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At least 1,657 records · Page 92Linked to original sources
PubMed2000

Paramedic success rate for blind nasotracheal intubation is improved with the use of an endotracheal tube with directional tip control.

STUDY OBJECTIVES: Blind nasotracheal intubation (BNTI) is used to secure the airway in patients who are spontaneously breathing. The success rate for BNTI is often lower than for orotracheal intubation. We conducted this study to determine whether the use of an endotracheal tube (ETT) capable of directional tip control can improve the BNTI success rate. METHODS: This prospective, experimental study was conducted by a state emergency medical services agency during 1997, 1998, and 1999. Consecutive patients undergoing attempted BNTI or orotracheal intubation were included. Five paramedic units were trained to use an ETT with triggeractivated distal tip directional control for BNTIs (intervention group). Ten units used conventional ETTs for BNTIs and served as concurrent controls (control group). Subjects in the 2 groups were enrolled concurrently with nonrandomized allocation based on the agency providing service. An intubation attempt was defined by tube passage, and success was defined as confirmed endotracheal placement. RESULTS: A total of 219 BNTIs were studied (141 in the control group and 78 in the intervention group). BNTI was successful in 82 (58%) of 141 cases using conventional ETTs, and in 56 (72%) of 78 cases using directional tip control (P =.04). The overall success rate was 63%. CONCLUSION: Use of ETTs with distal directional control is associated with a higher success rate for BNTI than conventional ETTs. Use of ETTs with directional tip control significantly improves the success rates for BNTIs.

Allied Health Personnel↗
PubMed2006

Nitrous oxide analgesia for intubating preterm neonates: a pilot study.

AIM: To evaluate the administration of an equimolar mixture of N2O and O2 for intratracheal intubation in preterm neonates with respiratory distress syndrome (RDS). DESIGN: Prospective evaluation of N2O/O2 in premature neonates with RDS. SETTING: Tertiary neonatal unit from March to August 2003. PATIENTS: Twenty-six of 79 neonates admitted for RDS within 48 h of birth. INTERVENTION: N2O/O2 was administered until muscle tone was suppressed. Surfactant was given intratracheally. Patients were extubated as soon as possible. MAIN OUTCOME MEASURES: The time needed for N2O/O2 to suppress muscle tone, an evaluation of sedation/analgesia through movements of the limbs, and indicators of stress-related haemodynamic change, all recorded by an independent observer. RESULTS: In the 26 patients, gestational age was 30.5 (25th, 75th percentile: 30, 32) wk and median body weight was 1540 (1220, 1900) g. Postnatal age at intubation was 2 (2, 3) h. N2O/O2 administration time was 8 (6, 10) min (range 4-15 min). Sedation/analgesia was complete in 77% of patients. No significant differences between pre-procedure and post-procedure values were found for heart rate (p=0.29) or mean arterial blood pressure (p=0.13) (paired Wilcoxon test). Time needed for intubation was 30 (20, 37) s (range 10-60 s). Side effects included transient agitation (3/26) and retching (2/26). Extubation occurred 5 (5, 10) min (range 2-15 min) after surfactant instillation. Apnoeas occurred in 3/26 patients within 2 h after extubation. Two patients required reintubation to repeat surfactant administration within 24 h after extubation. CONCLUSION: N2O/O2 may be helpful for intubation in preterm neonates. Larger randomized, double-blind studies are needed for a thorough evaluation of effectiveness and safety.

Analgesics, Non-Narcotic↗
PubMedDate not supplied

The use of etomidate for rapid-sequence intubation in the air medical setting.

OBJECTIVE: To describe the use of etomidate for rapid-sequence intubation (RSI) in the air medical environment. METHODS: This was a retrospective review of a consecutive series of patients receiving etomidate for RSI by a university hospital-based air medical program. Records of all patients more than 10 years of age requiring intubation during a 13-month period were reviewed. Data collected included demographics, site of intubation, person performing intubation, indication, diagnosis, medications administered, complications, and pre- and post-

Adolescent↗
PubMedDate not supplied

Blind tracheal intubation by paramedics through the LMA-Unique.

OBJECTIVE: The manufacturer of the laryngeal mask airway (LMA) reports success rates of 30-93% by practitioners attempting tracheal intubation through the LMA-Classic. No prior studies describe success rates through the (disposable) LMA-Unique by paramedics. The objective of this study was to measure the success rate of paramedics attempting to intubate the trachea blindly through the LMA-Unique. METHODS: During a paramedic refresher class and an emergency medical services teaching day conference, paramedics previously trained in the use of the LMA-Unique as a "rescue" airway device were instructed in the technique of tracheal intubation through the LMA-Unique. A Laerdal LMA-mannequin was immobilized with an extrication collar and held by an investigator in the head-neutral position. Paramedics were first asked to insert the LMA-Unique as previously trained, and to confirm adequate ventilation by seeing inflation of the mannequin's lungs. Then, subjects were asked to pass a well-lubricated 6-0 Mallinckrodt endotracheal tube through the LMA-Unique within a 60-second period. Tracheal placement of the endotracheal tube was then confirmed by visualization of the expanding mannequin lungs. Rates of success of LMA-Unique placement and endotracheal tube placement were measured. RESULTS: Fifty of the 52 (96%; CI 91% to 100%) paramedics successfully inserted the LMA-Unique on the first attempt. Only 11 of the 52 (21%; CI 10% to 32%) paramedics were successful in blind placement of the endotracheal tube into the trachea through the LMA-Unique within a 60-second period. The failures (41 of the 52) were visually confirmed to be located in the esophagus. CONCLUSION: In this study, when attempting blind tracheal intubation through the LMA-Unique, paramedics were rarely successful in tracheal placement. Basic LMA-Unique insertion, however, had a very high success rate.

Clinical Competence↗
PubMed1978

Effects of tracheal intubation on intracranial pressure following induction of anaesthesia with thiopentone or althesin in patients undergoing neurosurgery.

Intracranial pressure (i.c.p.) and mean arterial pressure (m.a.p.) were studied in 20 patients during the induction of anaesthesia for craniotomy. Tubocurarine was administered as the muscle relaxant and either thiopentone or Althesin for the induction of anaesthesia. No significant differences were found in the i.c.p. changes with induction, intubation or pharyngeal packing, between the thiopentone and the Althesin groups. Except for two patients (one in each group) the increases in i.c.p. associated with intubation were small. In these two patients moderate increases from normal values to 28 and 37 mm Hg were recorded, but in one of these patients coughing and straining followed intubation. Marked decreases in m.a.p. were noted in both groups, but the recovery of m.a.p. was significantly more rapid in the Althesin group. Only two patients had i.c.p. values greater than 20 mm Hg before operation and in neither did i.c.p. increase above control values during induction and intubation. Packing the pharynx produced minimal changes in i.c.p. in all patients.

Adult↗
PubMed1983

Intranasal administration of nitroglycerine attenuates the pressor response to laryngoscopy and intubation of the trachea.

The intranasal administration of nitroglycerine (NTG) was undertaken in 35 adult female patients 1 min before the induction of anaesthesia. A control group consisting of 32 patients did not receive NTG. Systolic arterial pressure (SAP) and heart rate (HR) were recorded before the induction of anaesthesia and at 0, 3, and 5 min after tracheal intubation. SAP did not increase significantly in the NTG group immediately after intubation, while significant decreases in SAP were observed at 3 and 5 min (P less than 0.005 and P less than 0.001 respectively). SAP did increase significantly in the control group. HR was increased in both groups immediately after intubation (P less than 0.001 and P less than 0.001 respectively). NTG administered intranasally is a safe, simple and effective method to attenuate the hypertensive response to laryngoscopy and tracheal intubation.

Administration, Intranasal↗
PubMed1984

Rate of onset of good intubating conditions, respiratory depression and hand muscle paralysis after vecuronium.

The development of neuromuscular blockade of the adductor pollicis muscle following vecuronium 0.1, 0.15 and 0.2 mg kg-1, was compared with the development of intubating conditions and respiratory paralysis. From this relationship, the optimal time after injection required for ideal tracheal intubation was calculated for the three doses of vecuronium. The effects of these doses of vecuronium on the onset, the duration of action and rate of recovery were studied. Vecuronium and "light" thiopentone anaesthesia produced ideal intubation conditions only when complete neuromuscular blockade had been established for at least 30 s. Intubation could be carried out with minimal reaction 3.5 and 2.5 min after the injection of vecuronium 0.1 mg kg-1 and 0.2 mg kg-1, respectively. Pancuronium 0.1 mg kg-1 produced good conditions about 3.8 min after injection. Suxamethonium 1.5 mg kg-1 (preceded by gallamine 20 mg 2 min earlier), produced excellent conditions in under 1 min. Hypopnoea occurred when the peripheral neuromuscular blockade was about 20-40% established with vecuronium or 50% established with pancuronium. Increasing the dose of vecuronium from 0.1 mg kg-1 to 0.2 mg kg-1 prolonged significantly the duration of action (from 21 to 48 min) but did not shorten significantly the onset time nor prolong the rate of recovery.

Adult↗
PubMed1985

Cardiovascular responses to tracheal intubation in small children. Effects of the induction of anaesthesia with halothane.

Cardiovascular changes in 27 children (mean age 1.5 yr) were studied during the induction of anaesthesia with 2.5% halothane and 70% nitrous oxide in oxygen. The eyelash reflex disappeared in a mean of 62 +/- 3.6 (SEM)s and tracheal intubation could be performed 4.9 +/- 0.2 min after the start of halothane anaesthesia. Intubating conditions were satisfactory in 85% of the children. Systolic arterial pressure increased by 10.8 +/- 1.9 mm Hg and diastolic pressures by 6.0 +/- 1.4 (SEM) mm Hg after intubation of the trachea. Heart rate decreased significantly after induction. No cardiac arrhythmias were noted. There were no significant changes in Q-T interval after induction, after intubation or during the later course of the anaesthetic.

Anesthesia, Inhalation↗
PubMed1987

Cardiovascular and catecholamine responses to laryngoscopy with and without tracheal intubation.

The catecholamine and cardiovascular responses to laryngoscopy alone have been compared with those following laryngoscopy and intubation in 24 patients allocated randomly to each group. Following induction with fentanyl and thiopentone, atracurium was administered and artificial ventilation undertaken via a face mask for 2 min with 67% nitrous oxide in oxygen. Following laryngoscopy, the vocal cords were visualized for 10 s. In one group of patients, ventilation was then re-instituted via a face mask, while in the second group the trachea was intubated during the 10-s period and ventilation of the lungs maintained. Arterial pressure, heart rate and plasma noradrenaline and adrenaline concentrations were measured before and after induction and at 1, 3 and 5 min after laryngoscopy. There were significant and similar increases in arterial pressure and circulating catecholamine concentrations following laryngoscopy with or without intubation. Intubation, however, was associated with significant increases in heart rate which did not occur in the laryngoscopy-only group.

Adult↗
PubMed1987

Effect of topical lignocaine on the sympathoadrenal responses to tracheal intubation.

The catecholamine and cardiovascular responses to laryngoscopy and tracheal intubation have been studied in 30 patients undergoing elective gynaecological surgery, allocated randomly to one of three groups: group 1 received 4% lignocaine 160 mg using a Forrester Spray; group 2 received 4% lignocaine 160 mg by "Laryng-o-jet"; group 3 received an equal volume of saline administered by Forrester Spray. In all three groups, there were similar and statistically significant increases in mean arterial pressure and plasma adrenaline and noradrenaline concentrations 1 min after intubation, with diminution of these responses by 5 min after intubation. There were no differences between the three groups at any stage, which suggests that topical anaesthesia of the mucosa of the upper airway, as performed conventionally, is ineffective as a means of ameliorating the pressor and catecholamine responses to routine laryngoscopy and intubation.

Adult↗
PubMed1987

Propofol or thiopentone: effects on intraocular pressure associated with induction of anaesthesia and tracheal intubation (facilitated with suxamethonium).

Changes in intraocular pressure (IOP) were studied in patients given propofol 2.1 mg kg-1 (n = 30) or thiopentone 4.9 mg kg-1 (n = 30) followed by suxamethonium 1.0 mg kg-1 and tracheal intubation. Half the patients in each group received an additional smaller dose of the same induction agent (propofol 1.0 mg kg-1 or thiopentone 2.0 mg kg-1) immediately before intubation. Both agents produced significant decreases in IOP which were slightly more marked with propofol. The administration of suxamethonium produced an increase in IOP in all groups, more so in those given thiopentone, in whom it exceeded the control values. Intubation of the trachea produced the greatest increase in IOP, averaging about 25% above control in all groups except in the group given the additional dose of propofol, in whom IOP remained below control values throughout the process of induction and intubation. Ten patients (33%) experienced pain on injection with propofol. A decrease in systolic arterial pressure of more than 30% was observed in 12 patients (40%) receiving propofol, compared with three (10%) of those given thiopentone.

Adolescent↗
PubMed1988

Anterior fontanelle pressure responses to tracheal intubation in the awake and anaesthetized infant.

In order to define the changes in intracranial pressure which occur during tracheal intubation in young infants, a Ladd transducer was used to monitor anterior fontanelle pressure (AFP) non-invasively in awake (group 1, n = 14) and anaesthetized (group 2, n = 10) infants during intubation of the trachea. Heart rate and systolic arterial pressure were also recorded. In quiet, undisturbed infants, AFP (mean +/- SEM) was similar in groups 1 (9.6 +/- 0.5 mm Hg) and 2 (8.7 +/- 0.8 mm Hg); with crying, AFP increased significantly in both groups. During laryngoscopy in group 1, AFP increased to 33.5 +/- 3.6 mm Hg, which was significantly greater than in the quiet infant, but did not differ significantly from measurements in the crying infant. In group 2, AFP increased significantly to 15.8 +/- 18 mm Hg during laryngoscopy. This increase was significantly less than the group 1 response. Neither heart rate nor systolic arterial pressure changed significantly in either group during laryngoscopy--when compared with measurements in the quiet state. It was concluded that AFP increases significantly during intubation and during crying in the infant. The response to intubation is only partially attenuated by the prior administration of general anaesthesia.

Anesthesia, General↗
PubMed1988

Effect of nifedipine on cardiovascular responses to laryngoscopy and intubation.

The efficacy of sublingual nifedipine in attenuating the pressor responses to laryngoscopy and intubation was studied in 40 patients undergoing elective surgery. Anaesthesia was induced with thiopentone 5.5 mg kg-1 i.v. and tracheal intubation was facilitated with suxamethonium 1.5 mg kg-1 i.v. Patients were allocated randomly to receive sublingual nifedipine 10 mg or placebo capsules 10 min before induction. Patients receiving placebo capsule showed significant increases in heart rate and arterial pressure associated with tracheal intubation (P less than 0.001). The increases in arterial pressure and rate-pressure product were reduced in nifedipine treated patients (P less than 0.001). Heart rate increased significantly in both groups immediately after intubation.

Administration, Sublingual↗
PubMed1990

Effect of nicardipine on the cardiovascular response to tracheal intubation.

We studied the cardiovascular responses to laryngoscopy and intubation in 30 patients who received nicardipine 15 micrograms kg-1 or 30 micrograms kg-1, or saline placebo 60 s before the start of laryngoscopy. Anaesthesia was induced with thiamylal 5 mg kg-1 i.v. and tracheal intubation was facilitated with vecuronium 0.2 mg kg-1. Patients receiving saline showed a significant increase in mean arterial pressure (MAP) and rate-pressure product (RPP) associated with tracheal intubation. The increases in MAP and RPP following tracheal intubation were reduced in both groups of patients who received nicardipine.

Anesthesia, Inhalation↗
PubMed1990

Effects of nebulized lignocaine on the intraocular pressure responses to tracheal intubation.

We have examined the effect of preoperative administration of nebulized lignocaine or saline on the intraocular pressure (IOP) response to tracheal intubation in 20 adults. In the saline group, tracheal intubation was associated with a significant increase in IOP above control and preintubation values (P less than 0.01); in the lignocaine group there was no change in IOP following intubation. After intubation, IOP was significantly less in the lignocaine group than in the saline group (P less than 0.05).

Adult↗
PubMed1990

Factor analysis in difficult tracheal intubation: laryngoscopy-induced airway obstruction.

We have studied eight patients with a history of difficult tracheal intubation, using x-ray laryngoscopy and local anaesthesia, a curved Macintosh blade and a standard intubating position. The view obtained was better than recorded previously during general anaesthesia in two patients, and in a third the x-ray showed that positioning the blade tip beneath the epiglottis would have improved vision, suggesting that reproducibility of the assessment may not be consistent. The "ease of intubation" and "complementary" angles may be helpful in the assessment of such patients. A "peardrop" effect is described whereby during laryngoscopy, the epiglottis became pressed against the posterior pharyngeal wall as a result of tongue compression. In the absence of muscle paralysis, removal of the blade caused immediate correction. However, during anaesthesia with neuromuscular block it is suggested that this not only occurs more readily but, may not correct when the blade is removed. Iatrogenic airway obstruction during moderately difficult tracheal intubation may be common and should be anticipated.

Airway Obstruction↗
PubMed1991

Attenuation of the pressor response to tracheal intubation in hypertensive proteinuric pregnant patients by lignocaine, alfentanil and magnesium sulphate.

The pressor response to intubation is known to be exaggerated in patients with gestational proteinuric hypertension (GPH). The effect of pretreatment with lignocaine 1.5 mg kg-1, magnesium sulphate 40 mg kg-1 or alfentanil 10 micrograms kg-1 on this pressor response was studied in 69 patients with moderate to severe GPH. Systolic arterial pressure exceeded baseline values for the first 5 min after tracheal intubation in the lignocaine group, with a peak increase of 31.6 (SEM 3.6) mm Hg at 2 min after intubation, but no mean increase in pressure occurred in the two other groups. Following intubation, six of 24 mothers in the alfentanil group, six of 21 in the lignocaine group and one of 24 in the magnesium group (P less than 0.05) exhibited a systolic arterial pressure (SAP) greater than 180 mm Hg sustained for 2 min or more. Alfentanil caused the least change in heart rate, but resulted in significant fetal depression.

Alfentanil↗
PubMed1992

Effect of verapamil on the cardiovascular responses to tracheal intubation.

We have studied the efficacy of verapamil in attenuating the cardiovascular responses to tracheal intubation in three groups of ASA grade I patients given verapamil 0.05 mg kg-1 or 0.1 mg kg-1 or saline 45 s before the start of laryngoscopy. Anaesthesia was induced with thiopentone 5 mg kg-1 i.v. and tracheal intubation was facilitated with vecuronium 0.2 mg kg-1. During anaesthesia, ventilation was assisted or controlled with 1% enflurane and 50% nitrous oxide in oxygen. In patients who received saline, there was a significant increase in mean arterial pressure and rate-pressure product associated with tracheal intubation. The increases were significantly less in verapamil-treated patients compared with those in the control group, although verapamil failed to prevent tachycardia caused by laryngoscopy and intubation.

Adult↗