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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↗

PubMed1975

A technique of nasotracheal intubation in patients with recent facio-maxillary injury.

A technique of nasotracheal intubation in patients with recent facial injury is described. Oral intubation is performed initially to ensure the safety of the patient during the procedure of nasal intubation.

Humans↗

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↗

PubMed1976

Continuous positive airway pressure without tracheal intubation in spontaneously breathing patients.

Indications for the use of therapy with continuous positive airway pressure (CPAP) in spontaneously breathing patients are increasing in number. The value of this technique without tracheal intubation was investigated in 14 patients with acute respiratory distress. In most patients (eight patients, or 57 percent) the technique was successful, as evidenced by avoidance of the necessity for tracheal intubation and improvements in clinical appearance, arterial oxygen pressure, and chest x-ray films. Complications were observed in three patients, but these necessitated discontinuation of therapy in only one. The use of this technique allows avoidance of endotracheal intubation and mechanical ventilation, with their attendant risks.

Acute Disease↗

PubMed1978

Cleft tongue and ulceration of hard palate: complications of oral intubation.

In a prospective study of the complications of endotracheal intubation and tracheotomy, we encountered an unusual complication of oral intubation. This report describes a 32-year-old man who sustained laceration and cleft of the tongue and ulceration of the hard palate as a result of the use of an oral airway in conjunction with oral intubation.

Adult↗

PubMed1979

Prolonged endotracheal intubation.

The advisability of prolonged oral or nasotracheal intubation is of continuing concern to physicians caring for patients requiring prolonged mechanical ventilatory assistance. Currently, in many health care centers, prolonged intubation is defined as being in excess of seven days. We treated a patient who required mechanical ventilatory assistance and in whom oral endotracheal intubation was maintained for two months without significant pathologic sequelae.

Aged↗

PubMed1976

Influence of ether anaesthesia and oro-gastric intubation on gastric evacuation and small bowel propulsion after laparotomy. A methodological study in the rat.

A model for the simultaneous study of gastric evacuation and small bowel propulsion in the rat is presented. By means of a modification, with both indwelling duodenal and gastric tubes, studies on fully conscious animals were possible. Gastric evacuation and small bowel propulsion were analysed with respect to the effects of ether anesthesia and gastric intubation. The gastric intubation in ether anaesthesia greatly retarded gastric evacuation but left small bowel propulsion unaffected one day after laparotomy. The main factor retarding gastric evacuation appeared to be the oro-gastric intubation procedure. Ether anaesthesia neither affected gastric evacuation nor small bowel propulsion after laparotomy when the test meal was deposited into the stomach and into the duodenum, respectively, via the permanent tubes.

Anesthesia, Inhalation↗

PubMed1979

[Arterio-tracheal fistula during long-term intubation of an awake patient. Case report (author's transl)].

Because of anterior softening of the trachea due to thyroid swelling a patient was intubated with a "Lanz-" endotracheal tube with low-pressure cuff after thyroidectomy. The awake, eating patient developed severe endotracheal haemorrhage during the 17 days of intubation. Thoracotomy revealed a 2 cm long horizontal rupture probably at the site of the tube tip at the anterior wall of the trachea. The opening was connected to a rupture of the right brachiocephalic trunk at its bifurcation. Interpositions of dacron prostheses between the trunk, the subclavian artery and the carotid artery and suture of the tracheal wall controlled the situation. However, the patient died from acute hepatic failure, as shown at post-mortem examination. This case report is a warning against long-term intubation of awake patients, as sometimes recommanded.

Brachiocephalic Trunk↗

PubMed1978

[Results of nasotracheal intubation in acute epiglottitis (author's transl)].

20 of 34 patients with acute epiglottitis were treated with nasotracheal intubation. One patient died because of pneumonia, one patient was clinically dead when he arrived at hospital. After successful reanimation she died some hours later. All other patients left the hospital without any symptoms after an average stay of 12 days. The average duration of nasotracheal intubation was 39 hours. Nasotracheal intubation and adequate antibiotic therapy offer the most effective and secure approach to acute epiglottitis. A protocol for diagnostic and therapeutic regimen is presented.

Acute Disease↗

PubMed1977

[Long-term intubation (author's transl)].

Establishment of a clear airway has become increasingly frequent and is of high importance, especially in patients with severe injuries, head injuries or intoxications. Though the endotracheal intubation-technique has been improved and soft intubation-tubes are now available, tracheostomy is not rendered unnecessary. However, its indications have changed and have become restricted. This trend was proved by the own experiences in 841 patients. The presuppositions for nasal long-term intubation are described in details.

Adult↗

PubMed1977

Circulatory responses to laryngoscopy and endotracheal intubation in patients with and without cardiovascular disease. Effect of prophylactic practolol.

The effect of small intravenous doses of practolol (0.2 mg/kg body weight) on the circulatory response to laryngoscopy and endotracheal intubation, when administered with atropine (0.01 mg/kg b.w.) prior to anaesthesia was studied in 39 patients with and without cardiovascular disease. Practolol diminished significantly the rise of mean arterial pressure and pulse rate affected by laryngoscopy and endotracheal intubation when performed under thiopentone-succinylcholine anaesthesia. Arrhythmias were also less frequent through the statistical significance could not be ascertained in this small series. The small practolol dose used had no adverse circulatory effects. It is suggested that the administration of a small prophylactic dose of practolol is useful in preventing the excessive cardiovascular response due to laryngoscopy and endotracheal intubation.

Adult↗