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PubMed1986

Roles of fentanyl and nitroglycerin in prevention of myocardial ischemia associated with laryngoscopy and tracheal intubation in patients undergoing operations of short duration.

The purpose of this study was to evaluate intravenous nitroglycerin given during induction of anesthesia as a means for prevention of myocardial ischemia and hemodynamic changes associated with induction, laryngoscopy, and intubation, in patients with stable angina scheduled for vascular operations of moderate duration. Forty-six patients were randomly assigned to receive either fentanyl, 3 micrograms/kg (group 1, n = 6), fentanyl, 8 micrograms/kg (group 2, n = 20), or fentanyl 3 micrograms/kg plus a continuous intravenous nitroglycerin infusion, 0.9 microgram X kg-1 X min-1 (group 3, n = 20), in addition to thiopental-pancuronium anesthetic induction, prior to laryngoscopy and intubation. The criteria for recognizing myocardial ischemia were the following: horizontal or downsloping ST segment depression equal to or greater than 1 mV, and/or ventricular arrhythmia, on CM5 recording. In group 1, myocardial ischemia occurred during laryngoscopy and intubation in four patients, and mean blood pressure (MBP), heart rate, and mean pulmonary wedge pressure (PCWP) increased significantly (P less than 0.05). Despite greater stability in MBP and heart rate in group 2, myocardial ischemia still occurred in four patients (not significantly different from group 1). Nitroglycerin added to low-dose fentanyl (group 3) produced significant reduction in myocardial ischemia (1/20) when compared with group 1 (P less than 0.01), and significantly greater stability in PCWP during laryngoscopy and intubation in comparison to groups 1 and 2. In patients with stable angina undergoing operations of short duration, the use of nitroglycerin infusion and low-dose fentanyl significantly decreases the incidence of myocardial ischemia associated with induction of anesthesia and tracheal intubation.

Aged↗
PubMed1987

[Behavior of adrenaline, noradrenaline, blood pressure and heart rate in intubation in relation to different doses of fentanyl].

In 24 patients undergoing ENT surgery the reactions of blood pressure, heart rate and plasma catecholamines were studied during standardized induction of anaesthesia as well as after additional fentanyl administration of 0.1 or 0.2 mg before intubation. In the control group (n = 8) six measurements were performed, i.e. one minute before and after the administration of the drugs for induction, as well as immediately after the insertion of the laryngoscope and one minute after intubation. In the reference groups two measurements were performed: before induction of anaesthesia and one minute after intubation, in the period of maximal circulatory reaction. 0.1 or 0.2 mg were administered in the fentanyl groups (n = 8 in each) after precurarization before injecting thiopentone. The blood pressure was measured by oscillometry, the heart rate was recorded by an ECG monitor, and the plasma catecholamines were determined by a radio-enzymatic method. In the control group without fentanyl only a rise in heart rate was observed in the induction period until laryngoscopy. After the insertion of the laryngoscope the increase in systolic and diastolic blood pressures, heart rate and plasma noradrenaline levels were marked. One minute after intubation these parameters rose again. The adrenaline concentration hardly changed during the entire period of induction. The administration of 0.1 mg fentanyl proved to be insufficient to depress the sympathoadrenergic reaction during intubation. Although plasma catecholamines did not rise, a marked increase in blood pressure and heart rate could not be avoided. The difference compared to 0.2 mg fentanyl was significant in the parameters blood pressure and heart rate (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia, Endotracheal↗
PubMed1995

[Analysis of the efficacy of the large mono-canalicular intubation stent in the treatment of lacrimation caused by congenital obstruction of the lacrimal ducts in infants].

BACKGROUND: Bicanaliculo-nasal intubation (BCNI) is considered as the method of choice in the treatment of naso-lacrimal duct obstruction (NLDO) in children. Side effects of BCNI are possible and monocanaliculo-nasal intubation (MCNI) provides the same results with fewer complications. Nevertheless, most of the short duration monocanaliculonasal stent complications concern the migration of the silicone stent in the canaliculus. We thought that this fact may be linked with the shape of the head of the monocanaliculonasal stent and decided to alter it. METHODS: Monocanaliculo-nasal intubation was performed in 52 cases, in 41 children, using a modified silicone mono-canalicular stent (large collarette stent). RESULTS: The results were compared with a reference series of 52 cases treated with the classical silicone mono-canalicular stent intubation. The rate of success was comparable in both series, but fewer complications were observed with this new device. In particular, no migration of the silicone in the canaliculus occurred. CONCLUSION: The authors state that this modified mono-canalicular stent decreases the lacrimo-nasal intubation morbidity without altering its effectiveness.

Catheterization↗
PubMed1986

Iatrogenic oesophageal perforation due to tracheal or nasogastric intubation.

Oesophageal perforation, due to a difficult endotracheal or nasogastric intubation occurred in a 49-year-old female. Perforation of the oesophagus is a rare complication of intubation of the trachea or oesophagus. Endotracheal intubation alone is most often blamed for iatrogenic oesophageal trauma following surgery. The incidence of iatrogenic oesophageal trauma is similar after nasogastric or endotracheal intubation. Iatrogenic oesophageal perforation occurs principally over the cricopharyngeus muscle on the posterior wall of the oesophagus. Here the oesophagus is thin and is markedly narrowed. Contamination of the perioesophageal space with gastric contents leads to diffuse cellulitis and infection. Diagnosis is made by evidence of cervical subcutaneous emphysema, cervical pain, dysphagia, temperature elevation and leukocytosis. Plain roentenograms of the neck and a contrast media swallow will confirm the diagnosis. Treatment consists of massive antibiotic therapy followed by surgical repair and drainage of the area. Mortality ranges from 10-15 per cent with early diagnosis to 50 per cent if surgery is delayed.

Esophageal Perforation↗
PubMed1988

The oesophageal detector device. Assessment of a new method to distinguish oesophageal from tracheal intubation.

A new method to distinguish oesophageal from tracheal intubation using the oesophageal detector device was evaluated. In 100 healthy adults, observers of differing experience reliably and rapidly detected 51 oesophageal and 49 tracheal intubations in a randomised, single-blind trial. In one case, blockage of the tracheal tube was detected swiftly and allowed corrective steps to be taken. This method can be used in patients with bronchospasm to detect correct tracheal placement when auscultation and decreased compliance of the chest may make clinical confirmation difficult. It can be concluded from this study that the oesophageal detector device is a reliable, rapid, inexpensive and easy to use method for the detection of oesophageal intubation and its very low cost should make it readily available in all situations where tracheal intubation is carried out.

Adolescent↗
PubMed1990

The end-tidal carbon dioxide detector. Assessment of a new method to distinguish oesophageal from tracheal intubation.

A new method to distinguish oesophageal from tracheal intubation using an end-tidal carbon dioxide detector was evaluated. In a prospective study on 50 healthy adult patients, the end-tidal carbon dioxide detector was reliably used to detect initial oesophageal intubation in 22 cases, and then to confirm tracheal intubation in all 50 patients. We conclude from this study that the end-tidal carbon dioxide detector is a reliable, rapid and easy method for the detection of oesophageal intubation.

Adolescent↗
PubMedDate not supplied

Pneumothorax following attempted nasogastric intubation for nutritional support.

Nasogastric intubation is a routine procedure, performed daily by both medical and nursing staff. It is a simple procedure, but not without complications which can be life threatening. We present an unusual, life threatening complication which occurred when nasogastric intubation using a no. 8 polyurethane tube with its metal stilet resulted in a pneumothorax after intubation of the endotracheal tree in the presence of a cuffed endotracheal tube. We emphasize that the presence of a cuffed endotracheal tube should not be considered a safeguard against pulmonary intubation during nasogastric placement of a feeding catheter.

Aged↗
PubMedDate not supplied

Middle ear pressure during and after prolonged nasotracheal and/or nasogastric intubation.

Changes in middle ear pressure during and after prolonged nasotracheal and/or nasogastric intubation were studied in 47 patients who had been intubated, for various reasons, during 1-24 days. All the patients had a negative middle ear pressure; in 84% of the ears the pressure was -200 mm of water or less. In most ears the pressure fell rapidly after the intubation, being most negative before extubation and during the first 2 days after. In all patients who could be followed the pressure returned to normal. The normalization was slow, depending upon the duration in intubation. Possible causes, such as abolished ventilation of the rhinopharynx, insufficient swallowing, mechanical occlusion of the tubal orifice, and the influence of anaesthetic gases are discussed. During the period after extubation the most probable cause is irritative and inflammatory reaction of the mucosa, leading to internal tubal occlusion.

Adult↗
PubMed1996

Increased success of blind nasotracheal intubation through the use of nasogastric tubes as a guide.

We were able to improve the success rate of blind nasotracheal intubation by using nasogastric tubes as a guide during intubation, first, for passing the endotracheal tube through the nasal cavity, and second, passing it from the pharynx to the larynx. By adding both sedation by modified neuroleptanalgesia (NLA) and topical and transtracheal administration of lidocaine, our technique became safer and smoother. We have completed 36 cases without accident, with an average time for intubation of 8.25 min. The Rüsh spiral tube was thought to be the most suited to this form of intubation because of the 90 degrees cut of its tip, its high-volume cuff, and its flexibility in all directions. These features are useful for hearing breath sounds, raising the tip of the tube by inflation of the cuff, and advancing the tube in a turning motion.

Anesthesia, Dental↗
PubMed2003

[Detection of esophageal intubation-assessment of several methods in clinical anesthesia].

OBJECTIVE: To evaluate the sensitivity and reliability of several widely used tests for prompt detection of inadvertent esophageal intubation. METHODS: Both endotracheal and esophageal intubations were made on 40 adult patients undergoing general anesthesia. The tests such as auscultation of bilateral apex of lungs and epigastrium by inexperienced examiners, capnography, SpO2, chest and upper abdomen movements, and airway resistance were evaluated. RESULTS: 90% and 96.25% cases in esophageal intubation were correctly diagnosed via auscultation of bilateral apex of lungs or epigastrium respectively. During esophageal ventilation, abdominal distension was found in 87.5% of cases, but none of them showed chest movements. Meanwhile, PetCO2 fluctuated between 1-2 mmHg, in association with a quick decline of SpO2 in 156 +/- 11 seconds. The airway mean resistance increased, whereas the period of plateau decreased significantly. CONCLUSIONS: (1) Auscultation of epigastrium in combination with bilateral apex of lungs is recommended because of the improved accuracy in tube positioning. (2) Capnography is the most reliable technique for the prompt detection of esophageal intubation, whereas other parameters do not seem to be of comparable value.

Adult↗
PubMed2006

[Dynamics of paranasal sinus and tympanic membrane changes in prolongely intubated patients].

67 prolongely intubated patients from intensive care unit were under our observation. Were performed ultrasound examination and CT scan of paranasal sinuses in prolongely intubated patients. In the same patients it was performed the examination of tympanic cavity by acoustic impendansometry. Also was performed bacteriologic examination of nasal discharge in prolongely intubated patients. Our investigations showed, that in prolongely intubated patients there is a high risk of development of polysinusitis and evstachitis, which can lead to so called fever of unknown origin and even to chronic sepsis. According to the authors, sanitation of nasal cavity must be performed every day at least 1 time, and if there is the shade--at least 2 times every day. To create the negative pressure, it is rational to use iamic--catheter and, through which activation of mucocilliary transport is performed. Changing of nasogastral probe is rational after one day by turns in each nasal pass. It is rational to cleanse places of pressing of these probes with the antiseptic solutions.

Eustachian Tube↗
PubMed1993

[Successful intubation with the Combitube of two patients with bull neck].

Endotracheal intubation is without doubt the optimal method for emergency airway management. Rapid intubation and effective ventilation are the major aims during cardiopulmonary resuscitation. As an alternative, the Combitube can be used whenever endotracheal intubation is not immediately possible. We report the successful use of the Combitube during cardiopulmonary resuscitation in two patients with bull-neck. The patients could be oxygenated and ventilated adequately with the Combitube. This case report shows that the Combitube may be a valuable tool for emergency intubation in difficult situations.

Angioplasty, Balloon, Coronary↗
PubMed1997

Unexpected left endobronchial intubation in a case of Turner's syndrome.

Patients with Turner's syndrome present a multiplicity of cardiovascular and airway abnormalities. We describe a case of Turner's syndrome with pericardial effusion who experienced an inadvertent endobronchial intubation due to displacement of the endotracheal tube immediately after the pericardial drainage. A sudden increase of airway pressure and decrease of oxygen saturation in the presence of breathing sound audible via the chest piece placed on the left hemithorax first misled us to call our attention to sputum impaction. No sputum was obtainable from airway suction. Inadvertent bronchial intubation was highly suspected at the post-anesthesia room when a decrease of right side breathing sound was noted together with a progressive fall of oxygen saturation. Emergent chest x-ray confirmed the diagnosis. It was thought that the mishap took place early in the act of or following the pericardial drainage. Our case serves as evidence once again to emphasize the possibility of endobronchial intubation due to displacement of endotracheal tube during anesthesia and the importance of monitoring to guard against inadvertent bronchial intubation, particularly in patients with associated problems such as Turner's syndrome with huge pericardial effusion.

Adult↗
PubMed2005

Efficacy of fentanyl and esmolol in the prevention of haemodynamic response to laryngoscopy and endotracheal intubation.

OBJECTIVE: To compare the effectiveness of single bolus dose of esmolol or fentanyl in attenuating the haemodynamic responses during laryngoscopy and endotracheal intubation. DESIGN: Randomized, placebo controlled, double blind study. PLACE AND DURATION OF STUDY: Department of Anaesthesia and Surgical Intensive Care Unit, Civil Hospital, Karachi, from December 1998 to November 1999. PATIENTS AND METHODS: Sixty adult ASA-I and ASA-II patients undergoing elective surgery were included in the study. The patients were randomly divided into three groups i.e., A, B and C. Heart rate, systolic, diastolic and mean blood pressures were recorded as 0= baseline and after administration of study drug, laryngoscopy and endotracheal intubation and 10 minutes thereafter. Study agent was injected 30 seconds before the induction of anaesthesia. Group 'A' (control) received 10 ml saline, group 'B' and group 'C' received fentanyl 2 mg/kg and esmolol 2 mg/kg respectively diluted to make a total volume of 10 ml in normal saline. RESULTS: Readings of heart rate, systolic, diastolic and mean arterial pressures were compared with baseline and among each group. The rise in heart rate was minimal in esmolol group and was statistically significant. Following intubation, blood pressure was increased in all groups but was least in group C. CONCLUSION: Bolus injection of fentanyl 2 mg/kg 2 minutes prior to laryngoscopy and intubation failed to protect against elevation of both the heart rate and systolic blood pressure, whereas esmolol at 2 mg/kg provided consistent and reliable protection against the increase of heart rate but not arterial blood pressure.

Adrenergic beta-Antagonists↗
PubMed1977

Endotracheal intubation. Complications in neonates.

Different opinions have developed on the use of endotracheal intubation in newborns and neonates for airway distress syndrome. The ensuing complications of the prolonged use of these airway tubes are drawing increased interest. This article reviews the case reports of 88 patients who received endotracheal intubation for airway problems and evaluates the complication rate as it correlates to the various contributing factors of duration of intubation, size of endotracheal tube, frequency of intubation, concomitant infections, and age of patient, which all lead to the complication rate.

Age Factors↗
PubMed1982

Acquired subglottic stenosis following prolonged endotracheal intubation. A canine model.

We developed a canine animal model of subglottic stenosis following prolonged intubation with modified non-cuffed endotracheal tubes. None of the puppies intubated for seven days had an irreversible stenosing subglottic lesion, whereas all animals intubated for 14 days or more had at least a 40% to 50% reduction of the subglottic lumen secondary to maturing fibrotic stenosis. The model described is more congruent with the known and suspected pathogenesis in those infants and children who require prolonged endotracheal intubation and subsequently acquire subglottic stenosis, and can be used in evaluating the efficacy of medical therapy or surgical therapy, or both, in the prevention or management of this disease.

Animals↗
PubMed1987

Prolonged intubation of neonates.

As the capabilities of modern medicine allow the survival of babies with increasingly lower gestational ages and birth weights, there is an increasing concern regarding the development of subglottic stenosis in those infants subjected to prolonged intubation. In this study, the general safety of neonatal intubation is assessed by a retrospective analysis of neonates who required intubation at Columbus (Ohio) Children's Hospital during a three-year period from 1977 to 1980. Of 343 surviving neonates, five (1.5%) developed clinically significant subglottic stenosis. The conclusion of this study is that endotracheal intubation is a safe method of airway management in neonates, even when used for extended periods.

Humans↗
PubMed1991

Paranasal sinusitis in burn patients following nasotracheal intubation.

Paranasal sinusitis is a complication of nasotracheal intubation. Of 99 nasally intubated adult patients who survived 48 hours after being burned, 22 who were intubated for more than 7 days underwent a computed tomographic scan of all paranasal sinuses, with timing dictated by the patient's clinical condition. Eight patients had computed tomographic and clinical findings consistent with sinusitis. Treatment consisted of removal of all nasal tubes, oral and topical nasal decongestants, and, when appropriate, culture-specific antibiotics. A subgroup of patients with preexisting sinus disease made up 50% of the patients with sinusitis; early conversion to an oral airway or a tracheostomy should be considered in such patients. Only one patient required surgical drainage of the sinuses. The frequency and morbidity of sinusitis in nasotracheally intubated burn patients does not justify the risk of routine conversion to an oral airway.

Adolescent↗