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At least 19 recordsLinked to original sources
PubMed1976

[Difficult intubations and proposed solutions. Intubation by fiberscopy].

After a review of the various techniques used in difficult intubations, the authors emphasize recent progress in the field of fiber endoscopy. The advantages of this technique, e.g. absence of trauma, increased field of exploration and reduction in dose of anaesthetic drugs, exceed the present disadvantages, e.g. high price of this material, relatively fragile apparatus, too long and diameter too great for use in children.

Fiber Optic Technology↗
PubMed1976

Endotracheal intubation and its relationship to bacterial colonization and systemic infection of newborn infants.

The role of antibiotics in preventing respiratory tract bacterial colonization and systemic infection after orotracheal intubation was prospectively studied in 54 newborn infants. Respiratory tract colonization was assessed from nasopharyngeal and tracheal aspirate cultures obtained at intubation and daily thereafter, while systemic infection was monitored by blood, cerebrospinal fluid, and suprapubic urine cultures performed initially and every three days thereafter while intubated. Colonization and systemic cultures were also obtained at extubation or death. The study group, provided with antibiotics at intubation, and the control group were similar in birthweight and gestational age, as well as race, sex, hospital or origin, and indication for intubation. Colonization at intubation was five times more common in infants intubated 12 or more hours after birth than in infants intubated earlier. Subsequent colonization was twice as frequent in infants intubated longer than 72 hours as well as in those requiring two or more reintubations. Systemic infection occurred only in those infants who were initially or subsequently colonized and was three times more frequent in the control group than in the study group.

Anti-Bacterial Agents↗
PubMed2026

Re-evaluating pediatric laryngoscope blade size recommendations: Comparable intubation performance across blade sizes in pediatric manikin models.

BACKGROUND: Pediatric airway management traditionally emphasizes strict adherence to age-based laryngoscope blade size recommendations, despite limited empirical validation. OBJECTIVES: To evaluate whether intubation performance varies across a range of blade sizes, and whether a Macintosh 2 blade performs comparably across multiple pediatric age groups in a simulation setting. METHODS: We conducted a randomized crossover simulation study using three pediatric airway manikins (neonate, infant, and child age groups). Emergency medicine residents and faculty physicians performed intubations using multiple laryngoscope blade types and sizes, including standard and nonstandard options. Primary outcomes were intubation time and first-attempt success. Secondary outcomes included complications and operator-rated ease of glottic view and tube passage. Between-blade differences were estimated with 95% confidence intervals. RESULTS: Across manikin sizes and blade types, intubation times were short and first-attempt success rates exceeded 98% in most conditions. Performance remained consistent even with blade sizes outside conventional age-based recommendations. Between-blade differences in intubation time were small, and complication rates were low across conditions. The Macintosh 2 blade performed comparably across all manikin sizes, with similar intubation times, high success rates, and favorable ease ratings. CONCLUSIONS: Intubation performance in pediatric manikin models was similar across a wide range of blade sizes. These hypothesis-generating findings warrant prospective clinical evaluation of simplified blade selection strategies for pediatric intubation.

Manikins↗
PubMed1976

[Vocal and laryngo-tracheal sequelae of prolonged intubation at the university medical clinic of the cantonal hospital at Lausanne].

70 patients (39 men and 31 women) submitted to a prolonged intubation at the Centre respiratoire de la Clinique médicale universitaire de Lausanne have been investigated. They represent the half of the patients having survived of 488 cases treated between January 1966 and June 1974. 33% of the investigated patients (i.e. 18% of all men and 48% of all females) complain about a permanent dysphonia related to the intubation. 17% of the patients (i.e. 13% of all men and 23% of all females) presented with a laryngotracheal lesion induced by the prolonged intubation. This study shows that laryngo-tracheal complications following prolonged intubation are more frequent in females than males. The time of intubation is a determinant factor for the development of complications. Following the first 48 h or intubation of the risk of laryngo-tracheal complication is proportional to the duration of the permanence of the nasal tube. The presence of pathogenous microbes (Klebsiella, Staphylococcus aureus, Bacterium coli, Proteus, Pseudomonas aeruginosa) in the tracheo-bronchial secretion is also important for the development of sequelae. In conclusion, laryngo-tracheal complications following prolonged intubation occur in the male when predisposing factors are present, whereas in the female post-intubation sequelae occur without such predisposing factors.

Adult↗
PubMed1975

The safety of intubation in croup and epiglottitis: an eight-year follow-up.

A series of 815 infectious croup (i.e., laryngotracheobronchitis) cases and 55 epiglottitis cases, encompassing an eight-year interval, is reviewed to determine the incidence of adverse effects of nasotracheal intubation used to manage upper airway obstruction. The racial, sex, and age distributions, in addition to modalities of treatment, are presented. The intubated cases (86 patients), representing 6.5 percent of all croup cases and 60 percent of all epiglottitis cases, are described in more detail with respect to presenting symptoms and physical findings. The average duration of intubation is 55 hours for epiglottis and 88 hours for croup. The incidence of immediate, reversible complications for the entire intubated series is 7 percent. The incidence of delayed, irreversible complications, as determined by: 1. noting any persistent post-extubation symptoms; 2. measuring peak expiratory flow rates; and 3. laryngeal polytomography, is 1.6 percent. The mortality secondary to intubation is 0 percent. The complication rate (1.6 percent) in this series of nasotracheal intubations is lower than the mortality (3.6 percent) in a large collective series of pediatric tracheotomies performed for airway obstruction in croup or epiglottitis. Other advantages of intubation vs. tracheotomy are described (i.e., shorter hospital stay, dilatatory effect of endotracheal tube). The authors conclude that nasotracheal intubation is safer than pediatric tracheotomy and should be considered the procedure of choice in the management of upper airway obstruction secondary to croup or epiglottitis.

Age Factors↗
PubMed1977

Orotracheal intubation in the newborn.

One hundred consecutive cases of orotracheal intubation in the premature and term newborn at the Hersehy Medical Center were studied retrospectively. The reason for intubation was for respiratory failure most commonly associated with hyaline membrane disease. The duration of intubation ranged from six hours to 63 days. Seventy-nine percent required intubation for more than 24 hours and 28 percent required intubation for more than one week. No tracheotomies were performed. There were 56 survivors, 50 of which were seen in follow-up examination at three, six or 18-month intervals. There were no cases of clinically evident upper airway damage or obstruction in this group. Post mortem examinations were carried out on 35 infants with tracheal necrosis found in one case. The authors feel that orotracheal intubation is superior to nasotracheal intubation and tracheotomy in this age group. This method of management should be carried out where there is adequate trained personnel and professional staff and equipment capable of proper orotracheal tube placement and management.

Follow-Up Studies↗
PubMed1979

Emergency room intubations--complications and survival.

Forty-three consecutive patients requiring endotracheal intubation in an emergency room were studied prospectively to define the complications associated with intubation and the survival of these patients, and to evaluate emergency room policies. The indications for intubation were acute respiratory failure (ARF) in 22 patients and cardiopulmonary arrest (CPA) in 21 patients. Thirty-eight complications occurred in 24 of the 43 patients. The department or level of training of the intubator did not affect the rate of complications. Furthermore, specific complications did not influence survival. Seventeen patients survived, all in the ARF group. Age less than 40 years and admission PaO2 greater than 40 mm Hg also were associated with increased survival. We conclude that the complication rate of emergency room intubations is high and would not appear to be lowered by limiting intubations to physicians from specific departments or with certain levels of training. The underlying diagnosis and condition on admission to the emergency room appear to be more important factors relating to survival than complications during intubation.

Acute Disease↗
PubMed1992

Translaryngeal guided intubation in a patient with raised intracranial pressure.

A 60-year old man with intracranial space occupying lesion, presented with difficulty in intubation at induction of anaesthesia. Several attempts at direct tracheal intubation were made until the airway was finally secured. Though the brain was slack, the tumour could not be located at this operation. He presented for re-operation with worse signs of raised intracranial pressure which may accompany repeated attempts at intubation, a planned translaryngeal guided intubation was employed to secure the airway. Where fibreoptic laryngoscope is unavailable and difficult tracheal intubation is envisaged, translaryngeal guided intubation may save time and reduce morbidity of prolonged and repeated attempts at tracheal intubation.

Craniopharyngioma↗
PubMed1977

[Laryngeal complications in newborns following intratracheal intubation (author's transl)].

Histological and bacteriological findings in comparison to clinical data concerning intubation for 38 dead premature infants and newborns were studied to elucidate conditions complicating intratrachial intubation at the laryngeal level. The larynx was intact in 3 cases. Slight lesions of mucosa (epithelabrasion, hemorrhage) were found in 13, moderately severe lesions (necrosis of epithelium, ulcers, pseudomembranes) in 11, and severe lesions (deep necrosis, perichondritis with sceletisation) in 10 cases. 1 case showed a stage of regeneration. The narrow passage between the two processus vocales is a site of predilection for tubus-induced lesions, the epithelium bein immediately adjacent to the cartilage. Successful bacteriological demonstration of the infectious agent correlated with the rising degree of mucosal lesions, and increasing duration of intubation. 3 cases, however, already had severe lesions after short-time-intubation. Formal and causal pathogenesis are described. Essential causes are: trauma of intubation, irritation by the tubus in situ, duration of intubation, and infection. Regenerative power of the infantile laryngeal mucosa is strong. Permanent lesions may occur as scarred stenosis. Careful indication, accurate and careful technology of intubation, choice of the smallest possible diameter of tubus, good care for the tubus, and generous prophylaxis against infections are to be demanded.

Hemorrhage↗
PubMed1976

[Prolonged endotracheal intubation or tracheostomy in children (author's transl)].

Five patients with subglottic tracheal stenosis following prolonged endotracheal intubation are reported. To minimize tracheal stenosis the indications for prolonged intubation should be well defined and tracheostomy considered as an alternative. The incidence of tracheal stenosis following prolonged intubation is stimilar to that following tracheostomy. The risk of stenosis increases with the duration of intubation, the degree of physical trauma to the laryngotracheal mucosa (suction, tube changing, restlessness), infection of the trachea or larynx, and with the age of the child. Prolonged intubation necessitates sedation and intensive care. Tracheostomy has a higher mortality but this and the risk of stenosis depend greatly on the operative technique. Particularly in cases where prolonged intubation increase the risk of tracheal stenosis, the advantages of tracheotomy become evident. Tracheostomised children rarely need sedation, the tracheobronchial tree can be easily and carefully toileted and the changing of the tube is without risk. Neither method is absolutely preferable, but the correct application of both will minimise the complication rate. The indications for each may be summarised as follows: for primary treatment of acute respiratory distress in children prolonged intubation is the treatment of choice. If after 3 days there is no chance of extubation, tracheostomy should be considered but this depends also on the child's age and behaviour, and on the laryngotracheal mucosal reaction. The younger the child the more cautiously should tracheostomy be considered. Children under 2 years of age should only be tracheostomised if there is no alternative.

Age Factors↗
PubMed1992

Laser recanalization versus endoscopic intubation in the palliation of malignant dysphagia: a randomized prospective study.

Forty patients with histologically confirmed malignant dysphagia were randomized to either endoscopic intubation or laser recanalization. Age, sex, tumour histology and site were evenly distributed between the groups. Results were analysed on an 'intention to treat' basis. All patients treated by laser achieved patency; there was one failed intubation. The best swallowing grade achieved was significantly better with laser recanalization (median 4 (range 3-4)) than with intubation (median 3 (range 2-4)) (P < 0.001). The median survival was 21.5 (range 4-62) weeks in the group receiving laser treatment, compared with 14.5 (range 7-102) weeks in the intubated group (P = 0.09). The median inpatient stay as a proportion of survival time was 14 per cent in the group receiving laser treatment compared with 15 per cent in the intubated group (P > 0.05). The median weight loss was less in the laser-treated patients (2.0 (range 2-8) versus 3.0 (range 0-10) kg, P = 0.04). These results indicate that laser recanalization provides better palliation of dysphagia than does intubation, but this is not reflected in an improvement in survival time.

Adult↗
PubMed1975

Surface alterations due to endotracheal intubation.

The varied complication of prolonged endotracheal intubation, including tracheal stenosis, stricture and tracheomalacia, are thought to be directly related to lateral tracheal wall pressure. To investigate the initiation, relevance and duration of these changes, studies were undertaken to assess the effects of intubation on the surface anatomy of the trachea by scanning electron microscopy. Tracheal mucosal morphology was studies in (1) anesthetized "normal" dogs; (2) d-ogs sacrificed 2 hours after intubation with cuff deflated or inflated to the "just seal" point using a cuff system producing the lowest tracheal wall pressure; and (3) dogs intubated for 2 hours and then examined at 2 and 7 days after extubation. Intubation without cuff inflation resulted in distinct linear areas of nearly complete ciliary denudation along the tract of tubal insertion within 2 hours. Inflated cuffs produced similar but more widespread changes especially over tracheal rings, indicating that pressure in areas of least resiliency significantly contributes to these alterations. Regeneration of cilia could be seen 2 days after extubation, but many anatomic features remained distorted; at 7 days, regeneration was nearly complete, but isolated areas of denudation could still be identified. Scanning electron micrographs of human tracheas taken at autopsy from patients who had had prolonged intubation with the same cuff system correlated well with those obtained from dogs.

Animals↗
PubMed1992

Placebo-controlled trial of prednisolone in children intubated for croup.

Many studies have attempted to find out whether steroid treatment is beneficial in children with croup, but the results have been inconclusive. We have done a prospective placebo-controlled study of the effect of prednisolone on two clinical endpoints--the duration of intubation and the need for reintubation. Reasons for exclusion were age under 6 months, congenital airway anomalies, and previous intubation. 70 eligible children were randomly assigned treatment with prednisolone 1 mg/kg (n = 38) or placebo (n = 32) every 12 h given by nasogastric tube until 24 h after extubation. 11 (34%) placebo-treated and only 2 (5%) prednisolone-treated patients required reintubation after accidental or elective extubation (p = 0.004, Fisher's exact test; odds ratio 8.9, 95% confidence interval 1.7-59.3). Survival analysis with log-normal regression showed that the duration of intubation was shorter with steroid therapy (p less than 0.003) and increasing age (p less than 0.02), but was not influenced by endotracheal tube size or abnormality on chest radiograph. The median duration of intubation was 138 (95% CI 118-160) h in children who received placebo and 98 (85-113) h in the prednisolone group. Steroid therapy reduces the duration of intubation and the need for reintubation in children intubated for croup.

Age Factors↗
PubMedDate not supplied

Facilitation of rapid-sequence intubation with large-dose vecuronium with or without priming.

STUDY OBJECTIVES: To determine the effect of priming on the intubation and onset times of vecuronium 0.3 mg/kg. DESIGN: Randomized, unblinded study. SETTING: Operating rooms and postanesthetic recovery unit of a university-affiliated general hospital. PATIENTS: Thirty female ASA physical status I and II patients scheduled for intraperitoneal surgery divided into two groups of 15 each. INTERVENTIONS: Anesthesia was induced and maintained with sufentanil, droperidol, thiopental sodium, and nitrous oxide in oxygen. Patients in Group 1 were given vecuronium 0.015 mg/kg 4 minutes before induction and vecuronium 0.285 mg/kg 1 minute after induction. Patients in Group 2 received a single 0.3 mg/kg dose of vecuronium 1 minute after thiopental sodium. The ulnar nerve was stimulated every 10 seconds with train-of-four supramaximal impulses of 0.2 millisecond duration at 2 Hz. The compound electromyogram (EMG) of the adductor pollicis was continuously recorded. The trachea was intubated when the amplitude of the EMG decreased to 15% to 25% of control. At the end of surgery, residual neuromuscular block was reversed with edrophonium 0.75 mg/kg. MEASUREMENTS AND MAIN RESULTS: All patients in Group 1 could be intubated in 80 seconds or less, and the longest onset time was 120 seconds. In Group 2, the longest intubation time was 140 seconds, and the longest onset time was 200 seconds. Clinical durations in both groups were unpredictable, ranging from 47 to 185 minutes in Group 1 and from 63 to 160 minutes in Group 2. Ten of the 30 patients required an additional 0.5 mg/kg of edrophonium for antagonism of the residual neuromuscular block. There were no significant changes in heart rate or blood pressure attributable to vecuronium. CONCLUSIONS: Seventy-five percent to 85% neuromuscular block of the adductor pollicis, required for atraumatic tracheal intubation, developed in 80 seconds or less when vecuronium 0.3 mg/kg was administered in divided doses and in 140 seconds or less when it was injected as a single bolus dose. Clinical duration of vecuronium 0.3 mg/kg is long and unpredictable, and reversal of residual neuromuscular block may require larger doses of anticholinesterases. It is recommended that an intubating dose of vecuronium 0.3 mg/kg be used only in patients undergoing long surgical procedures that require prolonged postanesthetic mechanical ventilation.

Adult↗
PubMedDate not supplied

Effects of nilvadipine on the cardiovascular responses to tracheal intubation.

STUDY OBJECTIVE: To evaluate the efficacy of nilvadipine given orally in attenuating the hypertensive response to laryngoscopy and intubation. DESIGN: Controlled, randomized, double-blind study. SETTING: Induction of anesthesia for elective surgery at a university hospital. PATIENTS: Thirty normotensive patients (ASA physical status I) undergoing elective surgery were divided into three groups of ten patients each. INTERVENTIONS: Either 2 mg of nilvadipine, 4 mg of nilvadipine, or a placebo (control) was administered orally 90 minutes before induction of anesthesia. Anesthesia was induced with thiopental sodium 5 mg/kg intravenously, and tracheal intubation was facilitated with vecuronium 0.2 mg/kg. During anesthesia, ventilation was assisted or controlled with 1% enflurane and 50% nitrous oxide (N2O) in oxygen. Laryngoscopy lasting 30 seconds was attempted 2 minutes after administration of thiopental sodium and vecuronium. MEASUREMENTS AND MAIN RESULTS: Patients receiving the placebo showed a significant increase in mean arterial pressure (MAP) and heart rate associated with tracheal intubation. The increase in MAP following tracheal intubation was significantly lower in nilvadipine-treated patients than in the control group (p less than 0.05). However, neither dose of nilvadipine attenuated the tachycardic response to intubation. CONCLUSIONS: Oral administration of nilvadipine before induction of anesthesia is a simple and practical method for attenuating pressor response to laryngoscopy and tracheal intubation after standard elective induction under additional 1% enflurane-N2O anesthesia.

Administration, Oral↗