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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↗
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↗
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↗
PubMed2026

Neuromuscular blocking agents for tracheal intubation of critically ill adults: a systematic review and meta-analysis.

BACKGROUND AND IMPORTANCE: Emergency tracheal intubation in critically ill adults is associated with a high risk of peri-intubation adverse events, making first-attempt success a key safety target. OBJECTIVE: This study aimed to evaluate whether the use of neuromuscular blocking agents (NMBAs) improves the proportion of first-attempt success and reduces adverse events during emergent intubations outside the operating room. METHODS: This was a systematic review and meta-analysis of randomized clinical trials or nonrandomized studies comparing sedative-hypnotic plus NMBA versus sedative-hypnotic alone in critically ill adults undergoing emergency endotracheal intubation in nonoperative settings. Animal, cadaveric, manikin/simulation, and pediatric studies were excluded. Articles were screened on 21 August 2025, in Ovid MEDLINE, Ovid Embase, Ovid Cochrane Central Register of Controlled Trials, and the Web of Science Core Collection. MAIN RESULTS: Of 4736 screened citations, 13 studies (8 cohort; 5 before-after studies) were included in the quantitative analysis, with 14 072 participants. NMBA use was associated with higher first-attempt success, which ranged from 69 to 92% (pooled odds ratio, 2.72; 95% onfidence interval: 1.42-5.21; low-certainty evidence). Secondary outcomes related to adverse events were rated as very low certainty due to sparse data, inconsistent reporting, and serious imprecision. CONCLUSION: NMBA use during emergency intubation was associated with improved first-attempt success, although the certainty of evidence was low.

Humans↗
PubMed1977

Rapid intubation with fazadinium and suxamethonium.

Fazadinium at two dose levels (1 mg/kg and 1.5 mg/kg) and suxamethonium at three dose levels (50 mg, 75 mg and 100 mg) were investigated in 106 adult patients to determine the time interval from injection to tracheal intubation. The intubating conditions were graded according to the scheme described by Lund and Stovner. Suxamethonium 100 mg gave the shortest time interval between the end of injection and intubation. There was no significant difference between the intubation time when smaller doses of suxamethonium (50 mg and 75 mg were used and those when AH8165 (1 mg and 1.5 mg/kg) were given. Suxamethonium 100 mg also produced a significantly higher incidence of excellent intubating conditions. The clinical implications of the findings are discussed.

Adult↗
PubMed1977

Rapid intubation with fazadinium. A comparison of fazadinium with suxamethonium and alcuronium.

The speed of onset and intubation conditions have been compared for suxamethonium 1 mg/kg, alcuronium 0-32 mg/kg and fazadinium 1 mg/kg and 1-25 mg/kg. Fazadinium 1 mg/kg was not significantly different in times to intubation from suxamethonium although the latter gave a highly significant greater number of patients with excellent conditions. The higher dose of 1-25 mg/kg fazadinium did not give significantly better intubating conditions than the lower dose. Although the times to intubation for the two dose levels of fazadinium did not differ statistically, the higher dose was significantly slower in onset than suxamethonium. Alcuronium was slower than either suxamethonium or fazadinium 1 mg/kg in producing satisfactory conditions. The nondepolarizing drug, fazadinium, may be a useful neuromuscular blocking agent in emergency cases where rapid intubation is required and when it is wished to avoid possible or probable adverse effects from the depolarising drug suxamethonium.

Adolescent↗
PubMed1979

[Morphological findings after tracheotomy and laryngeal intubation (author's transl)].

4 fatal cases after tracheotomy and 35 cases after endotracheal anaesthesia were examined taking pathomorphological aspects into consideration. In long-period intubation mucous membrane necroses occurred as of the 4th day. After 6 days' intubation skeletizations of the tracheal rings were established in each case. Infections of the decubial ulcers and errosion haemorrhages from the necrotically altered tracheal wall were frequent complications. Faulty intubation of the oesophagus and the right bronchus, aspirations and reflex-related circulatory failure during intubation as well as hypoxic damage as a result of the windpipe opening being impaired are discussed from the morphological point of view.

Accidents↗
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↗
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&#x2009;mL&#xb7;kg-1, PEEP of 6&#x2009;cm H2O, alveolar recruitment maneuvers) or conventional mechanical ventilation (CMV, tidal volume of 8-10&#x2009;mL&#xb7;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&#x2009;mmHg; 95% CI: 11.78-57.33; p&#x2009;<&#x2009;0.01), shortened median durations of postoperative mechanical ventilation (median difference: -4.5&#x2009;h, 95% CI: -8.5 to -0.5; p&#x2009;=&#x2009;0.013) and hospital stay (median difference: -3.0&#x2009;days, 95% CI: -5.0 to -1.0; p&#x2009;=&#x2009;0.019). PLV also reduced driving pressure, airway pressure and intrapulmonary shunt during OLV (all p&#x2009;<&#x2009;0.05). Desaturation occurred in 23.3% of CMV patients and 13.3% of PLV patients (p&#x2009;=&#x2009;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&#x2009;<&#x2009;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↗