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PubMedDate not supplied

Circulatory changes in patients with coronary artery disease following thiamylal-succinylcholine and tracheal intubation.

Circulatory responses after thiamylal (4 mg/kg) and succinylcholine (SCh) (2 mg/kg) administration followed by direct laryngoscopy and tracheal intubation were measured in 20 patients before elective aortocoronary vein bypass graft operations. Compared with awake measurements, the mean arterial pressure (MAP) decreased 19 +/- 3 torr (mean +/- SE) and heart rate (HR) increased 9 +/- 3 bpm 1 minute after thiamylal-SCh. MAP was increased 39 +/- 4 torr and HR 20 +/- 3 bpm above awake levels in response to laryngoscopy and tracheal intubation. Blood pressure and HR returned spontaneously to near awake levels without additional anesthesia within 5 minutes of anesthetic induction. Stroke volume index was decreased significantly after tracheal intubation but cardiac index was not altered. The authors conclude that thiamylal-SCh followed by tracheal intubation is an acceptable anesthetic induction sequence for patients without evidence of left ventricular heart failure who require anesthesia for elective coronary artery revascularization.

Anesthesia, Intravenous↗

PubMed1977

Glottic and subglottic stenosis from endotracheal intubation.

As a result of increased use of prolonged endotracheal intubation, complications of intubation are now being seen more often. Stenosis of the airway may develop at the level of the glottic or subglottic larynx, or in the trachea. Discussions of management do not always distinguish clearly between laryngeal stenosis and tracheal stenosis. Yet, these are two separate entities. Discussions of laryngeal stenosis usually deal with subglottic stenosis, with less emphasis on obstruction at the glottic level. Of 20 patients, 14 adults and six children, with stenosis of the larynx secondary to intubation, we were successful in establishing adequate airways in 16. An analysis of these 20 patients leads to the following conclusions: 1. Scarring in the glottic posterior commissure between the arytenoid cartilages is a frequent cause of laryngeal stenosis after intubation. 2. Endoscopic management can be successful in many cases if it is started early enough, and repeated as often as is necessary. The earlier it is begun, the better the results will be. 3. Indwelling stents which are extremely valuable in laryngeal stenosis from external trauma, may not be as useful in stenosis from endotracheal tube trauma.

Adolescent↗

PubMed1976

[Difficult intubations in anesthesia].

The authors present six cases of difficult intubation and review the literature on this subject; The circumstances during which difficult intubation may be feared are recalled; some are due to the morphology of the subject, the others to his previous pathology which may be rheumatological or dermatological. The authors then discuss the method of anaesthesia for this unusual intubation and the various technical means proposed to carry out safely the intubation itself.

Anesthesia↗

PubMed1976

[Use of closed circuit television for teaching tracheal intubation to medical students].

There are many occassions when patients could benefit from early intubation. This skill should be acquired by all doctors and not only by resuscitators and trainee anaesthetists. In Liverpool, all undergraduates in their fifth year of medicine are expected to intubate a minimum of ten patients lnder supervision of the anaesthetist. The use of closed circuit television has been explored and its value assessed in the teaching of intubation to undergraduates. The availability of hardware that is inexpensive, relatively simple to use and requiring minimal staff, such as Phikips VCR N1500 has made this approach to all. Videotapes are superior to film for this, since they are cheap, reusable and do not require chemical processing. The medium is versatile and replay immediate. Student performance can be recorded and replayed to allow positive identification of an imperfect technique. The videotape permits discussion and demonstration of methods of improvement of technique. A pre-recorded tape can be used to illustrate the anatomy and to demonstrate intubation in the absence of a patient. The fact that this is in black and white at the moment may be a disadvantage, but colour is not essential for recognition of the anatomy of the larynx. It must not be forgotten that in Britain, written permission is required before recording patients on "videograms". This can be obtained by modification of the consent forms signed by the patients prior to surgery.

Humans↗

PubMed1975

Indications for intubation in laryngotracheobronchitis in black children.

Fifty-eight children with laryngotracheobronchitis (LTB) were studied. Many were malnourished, or in the post-measles state, or had some lower respiratory tract or cardiac involvement. In these patients, factors helpful in assessing the need for relief of airway obstruction by tracheal intubation have been evaluated. A set of indications for intubation, which includes clinical and arterial blood gas features of LTB is suggested. Cognisance of complications of disease, where present, has also been taken. If cyanosis or muscular hypotonia or unawareness is present, intubation is urgently needed. When two of the following occur together, the need for intubation has arisen: (a) pulse rate greater than 170/min and respiratory rate greater than 55/min; (b) paCO2 greater than 37 mmHg; (c) paO2 less than 50 mmHg; and (d) a complication (cardiac failure or severe lower respiratory tract infection).

Black or African American↗

PubMed1978

[Some observations regarding long-term intubation and tracheotomy (author's transl)].

The development of new non-irritating thermoplastic endotracheal tubes together with improved nursing techniques have resulted in a considerable reduction in the number of tracheotomies. The choice of method to keep the airways patient depends on various factors and must be made individually. The advantages and disadvantages of naso-tracheal and oro-tracheal intubation and of tracheotomy are reviewed. Some of the risks and complications attendant on long-term naso-tracheal intubation are discussed. Maxillary sinusitis due to obstructed drainage should have X-ray examination without delay and, if necessary, treatment. Suspicious of an open fracture of the base of the skull constitutes a contraindication to nasal intubation. Provided there are no contra-indications and the organs touched by the endotracheal tube (nose, pharynx, larynx) are regularly inspected, nasotracheal intubation can, with careful nursing, be continued for prolonged periods. Tracheotomy is still indicated in some cases.

Humans↗

PubMedDate not supplied

Circulatory response to laryngoscopy and tracheal intubation with or without prior oropharyngeal viscous lidocaine.

Oropharyngeal topical anesthesia with viscous lidocaine (25 ml of 2% as a "mouthwash and gargle" 10 min before laryngoscopy) attenuated the pressor but not heart rate (HR) response during laryngoscopy and tracheal intubation. Compared with control patients, mean arterial pressure (MAP) increased less in response to tracheal intubation (23 +/- 5 torr versus 39 +/- 4 torr, p less than 0.05) and returned toward awake levels sooner in patients receiving viscous lidocaine. MAP increased more than 40 torr in response to intubation in 6/20 patients treated with viscous lidocaine, while 12/20 control patients manifested this degree of blood pressure elevation. HR increased about 20 bpm (p less than 0.05) with or without viscous lidocaine. Arterial lidocaine concentrations were less than 0.5 microgram/ml after oropharyngeal anesthesia. Prior topical anesthesia of the oropharynx with viscous lidocaine should be considered when pressor responses during tracheal intubation would be particularly likely or hazardous.

Anesthesia, Local↗

PubMed1978

[Nasotracheal intubation and tracheostomy in acute epiglottitis and laryngotracheal bronchitis].

Acute infectious respiratory distress in children has known different modalities of treatment during these past few years, but controversy remains between tracheostomy and naso-tracheal intubation as ways to cope with the problem. This study, which was undertaken at St. Justine's Hospital in Montreal, reports our complications with the two methods and shows that non-fatal complications are about the same but less serious with naso-tracheal intubation, whereas mortality was 3.2% with tracheostomy and 0% with naso-tracheal intubation. These results entitle us to think that naso-tracheal intubation is the treatment which should be used. This study also reviews different incidence in regards to age, sex, and seasonal prevalence between croup and epiglottitis and also compares the duration of hospital care between the two modalities.

Acute Disease↗

PubMed1978

The risks of tracheal intubation.

Various lesions have been described as post-intubation complications: injuries, of usually minor degree, of the pharynx and larynx, oedema of the larynx, ulcerations of the pharynx and larynx with pseudomembranes and bleeding, chondromalacy of the larynx, granulomata, oesophago-tracheal fistula, stenosis of the larynx or trachea, paralysis and synechia of the vocal cords, paralysis of the tongue. Etiologic factors of these complications are mainly chemical, in relation with the material of the tube and with the sterilization agents, or mechanical due to pressure on neighbouring tissues. Post-intubation sore throat seems independent from traumatic laryngoscopy. Although intubation is meant to provide safer ventilation, interference with respiration may occur by compression of the tube or accidental obstruction from various causes. It should not be forgotten that in anesthesia cases, for which intubation is not really required, it may be advantageous to administer the anesthetic by mask.

Aged↗

PubMed1979

[The endotracheal intubation of rabbits with xylazine and ketamine (author's transl)].

The intubation of rabbits is difficult. This is due to the anatomical structure of these animals. We intubated 40 New Zealand rabbits with a body weight of 2.0 to 2.8 kg with endotracheal tubes of an inner diameter 3.0 to 3.5 mm. Premedicating agents were Xylazine 1 ml/kg and Atropine 0.25 mg/kg. For induction of anaesthesia we used Ketamine in a dilution of 5 mg/ml and in dosages of 2.5 to 5.0 mg/kg. The intubation was performed with the aid of a Foregger childrens laryngoscope and a Wis-Hippel blade. For maintenance of anaesthesia we used a mixture of nitrous oxide/oxygen administered through a Kuhn system. In addition to this inhalation anesthetic Ketamine 1 to 2 mg was injected intermittently i.v. The recovery time with this method was extremely short in comparison to the use of intramuscular injections of Ketamine as monoanesthetic.

Anesthesia, Endotracheal↗

PubMed1977

Acute epiglottitis in children: management of 27 consecutive cases with nasotracheal intubation, with special emphasis on anaesthetic considerations.

Twenty-seven consecutive cases of acute epiglottitis in children were treated by nasotracheal intubation during a 25-month period. The duration of intubation averaged 44.2 hours. No mortality or morbidity occurred. Mean hospitalization was 4.5 days. Anaesthetic techniques are discussed. Ketamine is a somewhat controversial choice for these patients as it can enhance excitement, restlessness, and accidental extubation. This study reconfirms the ease of maintaining an assured airway by nasotracheal intubation in cases of acute epiglottitis.

Age Factors↗

PubMed2026

Effect of protective ventilation throughout the intubation period on perioperative oxygenation in patients undergoing MIDCABG: a randomised controlled trial.

INTRODUCTION: Minimally invasive direct coronary artery bypass grafting (MIDCABG) requires prolonged one-lung ventilation (OLV), increasing postoperative pulmonary complications (PPCs) risk. We investigated whether protective lung ventilation (PLV) throughout intubation benefits MIDCABG patients. METHODS: In this single-center randomized study, MIDCABG patients received PLV (low tidal volume of 6-8 mL·kg-1, PEEP of 6 cm H2O, alveolar recruitment maneuvers) or conventional mechanical ventilation (CMV, tidal volume of 8-10 mL·kg-1, without PEEP or maneuvers) from tracheal intubation to extubation. The primary outcome was perioperative oxygenation, assessed by the PaO2/FiO2 ratio. RESULTS: Sixty patients (n = 30 per group) were enrolled. Compared with CMV, PLV improved PaO2/FiO2 ratios (mean difference at OLV60: 34.56 mmHg; 95% CI: 11.78-57.33; p < 0.01), shortened median durations of postoperative mechanical ventilation (median difference: -4.5 h, 95% CI: -8.5 to -0.5; p = 0.013) and hospital stay (median difference: -3.0 days, 95% CI: -5.0 to -1.0; p = 0.019). PLV also reduced driving pressure, airway pressure and intrapulmonary shunt during OLV (all p < 0.05). Desaturation occurred in 23.3% of CMV patients and 13.3% of PLV patients (p = 0.506). Hemodynamic parameters were generally comparable between groups, except for lower MPAP and PVRI in the PLV group during OLV and after ICU admission (p < 0.05). The incidence of PPCs did not differ between groups. CONCLUSIONS: In patients undergoing MIDCABG, PLV applied throughout intubation improved perioperative oxygenation and shortened the duration of postoperative mechanical ventilation and hospital stay, but did not reduce PPCs. CLINICAL TRIAL REGISTRATION: ChiCTR1900022005.

Humans↗

PubMed1977

Conditions for tracheal intubation following fazadinium and pancuronium.

Intubating conditions were studied in two groups of patients who received either fazadinium 1 mg/kg or pancuronium 0.1 mg/kg (group 1), or either fazadinium 0.5 mg/kg or pancuronium 0.08 mg/kg (group 2). In group 1 intubating conditions were studied at 30, 45, 60 and 75 s after injection of the relaxant drug, and in group 2 at 60 s after injection. Fazadinium provided better intubating conditions than pancuronium during the first 60 s after administration in group 1 (P less than 0.01). In group 2 there was no significant difference between the conditions provided by the two drugs.

Humans↗

PubMed1978

Sources of gram-negative bacilli colonizing the tracheae of intubated patients.

Twenty acutely ill patients requiring prolonged orotracheal intubation were studied to determine the source and progression of gram-negative bacilli colonizing the trachea. Organisms recovered from daily tracheal, hypopharyngeal, and rectal cultures were typed and speciated to identify identical strains at the three sites. All patients acquired gram-negative bacilli in the trachea by day 3 after intubation. Thirty organisms that were not recovered from the tracheal aspirate immediately following intubation were isolated for at least two days some time thereafter. Nine of the 30 colonizing bacteria were Enterobacteriaceae, and all were found in another culture site, usually the hypopharynx, before isolation from the trachea. In contrast, only four of the 21 non-Enterobacteriaceae that colonized the trachea were recovered previously from either the hypopharynx or rectum, a finding which represents a significant difference (P = 0.0002). Quantitation of isolates from the hypopharynx was of no value in predicting subsequent acquisition in the trachea, and the numbers of bacteria recovered from the first positive tracheal specimen were not predictive of subsequent persistence in the trachea.

Acinetobacter↗

PubMed1977

Oral alimentation following intubation for esophageal carcinoma.

The nutritional status of 15 patients suffering from unresectable carcinoma of the midthoracic esophagus was evaluated before and after palliative pulsion intubation. All patients showed evidence of protein-calorie malnutrition, prior to intubation. Oral alimentation using a formulated hospital ward diet with an elemental dietary supplement reversed the nutritional deficit. A mean daily positive nitrogen balance of seven grams was achieved three weeks following intubation. No episode of tube blockage was observed and the elemental diet supplement was well tolerated.

Adult↗

PubMed1977

An evaluation of the cuff characteristics and incidence of laryngeal complications using a new nasotracheal tube in prolonged intubations.

A series of 1,187 nasotracheal intubations, carried out from January 1973 to December, 1975, used a new tube. The design included a smooth tip, a cuff with a large area of contact, low pressure and a high residual volume, and a radiopaque line which is easily visible on chest X-ray. A secondary irrigating lumen opening distal to the cuff provides closed-system irrigation, measurement of airway pressures, and sampling of tracheal gases. In the 811 intubated nontracheostomized patients who survived, the overall incidence of significant laryngeal damage was 1%. In patients intubated in excess of 10 days the damage incidence was 10%, and we suggest that tracheostomy should be carried out at this time. No patients suffered from any known permanent laryngeal damage.

Adult↗

PubMed1979

Epiglottis acuta treated with nasotracheal intubation.

Twenty children, ranging in age from 1--9 years, and one adult suffering from epiglottis acuta were treated with nasotracheal intubation performed under general anaesthesia and with ampicillin. Clinical cure was obtained in all cases with a mean intubation time of 34 hours. The diagnosis, epiglottis acuta, was suspected by the referring physician in 10 cases. The incidence of epiglottis acuta compared to laryngitis acuta was found to be 1:30. The mean hospital stay was 5.4 days. It is concluded that treatment of acute epiglottis by nasotracheal intubation in the hands of experienced anaesthesiologists and with close observation in an intesnive care unit, is a safe method of management with negligible morbidity and mortality.

Acute Disease↗

PubMed1978

Acute epiglottitis: intubation versus tracheostomy.

Acute epiglottitis is a disease with significant mortality. The patient, usually an otherwise healthy pre-school child, develops a sore throat and muffled voice from swollen supraglottic structures, and may progress rapidly to respiratory arrest. Early diagnosis and airway maintenance can prevent these fatalities. Whether to secure an airway by tracheostomy or endotracheal intubation is the subject of much discussion. Nineteen series totalling 738 cases of epiglottitis plus 11 new cases are reviewed. These patients were treated as follows: Tracheostomy = 348 (3 deaths - 0.86%); Endotracheal intubation = 216 (2 deaths - 0.92%); medical management with no artificial airway = 214 (13 deaths - 6.1%). The difference in morbidity and mortality between tracheostomy or nasotracheal intubation is so slight that the choice should be determined by local factors. Medical management with no artificial airway should not be used in children.

Canada↗