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At least 1,729 records · Page 96Linked to original sources
PubMed1988

The effect of tracheal intubation and surgical stimulation on median nerve somatosensory evoked potentials during anaesthesia.

This study was designed to determine whether alterations in the median nerve somatosensory evoked potentials occur during the stimuli of tracheal intubation and skin incision. Twenty-two patients scheduled for elective surgery and who required tracheal intubation were studied. Median nerve somatosensory evoked potentials were recorded, analysed and stored approximately every 40 seconds. Anaesthesia was induced with thiopentone and vecuronium used for neuromuscular blockade; the trachea was intubated 2 minutes after induction. Fentanyl 1.5 micrograms/kg was administered subsequently. Evoked potential monitoring was continued until at least 2 minutes after surgical incision. Induction of anaesthesia was associated with an increase in evoked potential latency of 0.8 msec and reduction in amplitude of 1.7 microV. Small, statistically insignificant changes occurred between induction of anaesthesia and tracheal intubation. Surgical incision was accompanied by a statistically significant mean decrease in evoked potential latency of 0.5 msec and a statistically significant increase in evoked potential amplitude of 0.6 microV. The fact that surgical stimulation produced an activating effect on evoked potentials suggests that they may be used as a measure of the neurophysiological effects of anaesthesia.

Anesthesia, General↗
PubMed1988

Nifedipine prevents the pressor response to laryngoscopy and tracheal intubation in patients with coronary artery disease.

The efficacy of sublingual nifedipine, administered one minute before anaesthetic induction, in order to minimise the pressor response to laryngoscopy and tracheal intubation was studied in a group of 15 patients who underwent coronary artery bypass surgery. Another group of 15 similar patients served as control. Premedication consisted of oral diazepam 5-10 mg, intramuscular morphine 0.2 mg/kg and promethazine 0.4 mg/kg. Anaesthesia was induced with morphine 0.1-0.15 mg/kg and thiopentone 3-5 mg/kg. Laryngoscopy and tracheal intubation were facilitated with suxamethonium 1.5 mg/kg. A significant increase in blood pressure occurred during and after laryngoscopy and tracheal intubation in the control group. This increase was absent in the patients pretreated with nifedipine. The nifedipine group also maintained a lower rate-pressure-product than the control group during the period of study. It is concluded that nifedipine 10 mg is a useful pretreatment to prevent the pressor response to laryngoscopy and tracheal intubation in patients with coronary artery disease.

Adult↗
PubMed1988

Teaching guided fibreoptic nasotracheal intubation. An assessment of an anaesthetic technique to aid training.

An anaesthetic technique suitable for training in fibreoptic intubation is described. It uses a capped oropharyngeal airway which leaves the nose free for fibreoptic intubation and allows the airway to be maintained and ventilation to be controlled if necessary. An assessment is made of the technique after 50 fibreoptic intubations with the Olympus LF-1 fibrescope. There were no failed intubations and no serious complications.

Adolescent↗
PubMed1988

Effects of thiopentone, etomidate and propofol on the haemodynamic response to tracheal intubation.

The haemodynamic response to tracheal intubation was compared in 303 patients in whom anaesthesia was induced with either thiopentone 4 mg/kg, etomidate 0.3 mg/kg or propofol 2.5 mg/kg, with and without fentanyl 2 micrograms/kg. There was after propofol alone a significant decrease in arterial blood pressure, which did not increase above control values after intubation. Significant increases in arterial pressure followed intubation in patients induced with thiopentone or etomidate alone. Increases in heart rate occurred with all agents after laryngoscopy. The use of fentanyl resulted in arterial pressures lower than those after the induction agent alone, and in an attenuation, but not abolition of the responses to laryngoscopy and intubation.

Adolescent↗
PubMed1989

The pressor response and laryngeal mask insertion. A comparison with tracheal intubation.

The pressor response associated with laryngoscopy and tracheal intubation may be harmful to certain patients. The laryngeal mask airway avoids the need for laryngoscopy and allows positive pressure ventilation of the lungs in appropriate patients. This study compared the pressor response of tracheal intubation with that of mask insertion in two groups of 24 and 23 healthy patients respectively. All patients were anaesthetised with thiopentone, nitrous oxide, enflurane and paralysed with atracurium. We have shown a similar, but attenuated pattern of response associated with mask insertion in comparison with laryngoscopy and intubation; significant differences between the groups were evident in arterial diastolic blood pressure immediately after insertion and again 2 minutes later. Use of the laryngeal mask may therefore offer some limited advantages over tracheal intubation in the anaesthetic management of patients where the avoidance of the pressor response is of particular concern.

Adult↗
PubMed1990

Pressor responses to tracheal intubation after sublingual captopril. A pilot study.

The effect of sublingual captopril on the pressor response to intubation was studied in 40 patients. Captopril was used in one of two doses (12.5 mg and 25 mg) 25 minutes before tracheal intubation. Both doses were associated with a significant reduction in the pressor response to intubation (p less than 0.05) compared to placebo, but no significant difference existed between the two doses. Neither dose controlled changes in heart rate at intubation. Untoward hypotension occurred in the treatment groups. Caution is advised in the peri-operative use of angiotensin-converting enzyme inhibitors.

Administration, Sublingual↗
PubMed1990

The effect of diltiazem on the cardiovascular response to tracheal intubation.

The efficacy of diltiazem in the attenuation of the cardiovascular response to laryngoscopy and tracheal intubation was studied in patients who received 0.2 or 0.3 mg/kg diltiazem 60 seconds before the start of laryngoscopy. These data were compared with a control group who received saline. Each group consisted of 10 patients who had elective surgery. Patients who received saline showed a significant increase in mean arterial pressure and rate pressure product associated with tracheal intubation. These increases after tracheal intubation were reduced in diltiazem-treated patients compared with those of the control group (p less than 0.05). The data suggest that a bolus injection of diltiazem is a simple, practical and effective method to attenuate the hypertensive response to laryngoscopy and tracheal intubation.

Blood Pressure↗
PubMed1991

Intravenous lignocaine and sympathoadrenal responses to laryngoscopy and intubation. The effect of varying time of injection.

We have studied the effect of varying the timing of a prior dose of intravenous lignocaine 1.5 mg/kg on the cardiovascular and catecholamine responses to tracheal intubation. Forty healthy patients were given an intravenous injection of either placebo or lignocaine 2, 3 or 4 minutes before tracheal intubation. There was a significant increase in heart rate of 21-26% in all groups. There was no significant increase in mean arterial pressure in response to intubation in any group of patients given lignocaine before intubation, but in the placebo group, mean arterial pressure increased by 19.1% compared to baseline values (p less than 0.05).

Adult↗
PubMed1991

Predicting difficult intubation.

Two pre-operative tests for the prediction of difficult intubation are assessed. A modified Mallampati test and a measurement of thyromental distance were performed at the pre-operative visit of 244 patients whose tracheas were subsequently intubated under general anaesthesia. Patients in whom the posterior pharyngeal wall could not be visualised below the soft palate, who also had a distance of less than 7 cm between the prominence of the thyroid cartilage and the bony point of the chin proved significantly more likely to present difficulty with intubation. The performance of these two simple tests on all patients before operation should allow the majority of cases of difficult intubation to be anticipated.

Adolescent↗
PubMed1992

Oxygen saturation and cardiovascular changes during fibreoptic intubation under general anaesthesia.

Sixty patients who required fibreoptic nasotracheal intubation were studied. Arterial oxygen saturation, arterial blood pressure and heart rate were monitored continuously during fibreoptic intubation under deep halothane anaesthesia. There were significant decreases (p less than 0.001) in arterial blood pressure and heart rate despite administration of intravenous colloid and atropine. Almost one third of the patients (18 out of 60) suffered a decrease in arterial oxygen saturation below 90% during the intubation sequence and in five patients the saturation fell below 80%. The episodes of desaturation were not related to the induction-intubation time or to the grade of laryngeal visibility at direct laryngoscopy.

Adolescent↗
PubMed1992

Hoarseness after tracheal intubation.

The reported incidence of hoarseness following short-term tracheal intubation varies widely. It has been reported as being permanent in 3%. This suggests that an enormous problem exists considering the numbers of patients intubated daily in the United Kingdom. A prospective study of 235 adult patients undergoing general anaesthesia in a district general hospital included 167 patients whose tracheas were intubated. Of these 167, 54 (32%) complained of hoarseness postoperatively. All but five returned to normal within 7 days. The others were hoarse for 9, 10, 12, 54 and 99 days. Those who were hoarse for 54 and 99 days had vocal cord granulomata. Regression analyses showed that certain patient and anaesthetic factors had a significant effect on the hoarseness. This study confirms a low incidence of prolonged or permanent hoarseness following short-term tracheal intubation.

Adolescent↗
PubMed1992

Thoracic electrical bioimpedance measurement of cardiac output and cardiovascular responses to the induction of anaesthesia and to laryngoscopy and intubation.

Noninvasive methods of determining cardiac output (by thoracic electrical bioimpedance) and arterial pressure (by intermittent oscillometry) were used to record minute-by-minute changes in heart rate, mean arterial pressure, stroke volume, cardiac output and systemic vascular resistance following induction of general anaesthesia and laryngoscopy and intubation in 60 healthy female patients who were either unpremedicated, or premedicated with temazepam or papaveretum-hyoscine. Anaesthesia was induced with a sleep dose (3-5 mg.kg-1) of thiopentone and maintained with 70% nitrous oxide in oxygen with 0.5-1% enflurane. Tracheal intubation was facilitated by administration of vecuronium 0.1 mg.kg-1. Mean arterial pressure and cardiac output decreased maximally 5 min after induction in all premedication groups by mean estimates of 21-25% and 14-22% respectively. Heart rate increased initially one minute after induction, but decreased to less than the baseline value 5 min after induction. Systemic vascular resistance was unchanged. The stimulus of laryngoscopy and tracheal intubation was accompanied by a significant pressor response and tachycardia one minute after intubation (with mean increases in mean arterial pressure and heart rate of 29-34% and 22-33% respectively). The increase in mean arterial pressure was secondary to an increase in systemic vascular resistance (36-57%), and was accompanied by a decrease in stroke volume (-25 to -31%). These changes were significant in all three groups. Cardiac output decreased only in unpremedicated patients. There were wide variations in the different haemodynamic indices.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Catecholamine response to laryngoscopy and intubation. The influence of three different drug combinations commonly used for induction of anaesthesia.

The haemodynamic response and changes in plasma catecholamine concentrations associated with laryngoscopy and tracheal intubation were compared during anaesthesia employing three strictly standardised techniques with commonly used drug combinations. Thirty-six patients were investigated consecutively resulting in 12 patients in each of three study groups. Anaesthesia was induced with thiopentone 5 mg.kg-1 (group 1), fentanyl 6 micrograms.kg-1 with thiopentone 5 mg.kg-1 (group 2), or midazolam 0.2 mg.kg-1 with fentanyl 6 micrograms.kg-1 (group 3). Undesirable changes in haemodynamic effects and an elevation of plasma catecholamine concentrations during laryngoscopy and intubation occurred in group 1. Heart rate and mean arterial pressure increased significantly (34% and 23% respectively). Noradrenaline concentration increased by a maximum of 147%. The addition of fentanyl (groups 2 and 3) attenuated the adverse haemodynamic response and elevation of plasma catecholamine concentrations; heart rate and mean arterial pressure did not differ from pre-intubation values and plasma catecholamine concentrations decreased steadily. Substitution of thiopentone by midazolam in combination with fentanyl abolished the adverse haemodynamic response and modified the increase in plasma catecholamine concentrations. 'High-dose' opioid anaesthesia is not necessary to produce optimal conditions during laryngoscopy and intubation.

Adolescent↗
PubMed1992

Cardiovascular effects of forces applied during laryngoscopy. The importance of tracheal intubation.

The relationship between the forces applied during laryngoscopy and cardiovascular changes were studied in patients undergoing laryngoscopy with or without intubation. This enabled us to differentiate between the cardiovascular effects of laryngoscopy and the effects of tracheal intubation. The forces applied during laryngoscopy were only weakly related to the cardiovascular changes, whereas tracheal intubation had a major influence. The many difficulties encountered in interpreting results from these studies are discussed. It is concluded that tracheal intubation causes more cardiovascular changes than laryngoscopy in routine uncomplicated procedures.

Adolescent↗
PubMed1993

Neuromuscular effects and intubating conditions following mivacurium: a comparison with suxamethonium.

Mivacurium chloride has been assessed in respect of intubating conditions and neuromuscular effects. The influence of suxamethonium on the onset and duration of subsequently administered mivacurium was also studied. A dose of 0.15 mg.kg-1 of mivacurium was found to provide unacceptable intubating conditions at 2 min in 9/9 patients and further studies were conducted using 0.2 mg.kg-1. Intubating conditions with this dose were acceptable in 65% and 80% of patients at 2 min and 2.5 min respectively. In comparison, intubating conditions were acceptable in 100% of patients at 1 min following 1 mg.kg-1 of suxamethonium. The onset of block occurred in 96 s and 97 s after 0.15 mg.kg-1 and 0.2 mg.kg-1 respectively, and the durations of block in terms of recovery of the first twitch (T1) to 25% and 90% of control, and to recovery of train-of-four ratio to 0.7, were 16.1 and 17.9; 24.1 and 25.8; and 24.2 and 27.0 min respectively with the two doses. The time for the onset of complete block with suxamethonium 1.0 mg.kg-1 was 50 s and the times to 25% and 90% recovery were 9.8 min and 13.3 min. The differences between suxamethonium and both doses of mivacurium were significant (p < 0.05) but there were no significant differences between the two doses of mivacurium in any of the neuromuscular measurements. Prior administration of suxamethonium had no influence on the effects of mivacurium. Cutaneous flushing was observed in 30 out of 75 patients but this was associated with transient hypotension in only two patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1995

Time course of action and intubating conditions following vecuronium, rocuronium and mivacurium.

The purpose of this study was to compare the time course of action and tracheal intubating conditions of vecuronium, rocuronium and mivacurium in anaesthetised patients. Anaesthesia consisted of thiopentone, fentanyl, N2O/O2 and isoflurane. After a 2 x ED90 dose the first attempt at tracheal intubation was made at 90 s. If required, maintenance doses of 0.5 x ED90 were administered. The intubating conditions after rocuronium were significantly better than those after vecuronium and mivacurium. The average onset times of rocuronium (172 s) and vecuronium (192 s) were significantly shorter than that of mivacurium (229 s). The clinical duration and recovery time were significantly shorter after mivacurium (13 and 6 min, respectively) than with vecuronium (33 and 14 min, respectively) and rocuronium (28 and 11 min, respectively). We conclude that rocuronium might be of advantage whenever the interval between the administration of the muscle relaxant and tracheal intubation must be short, whereas mivacurium may be of benefit if fast spontaneous recovery is required.

Adolescent↗
PubMed1996

The effect of increasing the dose of buprenorphine on the haemodynamic response associated with tracheal intubation.

The effect of buprenorphine on the haemodynamic response to tracheal intubation was studied at two dose levels, 2.5 micrograms.kg-1 and 5 micrograms.kg-1, in a placebo-controlled double-blind trial in 75 patients undergoing laparoscopic cholecystectomy. The study drugs were administered intravenously 8 min before induction of anaesthesia with thiopentone 5 mg.kg-1 and vecuronium 0.1 mg/kg-1. Buprenorphine 2.5 micrograms.kg-1 caused 50% attenuation of the blood pressure response whereas 5 micrograms/kg-1 caused 70% attenuation compared to the saline placebo. The maximum increase in heart rate was 14% of the control value after 2.5 micrograms.kg-1 and 11% after 5 micrograms/kg-1 of buprenorphine. A significant difference in heart rate was also observed between the two buprenorphine groups at 5 and 10 min after intubation. Blood pressure and heart rate both showed a significant fall from baseline values 10 min after intubation in both buprenorphine groups, with the changes being greater in the 5 micrograms.kg-1 group. We recommend the use of 2.5 micrograms.kg-1 buprenorphine for attenuation of the hypertensive response to intubation in major abdominal surgery.

Adult↗
PubMed1997

The cardiovascular responses to double lumen endobronchial intubation and the effect of esmolol.

The cardiovascular responses to double lumen endobronchial intubation and the effect of esmolol were examined in two groups of 10 ASA 2 & 3 patients undergoing pulmonary surgery in a double blind, placebo-controlled study. Endobronchial intubation was associated with a significant increase in arterial pressure and heart rate (p = 0.004), and a significant increase in plasma noradrenaline concentrations (p < 0.01) in the control group. The haemodynamic changes were smaller (p < 0.001) in the patients who received esmolol compared with the changes in the the control group. The increase in plasma noradrenaline concentrations was significantly greater (p < 0.05) in the esmolol group. The pressor response to endobronchial intubation in this study was of a similar magnitude to that known to occur in response to tracheal intubation.

Adrenergic beta-Antagonists↗