuronium, we could successfully intubate with a 6 mm spiral tube through the nostril without any major problems. Anesthesia and surgery went uneventfully, and no postoperative complications were noted. We confirmed that our newly developed mask adapter for fiberoptic bronchoscopy is as useful for children with difficult intubation as for adults.

Adolescent↗

PubMed1994

Use of esmolol to prevent hemodynamic changes during intubation in general anesthesia.

To assess the minimal effective dosage of esmolol to prevent hypertension and tachycardia during laryngoscopy and endotracheal intubation in fentanyl-pretreated anesthesia, a double-blinded, randomized study was conducted. Two hundred patients undergoing elective, noncardiac surgeries were randomly allocated into four groups: group A received saline, group B esmolol 20 mg, group C esmolol 40 mg and group D esmolol 60 mg intravenously. General anesthesia was induced with 0.1 mg/kg vecuronium, 5 micrograms/kg fentanyl and 0.3 mg/kg etomidate. Heart rates (HR), systolic blood pressures (SBP), mean arterial pressures (MAP) and diastolic blood pressures (DBP) were recorded before induction, after induction, before intubation, 30 seconds, 1 minute, 2 minutes, 4 minutes, 6 minutes, and 10 minutes after intubation. After intubation HR and SBP increased significantly in group A (86.7 beats/min, 166.6 mmHg) in comparison with groups C (77.6 beats/min, 153.9 mmHg) and D (73.4 beats/min, 153.4 mmHg) (p < 0.05). Tachycardia (HR > 100) was found in 13 of 50(26%) patients in group A, 10 of 50(20%) patients in group B, 7 of 50(14%) patients in group C and 2 of 50(4%) patients in group D. Hypertension (SBP > 180) was found in 18(36%) patients in group A, 19(38%) patients in group B, 9(18%) patients in group C, and 6(12%) patients in group D. When compared with group A, only group D had significantly lower incidence of these adverse events (p < 0.05). In conclusion, fentanyl 5 micrograms/kg could not completely prevent the hemodynamic changes associated with endotracheal intubation, and 60 mg esmolol was observed to have positive effect in helping to control these changes.

Adrenergic beta-Antagonists↗

PubMed1994

The effect of single bolus dose of esmolol for controlling the tachycardia and hypertension during laryngoscopy and tracheal intubation.

Tachycardia and hypertension usually accompany laryngoscopy and tracheal intubation. This response is undesirable, especially in patients with cardiovascular or intracranial diseases. Esmolol is a cardioselective, ultrashort-acting beta adrenergic blocking agent with a very short half-life. The efficacy of bolus dose of esmolol in blunting hemodynamic responses during laryngoscopy and tracheal intubation was evaluated. 45 patients (15 in each group) of ASA physical status I and II scheduled for elective non-cardiac surgery were included in this randomized, placebo-controlled study. At time zero, the study preparation (placebo, 100 or 200 mg of esmolol) was administered intravenously, followed by thiopentone 5 mg/kg and succinylcholine 1.5 mg/kg for induction. Tracheal intubation was performed 2 minutes after time zero. Anesthesia was maintained with 50% nitrous oxide and 1.0 MAC halothane in oxygen, and vecuronium 0.08 mg/kg. Heart rate (HR) and systolic blood pressure (SBP) were recorded every minute for 10 minutes. To compare with the placebo group, there was a significant decrease in either HR or SBP in 200 mg group in the 8 minutes course after intubation (p < 0.05). There was a significant decrease in HR in the 100 mg group at the 3rd, 4th, and 5th minutes when compared with the placebo group (p < 0.05). The differences in SBP between the 100 mg group and placebo group were significant at the 3rd and 4th minutes (p < 0.05). Both bolus dosages of esmolol could effectively attenuate the tachycardia and hypertension produced by laryngoscopy and tracheal intubation. Furthermore, esmolol 200 mg presented a better hemodynamic stability than esmolol 100 mg during induction of anesthesia.

Adrenergic beta-Antagonists↗

PubMed1993

Determining the optimal time for endotracheal intubation during onset of neuromuscular blockade.

The disappearance of the response to single twitch stimulation (STS), double burst stimulation (DBS) and zero post-tetanic count (PTC) were evaluated to determine which best indicated the optimal time of endotracheal intubation during onset of neuromuscular blockade induced by vecuronium (0.08 mg kg-1) in 199 patients under thiopentone and halothane anaesthesia. Evaluations were performed by mechanomyographic and manual methods using a Myograph and a peripheral nerve stimulator. The study consisted of six parts. In part 1 (n = 30) and part 2 (n = 30), the response to STS (0.1 Hz) were evaluated mechanically and manually, respectively. In part 3 (n = 64), post-tetanic count (PTC) changes were evaluated mechanically. In part 4 (n = 30) and part 5 (n = 30), response to DBS were evaluated mechanically and manually, respectively. Intubation was performed immediately after obtaining zero PTC, or absence of response to STS (0.1 Hz) and DBS, and the intubation score was determined. In the control group of patients, intubation was performed under the same anaesthetic conditions as in parts 1-5 but without the administration of any muscle relaxant. The time from administration of any muscle relaxant. The time from administration of vecuronium until disappearance of response was 2.16 +/- 0.56, 2.49 +/- 0.68, 2.04 +/- 0.29, 2.20 +/- 0.53, and 2.97 +/- 0.61 min in parts 1-5, respectively. Excellent intubation conditions were not established in any of the control patients, and in 50.0, 70.0, 55.0, 70.0 and 90.0% of the patients in parts 1-5, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1993

[The circulatory responses to tracheal intubation using the timing principle].

The circulatory responses to tracheal intubation using timing principle were investigated in 40 adult patients who underwent elective surgery. They were randomly assigned to one of two groups; 1) timing principle group, and 2) SCC group. In timing principle group, vecuronium 0.15 mg.kg-1 was administered. At the onset of clinical muscle weakness, thiopental 5 mg.kg-1 was given promptly. Sixty seconds after thiopental, patients were intubated. In SCC group, thiopental 5 mg.kg-1 was administered, and when patients lost consciousness, SCC 1 mg.kg-1 was given. After fasciculation, patients were intubated. The increases in systemic blood pressure, heart rate and rate pressure product were significantly lower in patients in timing principle group than in those in SCC group. Intubating conditions were almost excellent in both groups, and there were no complications in this study. In timing principle group, intubation was done 60 seconds after thiopental administration, and its timing coincided with the peak cerebral concentration of thiopental. We considered this coincidence was one of the reasons of fewer responses in patients in timing group than in those in SCC group.

Adolescent↗

PubMed1993

[Use of the laryngeal mask in difficult intubation].

Although the incidence of difficult airway is very low, involving less than 1% of all patients, failed air-way management is the main cause of mortality or serious morbidity during anaesthesia. Successful management of a difficult airway starts with recognition of the potential problem. A careful preoperative history and clinical examination should elicit obvious problems to allow prediction of a potentially difficult airway. Besides the introduction of different instruments and techniques, the laryngeal mask (LMA) has been suggested to be effective both in when difficult airway is known in advance to be present and after failed intubation. CASE REPORT. The use of the LMA in a patient scheduled for endoscopic resection of a ureteral stone as day surgery is described. The patient presented reduced mobility of the atlanto-occipital joint, temporomandibular ankylosis (mouth opening of 1.9 cm), dislocated teeth, and kyphosis of the thoracic spine. Due to deformation of the spine, the patient was placed in a half-sitting position (30 degrees). Anaesthesia was induced with fentanyl (1.5 micrograms.kg-1) and propofol (2 mg.kg-1). Although the conditions made it difficult to manage the patient's airway, the LMA was inserted without complications or trauma. Anaesthesia was maintained with isoflurane and nitrous oxide in oxygen. After 1.5 h of assisted ventilation the LMA was removed when the patient opened his mouth on request. DISCUSSION. Significant advances in the management of the difficult airway have been achieved in recent years. However, avoidable deaths on intubation have been attributed to unexpected difficulties and poorly managed situations. Thus every anaesthetist should be prepared for potential difficulties by training and be able to follow a rational plan of action. If despite all manoeuvres a tracheal tube cannot be passed, a failed intubation drill must be instituted, and if oxygenation is still not possible a failed ventilation drill must be followed. The LMA is a new device developed to provide an airway for anaesthesia. However, since the LMA can be inserted quickly and blind, it can be used as an alternative airway in patients in whom the trachea is difficult to intubate. The lower incidence of post-operative complications than with endotracheal intubation is a further advantage, particularly during anaesthesia for day surgery.

Aged↗

PubMed1993

[Role of nasolacrimal intubation in the treatment of lacrimation caused by congenital lacrimal duct obstruction in infants].

We report a study of a series of 83 cases of congenital nasolacrimal duct obstruction treated with monocanaliculonasal or bicanaliculonasal silicone intubation. Efficacy, complications, as well as the duration of the placement of the probes were studied. The analysis of the various factors of this series (age of the infants at the time of intubation, duration and type of intubation, complications) demonstrated the superiority of short-term monocanaliculonasal intubation (about four weeks) compared to longer intubation.

Age Factors↗