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Sample records for agitated intubated patients

  1. Humidification for intubated patients

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    Fotoula Babatsikou

    2008-10-01

    Full Text Available Artificial airways bypass the physiological mechanism of humidification and filtration of the inspired air, increasing, therefore, the possibilities of copious secretions production. Copious secretions increase the danger for atelektasis and respiratory infections. Moreover, clots can be shaped in the interior of the endotracheal tube or thracheostomy, resulting in increased work of breathing (WOB and reduced odds of successful extubation. It is also possible to lead progressively to complete obstruction of the endotracheal tube.Thus, the choice of a suitable humidification device during mechanical ventilation is of distinguished importance. There are various types of humidifiers. However, hydroscopic Heat and Moisture Exchangers (HMEs with filter and Heated Humidifiers (HHs, which provide humidity in form of water vapors, are currently used. When they are used correctly, and not in the cases where they are contraindicated, HMEs’ do not have complications and they decrease the cost of hospitalization as well as the staff workload. HMEs are better choice for short duration of intubation (<96 hours and during transports. HHs are preferred for patients with persisting hypercapnia, chronic respiratory failure and difficulty in ventilator weaning. HHs should be used for patients with prolonged duration of mechanical ventilation or patients that HMEs are contraindicated for. Neither HMEs nor HHs have been accused for increased incidences of ventilator associated pneumonia (VAP.

  2. Intubation of the morbidly obese patient

    DEFF Research Database (Denmark)

    Ydemann, Mogens; Rovsing, Marie Louise; Lindekaer, A L

    2012-01-01

    Several potential problems can arise from airway management in morbidly obese patients, including difficult mask ventilation and difficult intubation. We hypothesised that endotracheal intubation of morbidly obese patients would be more rapid using the GlideScope(®) (GS) (Verathon Inc Corporate...

  3. Submental Intubation in Maxillofacial Trauma Patients

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    Amin Rahpeyma

    2012-12-01

    Full Text Available Introduction: To describe a modified technique for submental intubation in severely traumatized maxillofacial patients and to evaluate complications arising from the procedure.  Materials and Methods: Submental intubation was performed in twelve patients with maxillofacial trauma ,from 2007 – 2012, which were operated under general anesthesia for treatment of facial fractures. Results: The patients ranged in age from 14 to 39 years.  No complications due to submental intubation, such as infection, hypertrophic scarring, lingual nerve injury, hematoma, bleeding, ranula formation, or orocutaneous fistula, were observed following submental intubation.  Conclusion:  Submental intubation is a very useful technique in the management of maxillofacial trauma patients, with a low complication rate.

  4. Risk factors for agitation in critically ill patients

    Science.gov (United States)

    de Almeida, Thiago Miranda Lopes; de Azevedo, Luciano Cesar Pontes; Nosé, Paulo Maurício Garcia; de Freitas, Flavio Geraldo Resende; Machado, Flávia Ribeiro

    2016-01-01

    Objective To evaluate the incidence of agitation in the first 7 days after intensive care unit admission, its risk factors and its associations with clinical outcomes. Methods This single-center prospective cohort study included all patients older than 18 years with a predicted stay > 48 hours within the first 24 hours of intensive care unit admission. Agitation was defined as a Richmond Agitation Sedation Scale score ≥ +2, an episode of agitation or the use of a specific medication recorded in patient charts. Results Agitation occurred in 31.8% of the 113 patients. Multivariate analysis showed that delirium [OR = 24.14; CI95% 5.15 - 113.14; p < 0.001], moderate or severe pain [OR = 5.74; CI95% 1.73 - 19.10; p = 0.004], mechanical ventilation [OR = 10.14; CI95% 2.93 - 35.10; p < 0.001], and smoking habits [OR = 4.49; CI95% 1.33 - 15.17; p = 0.015] were independent factors for agitation, while hyperlactatemia was associated with a lower risk [OR = 0.169; CI95% 0.04 - 0.77; p = 0.021]. Agitated patients had fewer mechanical ventilation-free days at day 7 (p = 0.003). Conclusion The incidence of agitation in the first 7 days after admission to the intensive care unit was high. Delirium, moderate/severe pain, mechanical ventilation, and smoking habits were independent risk factors. Agitated patients had fewer ventilator-free days in the first 7 days. PMID:28099638

  5. Submandibular intubation in awake patient of panfacial trauma

    OpenAIRE

    Kamra, S. K.; H K Khandavilli; Banerjee, P.

    2016-01-01

    Maxillofacial trauma patients present with airway problems. Submandibular intubation is an effective means of intubation to avoid tracheostomy for operative procedures. Airway is secured with oral endotracheal intubation in paralyzed patient and tube is then transplaced in sub mental or submandibular region. However there may be instances when paralyzing such trauma patients is not safe and short term tracheostomy is the only airway channel available for conduction of anesthesia. We report a ...

  6. Difficult Tracheal Intubation in Obese Gastric Bypass patients

    DEFF Research Database (Denmark)

    Dohrn, Niclas; Sommer, Thorbjørn; Bisgaard, J.

    2016-01-01

    Endotracheal intubation is commonly perceived to be more difficult in obese patients than in lean patients. Primarily, we investigated the association between difficult tracheal intubation (DTI) and obesity, and secondarily, the association between DTI and validated scoring systems used to assess...

  7. Intubation with Airtraq TM laryngoscope in a morbidly obese patient

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    Pratik Tantia

    2011-01-01

    Full Text Available In the present study, we report a case of successful endotracheal intubation using Airtraq TM Laryngoscope (AQL in a morbidly obese patient. A 35-year-old woman, morbidly obese (weight, 105 kg; height, 160 cm; BMI, 41 kg/m 2 , known hypertensive and diabetic, was admitted in the operating room for total abdominal hysterectomy under general anesthesia. The preoperative airway assessment anticipated both difficult bag-mask ventilation and intubation. Tracheal intubation using AQL was attempted after induction with propofol and relaxation with succinylcholine. Successful tracheal intubation was accomplished within 12 seconds of insertion of AQL into the oral cavity. The minimal hemodynamic response during this maneuver was advantageous in our patient.

  8. Tracheal intubation in patients with anticipated difficult airway using Boedeker intubation forceps and McGrath videolaryngoscope

    DEFF Research Database (Denmark)

    Strøm, C; Barnung, S; Kristensen, M S

    2015-01-01

    BACKGROUND: Videolaryngoscopes with sharp angulated blades improve the view of the vocal cords but this does not necessarily result in higher success rates of intubation The aim of this study was to evaluate the efficacy of using Boedeker intubation forceps in conjunction with McGrath Series 5 Vi...... by using a styletted tube. CONCLUSION(S): Most patients with anticipated difficult intubation can be successfully intubated with Boedeker intubation forceps and MVL. However, endotracheal tube placement failed in 3/25 patients despite a good laryngeal view.......BACKGROUND: Videolaryngoscopes with sharp angulated blades improve the view of the vocal cords but this does not necessarily result in higher success rates of intubation The aim of this study was to evaluate the efficacy of using Boedeker intubation forceps in conjunction with McGrath Series 5...... Videolaryngoscope (MVL) in patients with predictors for difficult intubation. METHODS: The study was conducted at the Department of Anaesthesia, Copenhagen University Hospital from September to December 2013. Patients with one or more predictors of difficult intubation scheduled for general anaesthesia were...

  9. Agitation in Dutch institutionalized patients with dementia : factor analysis of the Dutch version of the Cohen-Mansfield Agitation Inventory

    NARCIS (Netherlands)

    Zuidema, Sytse U; de Jonghe, Jos F M; Verhey, Frans R J; Koopmans, Raymond T C M

    2007-01-01

    BACKGROUND/AIMS: To establish the construct validity of the Dutch version of the Cohen-Mansfield Agitation Inventory (CMAI-D) in institutionalized patients with dementia. METHODS: The CMAI-D was administered to a large sample of 1,437 patients with moderate to severe dementia, receiving nursing home

  10. Agitation in Dutch institutionalized patients with dementia: factor analysis of the Dutch version of the Cohen-Mansfield Agitation Inventory.

    NARCIS (Netherlands)

    Zuidema, S.U.; Jonghe, J.F. de; Verhey, F.R.J.; Koopmans, R.T.C.M.

    2007-01-01

    BACKGROUND/AIMS: To establish the construct validity of the Dutch version of the Cohen-Mansfield Agitation Inventory (CMAI-D) in institutionalized patients with dementia. METHODS: The CMAI-D was administered to a large sample of 1,437 patients with moderate to severe dementia, receiving nursing home

  11. Preparation of the patient and the airway for awake intubation

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    Venkateswaran Ramkumar

    2011-01-01

    Full Text Available Awake intubation is usually performed electively in the presence of a difficult airway. A detailed airway examination is time-consuming and often not feasible in an emergency. A simple 1-2-3 rule for airway examination allows one to identify potential airway difficulty within a minute. A more detailed airway examination can give a better idea about the exact nature of difficulty and the course of action to be taken to overcome it. When faced with an anticipated difficult airway, the anaesthesiologist needs to consider securing the airway in an awake state without the use of anaesthetic agents or muscle relaxants. As this can be highly discomforting to the patient, time and effort must be spent to prepare such patients both psychologically and pharmacologically for awake intubation. Psychological preparation is best initiated by an anaesthesiologist who explains the procedure in simple language. Sedative medications can be titrated to achieve patient comfort without compromising airway patency. Additional pharmacological preparation includes anaesthetising the airway through topical application of local anaesthetics and appropriate nerve blocks. When faced with a difficult airway, one should call for the difficult airway cart as well as for help from colleagues who have interest and expertise in airway management. Preoxygenation and monitoring during awake intubation is important. Anxious patients with a difficult airway may need to be intubated under general anaesthesia without muscle relaxants. Proper psychological and pharmacological preparation of the patient by an empathetic anaesthesiologist can go a long way in making awake intubation acceptable for all concerned.

  12. COMPARITIVE STUDY OF INTUBATING CONDITIONS OF SUXAMETHONIUM AND MIVACURIUM CHLORIDE AS INTUBATING AGENTS IN PAEDIATRIC PATIENTS POSTED FOR TONSILLECTOMIES

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    Vasantha Kumar

    2014-01-01

    Full Text Available BACKGROUND : Suxamethonium , a depolarizing muscle relaxant has remained the undisputed drug for aiding intubation and an ideal drug for securing the airway because of its capabilities to produce excellent intubating conditions with in 60 seconds & short duration of action but is contraindicated in certain clinical conditions because of its side effects. AIM : The present study was undertaken to compare the intubating conditions as well as duration of actions of Suxamethonium 1 mg kg - 1 and mivacurium chloride , a new benzylisoquinolium non - depolarizing muscle relaxant with relatively rapid onset and short duration of action , 0.25mg kg - 1 at 60 seconds. METHODS : After institutional approval and informed consent , 60 ASA I and II pediatric patients posted for elective tonsillectomies were grouped into 30 patients each. We compared the intubating conditions and duration of action of Suxamethonium 1 mg kg - 1 and mivacurium chloride0.25mg kg - 1 at 60 seconds. Cardiovascular responses and any side effects related to histamine release were also studied. Statistical analysis: Statistical tools used in present study are student‘t’ test and ‘chi squared’ test. RESULTS : In group I , the intubating conditions in all the 30 patients were excellent except in 1 patient.In group II , 18 out of 30 patients had excellent intubating conditions , 7 patients had good , 3 patients fair and 2 patients had poor intubating conditions. CONCLUSIONS : The present study concluded that Suxamethonium produces excellent intubating conditions in 100% and mivacurium produces good to excellent intubating conditions in 83% at 60 seconds. Mivacurium chloride can be employed when Suxamethonium is contraindicated but Suxamethonium remains superior to mivacurium

  13. Submental intubation in patients with panfacial fractures: A prospective study

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    Premalatha M Shetty

    2011-01-01

    Full Text Available Submental intubation is an interesting alternative to tracheostomy, especially when short-term postoperative control of airway is desirable with the presence of undisturbed access to oral as well as nasal airways and a good dental occlusion. Submental intubation with midline incision has been used in 10 cases from October 2008 to March 2010 in the Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Mangalore. All patients had fractures of the jaws disturbing the dental occlusion associated with fracture of the base of the skull, or/and a displaced nasal bone fracture. After standard orotracheal intubation, a passage was created by blunt dissection with a haemostat clamp through the floor of the mouth in the submental area. The proximal end of the orotracheal tube was pulled through the submental incision. Surgery was completed without interference from the endotracheal tube. At the end of surgery, the tube was pulled back to the usual oral route. There were no perioperative complications related to the submental intubation procedure. Average duration of the procedure was less than 6 minutes. Submental intubation is a simple technique associated with low rates of morbidity. It is an attractive alternative to tracheotomy in the surgical management of selected cases of panfacial trauma.

  14. Endotracheal intubation in patients with cervical spine immobilization: a comparison of macintosh and airtraq laryngoscopes.

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    Maharaj, Chrisen H

    2007-07-01

    The Airtraq laryngoscope (Prodol Ltd., Vizcaya, Spain) is a novel single-use tracheal intubation device. The authors compared ease of intubation with the Airtraq and Macintosh laryngoscopes in patients with cervical spine immobilization in a randomized, controlled clinical trial.

  15. Awake tracheal intubation using Pentax airway scope in 30 patients: A Case series

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    Payal Kajekar

    2014-01-01

    Full Text Available Background and Aims: Pentax airway scope (AWS has been successfully used for managing difficult intubations. In this case series, we aimed to evaluate the success rate and time taken to complete intubation, when AWS was used for awake tracheal intubation. Methods: We prospectively evaluated the use of AWS for awake tracheal intubation in 30 patients. Indication for awake intubation, intubation time, total time to complete tracheal intubation, laryngoscopic view (Cormack and Lehane grade, total dose of local anaesthetic used, anaesthetists rating and patient′s tolerance of the procedure were recorded. Results: The procedure was successful in 25 out of the 30 patients (83%. The mean (standard deviation intubation time and total time to complete the tracheal intubation was 5.4 (2.4 and 13.9 (3.7 min, respectively in successful cases. The laryngeal view was grade 1 in 24 and grade 2 in one of 25 successful intubations. In three out of the five patients where the AWS failed, awake tracheal intubation was successfully completed with the assistance of flexible fibre optic scope (FOS. Conclusion: Awake tracheal intubation using AWS was successful in 83% of patients. Success rate can be further improved using a combination of AWS and FOS. Anaesthesiologists who do not routinely use FOS may find AWS easier to use for awake tracheal intubation using an oral route.

  16. Evaluation of the Airtraq and Macintosh laryngoscopes in patients at increased risk for difficult tracheal intubation.

    LENUS (Irish Health Repository)

    Maharaj, C H

    2008-02-01

    The Airtraq, a novel single use indirect laryngoscope, has demonstrated promise in the normal and simulated difficult airway. We compared the ease of intubation using the Airtraq with the Macintosh laryngoscope, in patients at increased risk for difficult tracheal intubation, in a randomised, controlled clinical trial. Forty consenting patients presenting for surgery requiring tracheal intubation, who were deemed to possess at least three characteristics indicating an increased risk for difficulty in tracheal intubation, were randomly assigned to undergo tracheal intubation using a Macintosh (n = 20) or Airtraq (n = 20) laryngoscope. All patients were intubated by one of three anaesthetists experienced in the use of both laryngoscopes. Four patients were not successfully intubated with the Macintosh laryngoscope, but were intubated successfully with the Airtraq. The Airtraq reduced the duration of intubation attempts (mean (SD); 13.4 (6.3) vs 47.7 (8.5) s), the need for additional manoeuvres, and the intubation difficulty score (0.4 (0.8) vs 7.7 (3.0)). Tracheal intubation with the Airtraq also reduced the degree of haemodynamic stimulation and minor trauma compared to the Macintosh laryngoscope.

  17. Failed fibreoptic intubation in a patient with a large mandibular fibreosseous lesion.

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    Baddoo, Hk; Parkins, Ge

    2008-12-01

    A case is presented of a 25 year old patient with a 15 year history of a lesion in the oral cavity, the histology of which showed it to be fibrous dysplasia. Conventional laryngoscopy and intubation were not possible as the lesion filled the entire oral cavity. Attempted awake fibreoptic intubation failed as the lesion extended into the nasopharynx and oropharynx, making it impossible to pass the fibreoptic scope beyond the nasopharynx. A tracheostomy was performed under local anaesthesia and surgery proceeded uneventfully. Although fibreoptic intubation has proved to be extremely useful in difficult intubations, there are a number of situations where fibreoptic intubation is not possible.

  18. TRACHEAL INTUBATION USING McGRATH VIDEO LARYNGOSCOPE IN MYASTHENIA GRAVIS PATIENTS

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    Venkata Sesha Sai Krishna

    2015-07-01

    Full Text Available BACKGROUND : Mc G rath video laryngoscope has been successfully used for managing difficult intubation in various clinical scenarios. In this case series, we aimed to evaluate the success rate and time taken to complete intubation without using muscle relaxants in myasthenia gravis patients coming for thymectomy. METHODS: We prospectively evaluate the use of Mcgrath video laryngoscope for intubation in ten myasthenia gravis patients coming for thymectomy. Intubation time, total time to complete tracheal intubation, laryngoscopic view (Cormack & Lehane grade, and patients tolerance of the procedure were recorded. RESULTS: The procedure was successful in all patients the mean (SD intubation time and total time to complete the tracheal intubation was 4.82 (0.53 and 10.21 (0.81 min, respectively. The laryngeal view was grade I in five and grade II in four patients. CONCLUSION: The Mcgrath Video Laryngoscope allowed a quicker intubation time, fewe r intubation attempts and greater ease of intubation in myasthenia gravis patients coming for thymectomy.

  19. Verification of endotracheal intubation in obese patients - temporal comparison of ultrasound vs. auscultation and capnography

    DEFF Research Database (Denmark)

    Pfeiffer, P; Bache, Stefan Holst; Isbye, D L

    2012-01-01

    Ultrasound (US) may have an emerging role as an adjunct in verification of endotracheal intubation. Obtaining optimal US images in obese patients is generally regarded more difficult than for other patients. This study compared the time consumption of bilateral lung US with auscultation...... and capnography for verifying endotracheal intubation in obese patients....

  20. Neural basis of three dimensions of agitated behaviors in patients with Alzheimer disease

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    Banno K

    2014-02-01

    Full Text Available Koichi Banno,1 Shutaro Nakaaki,2 Junko Sato,1 Katsuyoshi Torii,1 Jin Narumoto,3 Jun Miyata,4 Nobutsugu Hirono,5 Toshi A Furukawa,6 Masaru Mimura,2 Tatsuo Akechi1 1Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan; 2Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan; 3Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 4Department of Neuropsychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan; 5Department of Psychology, Kobe Gakuin University; Hyogo, Japan; 6Departments of Health Promotion and Human Behavior and of Clinical Epidemiology, Graduate School of Medicine/School of Public Health, Kyoto University, Kyoto, Japan Background: Agitated behaviors are frequently observed in patients with Alzheimer disease (AD. The neural substrate underlying the agitated behaviors in dementia is unclear. We hypothesized that different dimensions of agitated behaviors are mediated by distinct neural systems. Methods: All the patients (n=32 underwent single photon emission computed tomography (SPECT. Using the Agitated Behavior in Dementia scale, we identified the relationships between regional cerebral blood flow (rCBF patterns and the presence of each of three dimensions of agitated behavior (physically agitated behavior, verbally agitated behavior, and psychosis symptoms in AD patients. Statistical parametric mapping (SPM software was used to explore these neural correlations. Results: Physically agitated behavior was significantly correlated with lower rCBF values in the right superior temporal gyrus (Brodmann 22 and the right inferior frontal gyrus (Brodmann 47. Verbally agitated behavior was significantly associated with lower rCBF values in the left inferior frontal gyrus (Brodmann 46, 44 and the left insula (Brodmann 13. The psychosis symptoms were significantly correlated

  1. Nasogastric intubation causes gastroesophageal reflux in patients undergoing elective laparotomy.

    LENUS (Irish Health Repository)

    Manning, B J

    2012-02-03

    BACKGROUND: The routine use of nasogastric tubes in patients undergoing elective abdominal operation is associated with an increased incidence of postoperative fever, atelectasis, and pneumonia. Previous studies have shown that nasogastric tubes have no significant effect on the incidence of gastroesophageal reflux or on lower esophageal sphincter pressure in healthy volunteers. We hypothesized that nasogastric intubation in patients undergoing laparotomy reduces lower esophageal sphincter pressure and promotes gastroesophageal reflux in the perioperative period. METHODS: A prospective randomized case-control study was undertaken in which 15 consenting patients, admitted electively for bowel surgery, were randomized into 2 groups. Group 1 underwent nasogastric intubation after induction of anesthesia, and Group 2 did not. All patients had manometry and pH probes placed with the aid of endoscopic vision at the lower esophageal sphincter and distal esophagus, respectively. Nasogastric tubes, where present, were left on free drainage, and sphincter pressures and pH were recorded continuously during a 24-hour period. Data were analyzed with 1-way analysis of variance. RESULTS: The mean number of reflux episodes (defined as pH < 4) in the nasogastric tube group was 137 compared with a median of 8 episodes in the group managed without nasogastric tubes (P =.006). The median duration of the longest episode of reflux was 132 minutes in Group 1 and 1 minute in Group 2 (P =.001). A mean of 13.3 episodes of reflux lasted longer than 5 minutes in Group 1, with pH less than 4 for 37.4% of the 24 hours. This was in contrast to Group 2 where a mean of 0.13 episodes lasted longer than 5 minutes (P =.001) and pH less than 4 for 0.2% of total time (P =.001). The mean lower esophageal sphincter pressures were lower in Group 1. CONCLUSIONS. These findings demonstrate that patients undergoing elective laparotomy with routine nasogastric tube placement have significant gastroesophageal

  2. Dexmedetomidine premedication for fiberoptic intubation in patients of temporomandibular joint ankylosis: A randomized clinical trial

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    Kumkum Gupta

    2012-01-01

    Full Text Available Background : Fiberoptic intubation is the gold standard technique for difficult airway management in patients of temporomandibular joint. This study was aimed to evaluate the clinical efficacy and safety of dexmedetomidine as premedication with propofol infusion for fiberoptic intubation. Methods: Consent was obtained from 46 adult patients of temporomandibular joint ankylosis, scheduled for gap arthroplasty. They were enrolled for thisdouble-blind, randomized, prospective clinical trial with two treatment groups - Group D and Group P, of 23 patients each. Group D patients had received premedication of dexmedetomidine 1 μg/kg infused over 10 min followed by sedative propofol infusion and the control Group P patients were given only propofol infusion to achieve sedation. Condition achieved at endoscopy, intubating conditions, hemodynamic changes and postoperative events were evaluated as primary outcome. Results : The fiberoptic intubation was successful with satisfactory endoscopic and intubating condition in all patients. Dexmedetomidine premedication has provided satisfactory conditions for fiberoptic intubation and attenuated the hemodynamic response of fiberoptic intubation than the propofol group. Conclusion : Fiberoptic intubation was found to be easier with dexmedetomidine premedication along with sedative infusion of propofol with complete amnesia of the procedure, hemodynamic stability and preservation of patent airway.

  3. Behavior management approach for agitated behavior in Japanese patients with dementia: a pilot study

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    Sato J

    2012-12-01

    Full Text Available Junko Sato,1 Shutaro Nakaaki,2 Katsuyoshi Torii,1 Mizuki Oka,2 Atsushi Negi,1 Hiroshi Tatsumi,3 Jin Narumoto,4 Toshi A Furukawa,5 Masaru Mimura21Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, 2Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, 3Department of Health Science, Faculty of Psychological and Physical Science, Aichi Gakuin University, Nagoya, 4Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, 5Department of Health Promotion and Human Behavior (Cognitive-Behavioral Medicine, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, JapanBackground: Agitated behaviors are frequently observed in patients with dementia and can cause severe distress to caregivers. However, little evidence of the efficacy of nonpharmacological interventions for agitated behaviors exists for patients with dementia. The present pilot study aimed to evaluate a behavioral management program developed by the Seattle Protocols for patients with agitated behaviors in Japan.Methods: Eighteen patients with dementia (Alzheimer’s disease, n = 14; dementia with Lewy bodies, n = 4 participated in an open study testing the effectiveness of a behavioral management program. The intervention consisted of 20 sessions over the course of 3 months. The primary outcomes were severity of agitation in dementia, as measured using the Agitated Behavior in Dementia scale (ABID and the Cohen-Mansfield Agitation Inventory (CMAI.Results: The behavioral management program resulted in significant reductions in total scores on both the ABID and CMAI. Although both physically agitated and verbally agitated behavior scores on the ABID improved significantly, symptoms of psychosis did not improve after the intervention.Conclusion: The behavioral management technique may be beneficial to distressed caregivers of

  4. Hemodynamic responses and upper airway morbidity following tracheal intubation in patients with hypertension: conventional laryngoscopy versus an intubating laryngeal mask airway

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    Elif Bengi Sener

    2012-01-01

    Full Text Available OBJECTIVES: We compared hemodynamic responses and upper airway morbidity following tracheal intubation via conventional laryngoscopy or intubating laryngeal mask airway in hypertensive patients. METHODS: Forty-two hypertensive patients received a conventional laryngoscopy or were intubated with a intubating laryngeal mask airway. Anesthesia was induced with propofol, fentanyl, and cis-atracurium. Measurements of systolic and diastolic blood pressures, heart rate, rate pressure product, and ST segment changes were made at baseline, preintubation, and every minute for the first 5 min following intubation. The number of intubation attempts, the duration of intubation, and airway complications were recorded. RESULTS: The intubation time was shorter in the conventional laryngoscopy group than in the intubating laryngeal mask airway group (16.33 ± 10.8 vs. 43.04±19.8 s, respectively (p<0.001. The systolic and diastolic blood pressures in the intubating laryngeal mask airway group were higher than those in the conventional laryngoscopy group at 1 and 2 min following intubation (p<0.05. The rate pressure product values (heart rate x systolic blood pressure at 1 and 2 min following intubation in the intubating laryngeal mask airway group (15970.90 ± 3750 and 13936.76 ± 2729, respectively were higher than those in the conventional laryngoscopy group (13237.61 ± 3413 and 11937.52 ± 3160, respectively (p<0.05. There were no differences in ST depression or elevation between the groups. The maximum ST changes compared with baseline values were not significant between the groups (conventional laryngoscopy group: 0.328 mm versus intubating laryngeal mask airway group: 0.357 mm; p = 0.754. The number and type of airway complications were similar between the groups. CONCLUSION: The intense and repeated oropharyngeal and tracheal stimulation resulting from intubating laryngeal mask airway induces greater pressor responses than does stimulation resulting from

  5. Comparative study of heart rate responses to laryngoscopic endotracheal intubation and to endotracheal intubation using intubating laryngeal mask airway under general anaesthesia in patients with pure mitral stenosis for closed mitral commissurotomy.

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    Das, Soumi; Gupta, Sampa Dutta; Goswampi, Anupam; Kundu, Kanak Kanti

    2013-04-01

    The various drugs and methods studied in an attempt to curb the haemodynamic stress response associated with conventional laryngoscopic endotracheal intubation have not been found to be ompletely satisfactory. The rise in heart rate can be detrimental to patients with mitral stenosis. This study was aimed to compare the heart rate responses to endotracheal intubation using conventional laryngoscope and with the help of intubating laryngeal mask airway (ILMA) in patients with isolated mitral stenosis. Thirty-four adult patients of either sex, aged between 18 and 40 years with isolated mitral stenosis to undergo closed mitral commissurotomy were randomly allocated into two groups : Group A (n=17)- To be intubated using laryngoscopy. Group B (n=17)- To be intubated with the help of ILMA. The heart rate was recorded immediately preinduction, just prior to introducing the intubating device and postintubation every minute up to first 5 minutes. On applying statistical tests, it was found that the median heart rate values in group A at 2, 3, 4 and 5 minutes postintubation were significantly higher than in group B (pendotracheal intubation was associated with rise in heart rate, the rise was less with ILMA compared to laryngoscope. Hence, it can be concluded that use of ILMA may be a preferable device for endotracheal intubation laryngoscopy in patients with isolated mitral stenosis.

  6. Comparative randomised study of GlideScope® video laryngoscope versus flexible fibre-optic bronchoscope for awake nasal intubation of oropharyngeal cancer patients with anticipated difficult intubation

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    Essam Abd El-Halim Mahran

    2016-01-01

    Full Text Available Background and Aims: Awake flexible fibre-optic bronchoscope (FFS is the standard method of intubation in difficult airway in oral cancer patients. We decided to evaluate GlideScope® video laryngoscope (GL for intubation as compared to the standard FFS for nasal intubation in such patients. Methods: After the ethical committee approval, we included 54 oropharyngeal cancer patients divided randomly into two equal groups: Group G and Group F. After pre-medication and pre-oxygenation, awake nasal intubation was performed using GL in Group G and FFS in Group F. In both groups, we compared intubation time in seconds (mean ± standard deviation (primary outcome, success rate of the first intubation attempt, percentage of Cormack and Lehane glottic score and incidence of complications. We assumed that GL could be a suitable alternative for the standard FFS in nasal intubation of patients with oropharyngeal cancer. Success rate of the first attempt and Cormack and Lehane glottic score were compared using Chi-square test. Results: Intubation time in seconds was significantly shorter in Group G (70.85 ± 8.88 S than in Group F (90.26 ± 9.41 S with (P < 0.001. The success rate of the first attempt intubation was slightly higher in Group G (81.5% than Group F (78.8%. Cormack and Lehane glottic Score I and II showed insignificant difference between both Group G (92.6% and Group F (96.3%. We detected three cases of sore throat in each group. Conclusion: GlideScope® could be a suitable alternative to FFS in nasal intubation of oropharyngeal cancer patients.

  7. A comparison of lightwand and laryngoscopic intubation techniques in patients undergoing laparoscopic cholecystectomy

    Institute of Scientific and Technical Information of China (English)

    Chenglan Xie; Congjin Ju; Jiawen Cheng; Xuejun Yan; Dengquan Guo

    2009-01-01

    Objective:To assess the effects of lightwand and laryngoscopic intubation techniques in patients undergoing laparoscopic cholecystectomy (LC). Methods: 300 ASA physical status Ⅰ and Ⅱ patients, undergoing LC, were randomly assigned to two groups, with 150 cases in each group. Patients in the LS group underwent endotracheal intubation using a standard direct-suspension laryngoscopic technique. Patients in the LW group were intubated by using transillumination with a lightwand. Mean arterial pressure and heart rate were recorded before induction, and at 1, 3 and 5 min after intubation. The incidence and of sore throat, hoarseness, and dysphagia was assessed twenty-four hours after surgery. Results: This study demonstrated no clinically significant difference in cardiovascular variables between the two techniques. Patients had a significantly lower incidence of sore throat, hoarseness, and dysphagia when the lightwand was used for intubation. Conclusion: This study suggests that lightwand intubation may decrease the incidence of postoperative sore throat, hoarseness,and dysphagia, thereby potentially increasing satisfaction in surgical patients. Therefore, more frequent use of the lightwand is recommended for endotracheal intubation.

  8. Auricular Acupunctures Are Effective for the Prevention of Postoperative Agitation in Old Patients

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    Young-Chang P. Arai

    2010-01-01

    Full Text Available Postoperative cognitive problems and delirium are not uncommon in the elderly. We reported four cases in which auricular acupunctures on the ‘Shenmen’ and ‘Point Zero’ points successfully managed postoperative problematic behaviors of the three patients with dementia and the one patient postoperatively demonstrating an agitated behavior.

  9. Use of video-assisted intubation devices in the management of patients with trauma.

    Science.gov (United States)

    Aziz, Michael

    2013-03-01

    Patients with trauma may have airways that are difficult to manage. Patients with blunt trauma are at increased risk of unrecognized cervical spine injury, especially patients with head trauma. Manual in-line stabilization reduces cervical motion and should be applied whenever a cervical collar is removed. All airway interventions cause some degree of cervical spine motion. Flexible fiberoptic intubation causes the least cervical motion of all intubation approaches, and rigid video laryngoscopy provides a good laryngeal view and eases intubation difficulty. In emergency medicine departments, video laryngoscopy use is growing and observational data suggest an improved success rate compared with direct laryngoscopy.

  10. Fiberoptic bronchoscopy-assisted endotracheal intubation in a patient with a large tracheal tumor.

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    Pang, Lei; Feng, Yan-Hua; Ma, Hai-Chun; Dong, Su

    2015-04-01

    In the event of a high degree of airway obstruction, endotracheal intubation can be impossible and even dangerous, because it can cause complete airway obstruction, especially in patients with high tracheal lesions. However, a smaller endotracheal tube under the guidance of a bronchoscope can be insinuated past obstructive tumor in most noncircumferential cases. Here we report a case of successful fiberoptic bronchoscopy-assisted endotracheal intubation in a patient undergoing surgical resection of a large, high tracheal tumor causing severe tracheal stenosis. A 42-year-old Chinese man presented with dyspnea, intermittent irritable cough, and sleep deprivation for one and a half years. X-rays and computed tomography scan of the chest revealed an irregular pedunculated soft tissue mass within the tracheal lumen. The mass occupied over 90% of the lumen and caused severe tracheal stenosis. Endotracheal intubation was done to perform tracheal tumor resection under general anesthesia. After several failed conventional endotracheal intubation attempts, fiberoptic bronchoscopy-assisted intubation was successful. The patient received mechanical ventilation and then underwent tumor resection and a permanent tracheostomy. This case provides evidence of the usefulness of the fiberoptic bronchoscopy-assisted intubation technique in management of an anticipated difficult airway and suggests that tracheal intubation can be performed directly in patients with a tracheal tumor who can sleep in the supine position, even if they have occasional sleep deprivation and severe tracheal obstruction as revealed by imaging techniques.

  11. Feasibility of Conducting a Music Therapy Study With Hospice Patients with Dementia & Agitation

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    Matt Soskins

    2011-07-01

    Full Text Available This study's purpose was to explore non-pharmacological means for decreasing agitation in hospice patients with late stage dementia administered by caregivers.  Subjects in the study were patients on service with San Diego Hospice and the Institute for Palliative Medicine, diagnosed with late stage dementia, as determined by a FAST (Functional Assessment Staging score of 7, and who were known to become agitated while performing certain tasks (e.g., bathing or eating. A music therapist assessed the subjects using an adaptation of the Music Therapy Assessment (Krout, 2000. The Short Portable Mental Status Questionnaire (SPMSQ and Blessed Dementia Scale were administered pre- and post- intervention to assess cognitive functioning severity of dementia, respectively. Caregivers were trained to administer the Agitated Behavior Scale (ABS after performing the stressful task without music (baseline. The music therapist created a CD for each subject based on the following: a music background/preferences of subject (preferred styles of music, favorite selections or artists, obtained from family/caregiver, and b subject responses observed during the assessment. Caregivers were instructed to complete the agitated task during the music intervention and immediately following the task completed an ABS evaluation. Out of the 51 patients referred for the study, 11 met inclusion criteria and were consented. Eight subjects completed the study. According to demographic information the majority of subjects were female, had previous music experience, and lived in a skilled nursing facility. The most frequent agitated task was bathing, which caused agitation in 75% of subjects. SPMSQ results indicated all patients had severe cognitive impairment and pre-/post-scores were the same. Pre-music intervention ABS scores were a mean of 23.46 (SD=5.8, and a mean of 20.69 (SD=7.1 for post-music intervention. This indicated that subjects became slightly less agitated overall

  12. GlideScope videolaryngoscope vs. Macintosh direct laryngoscope for intubation of morbidly obese patients: a randomized trial

    DEFF Research Database (Denmark)

    Andersen, L H; Rovsing, Marie Louise; Olsen, K S

    2011-01-01

    Morbidly obese patients are at increased risk of hypoxemia during tracheal intubation because of increased frequency of difficult and impossible intubation and a decreased apnea tolerance. In this study, intubation with the GlideScope videolaryngoscope (GS) was compared with the Macintosh direct...

  13. COMPARISON BETWEEN MACINTOSH LARYNGOSCOPE AND MCGRATH VIDEO LARYNGOSCOPE FOR ENDOTRACHEAL INTUBATION IN NEUROSURGICAL PATIENTS

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    Aastha

    2016-03-01

    Full Text Available This study was done on sixty patients of ASA 1 and 2, undergoing elective surgery under general anaesthesia. The patients were allocated in two groups of 30 patients each. Patients selected were allocated to two groups and without risk factors. Direct laryngoscopy group (group 1 patients were intubated through direct laryngoscope. Video laryngoscopy group (group 2 patients were intubated through McGrath VLS. The distribution of patients according to age, sex and weight was comparable (p>.001 in both the two groups. The changes in heart rate, mean arterial pressure, oxygen saturation were not significant (p>.001 between the two groups after intubation at different time intervals. The number of attempts and intubation time was found to be significantly higher in McGrath VLS as compared to Macintosh laryngoscope. The increase in postoperative sore throat and hoarseness after 6 and 24 hrs following operation was found to be significant in group 1 compared to group 2. So from our study, we conclude that the use of McGrath video laryngoscope has no advantage over direct laryngoscopy in attenuating the cardiovascular responses attributed to tracheal intubation in patients with normal airway. It is also associated with greater number of attempts and longer intubation time. However, with the use of stylet, number of attempts can be reduced, although the use of stylet has its own complications. VLS has lesser incidence of post-operative sore throat and hoarseness as compared to Macintosh laryngoscopy.

  14. Validity, reliability and applicability of Portuguese versions of sedation-agitation scales among critically ill patients

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    Antonio Paulo Nassar Junior

    Full Text Available CONTEXT AND OBJECTIVE: Sedation scales are used to guide sedation protocols in intensive care units (ICUs. However, no sedation scale in Portuguese has ever been evaluated. The aim of this study was to evaluate the validity and reliability of Portuguese translations of four sedation-agitation scales, among critically ill patients: Glasgow Coma Score, Ramsay, Richmond Agitation-Sedation Scale (RASS and Sedation-Agitation Scale (SAS. DESIGN AND SETTING: Validation study in two mixed ICUs of a university hospital. METHODS: All scales were applied to 29 patients by four different critical care team members (nurse, physiotherapist, senior critical care physician and critical care resident. We tested each scale for interrater reliability and for validity, by correlations between them. Interrater agreement was measured using weighted kappa (k and correlations used Spearman's test. RESULTS: 136 observations were made on 29 patients. All scales had at least substantial agreement (weighted k 0.68-0.90. RASS (weighted k 0.82-0.87 and SAS (weighted k 0.83-0.90 had the best agreement. All scales had a good and significant correlation with each other. CONCLUSIONS: All scales demonstrated good interrater reliability and were comparable. RASS and SAS showed the best correlations and the best agreement results in all professional categories. All these characteristics make RASS and SAS good scales for use at the bedside, to evaluate sedation-agitation among critically ill patients in terms of validity, reliability and applicability.

  15. Using Simulation to Train Junior Psychiatry Residents to Work with Agitated Patients: A Pilot Study

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    Zigman, Daniel; Young, Meredith; Chalk, Colin

    2013-01-01

    Objective: This article examines the benefit and feasibility of introducing a new, simulation-based learning intervention for junior psychiatry residents. Method: Junior psychiatry residents were invited to participate in a new simulation-based learning intervention focusing on agitated patients. Questionnaires were used to explore the success of…

  16. Prehospital Use of the Intubating Laryngeal Mask Airway in Patients with Severe Polytrauma: A Case Series

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    Andrew M. Mason

    2009-01-01

    Full Text Available A case series of five patients is described demonstrating the utility of the intubating laryngeal mask airway in the prehospital setting, both as a primary airway rescue device and as a bridge to tracheal intubation. All patients were hypoxaemic, had sustained severe polytrauma and were trapped in their vehicles following road traffic collisions. A probability of survival study showed better-than-predicted outcomes for the group as a whole.

  17. Dexmedetomidine for awake intubation and an opioid-free general anesthesia in a superobese patient with suspected difficult intubation

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    Gaszynski T

    2014-07-01

    Full Text Available Tomasz Gaszynski,1 Ewelina Gaszynska,2 Tomasz Szewczyk31Department of Anesthesiology and Intensive Therapy, 2Department of Hygiene and Health Promotion, 3Department of Gastroenterology, Oncology, and General Surgery, Barlicki University Hospital, Medical University of Lodz, PolandAbstract: Super-obese patients (body mass index [BMI] >50 kg/m2 are at a particularly high risk of anesthesia-related complications during postoperative period, eg, critical respiratory events including respiratory arrest, and over-sedation leading to problems with maintaining airway open, hypoxia and hypercapnia. In this paper authors present a case of a 39-year-old super-obese (BMI 62.3 kg/m2 female patient who was admitted for surgical treatment of obesity. Preanesthesia evaluation revealed hypertension and type 2 diabetes mellitus (DM as comorbidities as well as potential for a difficult intubation– neck circumference of 46 cm, reduced neck mobility and DM type 2. Patient was intubated using "awake intubation" method using topical anesthesia and dexmedetomidine infusion. General anesthesia was maintained with sevoflurane and dexmedetomidine infusion instead of opioid administration in "opioid-free anesthesia method".Keywords: morbid obesity, non-opioid anesthesia, dexmedetomidine

  18. Direct Versus Video Laryngoscopy for Intubating Adult Patients with Gastrointestinal Bleeding

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    Jestin N. Carlson

    2015-12-01

    Full Text Available Introduction: Video laryngoscopy (VL has been advocated for several aspects of emergency airway management; however, there are still concerns over its use in select patient populations such as those with large volume hematemesis secondary to gastrointestinal (GI bleeds. Given the relatively infrequent nature of this disease process, we sought to compare intubation outcomes between VL and traditional direct laryngoscopy (DL in patients intubated with GI bleeding, using the third iteration of the National Emergency Airway Registry (NEARIII. Methods: We performed a retrospective analysis of a prospectively collected national database (NEARIII of intubations performed in United States emergency departments (EDs from July 1, 2002, through December 31, 2012. All cases where the indication for intubation was “GI bleed” were analyzed. We included patient, provider and intubation characteristics. We compared data between intubation attempts initiated as DL and VL using parametric and non-parametric tests when appropriate. Results: We identified 325 intubations, 295 DL and 30 VL. DL and VL cases were similar in terms of age, sex, weight, difficult airway predictors, operator specialty (emergency medicine, anesthesia or other and level of operator training (post-graduate year 1, 2, etc. Proportion of successful first attempts (DL 261/295 (88.5% vs. VL 28/30 (93.3% p=0.58 and Cormack-Lehane grade views (p=0.89 were similar between devices. The need for device change was similar between DL [2/295 (0.7% and VL 1/30 (3.3%; p=0.15]. Conclusion: In this national registry of intubations performed in the ED for patients with GI bleeds, both DL and VL had similar rates of success, glottic views and need to change devices.

  19. The Richmond Agitation-Sedation Scale: validity and reliability in adult intensive care unit patients.

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    Sessler, Curtis N; Gosnell, Mark S; Grap, Mary Jo; Brophy, Gretchen M; O'Neal, Pam V; Keane, Kimberly A; Tesoro, Eljim P; Elswick, R K

    2002-11-15

    Sedative medications are widely used in intensive care unit (ICU) patients. Structured assessment of sedation and agitation is useful to titrate sedative medications and to evaluate agitated behavior, yet existing sedation scales have limitations. We measured inter-rater reliability and validity of a new 10-level (+4 "combative" to -5 "unarousable") scale, the Richmond Agitation-Sedation Scale (RASS), in two phases. In phase 1, we demonstrated excellent (r = 0.956, lower 90% confidence limit = 0.948; kappa = 0.73, 95% confidence interval = 0.71, 0.75) inter-rater reliability among five investigators (two physicians, two nurses, and one pharmacist) in adult ICU patient encounters (n = 192). Robust inter-rater reliability (r = 0.922-0.983) (kappa = 0.64-0.82) was demonstrated for patients from medical, surgical, cardiac surgery, coronary, and neuroscience ICUs, patients with and without mechanical ventilation, and patients with and without sedative medications. In validity testing, RASS correlated highly (r = 0.93) with a visual analog scale anchored by "combative" and "unresponsive," including all patient subgroups (r = 0.84-0.98). In the second phase, after implementation of RASS in our medical ICU, inter-rater reliability between a nurse educator and 27 RASS-trained bedside nurses in 101 patient encounters was high (r = 0.964, lower 90% confidence limit = 0.950; kappa = 0.80, 95% confidence interval = 0.69, 0.90) and very good for all subgroups (r = 0.773-0.970, kappa = 0.66-0.89). Correlations between RASS and the Ramsay sedation scale (r = -0.78) and the Sedation Agitation Scale (r = 0.78) confirmed validity. Our nurses described RASS as logical, easy to administer, and readily recalled. RASS has high reliability and validity in medical and surgical, ventilated and nonventilated, and sedated and nonsedated adult ICU patients.

  20. Nasogastric tube insertion in anesthetized and intubated patients: a new and reliable method

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    Tsai Yung-Fong

    2012-08-01

    Full Text Available Abstract Background The “Rusch” intubation stylet is used to make endotracheal tube intubation easy. We designed this study to evaluate the usage of this equipment in the guidance of nasogastric tube (NGT insertion. Methods A total of 103 patients, aged 23 to 70 years, undergoing gastrointestinal or hepatic surgeries that required intraoperative NGT insertions were enrolled into our study. The patients were randomly allocated to the control group (Group C or the stylet group (Group S according to a computerized, random allocation software program. In the control group, the NGT was inserted with the patient’s head in an intubating position. In the stylet group, the NGT was inserted with the assistance of a “Rusch” intubation stylet tied together at the tips by a slipknot. The success rates of the two methods, the durations of the insertions, and the occurrences of complications were recorded. All of the failed cases in the control group were subjected to the new technique used in the stylet group, and the successful rescue rate was also evaluated. Results Successful insertions were recorded for 52/53 patients (98.1% in Group S and for 32/50 patients (64% in Group C. The mean insertion times were 39.5 ± 19.5 seconds in Group C and 40.3 ± 23.2 seconds in Group S. Successful rescues of failure cases in Group C were achieved in 17/18 patients (94.4% with the assistance of a “Rusch” intubation stylet. Conclusions The “Rusch” intubation stylet-guided method is reliable with a high success rate of NGT insertion in anesthetized and intubated patients. Trial registration Institutional Review Board of Chang Gung Memorial Hospital (IRB: 98-2669B and Australian New Zealand Clinical Trials Registry (ACTRN12611000423910

  1. Prehospital Use of IM Ketamine for Sedation of Violent and Agitated Patients

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    Kenneth A. Scheppke

    2014-11-01

    Full Text Available Introduction: Violent and agitated patients pose a serious challenge for emergency medical services (EMS personnel. Rapid control of these patients is paramount to successful prehospital evaluation and also for the safety of both the patient and crew. Sedation is often required for these patients, but the ideal choice of medication is not clear. The objective is to demonstrate that ketamine, given as a single intramuscular injection for violent and agitated patients, including those with suspected excited delirium syndrome (ExDS, is both safe and effective during the prehospital phase of care, and allows for the rapid sedation and control of this difficult patient population. Methods: We reviewed paramedic run sheets from five different catchment areas in suburban Florida communities. We identified 52 patients as having been given intramuscular ketamine 4mg/kg IM, following a specific protocol devised by the EMS medical director of these jurisdictions, to treat agitated and violent patients, including a subset of which would be expected to suffer from ExDS. Twenty-six of 52 patients were also given parenteral midazolam after medical control was obtained to prevent emergence reactions associated with ketamine. Results: Review of records demonstrated that almost all patients (50/52 were rapidly sedated and in all but three patients no negative side effects were noted during the prehospital care. All patients were subsequently transported to the hospital before ketamine effects wore off. Conclusion: Ketamine may be safely and effectively used by trained paramedics following a specific protocol. The drug provides excellent efficacy and few clinically significant side effects in the prehospital phase of care, making it an attractive choice in those situations requiring rapid and safe sedation especially without intravenous access. [West J Emerg Med. 2014;15(7:–0.

  2. [Regional anesthesia of the airways in difficult tracheal intubation in a conscious patient with spontaneous respiration].

    Science.gov (United States)

    Dziadz'ko, A M

    2002-01-01

    Clinical pattern of anesthesia, hemodynamic and gas exchange states were evaluated in 64 patients with congenital or acquired damage of maxillary-facial region due to tumor or trauma. 51 patients were intubated under locoregional anesthesia of the upper respiratory tract (superior laryngeal nerves, glossopharyngeal nerves, intratracheal anesthesia) by means of blind nasal or oral fiberoptic retrograde and by using laryngeal mask technique. In 12 cases fiberoptic device was used for intubation under local anesthesia by lidocaine solution. There was no airways obstruction in any case. Satisfactory anesthesia in oropharynx, larynx and trachea was reached in all cases, the most profound blockage of airways and lack of pharyngeal and laryngeal reflexes being in patients under locoregional anesthesia. So locoregional anesthesia can be used for awake intubation.

  3. Persistent genital arousal disorder: confluent patient history of agitated depression, paroxetine cessation, and a tarlov cyst.

    Science.gov (United States)

    Eibye, Simone; Jensen, Hans Mørch

    2014-01-01

    We report a case of a woman suffering from persistent genital arousal disorder (PGAD) after paroxetine cessation. She was admitted to a psychiatric department and diagnosed with agitated depression. Physical investigation showed no gynaecological or neurological explanation; however, a pelvic MRI scan revealed a Tarlov cyst. Size and placement of the cyst could not explain the patient's symptoms; thus neurosurgical approach would not be helpful. Her depression was treated with antidepressant with little effect. Electroconvulsive therapy improved the patient's symptoms though they did not fully resolve. More awareness of PGAD and thorough interdisciplinary conferences are necessary to insure an unequivocal treatment strategy.

  4. The optimal succinylcholine dose for intubating emergency patients: retrospective comparative study

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    M. Magdy Hussien

    2011-07-01

    Full Text Available Background : Succinylcholine remains the drug of choice for satisfactory rapid-sequence tracheal intubation. It is not clear from the literature why the 1 mg/kg dose of succinylcholine has been traditionally used. The effective dose (ED95 of succinylcholine is less than 0.3 mg/kg. The dose of 1 mg/kg represents 3.5 to 4 times the ED95. Objectives : To compare the effect of the traditionally used 1 mg/kg of succinylcholine with lower doses of 0.6 mg/kg and 0.45 mg/kg on intubation condition regarding the onset time, duration of action, duration of abdominal fasciculation, and the intubation grading. Methods : This retrospective comparative study was carried into three groups of ASA III & IV (American Society of Anesthesiologist's Physical Status III and IV non-prepared emergency patients who were intubated at emergency department of Hamad General Hospital, Doha, Qatar during January 1st 2007 to August 31, 2010. The Institutional Research Board (IRB approval was obtained. This study was limited to 88 patients who received fentanyl 1 µg/kg followed by etomidate 0.3 mg/kg intravenously as induction agents and succinylcholine as a muscle relaxant agent in doses of 0.45 mg/kg, 0.6 mg/kg, or 1 mg/kg. Results : Increasing the succinylcholine dosage shortened the onset time, prolonged the duration of action, and prolonged the duration of abdominal fasciculation significantly (P<.001. Tracheal intubation was 100% successful in the three groups of patients. Conclusion : Succinylcholine dose of 0.45 mg/kg provides an optimal intubation condition in ASA III & IV emergency non-prepared patients. Duration of action of succinylcholine is dose dependent; reducing the dose allows a more rapid return of spontaneous respiration and airway reflexes.

  5. Preanesthetic assessment data do not influence the time for tracheal intubation with Airtraq(tm video laryngoscope in obese patients

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    Dante Ranieri Jr.

    2014-06-01

    Full Text Available Purpose: this study investigated the influence of anatomical predictors on difficult laryngoscopy and orotracheal intubation in obese patients by comparing Macintosh and Airtraq(tm laryngoscopes. Methods: from 132 bariatric surgery patients (body mass index = 35 kg m-1, cervical perimeter, sternomental distance, interincisor distance, and Mallampati score were recorded. The patients were randomized into two groups according to whether a Macintosh (n = 64 or an Airtraq(tm (n = 68 laryngoscope was used for tracheal intubation. Time required for intubation was the first outcome. Cormack-Lehane score, number of intubation attempts, the Macintosh blade used, any need for external tracheal compression or the use of gum elastic bougie were recorded. Intubation failure and strategies adopted were also registered. Results: intubation failed in two patients in the Macintosh laryngoscope group, and these patients were included as worst cases scenario. The intubation times were 36.9 + 22.8 s and 13.7 + 3.1 s for the Macintosh and Airtraq(tm laryngoscope groups (p < 0.01, respectively. Cormack-Lehane scores were also lower for the Airtraq(tm group. One patient in the Macintosh group with intubation failure was quickly intubated with the Airtraq(tm. Cervical circumference (p < 0.01 and interincisor distance (p < 0.05 influenced the time required for intubation in the Macintosh group but not in the Airtraq(tm group. Conclusion: in obese patients despite increased neck circumference and limited mouth opening, the Airtraq(tm laryngoscope affords faster tracheal intubation than the Macintosh laryngoscope, and it may serve as an alternative when conventional laryngoscopy fails.

  6. Prehospital Intubation in Patients with Isolated Severe Traumatic Brain Injury: A 4-Year Observational Study

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    Mazin Tuma

    2014-01-01

    Full Text Available Objectives. To study the effect of prehospital intubation (PHI on survival of patients with isolated severe traumatic brain injury (ISTBI. Method. Retrospective analyses of all intubated patients with ISTBI between 2008 and 2011 were studied. Comparison was made between those who were intubated in the PHI versus in the trauma resuscitation unit (TRU. Results. Among 1665 TBI patients, 160 met the inclusion criteria (105 underwent PHI, and 55 patients were intubated in TRU. PHI group was younger in age and had lower median scene motor GCS (P=0.001. Ventilator days and hospital length of stay (P=0.01 and 0.006, resp. were higher in TRUI group. Mean ISS, length of stay, initial blood pressure, pneumonia, and ARDS were comparable among the two groups. Mortality rate was higher in the PHI group (54% versus 31%, P=0.005. On multivariate regression analysis, scene motor GCS (OR 0.55; 95% CI 0.41–0.73 was an independent predictor for mortality. Conclusion. PHI did not offer survival benefit in our group of patients with ISTBI based on the head AIS and the scene motor GCS. However, more studies are warranted to prove this finding and identify patients who may benefit from this intervention.

  7. [Secondary lung diseases in patients with nasotracheal intubation. Role of nosocomial sinusitis].

    Science.gov (United States)

    Meyer, P; Guérin, J M; Habib, Y; Lévy, C

    1988-01-01

    Nosocomial pneumonia is a frequent infectious complication in ICU patients. All the patients with prolonged nasotracheal intubation presenting with nosocomial pneumonia according to Salata's criteria were examined for sinusitis in the prospective study. Diagnosis was confirmed via CT-scan views and transnasal sinus puncture. In eleven nasally intubated patients, CT-scan views showed air fluid levels and multiple sinus involvement. Bacteriological studies isolated the same gram negative bacilli in both sinus and bronchial aspirates. In four cases, a polymicrobial sinusitis was found with a single organism predominant. This predominant germ was always found in bronchial aspirate. Recovery from pneumonia was obtained only after sinus drainage. Treatment included removing the nasal tubes, or performing tracheostomy and systemic antibiotics. One patient required surgical maxillary sinus drainage after failure of medical management. The occurrence of nosocomial pneumonia in nasotracheally intubated patients should lead physicians to explore the paranasal sinuses. Sinus CT-scan views should be routinely obtained in the assessment of pulmonary sepsis in patients with prolonged nasotracheal intubation. Persistent or ignored nosocomial sinusitis in such circumstances could be a major source of treatment failure.

  8. Impact of Post-Intubation Interventions on Mortality in Patients Boarding in the Emergency Department

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    Rahul Bhat

    2014-09-01

    Full Text Available Introduction: Emergency physicians frequently perform endotracheal intubation and mechanical ventilation. The impact of instituting early post-intubation interventions on patients boarding in the emergency department (ED is not well studied. We sought to determine the impact of postintubation interventions (arterial blood gas sampling, obtaining a chest x-ray (CXR, gastric decompression, early sedation, appropriate initial tidal volume, and quantitative capnography on outcomes of mortality, ventilator-associated pneumonia (VAP, ventilator days, and intensive care unit (ICU length-of-stay (LOS. Methods: This was an observational, retrospective study of patients intubated in the ED at a large tertiary-care teaching hospital and included patients in the ED for greater than two hours postintubation. We excluded them if they had incomplete data, were designated “do not resuscitate,” were managed primarily by the trauma team, or had surgery within six hours after intubation. Results: Of 169 patients meeting criteria, 15 died and 10 developed VAP. The mortality odds ratio (OR in patients receiving CXR was 0.10 (95% CI 0.01 to 0.98, and 0.11 (95% CI 0.03 to 0.46 in patients receiving early sedation. The mortality OR for patients with 3 or fewer interventions was 4.25 (95% CI 1.15 to 15.75 when compared to patients with 5 or more interventions. There was no significant relationship between VAP rate, ventilator days, or ICU LOS and any of the intervention groups. Conclusion: The performance of a CXR and early sedation as well as performing five or more vs. three or fewer post-intubation interventions in boarding adult ED patients was associated with decreased mortality. [West J Emerg Med. 2014;15(6:708-711

  9. Low-dose esmolol: hemodynamic response to endotracheal intubation in normotensive patients

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    Suresh Lakshmanappa

    2012-06-01

    Full Text Available Abstract Purpose: Endotracheal intubation is a frequently utilized and highly invasive component of anesthesia that is often accompanied by potentially harmful hemodynamic pressor responses. The purpose of this study was to investigate the efficiency of a single pre-induction 1 mg/kg bolus injection of esmolol for attenuating these hemodynamic responses to endotracheal intubation in normotensive patients. Material and methods: The study was composed of 100 randomly selected male and female patients between the ages of 18 and 60 that were scheduled for elective surgery and belonged to ASA grade I or II. Two minutes prior to intubation the control group received 10 mL of saline (n=50 and the experimental group received an injection of esmolol 1 mg/kg diluted to 10 mL (n=50. Heart rate (HR, systolic blood pressure (SBP, diastolic blood pressure (DBP, mean arterial pressure (MAP, and rate pressure product (RPP were compared to basal values before receiving medication (T-0, during pre-induction (T-1, induction (T-2, intubation (T-3, and post-intubation at 1 (T-4, 3 (T-6, 5 (T-8, and 10 (T-13 minutes. Results: Esmolol significantly attenuated the hemodynamic responses to endotracheal intubation at the majority of measured points. Attenuation of HR (10.8%, SBP (7.04%, DBP (3.99%, MAP (5%, and RPP (16.9% was observed in the esmolol group when compared to the control group values. Conclusions: A single pre-induction 1 mg/kg bolus injection of esmolol successfully attenuated the hemodynamic pressor response in normotensive patients. A significant attenuation of heart rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure was observed at the majority of measured time points in the esmolol administered group compared to the control group. [J Contemp Med 2012; 2(2.000: 69-76

  10. A Novel and Innovative Way of Nasogastric Tube Insertion in Anesthetized Intubated Patient

    Science.gov (United States)

    Sahu, Sandeep; Kishore, Kamal; Sachan, Vertika; Chatterjee, Arnidam

    2017-01-01

    Nasogastric tube (NGT) placement in anesthetized and intubated is sometimes very challenging with more than 50% failure rate in the first attempt. We describe a newer innovative Sahu's three in one, technique with use of GlideScope and forward placement of intubated trachea by external laryngeal maneuver, these both techniques lead to separation of trachea from esophagus so that endoscopic jejunal feeding tube guide wire strengthen NGT can be guided and manipulated to esophagus under direct vision. After informed consent, we used Sahu's three in one combo technique to insert NGT in adult anesthetized and intubated patients of both the sexes with high success in the first attempt. We found this technique easy, helpful, less time consuming with high success rate.

  11. Reduced cerebral oxygen–carbohydrate index during endotracheal intubation in vascular surgical patients

    DEFF Research Database (Denmark)

    Fabricius-Bjerre, Andreas; Overgaard, Anders; Winther-Olesen, Marie

    2015-01-01

    Brain activation reduces balance between cerebral consumption of oxygen versus carbohydrate as expressed by the so-called cerebral oxygen-carbohydrate-index (OCI). We evaluated whether preparation for surgery, anaesthesia including tracheal intubation and surgery affect OCI. In patients undergoing.......2 versus 0.7 ± 0.2 mmol l(-1) , Pintubation (P... to 4.6 ± 1.4 during surgery and to 5.6 ± 1.7 in the recovery room. In conclusion, preparation for surgery and tracheal intubation decrease OCI that recovers during surgery under the influence of sensory blockade....

  12. GlideScope Video Laryngoscope for Difficult Intubation in Emergency Patients: a Quasi-Randomized Controlled Trial

    Directory of Open Access Journals (Sweden)

    Koorosh Ahmadi

    2015-12-01

    Full Text Available Macintosh direct laryngoscope has been the most widely used device for tracheal intubation. GlideScope video laryngoscope (GVL has been recently introduced as an alternative device for performing intubation; however, its validity in emergency settings has not been thoroughly evaluated. The aim of this study was to compare Macintosh direct laryngoscope versus GVL for emergency endotracheal intubation. This quasi-randomized clinical trial was performed on 97 patients referred to Imam Reza Hospital whom all needed emergency intubation in 2011. Patients were divided into two groups of the easy airway and difficult airway; intubation was performed for patients with direct laryngoscopy or GVL. Then, the patients were evaluated in terms of demographic characteristics, successful intubation rate and intubation time. Data was analyzed by SPSS software 16. There was no significant difference in demographic characteristics of the patients in both easy airway and difficult airway groups who intubated with direct laryngoscopy and GVL methods (P>0.05. In difficult airway group, a significant difference was found in successful intubation at the first attempt (60.9% vs. 87.5%; P=0.036, overall intubation time (32.7 ± 14.58 vs. 22.5±7.88; P<0.001 and first attempt intubation time (28.43 ± 12.51 vs. 21.48±7.8; P=0.001 between direct laryngoscopy and GVL. These variables were not significantly different between two methods in easy airway group. According to the results, GVL can be a useful alternative to direct laryngoscopy in emergency situations and especially in cases with a difficult airway.

  13. Safety and effectiveness of drug therapy for the acutely agitated patient (Part 2

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    Gianluca Airoldi

    2013-04-01

    Full Text Available Acute agitation occurs in a variety of medical and psychiatric conditions, and the management of agitated, abusive, or violent patients is a common problem in the emergency department. Rapid control of potentially dangerous behaviors by physical restraint and pharmacologic tranquillization is crucial to ensure the safety of the patient and health-care personnel and to allow diagnostic procedures and treatment of the underlying condition. The purpose of this article (the second in a 2-part series is to review published data on the efficacy and safety of antipsychotic medications currently available for managing situations of this type. Arrhythmias caused by QT-prolonging drugs occur infrequently, and multiple factors are often involved, including concomitant use of other drugs affecting the same pathway (most antipsychotic drugs prolong the QT interval by blocking potassium IKr current in HERG channels of myocardial cells, electrolyte disorders and, possibly, genetic predisposition. Judicious use of typical antipsychotics (mainly haloperidol and benzodiazepines (mainly lorazepam, given intramuscularly alone or in combination, has proved to be safe and effective for controlling acute motor agitation related to psychiatric illness; cocaine, methamphetamine, and ethanol toxicity; ethanol withdrawal; and other factors. They are still widely used and are particularly useful when limited data are available on the patient’s history of cardiovascular disease, current use of medication, and/or the likelihood of illicit drug or alcohol intoxication; when the diagnosis involves medical comorbidity or intoxication; or when there is no specific treatment (e.g., personality disorders, learning disabilities, mental retardation, organic brain damage. If rapid tranquillization is necessary before a formal diagnosis can be made and there are uncertainties regarding the patient’s medical history, lorazepam is often considered the first-line drug of choice. In

  14. Effect of cisatracurium versus atracurium on intraocular pressure in patients undergoing tracheal intubation for general anesthesia

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    Mitra Jabalameli

    2011-01-01

    Conclusions: Compared with atracurium, administration of cisatracurium can better prevent the increase of IOP following tracheal intubation in general anesthesia. The observed difference might be related to different effects on hemodynamic variables. Application of these results in patients under ophthalmic surgery is warranted.

  15. Endotracheal suctioning versus minimally invasive airway suctioning in intubated patients : a prospective randomised controlled trial

    NARCIS (Netherlands)

    Van de Leur, JP; Zwaveling, JH; Loef, BG; Van der Schans, CP

    2003-01-01

    Study objective: Endotracheal suctioning in intubated patients is routinely applied in most ICUs but may have negative side effects. We hypothesised that on-demand minimally invasive suctioning would have fewer side effects than routine deep endotracheal suctioning, and would be comparable in durati

  16. "DIFFICULT AIRWAY MANAGEMENT IN A PATIENT WITH TREACHER-COLLIN’S SYNDROME WITH INTUBATING LARYNGEAL MASK AIRWAY "

    Directory of Open Access Journals (Sweden)

    M. Gharebaghian

    2006-08-01

    Full Text Available Treacher Collin’s syndrome (TCS is a rare inherited condition characterized by bilateral and symmetric abnormalities of structures within the first and second bronchial arches. Patients with TCS present a serious problem to anesthetists maintaining their airway as upper airway obstruction and difficult tracheal intubation due to severe facial deformity. Because of retrognathia, airway management of these patients is often challenging. We report the case of a 25-yr-old patient with TCS undergoing microtia repair under general anesthesia twice. In the first time he could not be intubated via direct laryngoscopy and was intubated via blind nasal intubation. In the second time, he was intubated through an ILMA using endotracheal tube.

  17. The Role of Inhaled Loxapine in the Treatment of Acute Agitation in Patients with Psychiatric Disorders: A Clinical Review

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    Domenico de Berardis

    2017-02-01

    Full Text Available Loxapine is a first generation antipsychotic, belonging to the dibenzoxazepine class. Recently, loxapine has been reformulated at a lower dose, producing an inhaled powder that can be directly administered to the lungs to treat the agitation associated with psychiatric disorders, such as schizophrenia and bipolar disorder. Thus, the aim of this narrative and clinical mini-review was to evaluate the efficacy and tolerability of inhaled loxapine in the treatment of acute agitation in patients with psychiatric disorders. The efficacy of inhaled loxapine has been evaluated in one Phase II trial on patients with schizophrenia, and in two Phase III trials in patients with schizophrenia and bipolar disorder. Moreover, there are two published case series on patients with borderline personality disorder and dual diagnosis patients. Inhaled loxapine has proven to be effective and generally well tolerated when administered to agitated patients with schizophrenia and bipolar disorder. Two case series have suggested that inhaled loxapine may also be useful to treat agitation in patients with borderline personality disorder and with dual diagnosis, but further studies are needed to clarify this point. However, the administration of inhaled loxapine requires at least some kind of patient collaboration, and is not recommended in the treatment of severe agitation in totally uncooperative patients. Moreover, the drug-related risk of bronchospasm must always be kept in mind when planning to use inhaled loxapine, leading to a careful patient assessment prior to, and after, administration. Also, the higher costs of inhaled loxapine, when compared to oral and intramuscular medications, should be taken into account when selecting it for the treatment of agitation.

  18. [Effective Dexmedetomidine Administration for the Prevention of Emergence Agitation and Postoperative Delirium in Patients with a History of Postoperative Delirium].

    Science.gov (United States)

    Fujisawa, Takanobu; Komasawa, Nobuyasu; Fujiwara, Atsushi; Kido, Haruki; Minami, Toshiaki

    2016-04-01

    We successfully performed intraoperative dexmedetomidine (DEX) administration for the prevention of emergence agitation or postoperative delirium after lung resection in four patients (71.3 ± 5.7 year old, 3 males and 1 female) with a past history of postoperative delirium. DEX was started at 0.35-0.45 μg x kg(-1) x hr(-1) continuously without loading. The average time from DEX initiation to extubation was 141.3 ± 94.4 minutes. No patient had emergence agitation, and DEX administration was continued until the following morning with monitoring in all patients without any symptoms of delirium. Intraoperative DEX administration may be beneficial for the prevention of emergence agitation or postoperative delirium in patients with a past history of postoperative delirium.

  19. Entropy correlates with Richmond Agitation Sedation Scale in mechanically ventilated critically ill patients.

    Science.gov (United States)

    Sharma, Ankur; Singh, Preet Mohinder; Trikha, Anjan; Rewari, Vimi; Chandralekha

    2014-04-01

    Sedation is routinely used in intensive care units. However due to absence of objective scoring systems like Bispectral Index and entropy our ability to regulate the degree of sedation is limited. This deficiency is further highlighted by the fact that agitation scores used in intensive care units (ICU) have no role in paralyzed patients. The present study compares entropy as a sedation scoring modality with Richmond Agitation Sedation Scale (RASS) in mechanically ventilated, critically ill patients in an ICU. Twenty-seven, mechanically ventilated, critically ill patients of either sex, 16-65 years of age, were studied over a period of 24 h. They received a standard sedation regimen consisting of a bolus dose of propofol 0.5 mg/kg and fentanyl 1 lg/kg followed by infusions of propofol and fentanyl ranging from 1.5 to 5 mg/kg/h and 0.5 to 2.0 lg/kg/h, respectively. Clinically relevant values of RASS for optimal ICU sedation (between 0 and -3) in non-paralyzed patients were compared to corresponding entropy values, to find if any significant correlation exists between the two. These entropy measurements were obtained using the Datex-Ohmeda-M-EntropyTM module. This module is presently not approved by Food and Drug Administration (FDA) for monitoring sedation in ICU. A total of 527 readings were obtained. There was a statistically significant correlation between the state entropy (SE) and RASS [Spearman's rho/rs = 0.334, p\\0.0001]; response entropy (RE) and RASS [Spearman's rho/rs = 0.341, p\\0.0001]). For adequate sedation as judged by a RASS value of 0 to -3, the mean SE was 57.86 ± 16.50 and RE was 67.75 ± 15.65. The present study illustrates that entropy correlates with RASS (between scores 0 and -3) when assessing the level of sedation in mechanically ventilated critically ill patients.

  20. Intubation conditions after rocuronium or succinylcholine for rapid sequence induction with alfentanil and propofol in the emergency patient

    DEFF Research Database (Denmark)

    Larsen, P B; Hansen, E G; Jacobsen, L S;

    2005-01-01

    and with increased risk of pulmonary aspiration of gastric content were randomized to a rapid-sequence induction with succinylcholine 1.0 mg kg[-1] or rocuronium 0.6 mg kg[-1]. Patients with a predicted difficult airway were excluded. A senior anaesthesiologist 'blinded' for the randomization performed...... the intubation 60 s after injection of the neuromuscular blocker. Intubating conditions were evaluated according to an established guideline. Tracheal intubation not completed within 30 s was recorded as failed. Results: 222 patients were randomized. Three patients had their operation cancelled and 10 did...

  1. Unrecognized Hypoxia and Respiratory Depression in Emergency Department Patients Sedated For Psychomotor Agitation: Pilot Study

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    Kenneth Deitch

    2014-07-01

    Full Text Available Introduction: The incidence of respiratory depression in patients who are chemically sedated in the emergency department (ED is not well understood. As the drugs used for chemical restraint are respiratory depressants, improving respiratory monitoring practice in the ED may be warranted. The objective of this study is to describe the incidence of respiratory depression in patients chemically sedated for violent behavior and psychomotor agitation in the ED. Methods: Adult patients who met eligibility criteria with psychomotor agitation and violent behavior who were chemically sedated were eligible. SpO2 and ETCO2 (end-tidal CO2 was recorded and saved every 5 seconds. Demographic data, history of drug or alcohol abuse, medical and psychiatric history, HR and BP every 5 minutes, any physician intervention for hypoxia or respiratory depression, or adverse events were also recorded. We defined respiratory depression as an ETCO2 of >50 mmHg, a change of 10% above or below baseline, or a loss of waveform for >15 seconds. Hypoxia was defined as a SpO2 of 15 seconds. Results: We enrolled 59 patients, and excluded 9 because of >35% data loss. Twenty-eight (28/50 patients developed respiratory depression at least once during their chemical restraint (56%, 95% CI 42-69%; the median number of events was 2 (range 1-6. Twenty-one (21/50 patients had at least one hypoxic event during their chemical restraint (42%, 95% CI 29-55%; the median number of events was 2 (range 1-5. Nineteen (19/21 (90%, 95% CI 71-97% of the patients that developed hypoxia had a corresponding ETCO2 change. Fifteen (15/19 (79%, 95% CI 56-91% patients who became hypoxic met criteria for respiratory depression before the onset of hypoxia. The sensitivity of ETCO2 to predict the onset of a hypoxic event was 90.48% (95% CI: 68-98% and specificity 69% (95% CI: 49-84%. Five patients received respiratory interventions from the healthcare team to improve respiration [Airway repositioning: (2

  2. Effects of aromatherapy on agitation and related caregiver burden in patients with moderate to severe dementia: A pilot study.

    Science.gov (United States)

    Turten Kaymaz, Tugce; Ozdemir, Leyla

    2016-11-29

    We examined the effects of aromatherapy on agitation in patients with dementia and evaluated related caregiver burden. Patients and their caregivers from two hospitals in Turkey were selected and divided into an intervention group (n = 14) and a control group (n = 14). Patients were stratified according to their dementia phase and intake of antipsychotic medication. The intervention group received aromatherapy via massage and inhalation at home for 4 weeks. The control group received no intervention. Data were collected using the Neuropsychiatric Inventory (NPI), the Cohen-Mansfield Agitation Inventory (CMAI) and the Zarit Burden Interview (ZBI). At 2 and 4 weeks, the NPI scores were significantly lower in the intervention group (p aromatherapy, agitation, neuropsychiatric symptoms, and caregiver distress significantly reduced, and aromatherapy prevented caregiver burden increase.

  3. Apneic oxygenation for elimination of respiratory motion artefact in an intubated patient undergoing helical chest computed tomography angiography.

    Directory of Open Access Journals (Sweden)

    Ioannis Pneumatikos

    2008-10-01

    Full Text Available Respiratory motion artifact in intubated and mechanically ventilated patients often reduces the quality of helical computed tomography pulmonary angiography (CTPA. Apneic oxygenation is a well established intra-operative technique that allows adequate oxygenation for short periods (up to 10 min in sedated and paralyzed patients. We describe the use of the apneic oxygenation for elimination of respiratory motion artefact in an intubated patient undergoing helical chest computed tomography angiography.

  4. Efficacy of voice therapy in patient with arytenoid dislocation as a complication of tracheal intubation

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    Md Noorain Alam

    2015-01-01

    Full Text Available Introduction: Tracheal intubation is the placement of a flexible plastic tube into the trachea to maintain an open airway or to serve as a conduit through which certain drugs are administered. Arytenoid dislocation is one of the rare reported complications of tracheal intubation. Decreased volume and breathiness are the most common voice symptoms. Need for the Study: There is lack of prospective and systemic study of the incidence of arytenoid dislocation and efficacy of voice therapy in such cases. Aim of the Study: Present study was carried out to find out the efficacy of voice therapy as independent management option in persons with arytenoid dislocation as a consequence of tracheal intubation. Materials and Methods: The study was based on a case study of a 37 year old male patient who reported to C U Shah Medical College and Hospital, Surendranagar with complaint of breathy and soft voice quality post laparotomy as a consequence of intubation. ENT examination revealed both vocal cord bowing with ? subclinical sublaxtition of arytenoid. Pre and post voice therapy assessment was done using GRBAS scale (for perceptual analysis, Praat software (for acoustical analysis and VHI scale (for measuring the effect of voice disorder on the quality of life. Voice therapy was given for two months and pre and post findings were compared. Results: Significant improvement was observed on all the measures. Conclusion: Although arytenoid cartilage dislocation following the use of intubation is a rare event, it is important to be aware of its occurrence and to conduct diagnostic tests as early as possible in case of persistent hoarseness. Voice therapy may be used as an adjunct to phonosurgery or independently an effective intervention.

  5. Use of intubating laryngeal mask airway in a morbidly obese patient with chest trauma in an emergency setting

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    Tripat Bindra

    2011-01-01

    Full Text Available A morbidly obese male who sustained blunt trauma chest with bilateral pneumothorax was referred to the intensive care unit for management of his condition. Problems encountered in managing the patient were gradually increasing hypoxemia (chest trauma with multiple rib fractures with lung contusions and difficult mask ventilation and intubation (morbid obesity, heavy jaw, short and thick neck. We performed awake endotracheal intubation using an intubating laryngeal mask airway (ILMA size 4 and provided mechanical ventilation to the patient. This report suggests that ILMA can be very useful in the management of difficult airway outside the operating room and can help in preventing adverse events in an emergency setting.

  6. [Tracheal resection for post-intubation subglottic stenosis in a patient with granulomatosis with polyangiitis (Wegener)].

    Science.gov (United States)

    Stoica, Radu; Negru, Irina; Matache, Radu; MirunaTodor

    2014-01-01

    Granulomatosis with polyangiitis (GPA or Wegener) is a systemic autoimmune disease with inflammation of small- and medium-size vessels. It can affect practically any organ or system, but renal, respiratory andjoint systems are most frequently damaged. Positive pANCA antibodies can raise the suspicion of diagnosis. Subglottic stenosis is relatively frequent, in a quarter of patients, especially in the third decade women. The case presented is of an 80-year-old woman, recently diagnosed with pulmonary, renal and systemic manifestations of GPA and with a subglottic stenosis rapidly evolving towards endotracheal intubation, tracheostomy with mechanical ventilation and renal failure. Further evolution has been favorable under corticoid therapy. After weaning from the mechanical ventilation and30 days after the suppression of the tracheostomy, the patient developed a tracheal stenosis with mixed etiology, secondary to vasculitis and prolonged intubation with tracheostomy. Tracheal resection with termino-terminal anastomosis was performed in emergency with simple post-operative evolution and without late complications.

  7. [Tracheal resection for post-intubation subglottic stenosis in a patient with granulomatosis with polyanaiitis (Wegener)].

    Science.gov (United States)

    Stoica, Radu; Negru, Irina; Matache, Radu; MirunaTodor

    2014-01-01

    Granulomatosis with polyangiitis (GPA or Wegener) is a systemic autoimmune disease with inflammation of small- and medium-size vessels. It can affect practically any organ or system, but renal, respiratory andjoint systems are most frequently damaged. Positive pANCA antibodies can raise the suspicion of diagnosis. Subglottic stenosis is relatively frequent, in a quarter of patients, especially in the third decade women. The case presented is of an 80-year-old woman, recently diagnosed with pulmonary, renal and systemic manifestations of GPA and with a subglottic stenosis rapidly evolving towards endotracheal intubation, tracheostomy with mechanical ventilation and renal failure. Further evolution has been favorable under corticoid therapy. After weaning from the mechanical ventilation and30 days after the suppression of the tracheostomy, the patient developed a tracheal stenosis with mixed etiology, secondary to vasculitis and prolonged intubation with tracheostomy. Tracheal resection with termino-terminal anastomosis was performed in emergency with simple post-operative evolution and without late complications.

  8. Endotracheal suctioning of the adult intubated patient--what is the evidence?

    DEFF Research Database (Denmark)

    Pedersen, Carsten M; Rosendahl-Nielsen, Mette; Hjermind, Jeanette

    2008-01-01

    Intubated patients may be unable to adequately cough up secretions. Endotracheal suctioning is therefore important in order to reduce the risk of consolidation and atelectasis that may lead to inadequate ventilation. The suction procedure is associated with complications and risks including...... bleeding, infection, atelectasis, hypoxemia, cardiovascular instability, elevated intracranial pressure, and may also cause lesions in the tracheal mucosa. The aim of this article was to review the available literature regarding endotracheal suctioning of adult intubated intensive care patients...... and to provide evidence-based recommendations The major recommendations are suctioning only when necessary, using a suction catheter occluding less than half the lumen of the endotracheal tube, using the lowest possible suction pressure, inserting the catheter no further than carina, suctioning no longer than 15...

  9. Comparison of different tests to determine difficult intubation in pediatric patients

    Directory of Open Access Journals (Sweden)

    Mehmet Turan Inal

    2014-12-01

    Full Text Available Background: The difficulties with airway management is the main reason for pediatric anesthesia-related morbidity and mortality. Objective: To assess the value of modified Mallampati test, Upper-Lip-Bite test, thyromental distance and the ratio of height to thyromental distance to predict difficult intubation in pediatric patients. Design: Prospective analysis. Measurements and results: Data were collected from 5 to 11 years old 250 pediatric patients requiring tracheal intubation. The Cormack and Lehane classification was used to evaluate difficult laryngoscopy. Sensitivity, specificity, positive predictive value and AUC values for each test were measured. Results: The sensitivity and specificity of modified Mallampati test were 76.92% and 95.54%, while those for ULBT were 69.23% and 97.32%. The optimal cutoff point for the ratio of height to thyromental distance and thyromental distance for predicting difficult laryngoscopy was 23.5 (sensitivity, 57.69%; specificity, 86.61% and 5.5 cm (sensitivity, 61.54%; specificity, 99.11%. The modified Mallampati was the most sensitive of the tests. The ratio of height to thyromental distance was the least sensitive test. Conclusion: These results suggested that the modified Mallampati and Upper-Lip-Bite tests may be useful in pediatric patients for predicting difficult intubation.

  10. Hemodynamic responses to endotracheal intubation performed with video and direct laryngoscopy in patients scheduled for major cardiac surgery.

    Science.gov (United States)

    Sarkılar, Gamze; Sargın, Mehmet; Sarıtaş, Tuba Berra; Borazan, Hale; Gök, Funda; Kılıçaslan, Alper; Otelcioğlu, Şeref

    2015-01-01

    This study aims to compare the hemodynamic responses to endotracheal intubation performed with direct and video laryngoscope in patients scheduled for cardiac surgery and to assess the airway and laryngoscopic characteristics. One hundred ten patients were equally allocated to either direct Macintosh laryngoscope (n = 55) or indirect Macintosh C-MAC video laryngoscope (n = 55). Systolic, diastolic, and mean arterial pressure, and heart rate were recorded prior to induction anesthesia, and immediately and two minutes after intubation. Airway characteristics (modified Mallampati, thyromental distance, sternomental distance, mouth opening, upper lip bite test, Wilson risk sum score), mask ventilation, laryngoscopic characteristics (Cormack-Lehane, percentage of glottic opening), intubation time, number of attempts, external pressure application, use of stylet and predictors of difficult intubation (modified Mallampati grade 3-4, thyromental distance intubation time. Number of attempts, external pressure, use of stylet, and difficult intubation parameters were similar. Endotracheal intubation performed with direct Macintosh laryngoscope or indirect Macintosh C-MAC video laryngoscope causes similar and stable hemodynamic responses.

  11. Failed endotracheal intubation

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    Sheykhol Islami V

    1995-07-01

    Full Text Available The incidence of failed intubation is higher in obstetric than other surgical patients. Failed intubation was the 2nd commonest cause of mortality during anesthesia. Bearing in mind that failre to intubate may be unavoidable in certain circumstances, it is worth reviewing. The factors, which may contribute to a disastrous out come. Priorities of subsequent management must include maintaining oxygenation and preventing aspiration of gastric contents. Fiber optic intubation is now the technique of choice with a high success rate and with least trauma to the patient.

  12. Interleukin-6 as a marker of inflammation secondary to endotracheal intubation in pediatric patients.

    Science.gov (United States)

    Vasileiou, Panagiotis V S; Chalkias, Athanasios; Brozou, Vasiliki; Papageorgiou-Brousta, Mary; Kaparos, George; Koutsovasilis, Anastasios; Xanthos, Theodoros; Iacovidou, Nicoletta

    2013-12-01

    Ιnterleukin-6 (IL-6) has been identified as an early biochemical marker of inflammation both in animal and human studies. With this study, we sought to examine the development of local inflammation of the glottic tissues in correlation with the duration of intubation in anesthetized pediatric patients. We measured IL-6 levels in the organic material isolated from the tip of the tube post-extubation in 48 children aged 7 months to 14 years old who were submitted to a total of 72 surgical procedures. A statistically significant positive correlation (ρ = 0.28, p = 0.05) was detected among duration of anesthesia and IL-6 concentration. The odds of having detectable IL-6 levels rose by 36.7 % for every 10 min of anesthetic duration (p = 0.045). In conclusion, the increase of IL-6 in relation to the duration of the intubation indicates an increased risk of inflammation.

  13. Confusing Hypoxia in a 21-Year-Old Intubated Multiple Trauma Patient

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    Parvin Kashani

    2014-03-01

    Full Text Available A 21-year-old man was brought to the emergency department due to multiple trauma (MT caused by a motor car accident (MCA. On arrival, the patient was intubated by prehospital emergency medical services (EMS and had a Glasgow coma scale (GCS score of 6 on 10 (Due to intubation, verbal score was omitted. Physical examination revealed blood pressure of 150/70 mmHg, oxygen saturation (O2sat of 60%, and pulse rate of 110/min. Examination of the tracheal tube site revealed incorrect esophageal placement. The patient was intubated again and his O2sat improved and reached approximately 96%. His pupils were reactive and of the same size. The Doll’s eye was normal, and plantar reflex was neuter in both sides. Neither expanding hematoma nor emphysema was observed in his neck. Laceration was noted on his left ear, but otorrhagia and tympanic perforation were not found. The lung sounds were normal in both sides. Extended focused abdominal sonography for trauma (e-FAST examination revealed the absence of free fluid in the abdomen and pericardial space. No deformity of limbs was noted and the distal pulses were palpable. The patient’s O2sat decreased during his admission to the emergency department, and further examination indicated obvious decreased sound in his right lung that could not be reversed by needle thoracostomy. On reviewing his previous chest computed tomography, an obvious questionable pathology was detected in his right side Figure 1.What is your diagnosis?

  14. [Orotracheal intubation of patients with acromegaly using the AirTraq laryngoscope].

    Science.gov (United States)

    Castañeda Pascual, M; Navarro García, C; Batllori Gastón, M; Anadón Senac, María P; Arrondo Nicolás, J; Martín Vizcaíno, M P

    2011-01-01

    An excess of growth hormone is responsible for the phenotypical characteristics of acromegaly. Tissue hypertrophy and growth also affect the airway, potentially making perioperative management difficult. If tests to foresee the likelihood of difficult airway have limitations affecting their sensitivity, specificity and predictive value even in the normal population, their reliability in patients with acromegaly is still more doubtful. At this time, videoassisted or optical laryngoscopes can offer a way to facilitate intubation in these patients. We report 3 cases in which the AirTraq optical laryngoscope was used to gain a full view of the vocal cords in acromegalic patients scheduled for pituitary surgery by the transsphenoidal route.

  15. Evaluation of the effect of nasogastric intubation on gastrointestinal function after gastrectomy in gastric cancer patients

    Directory of Open Access Journals (Sweden)

    Chamanzari Hamid

    2016-08-01

    Full Text Available Background and Objective: The optimal treatment strategy for patients with gastric cancer is gastrectomy. Typically, nasogastric intubation is used after this type of surgery to feed patients; however, there seems to be no unanimity of opinion on this topic. Therefore, this study aimed to evaluate the effect of nasogastric intubation on gastrointestinal function after gastrectomy in gastric cancer patients. Materials and Method: This clinical trial was conducted on gastric cancer patients, admitted to the general ward of Imam Reza Hospital in Mashhad, Iran in 2015. In total, 68 patients were selected through randomized convenience sampling and divided into two intervention and control groups of 34 individuals. Nasogastric tube insertion was applied for the intervention group after the surgery. Patients of the study groups were fasted for three days after the surgery, which was followed by the removal of nasogastric tubes and initiation of oral feeding. Gastrointestinal function of all the participants was evaluated six hours after transferring to the ward up to seven days after the surgery on a daily basis using nausea and vomiting assessment tools and researcher-made questionnaire of gastrointestinal function. Data analysis was performed in SPSS version 16 using Fisher’s exact test, Chi-square, Mann-Whitney U, repeated measures ANOVA and paired t-test. Results: In this study, the severity of nausea and vomiting, the first time of passing gas and severity of flatulence Intensity were less observed in the control group, compared to the intervention group. Moreover, postoperative food tolerance was higher in the patients of the control group, compared to the other study group (P<0.05. Conclusion: According to the results of this study, nasogastric intubation can delay normal gastrointestinal function after gastrectomy. Therefore, it is not recommended to use this method after gastrectomy.

  16. ShikaniTM Seeing Optical Stylet-aided tracheal intubation in patients with a large epiglottic cyst

    Institute of Scientific and Technical Information of China (English)

    LIN Na; LI Mei; SHI Song; LI Tian-zuo; ZHANG Bing-xi

    2011-01-01

    Large epiglottic cysts can block the glottis,leading to serious consequences.This condition presents a challenge in terms of airway management for anesthesiologists during induction of anesthesia.We report the use of a ShikaniTM Seeing Optical Stylet combined with a Macintosh laryngoscope to aid tracheal intubation in seven patients with large epiglottic cysts.Use of this technique can avoid cyst rupture and allow smooth,safe intubation.

  17. Endotracheal Tube Cuff Pressures in Patients Intubated Prior to Helicopter EMS Transport

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    Joseph Tennyson

    2016-11-01

    Full Text Available Introduction: Endotracheal intubation is a common intervention in critical care patients undergoing helicopter emergency medical services (HEMS transportation. Measurement of endotracheal tube (ETT cuff pressures is not common practice in patients referred to our service. Animal studies have demonstrated an association between the pressure of the ETT cuff on the tracheal mucosa and decreased blood flow leading to mucosal ischemia and scarring. Cuff pressures greater than 30 cmH2O impede mucosal capillary blood flow. Multiple prior studies have recommended 30 cmH2O as the maximum safe cuff inflation pressure. This study sought to evaluate the inflation pressures in ETT cuffs of patients presenting to HEMS. Methods: We enrolled a convenience sample of patients presenting to UMass Memorial LifeFlight who were intubated by the sending facility or emergency medical services (EMS agency. Flight crews measured the ETT cuff pressures using a commercially available device. Those patients intubated by the flight crew were excluded from this analysis as the cuff was inflated with the manometer to a standardized pressure. Crews logged the results on a research form, and we analyzed the data using Microsoft Excel and an online statistical analysis tool. Results: We analyzed data for 55 patients. There was a mean age of 57 years (range 18-90. The mean ETT cuff pressure was 70 (95% CI= [61-80] cmH2O. The mean lies 40 cmH2O above the maximum accepted value of 30 cmH2O (p120 cmH2O, the maximum pressure on the analog gauge. Conclusion: Patients presenting to HEMS after intubation by the referral agency (EMS or hospital have ETT cuffs inflated to pressures that are, on average, more than double the recommended maximum. These patients are at risk for tracheal mucosal injury and scarring from decreased mucosal capillary blood flow. Hospital and EMS providers should use ETT cuff manometry to ensure that they inflate ETT cuffs to safe pressures.

  18. The effects of dexmedetomidine on attenuation of stress response to endotracheal intubation in patients undergoing elective off-pump coronary artery bypass grafting

    Directory of Open Access Journals (Sweden)

    Sajith Sulaiman

    2012-01-01

    Full Text Available This study was designed to study the efficacy of intravenous dexmedetomidine for attenuation of cardiovascular responses to laryngoscopy and endotracheal intubation in patients with coronary artery disease. Sixty adult patients scheduled for elective off-pump coronary artery bypass surgery were randomly allocated to receive dexmedetomidine (0.5 mcg/kg or normal saline 15 min before intubation. Patients were compared for hemodynamic changes (heart rate, arterial blood pressure and pulmonary artery pressure at baseline, 5 min after drug infusion, before intubation and 1, 3 and 5 min after intubation. The dexmedetomidine group had a better control of hemodynamics during laryngoscopy and endotracheal intubation. Dexmedetomidine at a dose of 0.5 mcg/kg as 10-min infusion was administered prior to induction of general anesthesia attenuates the sympathetic response to laryngoscopy and intubation in patients undergoing myocardial revascularization. The authors suggest its administration even in patients receiving beta blockers.

  19. [A case of endotracheal intubation in prone position utilizing PENTAX-Airwayscope for morbidly obese patient].

    Science.gov (United States)

    Suzuki, Hiroto; Nakajima, Waka; Aoyagi, Mitsuo; Takahashi, Minori; Kuzuta, Toshimichi; Osaki, Mami

    2012-04-01

    We experienced the airway management of a morbidly obese patient in prone position utilizing PENTAX-Airwayscope (AWS) which is a novel airway device for endotracheal intubation. A 29-year-old man, who was 150 kg in weight and 51.9 kg x m(-2) in body mass index, was scheduled for the discectomy for lumbar disc herniation. After the topical anesthesia with lidocaine spray, the patient lay on his stomach by himself on the table. Following the induction of general anesthesia with ketamine and dexmedetomidine in prone position, an anatomically curved blade (INTLOCK) was inserted to his oral cavity first, then the body of AWS was attached. With the patient breathing spontaneously, we successfully inserted the reinforced endotracheal tube. After the maintenance of anesthesia with continuous infusion of dexmedetomidine, ketamin and remifentanil, the patient awoke clearly without pain and endotracheal tube was removed safely in the prone position. Although the prone position is not the standard position for endotracheal intubation under general anesthesia, our technique could be performed in emergency situations.

  20. Clinical assessment of awake endotracheal intubation using the lightwand technique alone in patients with difficult airways

    Institute of Scientific and Technical Information of China (English)

    XUE Fu-shan; HE Nong; LIAO Xu; XU Xiu-Zheng; XU Yachao; YANG Quan-yong; LUO Mao-ping; ZHANG Yan-ming

    2009-01-01

    Background There is few study to determine whether the use of the lightwand technique alone could achieve effective, safe and successful awake endotracheal intubation (ETI), therefore we designed a prospective clinical study to systematically evaluate the feasibility, safety and efficacy of awake ETI using the lightwand alone in patients with difficult airways.Methods Seventy adult patients with difficult airways were enrolled in this study. After the desired sedation with fentanyl and midazolam, airway topical anesthesia was performed with 9 ml of 2% lidocaine, which were in order sprayed in three aliquots at 5 minutes intervals into the supraglottic (two doses) and laryngotracheal areas (one dose) using a combined unit of the lightwand and MADgic atomizer. After airway topical anesthesia, awake ETI was performed using a Lightwand. Subjective assessments by patients and operators using the visual analogue scores (VAS), and objective assessments by an independent investigator using patients' tolerance and reaction scores, coughing severity, intubating conditions and cardiovascular variables were taken as the observed parameters.Results Of 210 airway sprays, 197 (93.8%) were successfully completed on the first attempt. The total time for airway spray was (14.6±1.5) minutes. During airway topical anesthesia, the average patients' tolerance scores were 1.7-2.3. After airway topical anesthesia, the mean VAS for discomfort levels that the patients reported was 6.5. Also airway topical anesthesia procedure was rated as acceptable and no discomfort by 94.3% of patients. The lightwand-guided awake ETI was successfully completed on first attempt within 29 seconds in all patients. During awake ETI, patients' reaction and coughing scores were 1.9 and 1.6, respectively. All patients exhibited excellent or acceptable intubating conditions. Cardiovascular monitoring revealed that changes of systolic blood pressure and heart rate at each stage of airway manipulations were less

  1. 氟比洛芬酯用于骨科手术后躁动的临床研究%Clinical research on flurbiprofen axetil for postoperative agitation in patients undergoing orthopedic surgery

    Institute of Scientific and Technical Information of China (English)

    廖春英

    2015-01-01

    目的:评价氟比洛芬酯与地佐辛预防骨科手术后躁动的疗效及安全性。方法90例美国麻醉医师协会分级标准(ASA)Ⅰ~Ⅱ级择期进行骨科全麻手术患者随机分为氟比洛芬酯(A组),地佐辛组(B组),对照组(C组),每组各30例,术中给予相同的麻醉诱导和维持方案,手术结束前15 min,A组静脉注射比洛芬酯予1 mg・ kg-1,B组静脉注射地佐辛10 mg,C组给予0.9% NaCl溶液2 mL。记录每组患者的拔管时间,躁动评分及躁动发生事件,拔管后5 min疼痛评分,拔管前后的平均动脉压、心率及术后不良反应发生率。结果 A,B组的躁动发生率、拔管后5 min疼痛评分均显著低于C组( P<0.05),但B组的恶心、呕吐等不良反应发生率显著高于A,C组( P<0.05)。结论手术结束前15 min,骨科全麻手术患者静脉滴注氟比洛芬酯1 mg・ kg-1可有效减少术后躁动的发生率,且术后不良反应发生率低。%Objective To observe the effect and safety of flurbiprofen axetil and dezocine for the prevention against postoperative agitation on patients undergoing orthopedic surgery .Methods Ninety patients with gradeⅠ-Ⅱaccording to the classification of American society of anes-thesiologists ( ASA ) undergoing orthopedic surgery in general anesthesia were randomly assigned to the flurbiprofen axetil group ( group A) , dezo-cine group ( group B ) and control group ( group C ) .Patients in each group were respectively injected with flurbiprofen axetil 1 mg・ kg -1 , dezocine 10 mg, and 0.9% NaCl 2 mL intravenously 15 minutes before the end of surgery.The data of time of endotracheal intubation removal, scale of postoperative agitation and the incidence of postoperative agita-tion, verbal rating scale (VRS) for pain 5 minutes after endotracheal in-tubation removal, mean arterial pressure (MAP) and heart rate (HR), postoperative adverse drug reactions were observed and

  2. A 12 month clinical audit of cervical spine imaging in multiply injured and intubated patients.

    Science.gov (United States)

    Ball, C; Watson, D

    2010-03-01

    Previous work has questioned how plain films should be used when imaging the cervical spine of trauma patients. The authors wanted to identify whether the National Institute for Clinical Excellence (NICE) guidelines were being followed with respect to the imaging of patients presenting with cervical spine injury over a 1 year period. Data retrieved from the Electronic Digital Information Service (EDIS) computerised database records of all patients presenting with a triage code 1 or 2 between 1 September 2007 and 31 August 2008 were used to conduct a retrospective audit that identified multiply injured and intubated patients who did not undergo CT of the cervical spine and to highlight the use of plain films when the patient was to undergo CT of the head and cervical spine. A clinical record search identified 52 patients with a mean age of 32 years, of whom 73% were males, who had been admitted with multiple traumas and had undergone imaging of the cervical spine. Although no patient was intubated without undergoing CT of the cervical spine or head, seven patients had plain films when it was clear that they were to undergo CT. In conclusion, the audit emphasised the excellent work of emergency department and radiology staff in identifying and imaging multiple trauma patients, as all patients requiring CT of the cervical spine received this investigation. However, careful thought should be given to ordering plain films before CT, as some patients who clearly required CT of the cervical spine underwent unnecessary lateral plain films in the emergency department, delaying their progression to definitive care.

  3. Awake fiberoptic or awake video laryngoscopic tracheal intubation in patients with anticipated difficult airway management

    DEFF Research Database (Denmark)

    Rosenstock, Charlotte Vallentin; Thøgersen, Bente; Afshari, Arash;

    2012-01-01

    Awake flexible fiberoptic intubation (FFI) is the gold standard for management of anticipated difficult tracheal intubation. The purpose of this study was to compare awake FFI to awake McGrath® video laryngoscope, (MVL), (Aircraft Medical, Edinburgh, Scotland, United Kingdom) intubation in patien...

  4. Optimal dose of intravenous oxycodone for attenuating hemodynamic changes after endotracheal intubation in healthy patients

    Science.gov (United States)

    Park, Yong-Hee; Lee, Seung-Hyuk; Lee, Oh Haeng; Kang, Hyun; Shin, Hwa-Yong; Baek, Chong-Wha; Jung, Yong Hun; Woo, Young Cheol

    2017-01-01

    Abstract Background: Intravenous oxycodone has been used as an adjunct to anesthetic agents. This study aimed to assess the optimal dose of intravenous oxycodone for the attenuation of the hemodynamic responses to laryngoscopy and endotracheal intubation. Methods: A prospective, randomized, double-blind study was conducted. Ninety-five patients were randomly divided into 5 groups based on the oxycodone dose: 0, 0.05, 0.1, 0.15, 0.2 mg/kg. After administering the assigned dose of intravenous oxycodone, anesthesia was induced with thiopental. Heart rate (HR) and blood pressure (BP) were measured at baseline, before intubation, and 1, 2, and 3 minutes after intubation. The percentage increase of BP was calculated as (highest BP after intubation − baseline BP)/baseline BP × 100 (%). The percentage increase of HR was calculated in same formula as above. Hypertension was defined as a 15% increase of systolic BP from baseline, and probit analysis was conducted. Results: Hemodynamic data from 86 patients were analyzed. The percentage increase of mean arterial pressure after intubation in groups 0.05, 0.1, 0.15, and 0.2 was significantly different from that in the control (P < 0.001). For HR, the percentage increase was lower than control group when oxycodone was same or more than 0.1 mg/kg (P < 0.05). Using probit analysis, the 95% effective dose (ED95) for preventing hypertension was 0.159 mg/kg (95% confidence interval [CI], 0.122–0.243). In addition, ED50 was 0.020 mg/kg (95% CI, −0.037 to 0.049). However, oxycodone was not effective for maintaining the HR in our study dosage. There were no significant differences in the incidence of hypotension during induction between groups. Conclusions: Using 0.1 mg/kg of intravenous oxycodone is sufficient to attenuate the increase of BP and HR during induction period in healthy patients. The ED95, which was 0.159 mg/kg, can be useful to adjust the dosage of IV oxycodone for maintain stable BP

  5. I-gel Laryngeal Mask Airway Combined with Tracheal Intubation Attenuate Systemic Stress Response in Patients Undergoing Posterior Fossa Surgery

    Directory of Open Access Journals (Sweden)

    Chaoliang Tang

    2015-01-01

    patients. In this study, we proposed that I-gel combined with tracheal intubation could reduce the stress response of posterior fossa surgery patients. Methods. Sixty-six posterior fossa surgery patients were randomly allocated to receive either tracheal tube intubation (Group TT or I-gel facilitated endotracheal tube intubation (Group TI. Hemodynamic and respiratory variables, stress and inflammatory response, oxidative stress, anesthesia recovery parameters, and adverse events during emergence were compared. Results. Mean arterial pressure and heart rate were lower in Group TI during intubation and extubation (P<0.05 versus Group TT. Respiratory variables including peak airway pressure and end-tidal carbon dioxide tension were similar intraoperative, while plasma β-endorphin, cortisol, interleukin-6, tumor necrosis factor-alpha, malondialdehyde concentrations, and blood glucose were significantly lower in Group TI during emergence relative to Group TT. Postoperative bucking and serious hypertensions were seen in Group TT but not in Group TI. Conclusion. Utilization of I-gel combined with endotracheal tube in posterior fossa surgery patients is safe which can yield more stable hemodynamic profile during intubation and emergence and lower inflammatory and oxidative response, leading to uneventful recovery.

  6. Awake fi beroptic intubation of a patient with amyotrophic lateral sclerosis: case report

    Directory of Open Access Journals (Sweden)

    Elif Bakı

    2012-12-01

    Full Text Available Amyotrophic Lateral Sclerosis is a rapidly progressive disease from the fi fth to sixth decades of life causing degeneration and death of the upper and lower motor neurons and no effective treatment. The diagnosis isdependent on the clinical presentation and consistent electrodiagnostic studies. Progressive denervation affects the muscles, causing muscular weakness and atrophy, when the ventilation muscles are affected deathdue to respiratory failure occurs within a few years. We present the case of a 54 years old, 180 cm height and 94 kg weight male patient with amyotrophic lateral sclerosis who underwent surgical treatment of thyroidcancer. Fiberoptic intubation was orally performed providing spontaneus breathing. Propofol was applied after passing vocal cords. Anesthesia was maintained with sevofl orane (%2 and a mixture of oxygen and airunder volume controlled ventilation. Rocuronium was used 20 mg at the beginning of the surgery. At the end of surgery, he wasn’t extubated and transferred to anesthesia intensive care unit. He was extubated after tenhours and he was awaked perfectly. The patient was discharged from intensive care unit after 24 hours and from hospital after ten days. We reported that amyotrophic lateral sclerosis patient with limited mouth opening who underwent thyroid surgery, using awake intubation.

  7. A study to investigate the relationship between difficult intubation and prediction criterion of difficult intubation in patients with obstructive sleep apnea syndrome

    Directory of Open Access Journals (Sweden)

    Omer Kurtipek

    2012-01-01

    Full Text Available Background and Aim: Obstructive sleep apnea (OSA syndrome is predisposed to the development of upper airway obstruction during sleep, and it poses considerable problem for anesthetic management. Difficult intubation (DI is an important problem for management of anesthesia. In this clinical research, we aim to investigate the relationship between DI and prediction criteria of DI in cases with OSA. Materials and Methods: We studied 40 [OSA (Group O, n = 20 and non-OSA, (Group C, n = 20] ASA I-II, adult patients scheduled tonsillectomy under general anesthesia. Same anesthetic protocol was used in two groups. Intubation difficulties were assessed by Mallampati grading, Wilson sum score, Laryngoscopic grading (Cormack and Lehane, a line joining the angle of the mouth and tragus of the ear with the horizontal, sternomental distance, and tyromental distance. Demographic properties, time-dependent hemodynamic variables, doses of reversal agent, anesthesia and operation times, and recovery parameters were recorded. Results: Significant difference was detected between groups in terms of BMI, Mallampati grading, Wilson weight scores, Laryngoscopic grading, sternomental distance, tyromental distance, doses of reversal agent, and recovery parameters. Conclusion: OSA patient′s DI ratio is higher than that of non-OSA patients. BMI Mallampati grading, Wilson weight scores, Laryngoscopic grading, sternomental distance, and tyromental distance evaluation might be predictors for DI in patients with OSA.

  8. Can intravenous acetaminophen reduce the needs to more opioids to control pain in intubated patients?

    Directory of Open Access Journals (Sweden)

    Babak Mahshidfar

    2016-01-01

    Full Text Available Aims: To evaluate the effect of intravenous (IV acetaminophen on reducing the need for morphine sulfate in intubated patients admitted to the Intensive Care Unit (ICU. Settings and Design: Current study was done as a clinical trial on the patients supported by mechanical ventilator. Subjects and Methods: Behavioral pain scale (BPS scoring system was used to measure pain in the patients. All of the patients received 1 g, IV acetaminophen, every 6 h during the 1 st and 3 rd days of admission and placebo during the 2 nd and 4 th days. Total dose of morphine sulfate needed, its complications, and the BPS scores at the end of every 6 h interval were compared. Results: Totally forty patients were enrolled. The mean pain scores were significantly lower in the 2 nd and 4 th days (4.33 and 3.66, respectively; mean: 4.0 in which the patients had received just morphine sulfate compared to the 1 st and 3 rd days (7.36 and 3.93, respectively; mean: 5.65 in which the patients had received acetaminophen in addition to morphine sulfate too (P < 0.001. Cumulative dose of morphine sulfate used, was significantly higher in the 1 st and 3 rd days (8.92 and 3.15 mg, respectively; 12.07 mg in total compared to the 2 nd and 4 th days (6.47 mg and 3.22 mg, respectively; 9.7 mg in total (P = 0.035. Conclusion: In our study, IV acetaminophen had no effect on decreasing the BPSs and need of morphine sulfate in intubated patients admitted to ICU.

  9. The prediction of difficult intubation in obese patients using mirror indirect laryngoscopy: A prospective pilot study

    Directory of Open Access Journals (Sweden)

    Arne O Budde

    2013-01-01

    Full Text Available Background: The incidence of difficult laryngoscopy and intubation in obese patients is higher than in the general population. Classical predictors of difficult laryngoscopy and intubation have been shown to be unreliable. We prospectively evaluated indirect mirror laryngoscopy as a predictor of difficult laryngoscopy in obese patients. Materials and Methods: 60 patients with a body mass index (BMI greater than 30, scheduled to undergo general anesthesia, were enrolled. Indirect mirror laryngoscopy was performed and was graded 1-4 according to Cormack and Lehane. A view of grade 3-4 was classified as predicting difficult laryngoscopy. Additional assessments for comparison were the Samsoon and Young modification of the Mallampati airway classification, Wilson Risk Sum Score, neck circumference, and BMI. The view obtained upon direct laryngoscopy after induction of general anesthesia was classified according to Cormack and Lehane as grade 1-4. Results: Sixty patients met the inclusion criteria; however, 8 (13.3% patients had an excessive gag reflex, and examination of the larynx was not possible. 15.4% of patients who underwent direct laryngoscopy had a Cormack and Lehane grade 3 or 4 view and were classified as difficult. Mirror laryngoscopy had a tendency toward statistical significance in predicting difficult laryngoscopy in these patients. Conclusions: This study is consistent with previous studies, which have demonstrated that no one individual traditional test has proven to be adequate in predicting difficult airways in the obese population. However, the new application of an old test - indirect mirror laryngoscopy - could be a useful additional test to predict difficult laryngoscopy in obese patients.

  10. The degree of intubation difficulties and the frequency of complications in obese patients at the Hospital Emergency Department and the Intensive Care Unit: Case-control study.

    Science.gov (United States)

    Cierniak, Marcin; Sobczak, Renata; Timler, Dariusz; Wieczorek, Andrzej; Borkowski, Bartosz; Gaszyński, Tomasz

    2016-12-01

    The intubation difficulties in obese patients are not a new problem. They may result from an accumulation of fat in the oral cavity and cheeks. A thick tongue is also a significant factor. The literature reports that some tests to determine the intubation difficulties in obese people may be unreliable. The observed predictors of difficult intubation were the thyromental and sternomental distance and the intubation difficulty scale: FRONT score.The aim of this study was to assess the degree of difficult intubation in obese patients by the parameters such as the thyromental and sternomental distance. The authors also tried to evaluate the frequency of the guidewire usage and the number of intubation attempts in obese patients in the research sample.The study included the group of 153 patients intubated in prehospital conditions. The research was conducted in 3 clinical centers receiving patients from prehospital care. Among the members of the research sample, obese patients with body mass index >35 were selected and evaluated for various predictors of intubation difficulties. Quantitative analysis of differences in the incidence of the variables was assessed using the chi-squared test for P < 0.05. Analyses were performed in STATISTICA.Complications such as postintubation hematomas were more frequent in obese patients of the research sample. The frequency of the guidewire usage observed in that group was also higher. As anticipated by the adopted predictors, most of the obese patients were classified as difficult to intubate.There is a correlation between the occurrence of injuries and the prevalence of obesity in the research sample and the same dependency has been demonstrated in the issue concerning the use of the guidewire. Although the majority of predictors indicated patients with intubation difficulties, many predictors could show falsely positive results. The greater amount of intubation attempts was observed in obese patients. Further studies devoted to

  11. Persistent Genital Arousal Disorder: Confluent Patient History of Agitated Depression, Paroxetine Cessation, and a Tarlov Cyst

    OpenAIRE

    Simone Eibye; Hans Mørch Jensen

    2014-01-01

    We report a case of a woman suffering from persistent genital arousal disorder (PGAD) after paroxetine cessation. She was admitted to a psychiatric department and diagnosed with agitated depression. Physical investigation showed no gynaecological or neurological explanation; however, a pelvic MRI scan revealed a Tarlov cyst. Size and placement of the cyst could not explain the patient’s symptoms; thus neurosurgical approach would not be helpful. Her depression was treated with antidepressant ...

  12. Monitoring Agitated Behavior After acquired Brain Injury

    DEFF Research Database (Denmark)

    Aadal, Lena; Mortensen, Jesper; Nielsen, Jørgen Feldbaek

    2016-01-01

    Purpose: To describe the onset, duration, intensity, and nursing shift variation of agitated behavior in patients with acquired brain injury (ABI) at a rehabilitation hospital. Design: Prospective descriptive study. Methods: A total of 11 patients with agitated behavior were included. Agitated...

  13. The use of the Airtraq® optical laryngoscope for routine tracheal intubation in high-risk cardio-surgical patients

    Directory of Open Access Journals (Sweden)

    Fiedler Britta

    2011-10-01

    Full Text Available Abstract Background The Airtraq® optical laryngoscope (Prodol Ltd., Vizcaya, Spain is a novel disposable device facilitating tracheal intubation in routine and difficult airway patients. No data investigating routine tracheal intubation using the Airtaq® in patients at a high cardiac risk are available at present. Purpose of this study was to investigate the feasibility and hemodynamic implications of tracheal intubation with the Aitraq® optical laryngoscope, in high-risk cardio-surgical patients. Methods 123 consecutive ASA III patients undergoing elective coronary artery bypass grafting were routinely intubated with the Airtraq® laryngoscope. Induction of anesthesia was standardized according to our institutional protocol. All tracheal intubations were performed by six anesthetists trained in the use of the Airtraq® prior. Results Overall success rate was 100% (n = 123. All but five patients trachea could be intubated in the first attempt (95,9%. 5 patients were intubated in a 2nd (n = 4 or 3rd (n = 1 attempt. Mean intubation time was 24.3 s (range 16-128 s. Heart rate, arterial blood pressure and SpO2 were not significantly altered. Minor complications were observed in 6 patients (4,8%, i.e. two lesions of the lips and four minor superficial mucosal bleedings. Intubation duration (p = 0.62 and number of attempts (p = 0.26 were independent from BMI and Mallampati score. Conclusion Tracheal intubation with the Airtraq® optical laryngoscope was feasible, save and easy to perform in high-risk patients undergoing cardiac surgery. In all patients, a sufficient view on the vocal cords could be obtained, independent from BMI and preoperative Mallampati score. Trial Registration DRKS 00003230

  14. Tracheal intubation in patients with cervical spine immobilization: a comparison of the Airwayscope, LMA CTrach, and the Macintosh laryngoscopes.

    LENUS (Irish Health Repository)

    Malik, M A

    2009-05-01

    The purpose of this study was to evaluate the effectiveness of the Pentax AWS, and the LMA CTrach, in comparison with the Macintosh laryngoscope, when performing tracheal intubation in patients with neck immobilization using manual in-line axial cervical spine stabilization.

  15. Evaluation of the GlideScope for tracheal intubation in patients with cervical spine immobilisation by a semi-rigid collar.

    Science.gov (United States)

    Bathory, I; Frascarolo, P; Kern, C; Schoettker, P

    2009-12-01

    Application of cervical collars may reduce cervical spine movements but render tracheal intubation with a standard laryngoscope difficult if not impossible. We hypothesised that despite the presence of a Philadelphia Patriot cervical collar and with the patient's head taped to the trolley, tracheal intubation would be possible in 50 adult patients using the GlideScope and its dedicated stylet. Laryngoscopy was attempted using a Macintosh laryngoscope with a size 4 blade, and the modified Cormack-Lehane grade was scored. Subsequently, laryngoscopy with the GlideScope was graded and followed by tracheal intubation. All patients' tracheas were successfully intubated with the GlideScope. The median (IQR) intubation time was 50 s (43-61 s). The modified Cormack-Lehane grade was 3 or 4 at direct laryngoscopy. It was significantly reduced with the GlideScope (p collar and having their head taped to the trolley is possible with the help of the GlideScope.

  16. Persistent Genital Arousal Disorder: Confluent Patient History of Agitated Depression, Paroxetine Cessation, and a Tarlov Cyst

    Directory of Open Access Journals (Sweden)

    Simone Eibye

    2014-01-01

    Full Text Available We report a case of a woman suffering from persistent genital arousal disorder (PGAD after paroxetine cessation. She was admitted to a psychiatric department and diagnosed with agitated depression. Physical investigation showed no gynaecological or neurological explanation; however, a pelvic MRI scan revealed a Tarlov cyst. Size and placement of the cyst could not explain the patient’s symptoms; thus neurosurgical approach would not be helpful. Her depression was treated with antidepressant with little effect. Electroconvulsive therapy improved the patient’s symptoms though they did not fully resolve. More awareness of PGAD and thorough interdisciplinary conferences are necessary to insure an unequivocal treatment strategy.

  17. A comparison of McCoy, TruView, and Macintosh laryngoscopes for tracheal intubation in patients with immobilized cervical spine

    Directory of Open Access Journals (Sweden)

    Neerja Bharti

    2014-01-01

    Full Text Available Background: Cervical spine immobilization results in a poor laryngeal view on direct laryngoscopy leading to difficulty in intubation. This randomized prospective study was designed to compare the laryngeal view and ease of intubation with the Macintosh, McCoy, and TruView laryngoscopes in patients with immobilized cervical spine. Materials and Methods: 60 adult patients of ASA grade I-II with immobilized cervical spine undergoing elective cervical spine surgery were enrolled. Anesthesia was induced with propofol, fentanyl, and vecuronium and maintained with isoflurane and nitrous oxide in oxygen. The patients were randomly allocated into three groups to achieve tracheal intubation with Macintosh, McCoy, or TruView laryngoscopes. When the best possible view of the glottis was obtained, the Cormack-Lehane laryngoscopy grade and the percentage of glottic opening (POGO score were assessed. Other measurements included the intubation time, the intubation difficulty score, and the intubation success rate. Hemodynamic parameters and any airway complications were also recorded. Results: TruView reduced the intubation difficulty score, improved the Cormack and Lehane glottic view, and the POGO score compared with the McCoy and Macintosh laryngoscopes. The first attempt intubation success rate was also high in the TruView laryngoscope group. However, there were no differences in the time required for successful intubation and the overall success rates between the devices tested. No dental injury or hypoxia occurred with either device. Conclusion: The use of a TruView laryngoscope resulted in better glottis visualization, easier tracheal intubation, and higher first attempt success rate as compared to Macintosh and McCoy laryngoscopes in immobilized cervical spine patients.

  18. Verbal De-escalation of the Agitated Patient: Consensus Statement of the American Association for Emergency Psychiatry Project BETA De-escalation Workgroup.

    Science.gov (United States)

    Richmond, Janet S; Berlin, Jon S; Fishkind, Avrim B; Holloman, Garland H; Zeller, Scott L; Wilson, Michael P; Rifai, Muhamad Aly; Ng, Anthony T

    2012-02-01

    Agitation is an acute behavioral emergency requiring immediate intervention. Traditional methods of treating agitated patients, ie, routine restraints and involuntary medication, have been replaced with a much greater emphasis on a noncoercive approach. Experienced practitioners have found that if such interventions are undertaken with genuine commitment, successful outcomes can occur far more often than previously thought possible. In the new paradigm, a 3-step approach is used. First, the patient is verbally engaged; then a collaborative relationship is established; and, finally, the patient is verbally de-escalated out of the agitated state. Verbal de-escalation is usually the key to engaging the patient and helping him become an active partner in his evaluation and treatment; although, we also recognize that in some cases nonverbal approaches, such as voluntary medication and environment planning, are also important. When working with an agitated patient, there are 4 main objectives: (1) ensure the safety of the patient, staff, and others in the area; (2) help the patient manage his emotions and distress and maintain or regain control of his behavior; (3) avoid the use of restraint when at all possible; and (4) avoid coercive interventions that escalate agitation. The authors detail the proper foundations for appropriate training for de-escalation and provide intervention guidelines, using the "10 domains of de-escalation."

  19. Verbal De-escalation of the Agitated Patient: Consensus Statement of the American Association for Emergency Psychiatry Project BETA De-escalation Workgroup

    Directory of Open Access Journals (Sweden)

    Janet S. Richmond

    2012-04-01

    Full Text Available Agitation is an acute behavioral emergency requiring immediate intervention. Traditional methods of treating agitated patients, ie, routine restraints and involuntary medication, have been replaced with a much greater emphasis on a noncoercive approach. Experienced practitioners have found that if such interventions are undertaken with genuine commitment, successful outcomes can occur far more often than previously thought possible. In the new paradigm, a 3-step approach is used. First, the patient is verbally engaged; then a collaborative relationship is established; and, finally, the patient is verbally deescalated out of the agitated state. Verbal de-escalation is usually the key to engaging the patient and helping him become an active partner in his evaluation and treatment; although, we also recognize that in some cases nonverbal approaches, such as voluntary medication and environment planning, are also important. When working with an agitated patient, there are 4 main objectives: (1 ensure the safety of the patient, staff, and others in the area; (2 help the patient manage his emotions and distress and maintain or regain control of his behavior; (3 avoid the use of restraint when at all possible; and (4 avoid coercive interventions that escalate agitation. The authors detail the proper foundations for appropriate training for de-escalation and provide intervention guidelines, using the ‘‘10 domains of deescalation.’’ [West J Emerg Med. 2012;13(1:17–25.

  20. Use of laryngeal mask airway for non-endotracheal intubated anesthesia for patients with pectus excavatum undergoing thoracoscopic Nuss procedure

    Science.gov (United States)

    Du, Xiaojun; Mao, Songsong; Cui, Jianxiu; Ma, Jue; Zhang, Guangyan; Zheng, Yong; Zhou, Haiyu; Xie, Liang; Zhang, Dongkun; Shi, Ruiqing

    2016-01-01

    Background The aim of the present study was to determine the safety and feasibility of the use of laryngeal mask airway (LMA) for non-endotracheal intubated anesthesia for patients with pectus excavatum (PE) undergoing thoracoscopic Nuss procedure. Methods Between July 2015 and December 2015, 30 selected patients with PE were planned to undergo a thoracoscopic Nuss procedure using LMA for non-endotracheal intubated anesthesia in the Guangdong General Hospital. The clinical data were analyzed to evaluate the safety and feasibility of this technique. Results Of the 30 selected patients, two were female, the mean age was 16.04±5.09 years and the average Haller index was 3.37±0.88. A total of 27 cases (90%) succeeded at the first attempt, one patient required conversion to an endotracheal tube (ETT) because of continuous air leak. The peripheral O2 saturation (SpO2), end-tidal carbon dioxide (EtCO2) values, heart rate (HR), and mean arterial blood pressure (MAP) remained stable throughout the procedure in all cases. All of the 30 patients were successfully corrected without requiring conversion to an open surgery. Two patients experienced postoperative nausea and one reported a sore throat. Neither gastro-esophageal reflux nor in-hospital mortality occurred. Conclusions The use of LMA for non-endotracheal intubated anesthesia for selected patients with PE undergoing thoracoscopic Nuss procedure is clinically safe and technically feasible. PMID:27621860

  1. Dexmedetomidine for awake intubation and an opioid-free general anesthesia in a superobese patient with suspected difficult intubation

    OpenAIRE

    Gaszynski T; Gaszynska E; Szewczyk T

    2014-01-01

    Tomasz Gaszynski,1 Ewelina Gaszynska,2 Tomasz Szewczyk31Department of Anesthesiology and Intensive Therapy, 2Department of Hygiene and Health Promotion, 3Department of Gastroenterology, Oncology, and General Surgery, Barlicki University Hospital, Medical University of Lodz, PolandAbstract: Super-obese patients (body mass index [BMI] >50 kg/m2) are at a particularly high risk of anesthesia-related complications during postoperative period, eg, critical respiratory events including respi...

  2. Comparison the efficacy of herbal mouthwash with chlorhexidine on gingival index of intubated patients in Intensive Care Unit

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    Sahra Rezaei

    2016-01-01

    Full Text Available Background: Intubated patients in Intensive Care Unit (ICU are not able to take care of their mouth health, so they are at risk of bacterial colonization and dental plaques formation that can lead to systemic diseases such as pneumonia and gingivitis. Aims: In randomized, double-blind clinical study, the efficacy of natural herbal mouthwash containing Salvadora persica ethanol extract and Aloe vera gel was compared with chlorhexidine on gingival index (GI of intubated patients in ICU. Materials and Methods: Seventy-six intubated patients (18–64 years old with mean age 40.35 ± 13.2 in ICU were admitted to this study. The patients were randomly divided into two groups: (1 Herbal mouthwash and (2 chlorhexidine solution. Before the intervention, the GIs was measured by modified GI device into two groups. The mouth was rinsed by mouthwashes every 2–3 h for 4 days. 2 h after the last intervention, GIs were determined. Results: Along with mechanical methods, herbal mouthwash in reducing GI was statistically significant than that of chlorhexidine (P < 0.05. Conclusion: The results of this study introduce a new botanical extract mouthwash with dominant healing effects on GI (1.5 ± 0.6 higher than that of synthetic mouthwash, chlorhexidine (2.31 ± 0.73.

  3. Tracheal intubation in patients with rigid collar immobilisation of the cervical spine: a comparison of Airtraq and LMA CTrach devices.

    Science.gov (United States)

    Arslan, Z I; Yildiz, T; Baykara, Z N; Solak, M; Toker, K

    2009-12-01

    The aim of this study was to evaluate the effectiveness of the Airtraq and CTrach in lean patients with simulated cervical spine injury after application of a rigid cervical collar. Eighty-six consenting adult patients of ASA physical status 1 or 2, who required elective tracheal intubation were included in this study in a randomised manner. Anaesthesia was induced using 1 microg kg(-1) fentanyl, 3 mg kg(-1) propofol and 0.6 mg kg(-1) rocuronium, following which a rigid cervical collar was applied. Comparison was then made between tracheal intubation techniques using either the AirTraq or CTrach device. The mean (SD) time to see the glottis was shorter with the Airtraq than the CTrach (11.9 (6.8) vs 37.6 (16.7)s, respectively; p cervical spine immobilisation.

  4. The importance of neck circumference to thyromental distance ratio (NC/TM as a predictor of difficult intubation in obstructive sleep apnea (OSA patients

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    Hala Ezzat Abdel Naim

    2014-07-01

    Conclusion: Difficult intubation in OSA obese patients was independently associated with a Mallampati score of III or IV, and NC/TM ⩾5.15. Moreover, NC/TM yielded a high sensitivity, specificity and a negative predictive value.

  5. Does C-MAC® video laryngoscope improve the nasotracheal intubating conditions compared to Macintosh direct laryngoscope in paediatric patients posted for tonsillectomy surgeries?

    Science.gov (United States)

    Patil, Vinuta V; Subramanya, Bala H; Kiranchand, N; Bhaskar, S Bala; Dammur, Srinivasalu

    2016-01-01

    Background and Aims: C-MAC® video laryngoscope (VL) with Macintosh blade has been found to improve Cormack-Lehane (C-L) laryngoscopic view as well as intubating conditions for orotracheal intubation. However, studies done on the performance of C-MAC® VL for nasotracheal intubation (NTI) are very few in number. Hence, we compared laryngoscopy and intubating conditions between Macintosh direct laryngoscope and C-MAC® VL for NTI. Methods: Sixty American Society of Anesthesiologists Physical Status I, II patients, aged 8–18 years, posted for tonsillectomy surgeries under general anaesthesia with NTI were randomised, into two groups. Patients in group 1 were intubated using Macintosh direct laryngoscope and group 2 with C-MAC® VL. C-L grading, time required for intubation, need for additional manoeuvres and haemodynamic changes during and after intubation were compared between the groups. Results: C-L grade 1 views were obtained in 26 and 29 patients in group 1 and group 2, respectively (86.7% vs. 96.7%). Remaining patients were having C-L grade 2 (13.3% vs. 3.3%). Duration of intubation was less than a minute in group 2 (93.3%). Need for additional manoeuvres (M1–M5) were more in group 1 (97% vs. 77%). M1 (external manipulation) was needed more in group 2 compared to group 1 (53.3% vs. 30%). Magill's forceps alone (M4) and M4 with additional external manipulation (M5) were needed more in group 1 compared to group 2 (60% vs. 16%). Conclusion: The overall performance of C-MAC® VL was better when compared to conventional direct Macintosh laryngoscope during NTI in terms of glottis visualisation, intubation time and need for additional manoeuvres.

  6. A comparative study of endotracheal intubation as per intubation difficulty score, using Airtraq and McCoy laryngoscopes with manual-in-line axial stabilization of cervical spine in adult patients

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    Nilesh Sarvaiya

    2016-08-01

    Conclusions: The Airtraq facilitates the ease of intubation by providing a better view of the larynx as compared to McCoy laryngoscope in patients with manual-in-line axial stabilization of cervical spine. [Int J Res Med Sci 2016; 4(8.000: 3211-3218

  7. Novel use of an exchange catheter to facilitate intubation with an Aintree catheter in a tall patient with a predicted difficult airway: a case report

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    Gruenbaum Shaun E

    2012-04-01

    Full Text Available Abstract Introduction The Aintree intubating catheter (Cook® Medical Inc., Bloomington, IN, USA has been shown to successfully facilitate difficult intubations when other methods have failed. The Aintree intubating catheter (Cook® Medical Inc., Bloomington, IN, USA has a fixed length of 56 cm, and it has been suggested in the literature that it may be too short for safe use in patients who are tall. Case presentation We present the case of a 32-year-old, 180 cm tall Caucasian woman with a predicted difficult airway who presented to our facility for an emergency cesarean section. After several failed intubation attempts via direct laryngoscopy, an airway was established with a laryngeal mask airway. After delivery of a healthy baby, our patient's condition necessitated tracheal intubation. A fiber-optic bronchoscope loaded with an Aintree intubating catheter (Cook® Medical Inc., Bloomington, IN, USA was passed through the laryngeal mask airway into the trachea until just above the carina, but was too short to safely allow for the passage of an endotracheal tube. Conclusions We present a novel technique in which the Aintree intubating catheter (Cook® Medical Inc., Bloomington, IN, USA was replaced with a longer (100 cm exchange catheter, over which an endotracheal tube was passed successfully into the trachea.

  8. Rapid-Sequence Intubation

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    Evangelina Dávila Cabo de Villa

    2015-09-01

    Full Text Available In medical practice there are several situations that require immediate intervention of the airway in some patients, in order to ensure proper entrance and exit of gases into and out of the lungs and prevent aspiration. Rapid-sequence intubation has been considered as the administration of a hypnotic agent and a neuromuscular relaxant consecutively (virtually simultaneously to facilitate orotracheal intubation in critically ill patients and minimize the risk of aspiration. This paper aims to collect elements that promote a successful medical management according to the situation presented, since there is no single way of proceeding in case of rapid-sequence intubation. The elements to consider include: knowing the anatomy of the upper respiratory tract, having a group of drugs to choose from, receiving adequate training and having an alternative plan for the difficulties that may arise.

  9. Predictive value of preoperative tests in estimating difficult intubation in patients who underwent direct laryngoscopy in ear, nose, and throat surgery

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    Osman Karakus

    2015-04-01

    Full Text Available BACKGROUND AND OBJECTIVES: Predictive value of preoperative tests in estimating difficult intubation may differ in the laryngeal pathologies. Patients who had undergone direct laryngoscopy (DL were reviewed, and predictive value of preoperative tests in estimating difficult intubation was investigated. METHODS: Preoperative, and intraoperative anesthesia record forms, and computerized system of the hospital were screened. RESULTS: A total of 2611 patients were assessed. In 7.4% of the patients, difficult intubations were detected. Difficult intubations were encountered in some of the patients with Mallampati scoring (MS system Class 4 (50%, Cormack-Lehane classification (CLS Grade 4 (95.7%, previous knowledge of difficult airway (86.2%, restricted neck movements (cervical ROM (75.8%, short thyromental distance (TMD (81.6%, vocal cord mass (49.5% as indicated in parentheses (p < 0.0001. MS had a low sensitivity, while restricted cervical ROM, presence of a vocal cord mass, short thyromental distance, and MS each had a relatively higher positive predictive value. Incidence of difficult intubations increased 6.159 and 1.736-fold with each level of increase in CLS grade and MS class, respectively. When all tests were considered in combination difficult intubation could be classified accurately in 96.3% of the cases. CONCLUSION: Test results predicting difficult intubations in cases with DL had observedly overlapped with the results provided in the literature for the patient populations in general. Differences in some test results when compared with those of the general population might stem from the concomitant underlying laryngeal pathological conditions in patient populations with difficult intubation.

  10. Influence of local mucosal anesthesia combined with non tracheal intubation general anesthesia on EMR patients' intra-operative serum indexes

    Institute of Scientific and Technical Information of China (English)

    Sheng-Yong Liang

    2015-01-01

    Objective:To analyze the influence of local mucosal anesthesia combined with non tracheal intubation general anesthesia on EMR patients’ intra-operative serum indexes.Methods: 162 patients who received EMR from September 2013 to September 2014 in our hospital were enrolled and randomly divided into the observation group, including 81 cases, who received local mucosal anesthesia combined with non tracheal intubation general anesthesia, and the control group, including 81 cases, who received local mucosal anesthesia combined with routine tracheal intubation general anesthesia. Then inflammation index, stress index and immune index, etc were compared.Results:1) after general anesthesia, serum cytokine levels of IL-23, IL-32, PCT,β-EP and TNF-α, etc of the observation group were all significantly lower than those of the control group(P<0.05); 2) after general anesthesia, serum cytokine levels of COR, ET, TH and Ins, etc of the observation group were significantly lower than those of the control group(P<0.05); 3) after general anesthesia, serum levels of sICAM 1, CD11b, CD18 and CD20 of the observation group were lower than those of the control group; CD56 level was higher than that of the control group(P<0.05).Conclusion:Local mucosal anesthesia combined with non tracheal intubation general anesthesia provides sufficient anesthetic depth for EMR patients, and at the same time, can effectively reduce intra-operative systemic inflammatory response and stress response and contribute to the protection of body's immune function.

  11. [Prophylactic use of icatibant before tracheal intubation of a patient with hereditary angioedema type III. (A literature review of perioperative management of patients with hereditary angioedema type III)].

    Science.gov (United States)

    Iturri Clavero, F; González Uriarte, A; Tamayo Medel, G; Gamboa Setién, P M

    2014-01-01

    Type III hereditary angioedema is a rare familial disorder that has recently been described as a separate condition. Triggers for episodes of angioedema include surgery, dental procedures, and tracheal intubation maneuvers. Since episodes affecting the upper airway are potentially life-threatening, prophylactic treatment is recommended in these situations. The use of icatibant (Firazyr(®)), for prevention of angioedema prior to tracheal intubation, is reported in a patient with type iii hereditary angioedema. A literature review on the anesthetic management of this condition was conducted.

  12. Endotracheal intubation in the ICU.

    Science.gov (United States)

    Lapinsky, Stephen E

    2015-06-17

    Endotracheal intubation in the ICU is a high-risk procedure, resulting in significant morbidity and mortality. Up to 40% of cases are associated with marked hypoxemia or hypotension. The ICU patient is physiologically very different from the usual patient who undergoes intubation in the operating room, and different intubation techniques should be considered. The common operating room practice of sedation and neuromuscular blockade to facilitate intubation may carry significant risk in the ICU patient with a marked oxygenation abnormality, particularly when performed by the non-expert. Preoxygenation is largely ineffective in these patients and oxygen desaturation occurs rapidly on induction of anesthesia, limiting the time available to secure the airway. The ICU environment is less favorable for complex airway management than the operating room, given the frequent lack of availability of additional equipment or additional expert staff. ICU intubations are frequently carried out by trainees, with a lesser degree of airway experience. Even in the presence of a non-concerning airway assessment, these patients are optimally managed as a difficult airway, utilizing an awake approach. Endotracheal intubation may be achieved by awake direct laryngoscopy in the sick ICU patient whose level of consciousness may be reduced by sepsis, hypercapnia or hypoxemia. As the patient's spontaneous respiratory efforts are not depressed by the administration of drugs, additional time is available to obtain equipment and expertise in the event of failure to secure the airway. ICU intubation complications should be tracked as part of the ICU quality improvement process.

  13. Music in the nursing home : hitting the right note! The provision of music to dementia patients with verbal and vocal agitation in Dutch nursing homes

    NARCIS (Netherlands)

    van der Geer, E. R.; Vink, A. C.; Schols, J. M. G. A.; Slaets, J. P. J.

    2009-01-01

    Background: The study aims to provide insight into the type of music being offered in Dutch nursing homes to patients with both dementia and verbal and vocal agitation. It also investigates the degree to which the music offered corresponds to the musical preferences of the nursing home residents. Me

  14. ProSeal laryngeal mask airway: An alternative to endotracheal intubation in paediatric patients for short duration surgical procedures

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    Jaya Lalwani

    2010-01-01

    Full Text Available The laryngeal mask airway (LMA is a supraglottic airway management device. The LMA is preferred for airway management in paediatric patients for short duration surgical procedures. The recently introduced ProSeal (PLMA, a modification of Classic LMA, has a gastric drainage tube placed lateral to main airway tube which allows the regurgitated gastric contents to bypass the glottis and prevents the pulmonary aspiration. This study was done to compare the efficacy of ProSeal LMA with an endotracheal tube in paediatric patients with respect to number of attempts for placement of devices, haemodynamic responses and perioperative respiratory complications. Sixty children, ASA I and II, weighing 10-20 kg between 2 and 8 years of age group of either sex undergoing elective ophthalmological and lower abdominal surgeries of 30-60 min duration, randomly divided into two groups of 30 patients each were studied. The number of attempts for endotracheal intubation was less than the placement of PLMA. Haemodynamic responses were significantly higher (P<0.05 after endotracheal intubation as compared to the placement of PLMA. There were no significant differences in mean SpO 2 (% and EtCO 2 levels recorded at different time intervals between the two groups. The incidence of post-operative respiratory complications cough and bronchospasm was higher after extubation than after removal of PLMA. The incidence of soft tissue trauma was noted to be higher for PLMA after its removal. There were no incidences of aspiration and hoarseness/sore throat in either group. It is concluded that ProSeal LMA can be safely considered as a suitable and effective alternative to endotracheal intubation in paediatric patients for short duration surgical procedures.

  15. RATIO OF PATIENTS HEIGHT TO THYROMENTAL DISTANCE ( RHTMD COMPARED TO THYROMENTAL DISTANCE FOR PREDICTION OF DIFFICULT INTUBATION

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    Mohan

    2015-10-01

    Full Text Available BACKGROUND AND RATIONALE : Preoperative evaluation is important in the detection of patients at risk for difficult tracheal intubation. Thyromental distance (TMD is often used for these purposes, but its value as an indicator for difficult intubation is questionable, as it varies with patient size and body proportions. The purpose of the present study was to evaluate and compare the accuracies of th e Ratio o f Patient’s Height t o TMD (ratio of height to TMD=RHTMD, with TMD and Modified Mallampati classification (MP in the prediction of difficult tracheal intubation. OBJECTIVE : This study is an attempt in finding an airway index by making simple measurements to anticipate difficult airway and compare RHTMD with TMD and MP classification for predicting difficult airway. METHODS : 170 apparently normal ASA I & II patients who were u ndergoing elective surgeries under General Anaesthesia (GA were included in the study. The MP, TMD and RHTMD were determined in each patient preoperatively and Cormack – Lehane (CL grading was assessed during laryngoscopy. TMD ≤6.5cm, RHTMD > 25 and MP c lass III & IV were considered difficult intubation; these values were compared with CL grading. CL grade III&IV were considered as difficult intubation. The optimal predictive value was chosen using a receiver operating characteristic (ROC curve. The area s under the ROC curves (AUC of TMD and RHTMD were compared to determine the performance of the different predictive tests used. The sensitivity, specificity, and positive and negative predictive values of each of the predictive tests were calculated accor ding to standard formulae. RESULTS : Difficult intubation occurred in 6 out of 170 patients (3.5% in the study. The sensitivity of Modified Mallampati classification was 33.3% and specificity was 90.8%. The test has a positive predictive value of 11.7%, ne gative predictive value of 97.3% and overall accuracy of 88.8%. The sensitivity of TMD was 33.3% and

  16. A study to investigate the relationship between difficult intubation and prediction criterion of difficult intubation in patients with obstructive sleep apnea syndrome

    OpenAIRE

    Omer Kurtipek; Berrin Isik; Mustafa Arslan; Yusuf Unal; Yusuf Kizil; Yusuf Kemaloglu

    2012-01-01

    Background and Aim: Obstructive sleep apnea (OSA) syndrome is predisposed to the development of upper airway obstruction during sleep, and it poses considerable problem for anesthetic management. Difficult intubation (DI) is an important problem for management of anesthesia. In this clinical research, we aim to investigate the relationship between DI and prediction criteria of DI in cases with OSA. Materials and Methods: We studied 40 [OSA (Group O, n = 20) and non-OSA, (Group C, n = 20)] ASA...

  17. Clinical study of midazolam sequential with dexmedetomidine for agitated patients undergoing weaning to implement light sedation in intensive care unit

    Institute of Scientific and Technical Information of China (English)

    Xing Lu; Jun Li; Tong Li; Jie Zhang; Zhi-Bo Li; Xin-Jing Gao; Lei Xu

    2016-01-01

    Purpose:To evaluate midazolam sequential with dexmedetomidine for agitated patients undergoing weaning to implement light sedation in ICU.Methods:This randomized,prospective study was conducted in Tianjin Third Central Hospital,China.Using a sealed-envelope method,the patients were randomly divided into 2 groups (40 patients per group).Each patient of group A received an initial loading dose of midazolam at 0.3-3 mg/kg·h 24 h before extubation,followed by an infusion of dexmedetomidine at a rate of 0.2-1 μg/kg·h until extubation.Each patient of group B received midazolam at a dose of 0.3-3 mg/kg·h until extubation.The dose of sedation was regulated according to RASS sedative scores maintaining in the range of-2-1.All patients were continuously monitored for 60 min after extubation.During the course,heart rate (HR),mean artery pressure (MAP),extubation time,adverse reactions,ICU stay,and hospital stay were observed and recorded continuously at the following time points:24 h before extubation (T1),12 h before extubation (T2),extubation (T3),30 min after extubation (T4),60 min after extubation (T5).Results:Both groups reached the goal of sedation needed for ICU patients.Dexmedetomidine was associated with a significant increase in extubation quality compared with midazolam,reflected in the prevalence of delirium after extubation (20% (8/40) vs 45% (18/40)),respectively (p =0.017).There were no clinically significant decreases in HR and MAP after infusing dexmedetomidine or midazolam.In the group A,HR was not significantly increased after extubation;however,in the group B,HR was significantly increased compared with the preextubation values (p < 0.05).HR was significantly higher in the group B compared with the group A at 30 and 60 main after extubation (both,p < 0.05).Compared with preextubation values,MAP was significantly increased at extubation in the group B (p < 0.05) and MAP was significantly higher at T3,T4,T5 in the group B than group A (p < 0

  18. Suicidality and symptoms of anxiety, irritability, and agitation in patients experiencing manic episodes with depressive symptoms: a naturalistic study

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    Eberhard J

    2016-08-01

    Full Text Available Jonas Eberhard,1 Emmanuelle Weiller2 1Department of Clinical Sciences, Lund University, Lund, Sweden; 2H. Lundbeck A/S, Copenhagen, Denmark Purpose: Patients with a bipolar I disorder (BD-I manic episode meeting the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5, criteria for “with mixed features” have a high incidence of suicide attempts and of anxiety, irritability, and agitation (AIA symptoms. The aim of this analysis was to explore the relationship between suicidality and AIA symptoms in patients with BD-I experiencing mania with depressive symptoms, using data from a previous naturalistic study.Patients and methods: Psychiatrists completed an online questionnaire about their adult patients who had a current BD-I manic episode. Questions covered the DSM-5 “with mixed features” specifier, the severity of AIA symptoms, the frequency and controllability of suicidal ideation, and the number of suicide attempts.Results: Of 1,035 patients with BD-I mania who were included in the analyses, 348 (33.6% met the criteria for the DSM-5 “with mixed features” specifier (three or more depressive symptoms. These patients were further stratified according to the severity of their AIA symptoms: “mild AIA” (zero or one AIA symptom above a severity threshold; 105 patients or “severe AIA” (all three AIA symptoms above a severity threshold; 167 patients. A greater incidence of suicidal ideation was observed in the severe AIA group (71.9% than in the mild AIA group (47.6%. Twice as many patients had easily controlled suicidal ideation than difficult-to-control suicidal ideation in both subgroups. The mean number of suicide attempts was higher in the severe AIA group than in the mild AIA group, during the current episode (0.84 vs 0.34 attempts, respectively; P<0.05 and over the patient’s lifetime (1.56 vs 1.04 attempts, respectively.Conclusion: The high risk of suicide among BD-I mania patients with depressive

  19. EFFECT OF INTRAVENOUS LIDOCAINE, INTRAVENOUS ESMOLOL AND INTRAVENOUS CLONIDINE ON HAEMODYNAMIC RESPONSES TO LARYNGOSCOPY AND ORO - TRACHEAL INTUBATION IN NORMOTENSIVE PATIENTS: A DOUBLE BLINDED, COMPARITIVE STUDY

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    Savitha

    2014-01-01

    Full Text Available The pressure response to laryngoscopy and endotracheal intubation is without sequel in healthy individuals. In patients with pre - existing diseases , may precipitate myocardial ischemia , arrhythmias , infarction and cerebral hemorrhage . In view of that , the objectives of our study was , to assess the hemodynamic variations to laryngoscopic intubation and to evaluate the comparative efficacy of I.V Lidocaine , I.V Esmolol and I.V Clonidine , in attenuating the sympathetic response to laryngoscopy and orotracheal intubation in normotensive patients. METHODS : In our double blind , randomized , clinical prospective study 105 Indian ethnicity patients of either sex requiring oral intubation , who met inclusion criteria , were considered. Randomly patients were stratified into three groups (n=35 patients each Group C , Group E and Group L to receive inj Clonidine 1.5 μg/kg , inj Esmolol 1.5 mg/kg and inj Lidocaine 1.5 mg/kg respectively at 15min , 3min and 3min prior to intubation as premedication. Two senior postgraduates wh o were not involved in patient care were responsible for blinding techniques. Data obtained were analyzed after decoding. Analysis of variance (ANOVA , Chi - square/Fisher Exact test has been used to find the significance of study parameters on categorical s cale between the three groups. RESULTS : In our study there was strongly significant raise in heart rate (HR , systolic blood pressure (SBP , diastolic blood pressure (DBP and mean arterial pressure (MAP at one minute following intubation in all three groups (p <0.001. HR reached base line at 4min in group E which was statistically significant (p <0.001. In group C , SBP and DBP reached base line value in 2 min and 3 min Which is again statistically stro ngly significant (p <0.001. CONCLUSION : Esmolol 1.5 mg/kg I.V , 3 min prior to oro - tracheal intubation is a better drug of choice to control HR and Clonidine 1.5 μg/kg I.V , 15 min prior to orotracheal intubation is

  20. Bronchoscopy-guided nasotracheal intubation in patients of gastric tube intubation%纤维支气管镜引导下经鼻气管插管患者的胃管置入

    Institute of Scientific and Technical Information of China (English)

    田芳; 王巍

    2014-01-01

    目的:探讨在纤维支气管镜引导下经鼻气管插管患者的胃管置入方法。方法选择我科2011年至2013年间收住院的在纤维支气管镜的引导下经鼻气管插管后机械通气的60例患者,随机分两组,试验组30例采用在纤维支气管镜引导下留置胃管,对照组30例采用传统的方法留置胃管。结果试验组一次性插管的成功率明显高于对照组。结论在纤维支气管镜引导下对经鼻气管插管患者的胃管留置成功率较高,可以临床推广。%Objective To study the ifberoptic bronchoscopy in patients with nasal tracheal intubation guided by stomach tube placement method.Methods Choose 2011 ~ 2011 closed under the guidance of ifber bronchoscope in hospital after nasal endotracheal intubation mechanical ventilation of 60 patients, randomly divided into two groups, treatment group 30 cases used in guided by ifber bronchoscope indwelling gastric tube, the control group 30 cases with traditional method of indwelling gastric tube.Results the experimental group one-time success rate of intubation was obviously higher than that of control group. Conclusion fiberoptic bronchoscopy in patients with nasal tracheal intubation guided by gastric tube indwelling the success rate is high, can the clinical promotion..

  1. A Comparison of Performance of Endotracheal Intubation Using the Levitan FPS Optical Stylet or Lary-Flex Videolaryngoscope in Morbidly Obese Patients

    Directory of Open Access Journals (Sweden)

    Tomasz Gaszynski

    2014-01-01

    Full Text Available Introduction. The use of videolaryngoscopes is recommended for morbidly obese patients. The aim of the study was to evaluate the Levitan FPS optical stylet (Levitan vs Lafy-Flex videolaryngoscope (Lary-Flex in a group of MO patients. Methods. Seventy-nine MO (BMI>40 kg m−2 patients scheduled for bariatric surgery were included in the study and randomly allocated to the Levitan FPS or Lary-Flex group. The primary endpoint was time to intubation and evaluation laryngoscopic of glottic view. Anesthesiologists were asked to evaluate the glottic view first under direct laryngoscopy using the videolaryngoscope as a standard laryngoscope (monitor display was excluded from use and then using devices. The secondary endpoint was the cardiovascular response to intubation and the participant’s evaluation of such devices. Results. The time to intubation was 8.572.66 sec. versus 5.790.2 sec. for Levitan and Lary-Flex, respectively (P1 under direct laryngoscopy, the study devices improved CL grade to 1. The Levitan FPS produced a greater cardiovascular response than the Lary-Flex videolaryngoscope. Conclusion. The Lary-Flex videolaryngoscope and the Levitan FPS optical stylet improve the laryngeal visualization in morbidly obese patients, allowing for fast endotracheal intubation, but Lary-Flex produces less cardiovascular response to intubation attempt.

  2. Tracheal intubation in patients with cervical spine immobilization: A comparison of McGrath ® video laryngoscope and Truview EVO2 ® laryngoscope

    Directory of Open Access Journals (Sweden)

    Ruchi Bhola

    2014-01-01

    Full Text Available Background and Aims: Literature suggests that glottic view is better when using McGrath® Video laryngoscope and Truview® in comparison with McIntosh blade. The purpose of this study was to evaluate the effectiveness of McGrath Video laryngoscope in comparison with Truview laryngoscope for tracheal intubation in patients with simulated cervical spine injury using manual in-line stabilisation. Methods: This prospective randomised study was undertaken in operation theatre of a tertiary referral centre after approval from the Institutional Review Board. A total of 100 consenting patients presenting for elective surgery requiring tracheal intubation were randomly assigned to undergo intubation using McGrath® Video laryngoscope (n = 50 or Truview® (n = 50 laryngoscope. In all patients, we applied manual-in-line stabilisation of the cervical spine throughout the airway management. Statistical testing was conducted with the statistical package for the social science system version SPSS 17.0. Demographic data, airway assessment and haemodynamics were compared using the Chi-square test. A P < 0.05 was considered significant. Results: The time to successful intubation was less with McGrath video laryngoscope when compared to Truview (30.02 s vs. 38.72 s. However, there was no significant difference between laryngoscopic views obtained in both groups. The number of second intubation attempts required and incidence of complications were negligible with both devices. Success rate of intubation with both devices was 100%. Intubation with McGrath Video laryngoscope caused lesser alterations in haemodynamics. Conclusions: Both laryngoscopes are reliable in case of simulated cervical spine injury using manual-in-line stabilisation with 100% success rate and good glottic view.

  3. Tracheotomy does not affect reducing sedation requirements of patients in intensive care – a retrospective study

    OpenAIRE

    Veelo, Denise P; Dongelmans, Dave A; Binnekade, Jan M; Korevaar, Johanna C; Vroom, Margreeth B; Schultz, Marcus J

    2006-01-01

    Introduction Translaryngeal intubated and ventilated patients often need sedation to treat anxiety, agitation and/or pain. Current opinion is that tracheotomy reduces sedation requirements. We determined sedation needs before and after tracheotomy of intubated and mechanically ventilated patients. Methods We performed a retrospective analysis of the use of morphine, midazolam and propofol in patients before and after tracheotomy. Results Of 1,788 patients admitted to our intensive care unit d...

  4. Comparison of intubation success and glottic visualization using King Vision and C-MAC videolaryngoscopes in patients with cervical spine injuries with cervical immobilization: A randomized clinical trial

    Science.gov (United States)

    Shravanalakshmi, Dhanyasi; Bidkar, Prasanna U.; Narmadalakshmi, K.; Lata, Suman; Mishra, Sandeep K.; Adinarayanan, S.

    2017-01-01

    Background: Glottic visualization can be difficult with cervical immobilization in patients with cervical spine injury. Indirect laryngoscopes may provide better glottic visualization in these groups of patients. Hence, we compared King Vision videolaryngoscope, C-MAC videolaryngoscope for endotracheal intubation in patients with proven/suspected cervical spine injury. Methods: After standard induction of anesthesia, 135 patients were randomized into three groups: group C (conventional C-MAC videolaryngoscope), group K (King Vision videolaryngoscope), and group D (D blade C-MAC videolaryngoscope). Cervical immobilization was maintained with Manual in line stabilization with anterior part of cervical collar removed. First pass intubation success, time for intubation, and glottic visualization (Cormack – Lehane grade and percentage of glottic opening) were noted. Intubation difficulty score (IDS) was used for grading difficulty of intubation. Five-point Likert scale was used for ease of insertion of laryngoscope. Results: First attempt success rate were 100% (45/45), 93.3% (42/45), and 95.6% (43/45) in patients using conventional C-MAC, King Vision, and D blade C-MAC videolaryngoscopes, respectively. Time for intubation in seconds was significantly faster with conventional C-MAC videolaryngoscope (23.3 ± 4.7) compared to D blade C-MAC videolaryngoscope (26.7 ± 7.1), whereas conventional C-MAC and King Vision were comparable (24.9 ± 7.2). Good grade glottic visualization was obtained with all the three videolaryngoscopes. Conclusion: All the videolaryngoscopes provided good glottic visualization and first attempt success rate. Conventional C-MAC insertion was significantly easier. We conclude that all the three videolaryngoscopes can be used effectively in patients with cervical spine injury. PMID:28217398

  5. Nasal intubation: A comprehensive review

    Directory of Open Access Journals (Sweden)

    Varun Chauhan

    2016-01-01

    Full Text Available Nasal intubation technique was first described in 1902 by Kuhn. The others pioneering the nasal intubation techniques were Macewen, Rosenberg, Meltzer and Auer, and Elsberg. It is the most common method used for giving anesthesia in oral surgeries as it provides a good field for surgeons to operate. The anatomy behind nasal intubation is necessary to know as it gives an idea about the pathway of the endotracheal tube and complications encountered during nasotracheal intubation. Various techniques can be used to intubate the patient by nasal route and all of them have their own associated complications which are discussed in this article. Various complications may arise while doing nasotracheal intubation but a thorough knowledge of the anatomy and physics behind the procedure can help reduce such complications and manage appropriately. It is important for an anesthesiologist to be well versed with the basics of nasotracheal intubation and advances in the techniques. A thorough knowledge of the anatomy and the advent of newer devices have abolished the negative effect of blindness of the procedure.

  6. Laryngotracheal Injury following Prolonged Endotracheal Intubation

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    J. Mehdizadeh

    2006-07-01

    Full Text Available Background: Prolonged endotracheal intubation is a growing method for supporting ventilation in patients who require intensive care. Despite considerable advancement in endotracheal intubation, this method still has some complications; the most important is laryngo-tracheal injuries. Methods: Over a 2-year period, this retrospective study was conducted on 57 patients with history of prolonged intubation who were referred to the ENT Department of Amir Alam Hospital. For each patient, a complete evaluation including history, physical examination, and direct laryngoscopy and bronchoscopy was done under general anesthesia. Results: Fifty-seven patients (44 male; mean age, 23.014.7 years were studied. Mean intubation period was 15.88 days. The most common presenting symptom was dyspnea (62%. Head trauma was responsible for most cases of intubation (72.4%. The most common types of tracheal and laryngeal lesions were tracheal (56.9% and subglottic (55.2% stenosis, respectively. Mean length of tracheal stenosis was 0.810.83 cm. There was a statistically significant relationship between length of tracheal stenosis and intubation period (P=0.0001 but no relation was observed between tracheal stenosis and age, sex, and etiology of intubation (All P=NS. Among the glottic lesions, inter- arytenoids adhesion was the most common lesion (25.9%. No statistically significant relation was found between glottic and subglottic lesions and age, sex and intubation period (all P=NS. Length of stenosis and intubation period was significantly greater in tracheal/ subglottic lesions than those in glottic/ supraglottic lesions (all P=NS. Conclusion: After prolonged endotracheal intubation, laryngo-tracheal lesions had no relation with patient’s age, sex, and cause of intubation.There was direct relation between length of tracheal stenosis and intubation period. Glottic lesions were more commonly observed in head trauma patients. Lesion length and intubation

  7. Cervical spine movement during intubation

    Directory of Open Access Journals (Sweden)

    Amlan Swain

    2017-01-01

    Full Text Available There have been growing concerns following documented instances of neurological deterioration in patients with cervical spine injury as a result of intubation. A significant body of evidence has since evolved with the primary objective of ascertaining the safest way of securing the endotracheal tube in patients with suspected and proven cervical injury. The search for a mode of intubation producing the least movement at the cervical spine is an ongoing process and is limited by logistic and ethical issues. The ensuing review is an attempt to review available evidence on cervical movements during intubation and to comprehensively outline the movement at the cervical spine with a wide plethora of intubation aids. Literature search was sourced from digital libraries including PubMed, Medline and Google Scholar in addition to the standard textbooks of Anaesthesiology. The keywords used in literature search included 'cervical spine motion,' 'neurological deterioration,' 'intubation biomechanics,' 'direct laryngoscopy,' 'flexible fibreoptic intubation,' 'video laryngoscopes' and 'craniocervical motion.' The scientific information in this review is expected to assist neuroanaesthesiologists for planning airway management in patients with neurological injury as well as to direct further research into this topic which has significant clinical and patient safety implications.

  8. THE COMPARATIVE STUDY OF STANDARD MACINTOSH HANDLE VERSUS SHORT HANDLE FOR LARYNGOSCOPY AND INTUBATION IN OBSTETRIC PATIENTS FOR LOWER SEGMENT CESAREAN SECTION

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    Neeharika

    2014-09-01

    Full Text Available : INTRODUCTION: The incidence of failed intubation is higher in obstetrics (1:280 than other surgical patients (1:2230. The anatomical factors that place the pregnant patient at increased risk for airway complications and difficult intubation include pregnancy induced generalized weight gain particularly increase in breast size, respiratory mucosal edema, and an increased risk of pulmonary aspiration. In the supine position, the enlarged breasts tend to fall back against the neck, which can interfere with insertion of the laryngoscope. The aim of our study is to assess the efficacy of short handle laryngoscope versus standard Macintosh handle laryngoscope for laryngoscopy and intubation in obstetric patients posted for Lower Segment Cesarean Section. PLAN OF STUDY: Randomized prospective study. ASA grade I and II full term obstetric patients posted for elective or emergency LSCS studied in two groups[ Group I (n=20 - Standard Macintosh handle, Group II (n=20 - Short / stubby handle (Anesthetics make, India]. Height and weight of patients were recorded. Head, neck and oral cavity of the patient were examined to rule out any obvious pathology and to detect any anticipated difficult intubations for exclusion. Examination of the airway included: neck length, sternomental distance, thyromental distance, inter incisor gap, chest circumference and modified Mallampati grading. The observations noted during laryngoscopy: number of attempts for insertion of laryngoscope into oral cavity, ease of insertion of laryngoscope blade into oral cavity, number of attempts for successful intubation, duration of laryngoscopy and intubation, perpendicular distance from the lower edge of distal end of laryngoscope handle to patient’s chest wall. OBSERVATIONS: The perpendicular distance was significantly higher in group II (16 cm than group I (13.6 cm.The time for laryngoscopy and intubation hard a significant correlation to weight as well as chest circumference in

  9. BLIND NASAL INTUBATION IN CRANIOROFACIAL TRAUMA

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    K.R.DavidThakaran

    2013-09-01

    Full Text Available Restricted mouth opening presents one of the greatest challenges to the anesthetist for endotracheal intubation and ventilation. Awake blind nasal intubation has been one of the finest and favored techniques for intubation in previous decades for restricted mouth opening patients. A coordinated team approach, monitoring and adequate counseling of the patient is mandatory for the airway management to carry out a safe surgical procedure

  10. Flurbiprofen Axetil Enhances Analgesic Effects of Sufentanil and Attenuates Postoperative Emergence Agitation and Systemic Proinflammation in Patients Undergoing Tangential Excision Surgery

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    Wujun Geng

    2015-01-01

    Full Text Available Objective. Our present study tested whether flurbiprofen axetil could reduce perioperative sufentanil consumption and provide postoperative analgesia with decrease in emergency agitation and systemic proinflammatory cytokines release. Methods. Ninety patients undergoing tangential excision surgery were randomly assigned to three groups: (1 preoperative dose of 100 mg flurbiprofen axetil and a postoperative dose of 2 μg/kg sufentanil and 10 mL placebo by patient-controlled analgesia (PCA pump, (2 preoperative dose of 100 mg flurbiprofen axetil and a postoperative dose of 2 μg/kg sufentanil and 100 mg flurbiprofen axetil by PCA pump, and (3 10 mL placebo and a postoperative dose of 2 μg/kg sufentanil and 10 mL placebo by PCA pump. Results. Preoperative administration of flurbiprofen axetil decreased postoperative tramadol consumption and the visual analog scale at 4, 6, 12, and 24 h after surgery, which were further decreased by postoperative administration of flurbiprofen axetil. Furthermore, flurbiprofen axetil attenuated emergency agitation score and Ramsay score at 0, 5, and 10 min after extubation and reduced the TNF-α and interleukin- (IL- 6 levels at 24 and 48 h after the operation. Conclusion. Flurbiprofen axetil enhances analgesic effects of sufentanil and attenuates emergence agitation and systemic proinflammation in patients undergoing tangential excision surgery.

  11. Dexmedetomidine as an adjunct to anesthetic induction to attenuate hemodynamic response to endotracheal intubation in patients undergoing fast-track CABG

    Directory of Open Access Journals (Sweden)

    Menda Ferdi

    2010-01-01

    Full Text Available During induction of general anesthesia hypertension and tachycardia caused by tracheal intubation may lead to cardiac ischemia and arrhythmias. In this prospective, randomized study, dexmedetomidine has been used to attenuate the hemodynamic response to endotracheal intubation with low dose fentanyl and etomidate in patients undergoing myocardial revascularization receiving beta blocker treatment. Thirty patients undergoing myocardial revascularization received in a double blind manner, either a saline placebo or a dexmedetomidine infusion (1 µg/kg before the anesthesia induction. Heart rate (HR and blood pressure (BP were monitored at baseline, after placebo or dexmedetomidine infusion, after induction of general anesthesia, one, three and five minutes after endotracheal intubation. In the dexmedetomidine (DEX group systolic (SAP, diastolic (DAP and mean arterial pressures (MAP were lower at all times in comparison to baseline values; in the placebo (PLA group SAP, DAP and MAP decreased after the induction of general anesthesia and five minutes after the intubation compared to baseline values. This decrease was not significantly different between the groups. After the induction of general anesthesia, the drop in HR was higher in DEX group compared to PLA group. One minute after endotracheal intubation, HR significantly increased in PLA group while, it decreased in the DEX group. The incidence of tachycardia, hypotension and bradycardia was not different between the groups. The incidence of hypertension requiring treatment was significantly greater in the PLA group. It is concluded that dexmedetomidine can safely be used to attenuate the hemodynamic response to endotracheal intubation in patients undergoing myocardial revascularization receiving beta blockers.

  12. Hemodynamic changes during tracheal intubation using propofol and rocuronium after pre-treatment with ephedrine in adult patients

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    Yeshraj Gangaiah

    2015-12-01

    Results: Pre-treatment with ephedrine hydrochloride prior to induction with propofol provided enhanced intubating conditions compared to propofol alone during rapid tracheal intubation 60 seconds after rocuronium bromide injection. However, it did not produce significant elevations of systolic and diastolic blood pressure as well as mean arterial pressure from the baseline. Pre-treatment in the EPR group resulted in an increase in the heart rate compared to the SPR group 1 min post intubation. Conclusion: The findings of the present study display that pre-treatment with ephedrine prior to propofol administration produces better intubating conditions compared to propofol alone during rapid tracheal intubation with rocuronium without significant hemodynamic changes. However, pre-treatment produced mild tachycardia, which was advantageous. It did not have any effect on the duration of laryngoscopy and the time taken for intubation. [J Exp Integr Med 2015; 5(4.000: 193-199

  13. Occurrence and severity of agitated behavior after severe traumatic brain injury

    DEFF Research Database (Denmark)

    Moth Wolffbrandt, Mia; Poulsen, Ingrid; Engberg, Aase W;

    2013-01-01

    To investigate the occurrence and severity of agitation in patients after severe traumatic brain injury (TBI), to identify predictors of agitation and to study interrater reliability for a translated version of the Agitated Behavior Scale (ABS).......To investigate the occurrence and severity of agitation in patients after severe traumatic brain injury (TBI), to identify predictors of agitation and to study interrater reliability for a translated version of the Agitated Behavior Scale (ABS)....

  14. Long-term survival in elderly patients with a do-not-intubate order treated with noninvasive mechanical ventilation

    Directory of Open Access Journals (Sweden)

    Riario-Sforza GG

    2011-04-01

    Full Text Available Paolo Scarpazza1, Cristoforo Incorvaia2, Paolo Amboni3, Giuseppe di Franco1, Stefania Raschi1, Pierfranco Usai1, Monica Bernareggi1, Cristiano Bonacina1, Chiara Melacini1, Roberta Cattaneo1, Serena Bencini1, Chiara Pravettoni2, Gian Galeazzo Riario-Sforza2, Gianni Passalacqua4, Walter Casali11Divisione di Broncopneumotisiologia, Ospedale Civile, Vimercate, Italy; 2Pulmonary Rehabilitation, Istituti Clinici di Perfezionamento, Milan, Italy; 3Clinical Chemistry Laboratory, Ospedali Riuniti, Bergamo, Italy; 4Allergy and Respiratory Diseases, University Of Genoa, Genoa, ItalyBackground: Noninvasive mechanical ventilation (NIMV is an effective tool in treating patients with acute respiratory failure (ARF, since it reduces both the need for endotracheal intubation and the mortality in comparison with nonventilated patients. A particular issue is represented by the outcome of NIMV in patients referred to the emergency department for ARF and with a do-not-intubate (DNI status because of advanced age or excessively critical conditions. This study evaluated long-term survival in a group of elderly patients with acute hypercapnic ARF who had a DNI order and who were successfully treated by NIMV.Methods: The population consisted of 54 patients with a favorable outcome after NIMV for ARF. They were followed up for 3 years by regular control visits, with at least one visit every 4 months, or as needed according to the patient’s condition. Of these, 31 continued NIMV at home and 23 were on long-term oxygen therapy (LTOT alone.Results: A total of 16 of the 52 patients had not survived at the 1-year follow-up, and another eight patients died during the 3-year observation, with an overall mortality rate of 30.8% after 1 year and 46.2% after 3 years. Comparing patients who continued NIMV at home with those who were on LTOT alone, 9 of the 29 patients on home NIMV died (6 after 1 year and 3 after 3 years and 15 of the 23 patients on LTOT alone died (10 after 1

  15. [Fiberoptic tracheal intubation through a laryngeal mask airway in a pediatric patient with treacher collins syndrome].

    Science.gov (United States)

    Ogata, Tokiko; Saito, Tomoyuki; Tachikawa, Mayumi; Arai, Takero; Okuda, Yasuhisa

    2013-12-01

    A 6-month-old girl with Treacher Collins syndrome was scheduled for tracheotomy because of severe airway obstruction. During slow induction of anesthesia with inhalation of sevoflurane, assisted mask ventilation was successfully performed using oropharyngeal airway. Either direct laryngoscope or GlideScope Video Laryngoscope could not reveal any part of the epiglottis (Cormack and Lehane grade 4). Even fiberoptic bronchoscopic examination assisted by GlideScope Video Laryngoscope gave a poor view of the pharynx on the video monitor. Laryngeal mask airway (LMA) was inserted easily and allowed adequate ventilation, through which fiberoptic intubation was successfully achieved. We cut the LMA short in order to pass the 3 mm tracheal tube until the glottis through it.

  16. Individual Music Therapy for Agitation in Dementia

    DEFF Research Database (Denmark)

    Ridder, Hanne Mette Ochsner; Stige, Brynjulf; Qvale, Liv Gunnhild

    2013-01-01

    Objectives: Agitation in nursing home residents with dementia leads to increase in psychotropic medication, decrease in quality of life, and to patient distress and caregiver burden. Music therapy has previously been found effective in treatment of agitation in dementia care but studies have been...... methodologically insufficient. The aim of this study was to examine the effect of individual music therapy on agitation in persons with moderate/severe dementia living in nursing homes, and to explore its effect on psychotropic medication and quality of life. Method: In a crossover trial, 42 participants...... with dementia were randomized to a sequence of six weeks of individual music therapy and six weeks of standard care. Outcome measures included agitation, quality of life and medication. Results: Agitation disruptiveness increased during standard care and decreased during music therapy. The difference at −6...

  17. Influence of head flexion on intraocular pressure, cardiovascular, and respiratory responses in patients undergoing cataract surgery after endotracheal intubation

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    MR Safavi

    2007-11-01

    Full Text Available Background: In cataract surgery, the periorbital area is prepared anddraped after induction of general anesthesia and endotracheal intubation (ETI.For this purpose, the patient’s head and neck is usually flexed 30 to 45degrees. Neck flexion causes displacement of the endotracheal tube tip towardthe carina. Stimulation of the tracheal mucosa may cause bucking, increasedintraocular pressure (IOP, laryngospasm and/or bronchospasm, during lightanesthesia. Laryngeal constriction and all components of the tracheal responsemay affect end-tidal carbon dioxide pressure (PETCO2 and peripheral arterialhemoglobin oxygen saturation (SpaO2. Thus, in the current study, weinvestigated the influence of head and neck flexion on heart rate (HR, systolicand diastolic blood pressure (SAP and DAP, SpaO2, PETCO2, and IOP in patientsundergoing cataract surgery with endotracheal intubation during generalanesthesia.Patients and Methods: The present prospective study comprised patientsaged from 40 to 80 year with 106 American Society of Anesthesia (ASA physicalstatus I and II. Anesthesia was induced with thiopental sodium, lidocaine andfentanyl. Atracurium 0.5 mg/kg was administered to facilitate trachealintubation. HR, SAP, DAP, SpaO2, PETCO2, and IOP were measured at 1, 2, and 5minutes after head flexion.Results: Mean SAP, DAP, IOP, and HR was increased after ETI and headflexion compared with baseline values. PETCO2 and SpaO2 were decreased after ETIand at 1, 2 minutes after head flexion compared with baseline values.Conclusion: In patients undergoing cataract surgery during generalanesthesia, endotracheal tube movement caused changes in head and neck positionresulting in significant effects on heart rate, systolic and diastolic bloodpressures, laryngeal reflexes, SpaO2, PETCO2, and intraocular pressure.

  18. USE OF A BLIND INTUBATION DEVICE FOR NASOTRA-CHEAL INTUBATION IN TEMPOROMANDIBULAR JOINT ANKYLOSIS

    Institute of Scientific and Technical Information of China (English)

    2011-01-01

    Objective To evaluate light-guided tracheal intubation using blind intubation device (BID) in adult patients with temporomandibular joint ankylosis. Methods Twenty adult patients, American Society of Anesthesiologists (ASA) physical status Ⅰ or Ⅱ, with temporomandibular joint ankylosis were selected for awake blind nasal intubation. The patients were prepared with nasal decongestants and inhaled 100% oxygen for 3min, then fentanyl (2μg/kg) and midazolam (1-5 mg) were intravenously injected for sedation. Top...

  19. A survey of a population of anaesthesiologists from South India regarding practices for rapid sequence intubation in patients with head injury

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    Satyen Parida

    2016-01-01

    Full Text Available Background and Aims: Evidence and utility of the individual steps of the rapid sequence induction and tracheal intubation protocols have been debated, especially in the setting of traumatic brain injury. The purpose of this survey was to determine preferences in the current approach to rapid sequence intubation ( RSI in head injury patients among a population of anaesthesiologists from South India. Methods: A questionnaire was E-mailed to all the members of the Indian Society of Anaesthesiologists′ South Zone Chapter to ascertain their preferences, experience and comfort level with regard to their use of rapid sequence intubation techniques in adult patients with head injury. Participants were requested to indicate their practices for RSI technique for a head-injured patient upon arrival at the Emergency Medical Services department of their hospital. Results: The total response rate was 56.9% (530/932. Of the total respondents, 35% of the clinicians used cricoid pressure routinely, most respondents (68% stated that they pre-oxygenate the patients for about 3 min prior to RSI, thiopentone (61% and propofol (34% were commonly used prior to intubation. Rocuronium was the muscle relaxant of choice for RSI among the majority (44%, compared to succinylcholine (39%. Statistical analyses were performed after the initial entry onto a spreadsheet. Data were summarised descriptively using frequency distribution. Conclusion: In a rapid sequence intubation situation, the practice differed significantly among anaesthesiologists. Owing to disagreements and paucity of evidence-based data regarding the standards of RSI, it is apparent that RSI practice still has considerable variability in clinical practice.

  20. A pillow of 8 cm height did not improve laryngeal view and alignment of airway axes but increased anesthesiologist discomfort compared to a pillow of 4 cm height during tracheal intubation in adult patients

    Science.gov (United States)

    Hong, Hyo Ju; Kim, Sung Hoon; Hwang, Jung Won; Lee, Hyung Chul

    2016-01-01

    Background Neck flexion by head elevation using an 8 to 10 cm thick pillow and head extension has been suggested to align the laryngeal, pharyngeal and oral axis and facilitate tracheal intubation. Presently, the laryngeal view and discomfort for tracheal intubation were evaluated according to two different degrees of head elevation in adult patients. Methods This prospective randomized, controlled study included 50 adult patients aged 18 to 90 years. After induction of anesthesia, the Cormack Lehane grade was evaluated in 25 patients using a direct laryngoscope while the patient's head was elevated with a 4 cm pillow (4 cm group) and then an 8 cm pillow (8 cm group). In the other 25 patients, the grades were evaluated in the opposite sequence and tracheal intubation was performed. The success rate and anesthesiologist's discomfort score for tracheal intubation, and laryngeal, pharyngeal and oral axes were assessed. Results There were no differences in the laryngeal view and success rate for tracheal intubation between the two groups. The discomfort score during tracheal intubation was higher in the 8 cm group when the patient's head was elevated 4 cm first and then 8 cm. The alignment of laryngeal, pharyngeal and oral axes were not different between the two degrees of head elevation. Conclusions A pillow of 8 cm height did not improve laryngeal view and alignment of airway axes but increased the anesthesiologist discomfort, compared to a pillow of 4 cm height, during tracheal intubation in adult patients. PMID:27066204

  1. Delayed sequence intubation: is it ready for prime time?

    Science.gov (United States)

    Taylor, John A; Hohl, Corinne Michele

    2017-01-01

    Clinical question Does delayed sequence intubation (DSI) improve preoxygenation and safety when intubating otherwise uncooperative patients? Article chosen Weingart SD, Trueger S, Wong N, et al. Delayed sequence intubation: a prospective observational study. Ann Emerg Med 2015;65(4):349-55. doi:10.1016/j.annemergmed.2014.09.025 OBJECTIVE: To investigate whether the administration of ketamine 3 minutes prior to the administration of a muscle relaxant allows for optimal preoxygenation in uncooperative patients undergoing intubation.

  2. Comparison of the single-use Ambu(®) aScope™ 2 vs the conventional fibrescope for tracheal intubation in patients with cervical spine immobilisation by a semirigid collar*.

    Science.gov (United States)

    Krugel, V; Bathory, I; Frascarolo, P; Schoettker, P

    2013-01-01

    Fibreoptic intubation remains a key technique for the management of difficult intubation. We randomly compared the second generation single-use Ambu(®) aScope™ 2 videoscope with a standard re-usable flexible intubating fibrescope in 50 tracheal intubations in patients with a difficult airway simulated by a semirigid collar. All patients' tracheas were intubated successfully with the aScope 2 or the re-usable fibrescope. The median (IQR [range]) time to intubate was significantly longer with the aScope 2 70 (55-97 [41?-226]) s vs 50 (40-59 [27-175]) s, p = 0.0003) due to an increased time to see the carina. Quality of vision was significantly lower with the aScope 2 (excellent 24 (48%) vs 49 (98%), p = 0.0001; good 22 (44%) vs 1 (2%), p = 0.0001; poor 4 (8%) vs 0, p = 0.12) but with no difference in the subjective ease to intubate (easy score of 31 (62%) vs 38 (76%), p = 0.19; intermediate 12 (24%) vs 7 (14%), p = 0.31; difficult 7 (14%) vs 5 (5%), p = 0.76). The longer times to intubate and the poorer scores for quality of vision do not support the use of the single-use aScope 2 videoscope as an alternative to the re-usable fibrescope.

  3. Levodopa reverse stridor and prevent subsequent endotracheal intubation in Parkinson disease patients with bilateral vocal cord palsy

    Science.gov (United States)

    Tsai, Chia-Chan; Wu, Meng-Ni; Liou, Li-Min; Chang, Yang-Pei

    2016-01-01

    Abstract Background: Respiratory abnormalities are often overlooked; however, because of their potential comorbidity, they must be analyzed to determine the most effective treatment for patients with Parkinson disease (PD). Among various theories on respiratory abnormalities in PD, “upper airway obstruction” and “restrictive respiratory disorders” are 2 of the most accepted etiologies; both appear to be related to basal ganglia dysfunction. Complex vocal cord muscle dysfunction contributes to stridor, which can be a manifestation of nigrostriatal dopaminergic dysfunction. Stridor is a lethal form of upper airway obstruction in PD patients; its most frequent causes are bilateral vocal cord palsy, laryngeal spasms, and dystonia of the supra-laryngeal muscle. Several previous studies have suggested that levodopa administration induces a significant improvement of both lung function and symptoms of parkinsonian syndrome. Case Summary: We reported a 77-year-old gentleman PD patient admitted for acute levodopa-responsive stridor resulting from bilateral vocal cord palsy. Dopaminergic therapy prevented the need for subsequent endotracheal intubation and tracheostomy treatment. Conclusion: It is vital to understand that complex vocal cord muscle dysfunction may be related to nigrostriatal dopaminergic dysfunction in PD patients. The strategy of levodopa up-titration should be considered an option because it may be beneficial in relieving both stridor and parkinsonian syndrome, and in preventing respiratory failure. PMID:27977587

  4. Intentional esophageal intubation to improve visualization during emergent endotracheal intubation in the context of massive vomiting: a case report.

    Science.gov (United States)

    Sorour, Khaled; Donovan, Lucas

    2015-03-01

    Impaired visualization during intubation due to vomitus of gastric contents is a potential cause of failed intubation. An 82-year-old woman was intubated emergently for respiratory distress secondary to aspiration of gastric contents. Her intubation was hindered by the presence of a massive amount of ongoing vomitus that impaired visualization and overwhelmed all suction capabilities. Intentional blind intubation of the esophagus with an endotracheal tube was performed with successful diversion of ongoing vomitus away from the airway. Thereafter, after brief suctioning, the larynx was quickly visualized and the patient was successfully intubated.

  5. Managing agitated behaviour in older people.

    Science.gov (United States)

    King, Camille

    2012-09-01

    Older people diagnosed with dementia can have complex needs, especially when they exhibit agitated behaviour. Patients with agitated behaviour challenge the delivery of health care. Often the behaviour is a symptom of unmet needs in this population (Dewing 2010). It is important for nurses to understand the underlying causes and apply evidence-based interventions in their nursing practice to promote health, safety and the highest quality of life possible. This article defines and classifies agitated behaviours, discusses implications for their management and then presents evidence-based interventions nurses can use. The interventions are categorised according to each of the five senses.

  6. 痴呆患者激越症状的识别和处理%Identification and treatment of agitation symptoms in dementia patients

    Institute of Scientific and Technical Information of China (English)

    刘慧慧; 徐白萱; 李灿; 孙璇; 孙虹; 刘赛男; 谭纪萍; 姜磊; 郭艳娥; 王振福; 贾建军

    2015-01-01

    Objective To study the therapeutic effect of memantine on agitation symptoms by early identifying them in dementia patients .Methods Neuropsychology was assessed in 10 dementia patients with behavioral and psychological symptoms according to MMSE ,MoCA and NPI .The patients underwent brain MRI and PIB‐PET MRI scanning for further diagnosis of agitation symptoms and reexamined 3 months after they were treated with memantine .Results The agi‐tated ,aggressive ,irritative and anxiety symptoms were siginificantly improved in all the 10 pa‐tients ,and their cognitive function and daily living ability were also improved .The typical symp‐toms in 3 out of the 10 dementia patients were significantly improved .The mild agitation symp‐toms that were difficult to identify could be effectively treated with memantine .Conclusion The early the agitation symptoms are diagnosed ,the better the therapeutic effect is .%目的:早期识别痴呆患者的激越症状,并观察盐酸美金刚的疗效。方法对10例伴有精神行为症状的痴呆患者行神经心理评估,包括简易智能状态检查量表、蒙特利尔认知评估量表和神经精神量表等;并行头颅结构M RI和匹兹堡复合物B正电子发射断层显像M RI扫描进一步明确诊断,使用盐酸美金刚治疗3个月后,复查神经心理量表。结果10例痴呆患者的激越/攻击、易激惹、焦虑等症状均有显著改善,认知功能和日常生活能力亦有改善。其中3例患者症状改善明显,且具有典型表现。对于临床较难识别的轻度激越症状,可通过盐酸美金刚治疗有效获得侧面证据。结论早期识别痴呆患者的激越症状,早期干预可获明显疗效。

  7. Changes in oxidative stress from tracheal aspirates sampled during chest physical therapy in hospitalized intubated infant patients with pneumonia and secretion retention

    OpenAIRE

    Leelarungrayub J; Borisuthibandit T; Yankai A; Boontha K

    2016-01-01

    Jirakrit Leelarungrayub,1 Thirasak Borisuthibandit,2 Araya Yankai,1 Kritsana Boontha1 1Department of Physical Therapy, Faculty of Associated Medical Sciences, 2Department of Pediatric, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand Objective: This study aimed to show the changes in oxidative stress and clinical condition from either chest physical therapy (CPT) or CPT with aerosol treatment in infant patients with pneumonia.Methods: From 52 intubated patients, three groups...

  8. Comparison of the laryngeal view during intubation using Airtraq and Macintosh laryngoscopes in patients with cervical spine immobilization and mouth opening limitation

    OpenAIRE

    Koh, Jae-Chul; Lee, Jong Seok; Lee, Youn-Woo; Chang, Chul Ho

    2010-01-01

    Background For patients suspicious of cervical spine injury, a Philadelphia cervical collar is usually applied. Application of Philadelphia cervical collar may cause difficult airway. The aim of this study was to evaluate the laryngeal view and the success rate at first intubation attempt of the Airtraq and conventional laryngoscopy in patients with simulated cervical spine injury after application of a Philadelphia cervical collar. Methods Anesthesia was induced with propofol, remifentanil, ...

  9. A modified submental orotracheal intubation

    Science.gov (United States)

    Savitha, Keelara Shivalingaiah; Kujur, Abha Rani; Vikram, M. S.; Joseph, Shirley

    2016-01-01

    In patients with concomitant occurrence of maxillofacial and basilar skull fractures, open reduction and internal fixation is the treatment. It requires intermittent intra operative dental occlusion which precludes oral or nasal intubation. In such cases submental intubation (SMI) is a recognized technique in practice. We describe a modified technique for smooth exteriorization of the endotracheal tube (ETT) during SMI. As the SMI technique is unusual for the performer, emphasis is laid on the applied aspects to minimize probable complications during the procedure. With the modified technique we performed SMI uneventfully on five patients PMID:26957708

  10. Efficacy of intravenous dexmedetomidine on patient's satisfaction, comfort and sedation during awake fibre-optic intubation in patients with cervical spondylotic myelopathy posted for elective cervical fixation

    Directory of Open Access Journals (Sweden)

    Saikat Niyogi

    2017-01-01

    Full Text Available Background and Aims: Various anaesthetic drugs, in addition to airway block, are used for producing favourable intubation conditions during awake fibre-optic intubation (AFOI, but most of them cause respiratory depression and hypoxaemia. The aim of this study was to evaluate the efficacy of intravenous (IV dexmedetomidine (DEX on sedation, patient comfort and cardiovascular responses during AFOI in patients with cervical spondylotic myelopathy (CSM. Methods: This randomised, placebo-controlled, double-blinded, prospective study was conducted on 56 adult patients with cervical spondylotic myelopathy (CSM undergoing elective cervical fixation, who were randomly allocated into two groups - Group D and Group C. Group D patients received DEX infusion at a rate of 1 μg/kg for the first 10 min followed by 0.5 μg/kg/h and Group C received 0.9% normal saline infusion in the same manner. Airway blocks with lignocaine were given to all patients before undergoing AFOI. Patient's alertness, sedation and cardiorespiratory changes during the procedure were assessed by the Observer Assessment Awareness and Sedation (OAA/S scale. On the 1st post-operative day, patient's' comfort during AFOI was assessed by visual analogue scale (VAS. Results: Patients of Group D had an acceptable level of sedation (OAA/S score: 20 to 17 with greater comfort and satisfaction (VAS: 40–60, compared to control group (VAS: 50–90, P < 0.001.. Moreover, haemodynamic parameters were less significantly altered in the DEX group during AFOI. Conclusions: IV DEX infusion during AFOI improves patient's tolerances with an acceptable level of sedation without significant haemodynamic instability and respiratory depression.

  11. Changes in oxidative stress from tracheal aspirates sampled during chest physical therapy in hospitalized intubated infant patients with pneumonia and secretion retention

    OpenAIRE

    Leelarungrayub, Jirakrit; Borisuthibandit, Thirasak; Yankai,Araya; Boontha, Kritsana

    2016-01-01

    Objective This study aimed to show the changes in oxidative stress and clinical condition from either chest physical therapy (CPT) or CPT with aerosol treatment in infant patients with pneumonia. Methods From 52 intubated patients, three groups were composed: groups A, B, and C comprising 21 patients aged 5.3±0.6 months (CPT program), 20 patients aged 5.6±0.7 months (aerosol treatment before CPT program), and eleven patients aged 5.0±0.35 months (control), respectively. CPT was composed of ma...

  12. The effects of preemptive pregabalin on attenuation of stress response to endotracheal intubation and opioid- sparing effect in patients undergoing off-pump coronary artery bypass grafting

    Directory of Open Access Journals (Sweden)

    Ayya Syama Sundar

    2012-01-01

    Full Text Available The clinical study was designed to evaluate and compare single preoperative dose of pregabalin to a placebo regarding hemodynamic responses to laryngoscopy and endotracheal intubation, to assess perioperative fentanyl requirement and any side-effects. It was a randomized, double-blind, placebo-controlled, parallel assignment, efficacy study. The study was done at a tertiary university hospital. This study was a comparison between two groups of 30 adult patients scheduled for elective off pump coronary artery bypass surgery. In the control group, the patients were given placebo capsules, and in the pregabalin group, the patients were given pregabalin 150 mg capsule orally 1 h before surgery. The patients were compared for hemodynamic changes before the start of the surgery, after induction, 1, 3, and 5 min after intubation. Additionally, fentanyl requirement during surgery and the first postoperative day was also compared. The present study shows that a single oral dose of 150 mg pregabalin given 1 h before surgery attenuated the pressor response to tracheal intubation in adults, but the drug did not show any effect on perioperative opioid consumption and was devoid of side-effects in the given dose.

  13. Effects of combination oral care on oral health, dry mouth and salivary pH of intubated patients: A randomized controlled trial.

    Science.gov (United States)

    Jang, Chun Sun; Shin, Yong Soon

    2016-10-01

    Intubated patients are at risk of oral health problems. Although a variety of oral care regimens for intubated patients have been studied, there is a lack of research on the effects of combination oral care that includes tooth brushing, chlorhexidine and cold water. This open-labelled, randomized, controlled trial aimed to evaluate the effects of combination oral care on oral health status. Participants aged 20 years and older were recruited on the first day after intubation through convenience sampling in a medical intensive care unit. Random assignment was performed using an internet randomization service. The primary outcome was oral health status. Data were collected during May and June 2013. Participants were randomized to one of two groups (23 intervention and 21 control). The final analysis included 18 patients with combination oral care and 17 in the control group. The intervention group had better oral health (effect size = 1.56), less dry mouth and higher salivary pH than the control group. Any additional burden of providing combination oral care to patients who are mechanically ventilated is worthwhile in terms of clinical outcomes.

  14. Dexmedetomidine for Preventing the Agitation after Sevoflurane Anesthesia in Pediatric Patients During Wakefulness%右美托咪定预防小儿七氟烷麻醉后苏醒期的躁动反应

    Institute of Scientific and Technical Information of China (English)

    张志军; 张永平

    2013-01-01

    [目的]探讨右美托咪定对小儿七氟烷麻醉后苏醒期躁动的预防作用。[方法]本院80例急诊手术患儿,按实验设计分成右美托咪定组(A组)和对照组(B组),每组40例。两组患儿均采用七氟烷吸入诱导,气管插管后行机械通气,术中予吸入七氟烷-空氧混合气体维持。A组在此基础上连续静脉输注右美托咪定0.5μg/(kg · h )至手术结束前5 min停用。采用改良Aldrete评分、PAEDS评分和CHEOPS评分对两组患儿的复苏状况、苏醒期躁动和术后疼痛进行评估。[结果]两组患儿麻醉后恢复室(PACU)停留时间相比较差异无显著性( P>0.05),A组苏醒期各时间段躁动发生率均小于B组( P<0.05)。两组患儿各时段改良 Aldrete评分比较无统计学差异。入PACU后B组各时点PAEDS评分均高于 A组( P <0.05),且第20 min和第30 min B组CHEOPS评分高于 A组( P <0.05)。[结论]静脉连续输注右美托咪定不会显著延长小儿的苏醒时间,且苏醒过程中躁动的发生率明显降低,因此右美托咪定能预防小儿七氟烷麻醉后苏醒期的躁动反应。%[Objective] To explore dexmedetomidine for preventing the agitation after sevoflurane anesthesia in chil-dren during wakefulness .[Methods]According to experimental design ,80 pediatric patients with emergency operation in our hospital were randomly assigned into dexmedetomidine group (Group A) and control group(Group B) with 40 cases in each group .Pediatric patients in both groups were given mechanical ventilation after tracheal intubation under sevoflurane induction inhalation ,and then inhaled with sevoflurane and oxygen-air mixed gas for anesthesia maintenance .Additional-ly ,Group A received continuous intravenous infusion with dexmedetomidine 0 .5μg/kg/hr until 5min before the end of surgery .The modified Aldrete scale ,PAEDS score and CHEOPS score were used to evaluate the resuscitation

  15. Laryngeal morbidity after tracheal intubation

    DEFF Research Database (Denmark)

    Sørensen, M K; Rasmussen, N; Kristensen, M S

    2013-01-01

    BACKGROUND: Tracheal intubation may cause vocal fold damage. The trial was designed to assess laryngeal morbidity comparing the Endoflex(®) tube with a conventional endotracheal tube with stylet. We hypothesised that laryngeal morbidity within the first 24 h after extubation would be lower...... with the Endoflex tube than with the conventional endotracheal tube with stylet because of less rigidity. METHODS: This randomised trial included 130 elective surgical patients scheduled for general anaesthesia with endotracheal intubation. Pre- and post-operative assessment of hoarseness, vocal fold pathology......, and voice analysis using the Multidimensional Voice Program was performed. Induction of anaesthesia was standardised. After complete neuromuscular paralysis, intubation was done with an Endoflex tube or a conventional endotracheal tube with stylet. RESULTS: Post-operative hoarseness was found in 45...

  16. Dexmedetomidine provides optimum conditions during awake fiberoptic intubation in simulated cervical spine injury patients

    Directory of Open Access Journals (Sweden)

    Pooja Chopra

    2016-01-01

    Conclusions: Dexmedetomidine provides optimum sedation without compromising airway or hemodynamic instability with better patient tolerance and satisfaction for AFOI. It also preserves patient arousability for the postintubation neurological assessment.

  17. An incidentaloma at ileal intubation.

    LENUS (Irish Health Repository)

    Donnellan, Fergal

    2012-02-01

    The authors report the case of a primary small bowel lymphoma discovered incidentally in a 33-year-old male following ileal intubation at colonoscopy. The patient subsequently underwent curative treatment with chemotherapy. This case not only highlights the importance of routine ileoscopy but also the successful use of chemotherapy in a disease for which the optimal treatment modality has not been well characterized.

  18. Prediction of difficult intubations using conventional indicators; Does rapid sequence intubation ease difficult intubations? A prospective randomised study in a tertiary care teaching hospital

    Directory of Open Access Journals (Sweden)

    Gangadharan Lakshmi

    2011-01-01

    Full Text Available Background : Endotracheal intubations performed in the Emergency Department. Aims : To assess whether conventional indicators of difficult airway can predict a difficult intubation in the Emergency Setting and to investigate the effect of rapid sequence intubation (RSI on ease of intubation. Settings and Design : A prospective randomized study was designed involving 60 patients requiring intubation, over a period of 4 months. Materials and Methods : Demographic profile, details of methods used, airway assessment, ease of intubation, and Cormack and Lehane score were recorded. Airway assessment score and ease of intubation criteria were devised and assessed. Statistical Analysis : Descriptive statistical analysis was carried out. Chi-square/2 × 2, 2 × 3, 3 × 3, Fisher Exact test have been used to find the significance of study parameters on categorical scale between two or more groups. Results : Patients with a Mallampatti score of three or four were found to have worse laryngoscopic views (Cormack-Lehane score, 3 or 4. Of all airway indicators assessed, an increased Mallampatti score was found to have significant correlation with increased difficulty in intubation. The use of RSI was associated with better laryngoscopic views, and easier intubations. Conclusions : An airway assessment using the Mallampatti score is invaluable as a tool to predict a difficult airway and should be performed routinely if possible. RSI aids intubation ease. If not otherwise contraindicated, it should be performed routinely for all intubations in the ED.

  19. Nasotracheal intubation of a patient with restricted mouth opening using a McGrath MAC X-Blade and Magill forceps.

    Science.gov (United States)

    Arslan, Zehra İpek; Ozdal, P; Ozdamar, D; Agır, H; Solak, M

    2016-10-01

    We experienced a case of successful nasotracheal intubation using the X-Blade of the McGrath MAC in a 28-year-old woman with a 2.5-cm mouth opening. She had no teeth on the right side, her neck movement was limited, her mandibular protrusion was grade C, and her Mallampati could not be evaluated. Her tongue was fixed to the left wall during a previous surgery. We evaluated the awake glottic view using the McGrath MAC X-Blade and topical oral anesthesia. We obtained a Cormack-Lehane grade II view and then decided to administer general anesthesia. Intubation was attempted with a Macintosh laryngoscope, but we could not insert the scope deeply enough and there was no area in which to insert the Magill forceps or endotracheal tube. We then used the X-Blade 3 of the McGrath MAC and obtained a sufficient area in which to insert the tube and manipulate the Magill forceps. A laryngoscopic view was achieved in 7 s and nasotracheal intubation was performed in 16 s with a 7.0-mm spiral tube using the Magill forceps. McGrath MAC X-Blade can be used with the Magill forceps in patients with restricted mouth opening with careful patient selection, in experienced hands.

  20. Mislykket intubation og efterfølgende luftvejshåndtering ved sectio i generel anaestesi

    DEFF Research Database (Denmark)

    Winther, Louise Pagh; Mitchell, Anja Ulrike; Møller, Ann Merete

    2010-01-01

    There is an increased risk of intubation failure and aspiration when performing Caesarean section (CS) in general anaesthesia. We describe an incidence of failed intubation and airway management of a CS patient at Herlev Hospital in 2007. Intubation and placement of an intubating laryngeal mask (LM...

  1. Glidescope Video Laryngoscope Use for Tracheal Intubation in a Patient with CHARGE Syndrome

    OpenAIRE

    Sarıçiçek, Vahap; Mızrak, Ayşe; Şahin, Mehrican; GÖKSU, Sıtkı; Gül, Rauf; Cesur, Mehmet

    2014-01-01

    CHARGE syndrome is an autosomal dominant syndrome in which ocular coloboma (C), heart defects (H), choanal atresia (A), growth retardation (R), genital hypoplasia (G), ear abnormalities (E), and tracheoesophageal fistula, dysphagia, cleft palate, micrognathia, facial paralysis, hypopituitarism, and brain abnormalities may be seen in patients. The patients with CHARGE syndrome face surgical procedures many times from birth. Especially, the problems we meet in the airway may be special. In this...

  2. Emergency intubation using a light wand in patients with facial trauma

    Directory of Open Access Journals (Sweden)

    Sahu Sandeep

    2009-01-01

    Full Text Available Airway management in the operating room is the responsibility of anesthesiologists, although a variety of personnel may be responsible for airway management outside the operating room. Emergency department physicians are prominently involved in airway management in the emergency room both independently and with anesthesiologists. Airway management in trauma patients remains the domain of anesthesiologists. An 18-year old male patient was brought to our emergency room after an alleged history of suicidal attempt with gunshot under the chin. He was scheduled to undergo emergency tracheotomy, debridement, and closure of facial laceration under general anaesthesia, presenting a challenge for. He had to undergo emergency tracheotomy, debridement, and closure of facial lacerations under general anesthesia. The injuries made the patient′s airway management a complex issue. We present the use of the light wand to manage the difficult airway of this patient with complex facial trauma.

  3. Dexmedetomidine and propofol for cerebral angiography in non-intubated patients: A comparative study

    Directory of Open Access Journals (Sweden)

    Sujoy Banik

    2015-01-01

    Full Text Available Context: Patients posted for cerebral angiography may be restless and drowsy with high chance of inadvertent movements. Aims: The primary objective was to compare the incidence of inadvertent movements between propofol and dexmedetomidine groups. The secondary objectives include comparison of recovery time and characteristics, Steward′s score, and haemodynamic and respiratory parameters between the two groups. Settings and Design: Prospective, randomised, double-blind, pilot study. Materials and Methods: In all, 20 adult uncooperative, drowsy patients were randomised to dexmedetomidine (1 μg/kg bolus over 10 minutes followed by 0.3-0.7 μg/kg/hour infusion or propofol (100 μg/kg/min for 10 minutes followed by 25-75 μg/kg/min infusion. Rate of movement, success of sedation, haemodynamics, respiratory parameters, Steward′s recovery score and recovery time were recorded. Statistical analysis used: Repeated measures of analysis of variance, Mann-Whitney test, independent and paired t-tests, and Fisher test. Results: The median rate of movement was similar (1, P = 0.206 with success of sedation achieved in 7 (70% patients in Group D and 9 (90% patients in Group P, which was comparable (P = 0.582. The median recovery time in patients in Group D was 150 (37-764 seconds and in Group P was 128 (54-174 seconds (P = 0.519 with similar Steward′s scores (P = 0.363. Haemodynamics and respiratory variables were well-maintained during loading and maintenance dose infusions in both the groups. Conclusions: Dexmedetomidine is a safe alternative for diagnostic cerebral angiography. Its success of sedation, median rate of movement during the imaging procedure, haemodynamics, respiratory parameters, recovery time and Steward′s recovery score were similar to propofol in our study.

  4. Automatic detection of oesophageal intubation based on ventilation pressure waveforms shows high sensitivity and specificity in patients with pulmonary disease

    NARCIS (Netherlands)

    Kalmar, Alain F.; Absalom, Anthony; Rombouts, Pieter; Roets, Jelle; Dewaele, Frank; Verdonck, Pascal; Stemerdink, Arjanne; Zijlstra, Jan G.; Monsieurs, Koenraad G.

    2016-01-01

    Background: Unrecognised endotracheal tube misplacement in emergency intubations has a reported incidence of up to 17%. Current detection methods have many limitations restricting their reliability and availability in these circumstances. There is therefore a clinical need for a device that is small

  5. A COMPARISON OF McC OY LARYNGOSCOPE AND MCGRATH VIDEO LARYNGOSCOPES FOR TRACHEAL INTUBATION IN PATIENTS WITH IMMOBILIZED CERVICAL SPINE

    Directory of Open Access Journals (Sweden)

    Annapurna Sarma

    2015-08-01

    Full Text Available INTRODUCTION : Expert airway management is the most essential requirement of an anesthesiologist . Difficult and failed intubation is the leading causes of anesthetic related morbidity and mortality. AIM OF STUDY: The purpose of this study was to compare the effectiveness of McCoy laryngoscope and McGrath video laryngoscope in tracheal intubation in patients using Manual in - line stabilization (MILS for cervical spine injury. MATERIALS AND METHODS : This study was condu cted in King George Hospital , Visakhapatnam, Andhra Pradesh on 60 patients aged 20 – 70, of American Society of Anesthesiologists physical status I – III, posted for elective surgery for cervical spine injury under general anesthesia. The patients were assigne d to two groups. One group was named as MC where McCoy laryngoscope was used, other group named as MG, where McGrath video laryngoscope was used for laryngoscopy during tracheal intubation . Two groups were compared on the basis of demogr aphic data, airway examination, comparison of visualization of vocal cords with McC oy laryngoscope and video laryngoscope and comparison of laryngoscope time. RESULTS: There was no significant difference between male and female sex. Most of the patients falls into Mallampati score I (60%, followed by score II and III (25 and 14% respectively. Statistically highly significant improvement in laryngoscope view was noted with video laryngoscope than with McCoy laryngoscope with Chi - square value=49.52; DF= 10; p - value=0.000(highl y significant. Statistically highly significant difference was seen in effective laryngoscopy time of McCoy and Video laryngoscope. CONCLUSION: We conclude McGrath video laryngoscope is superior to McCoy laryngoscope in terms of providing better intubatin g conditions in patients requiring MILS, though there is a little prolongation of effective laryngoscope time .

  6. Methods and complications of nasoenteral intubation.

    Science.gov (United States)

    Halloran, Owen; Grecu, Bianca; Sinha, Ashish

    2011-01-01

    Nasoenteral intubation is among the most common procedures performed by clinicians across all medical specialties. The most common technique for nasoenteral intubation is blind passage, as it does not require the use of sophisticated or expensive medical equipment. Unfortunately, blind placement too frequently results in trauma and is a source of significant morbidity and mortality. It is apparent that altered mental status, a preexisting endotracheal tube, and critical illness put a patient in a higher risk group for malposition and complications. Nasoenteral intubation should be attempted only with an understanding of the possibility for difficult placement and the potential complications that can arise from trauma or malposition.

  7. Patient-specific depth of endotracheal intubation-from anthropometry to the Touch and Read Method

    Science.gov (United States)

    Oh, Saecheol; Bang, Seunguk; Kwon, Woojin; Shim, Jungwoo

    2016-01-01

    Objective: Knowledge of accurate airway length (AL) enables safer placement of the endotracheal tube (ETT) in the trachea. Our objective was to check the safety of a new formula (Touch and Read method) to determine ETT depth. Methods: AL was measured in 176 patients. Patients were divided into a normal group (AL >25 cm in men, >23 cm in women) and a risk group (AL ≤25 cm in men, ≤23cm in women). A control test (Conventional method) was performed in which the ETT was secured at a depth of 23 cm from the central incisor in men and 21 cm in women. In the experimental test (Touch and Read method), the ETT was secured at a depth equal to the distance from the angle of the mouth to the epiglottis tip plus 12.5 cm in men and 11.5 cm in women. The mean distance from the tube tip to the carina and that from the vocal cords to tube cuff were compared between the control and experimental tests in each group. Results: The two distances were similar between control and experimental tests in the normal group, but differed in the risk group (Women: mean distance from tube tip to carina, 1.2 cm and from vocal cords to cuff, 2.7 cm [control test]; 1.9 and 2.0 cm, respectively [experimental test]. Men: 0.7 and 3.5 cm, respectively [control test]; 2.0 and 2.3 cm, respectively [experimental test]). Conclusion: Touch and Read method enables safer placement of the ETT in the trachea than the conventional method in the risk group. PMID:27882028

  8. A randomized, double-blind, placebo-controlled study of rapid-acting intramuscular olanzapine in Japanese patients for schizophrenia with acute agitation

    Directory of Open Access Journals (Sweden)

    Katagiri Hideaki

    2013-01-01

    Full Text Available Abstract Background Olanzapine rapid-acting intramuscular (IM injection is an atypical antipsychotic drug already used overseas and recently approved in Japan. The objective of this study was to confirm the efficacy of rapid-acting IM olanzapine 10 mg was greater than IM placebo in patients with exacerbation of schizophrenia with acute psychotic agitation by comparing changes from baseline to 2 hours after the first IM injection, as measured by the Positive and Negative Syndrome Scale-Excited Component (PANSS-EC total score. Methods We conducted a placebo-controlled, randomized, double-blind, parallel-group study in Japanese patients diagnosed with schizophrenia according to the diagnostic criteria specified in the DSM-IV-TR. Patients were randomized to 2 treatment groups: IM olanzapine (10 mg or IM placebo. The primary efficacy outcome was the change in PANSS-EC from baseline to 2 hours after the first IM injection. Treatment groups were compared with an analysis of variance model which included treatment and site as factors. During the 24-hour treatment period, safety was assessed by clinical examination and laboratory investigations, electrocardiograms, extrapyramidal symptoms scales, and recording spontaneously reported adverse events. Results Of the 91 randomized patients, 90 patients (45 IM olanzapine-group; 45 IM placebo-group were in the full analysis set. The mean change of PANSS-EC total score from baseline to 2 hours after the first IM injection (mean±standard deviation was −9.2±4.5 for the IM olanzapine group and −2.8±5.6 for the IM placebo group. The difference between treatment groups was statistically significant (p Conclusion The efficacy of IM olanzapine 10 mg in patients with exacerbation of schizophrenia with acute psychotic agitation was greater than IM placebo in the primary efficacy measure, PANSS-EC. Intramuscular olanzapine 10 mg was shown to be generally safe and tolerable, and could be a new option for treatment

  9. Comparative study of hemodynamic responses to orotracheal intubation with intubating laryngeal mask airway and direct laryngoscope

    Institute of Scientific and Technical Information of China (English)

    ZHANG Guo-hua; XUE Fu-shan; SUN Hai-yan; LI Cheng-wen; SUN Hai-tao; LI Ping; LIU Kun-peng

    2006-01-01

    Background Intubating laryngeal mask airway (ILMA) offers a new approach for orotracheal intubation and is expected to produce less cardiovascular stress responses. However, the available studies provide inconsistent results. The purpose of this study was to identify whether there is a clinically relevant difference in hemodynamic responses to orotracheal intubation by using ILMA and direct laryngoscope (DLS).Methods A total of 53 adult patients, ASA physical status Ⅰ-Ⅱ, scheduled for elective plastic surgery under general anesthesia requiring the orotracheal intubation, were randomly allocated to either DLS or ILMA groups.After a standard intravenous anesthesia induction, orotracheal intubation was performed. Noninvasive blood pressure and heart rate were recorded before (baseline values) and after anesthesia induction (post-induction values), at intubation and every minute for the first 5 minutes after intubation. The data were analyzed using Chisquare test, paired and unpaired Student's t test, and repeated-measures analysis of variance as appropriate.Results The mean intubation time in the ILMA group was longer than that in the DLS group (P<0.05). The blood pressure and heart rate increased significantly after intubation in the two groups compared to the postinduction values (P<0.05), but the maximum value of blood pressure during the observation did not exceed the baseline value, while the maximum value of heart rate was higher than the baseline (P<0.05). During the observation, there were no significant differences in blood pressure and heart rate among each time point and in the maximum values between the two groups.Conclusions Orotracheal intubations by using ILMA and DLS produce similar hemodynamic response. ILMA has no advantage in attenuating the hemodynamic responses to orotracheal intubation compared with DLS.

  10. Comparison of haemodynamic responses to intubation: Flexible fibreoptic bronchoscope versus bonfils rigid intubation endoscope

    Directory of Open Access Journals (Sweden)

    Kapil Gupta

    2012-01-01

    Full Text Available Background : The flexible fibreoptic bronchoscope and bonfils rigid intubation endoscope are being widely used for difficult intubations. Methods: The haemodynamic response to intubation under general anaesthesia was studied in 60 adult female patients who were intubated using either flexible fibreoptic bronchoscope or bonfils rigid intubation endoscope (30 in each group. Non-invasive blood pressure and heart rate (HR was recorded before induction of anaesthesia, immediately after induction, at the time of intubation and, thereafter, every minute for the next 5 min. The product of HR and systolic blood pressure (rate pressure product at every point of time was also calculated. Statistical Analyses: Graph pad prism, 5.0 statistical software, independent t test and repeated measure ANOVA test were used. Results: Both bonfils rigid intubation endoscope and flexible fibreoptic bronchoscope required a similar time (less than 1 min for orotracheal intubation. After intubation, there was a significant increase in HR, blood pressure and rate pressure product (P<0.001 in both the groups compared with the baseline and post-induction values. There was no significant difference in HR, blood pressure and rate pressure product at any of the measuring points or in their maximum values during observation between the two groups. The time required for recovery of systolic blood pressure and HR to post-induction value (±10% was not significantly different between the two groups (more than 2 min. Conclusion: In female adults under general anaesthesia, bonfils rigid intubation endoscope and flexible fibreoptic bronchoscope require a similar time for successful orotracheal intubation and cause a similar magnitude of haemodynamic response.

  11. SOVIET AGITATION TEXTILE IN THE HISTORY OF AGRONOMY

    Directory of Open Access Journals (Sweden)

    Tsatsenko L. V.

    2015-09-01

    Full Text Available The article considers questions connected with the history of popularization of agricultural knowledge through the agitation textiles. Agitation textiles are similar in content to the propaganda posters, as well as propaganda porcelain. The issues of emergence of the given kind of art are examined in the work. Agitation textile or agit-textile appeared in Soviet Russia in the 1920s. Its authors were members of the textile section. Agit-textile has several titles: themed fabric or agitation tissue, but the essence remains the same - it is a bright, imaginative reflection of the era of great transformations expressed in electrification, industrialization, changes in the military and sports, collectivization. In contrast to the construction of industrialization, the theme of agriculture required an entirely different approach. Even common problems for the country in the village are of particular color. Here it was necessary to not just agitate for something new: it was required to patiently explain why the new better than the old, to prove that it is necessary, inevitable. It is better to see once than to hear many times. The article has shown the history of the agitation textiles, goals and objectives, an illustrative range of tissue samples, as well as an analysis of the agitation textile appearance in 1970 on the example of solving a specific problem

  12. Platelet preservation: agitation and containers.

    Science.gov (United States)

    van der Meer, Pieter F; de Korte, Dirk

    2011-06-01

    For platelets to maintain their in vitro quality and in vivo effectiveness, they need to be stored at room temperature with gentle agitation in gas-permeable containers. The mode of agitation affects the quality of the platelets, and a gentle method of agitation, either a circular or a flat bed movement, provides the best results. Tumblers or elliptical agitators induce platelet activation and subsequent damage. As long as the platelets remain in suspension, the agitation speed is not important. Agitation of the platelet concentrates ensures that the platelets are continuously oxygenated, that sufficient oxygen can enter the storage container and that excess carbon dioxide can be expelled. During transportation of platelet concentrates, nowadays over long distances where they are held without controlled agitation, platelets may tolerate a certain period without agitation. However, evidence is accumulating that during the time without agitation, local hypoxia surrounding the platelets may induce irreversible harm to the platelets. Over the decades, more gas-permeable plastics have been used to manufacture platelet containers. The use of different plastics and their influence on the platelet quality both in vitro and in vivo is discussed. The improved gas-permeability has allowed the extension of platelet storage from 3 days in the early 1980s, to currently at least 7 days. In the light of new developments, particularly the introduction of pathogen reduction techniques, the use of platelet additive solutions and the availability of improved automated separators, further (renewed) research in this area is warranted.

  13. A comparative clinical study of dexmedetomidine versus placebo to attenuate hemodynamic response to endotracheal intubation in patients undergoing off pump coronary arterial bypass grafting

    Directory of Open Access Journals (Sweden)

    Soniya R Sulhyan

    2014-01-01

    Full Text Available Context: Direct laryngoscopy and endotracheal intubation are the most stressful periods during induction of anesthesia. These events can lead to hypertension, tachycardia, arrhythmias and myocardial ischaemia. Aims: (1 To evaluate the haemodynamic response to laryngoscopy and endotracheal intubation with a single preinduction infusion of dexmedetomidine (DEX 1 μg/kg over a 10 min period, (2 To assess the incidence of side effects, that is, rebound hypertension, bradycardia and hypotension etc., associated with the use of DEX. Settings and Design: This was a prospective, double-blind, parallel group randomized clinical trial of DEX (1 μg/kg before anesthetic induction to study the attenuation of hemodynamic response to endotracheal intubation in 60 adult patients undergoing elective off pump coronary arterial bypass grafting. Materials and Methods: Patients were randomly allocated to receive either DEX (DEX group, n = 30 or 0.9% normal saline (PLA group, n = 30. Hemodynamic variables were recorded at baseline (Abbreviated as TB, after completion of drug infusion (Abbreviated as TC, 3 min after induction and immediately before intubation (T0, at the 1 st (T1, 3 rd (T3 and 5 th (T5 min after intubation. Statistical Analysis Used: The data are presented as mean ± standard deviation. Demographic data were analysed by Student′s t-test between the two groups. Analysis of variance for repeated measures f-test was used to analyze changes over time. A P < 0.05 was considered as significant and P < 0.01 or 0.001 was considered as highly significant. Results: All the hemodynamic variables were comparable in both groups at baseline. Heart rate values were statistically significantly lower in the DEX group at TC and highly statistically significantly lower at T1, T3 and T5 values. Systolic blood pressure values were statistically significantly lower in the DEX group at T0 and highly statistically significantly lower at T1, T3 and T5. Diastolic blood

  14. A simple technique to reduce epistaxis and nasopharyngeal trauma during nasotracheal intubation in a child with factor IX deficiency having dental restoration.

    Science.gov (United States)

    Delgado, Anita V; Sanders, John C

    2004-10-01

    Epistaxis and airway trauma are often associated with nasotracheal intubation. We describe a patient with Factor IX deficiency who required nasotracheal intubation. An inexpensive, nonproprietary, rapid technique was used to reduce the trauma of intubation.

  15. SEVOFLURANE VERSUS HALOTHANE FOR GENERAL ANESTHESIA IN PEDIATRIC PATIENTS – A COMPARATIVE STUDY OF INDUCTION TIME, INTUBATION TIME AND EMERGENCE TIME

    Directory of Open Access Journals (Sweden)

    Santosh K

    2014-03-01

    Full Text Available AIM: This study was conducted to compare the speed of induction, intubation, and speed of emergence with sevoflurane and halothane in pediatric patients. METHODOLOGY: All the patients had full preanesthetic check-up and the routine investigation (complete blood count, urine albumin was done. Patients were kept fasting for 6 hrs. for solid food, 4hours for semisolid and 2 hours for liquid. They were randomly divided into Gr S and Gr H each comprising of 30 patients each to receive sevoflurane and halothane with 60% nitrous and 40% oxygen respectively by inhalation. On arrival in the operation theatre, the standard monitors were applied including an electrocardiogram, pulse oximeter, non-invasive blood pressure and precordial stethoscope and the baseline readings of respective parameters were taken. Anesthetic induction was done with face mask application using incremental dosing of 0.5% for halothane and 1% for sevoflurane every three to five breath to deliver maximum inspired concentration of upto 5% halothane(maximum inspired concentration or 8% sevoflurane (maximum inspired concentration. Spontaneous ventilation was maintained till loss of eye lash reflex. Following the loss of the eyelash reflex, the vaporizer concentration was decreased to 4% for sevoflurane and 0.86 % for halothane (approximately 2 MAC. Intravenous catheter was inserted. Inhalational agent at the same concentration was given until the loss of corneal reflex. After the intravenous line was secured, inj pentazocine 0.3 mg/kg was given. The patients were intubated with appropriate size endotracheal tube only after the loss of corneal reflex. After successful intubation, intravenous vecuronium 0.1 mg/kg was administered for muscle paralysis and the anesthetic concentrations was adjusted at 1.3 MAC with N2O (0.56% halothane and 2.6% sevoflurane. Time intervals measured: (induction time, intubation time, emergence time were measured. Vitals recorded: Heart rate, systolic

  16. A simple method to use the preformed nasotracheal tube during the lightwand-guided awake nasal intubation in the patients with difficult airways

    Institute of Scientific and Technical Information of China (English)

    XUE Fu-shan; YANG Quan-yong; XU Ya-chao; LIAO Xu

    2009-01-01

    @@ To the Editor: Management of a difficult airway remains one of the major challenges to the anesthetists in clinical practice.1 Lightwand-guided nasal intubation has been shown to be a useful technique in the patients with known difficult airways.2-4 Also the preformed nasotracheal tubes (PNTs) are commonly selected for nasal intubation in the patients undergoing head and neck surgery because they are easy to secure,provide convenient surgical access and help to reduce nasal damage.5 However, the anesthetists must be faced with a problem that the PNT is significantly longer than the wand of the Trachlight TM (Laerdal Medical Corporation, New York, USA). For example, the lengths of the sizes 6.0-7.5 Portex Polar cuffed nasal tubes (Portex Lmited Hythe, England) range from 43 to 46 cm,whereas the wand of the Trachlight TM is only 33 cm long.After the wand of the TrachlightTM is inserted into the PNT, therefore, its distal light bulb is not able to protrude beyond the distal end of the PNT. We have adapted a simple method to solve this problem.

  17. First-pass intubation success rate during rapid sequence induction of prehospital anaesthesia by physicians versus paramedics

    NARCIS (Netherlands)

    Peters, J.H.; Wageningen, B. van; Hendriks, I.; Eijk, R.J.R.; Edwards, M.J.; Hoogerwerf, N.; Biert, J.

    2015-01-01

    INTRODUCTION: Endotracheal intubation is a frequently performed procedure for securing the airway in critically injured or ill patients. Performing prehospital intubation may be challenging and intubation skills vary. We reviewed the first-attempt tracheal intubation success rate in a Dutch prehospi

  18. Attenuation of cardiovascular stress response to endotracheal intubation by the use of remifentanil in patients undergoing Cesarean delivery.

    Science.gov (United States)

    Kutlesic, Marija S; Kutlesic, Ranko M; Mostic-Ilic, Tatjana

    2016-04-01

    The induction-delivery time during Cesarean section is traditionally conducted under light anesthesia because of the possibility of anesthesia-induced neonatal respiratory depression. The serious consequences of such an approach could be the increased risk of maternal intraoperative awareness and exaggerated neuroendocrine and cardiovascular stress response to laryngoscopy, endotracheal intubation, and surgical stimuli. Here, we briefly discuss the various pharmacological options for attenuation of stress response to endotracheal intubation during Cesarean delivery and then focus on remifentanil, its pharmacokinetic properties, and its use in anesthesia, both in clinical studies and case reports. Remifentanil intravenous bolus doses of 0.5-1 μg/kg before the induction to anesthesia provide the best compromise between attenuating maternal stress response and minimizing the possibility of neonatal respiratory depression. Although neonatal respiratory depression, if present, usually resolves in a few minutes without the need for prolonged resuscitation measures, health care workers skilled at neonatal resuscitation should be present in the operating room whenever remifentanil is used.

  19. Randomized controlled trial of the Pentax AWS, Glidescope, and Macintosh laryngoscopes in predicted difficult intubation.

    LENUS (Irish Health Repository)

    Malik, M A

    2009-11-01

    The purpose of this study was to determine the potential for the Pentax AWS and the Glidescope to reduce the difficulty of tracheal intubation in patients at increased risk for difficult tracheal intubation, in a randomized, controlled clinical trial.

  20. Comparison of intubating conditions and haemodynamic responses during rapid tracheal intubation using either suxamethonium or rocuronium with ephedrine pretreatment

    Directory of Open Access Journals (Sweden)

    Madhusudan M

    2014-07-01

    Full Text Available Background: Suxamethonium is considered as the “gold standard” for tracheal intubation. Because of innumerable contraindications for the use of this drug, there is a continuous search for other alternatives. Methods: In a prospective, randomized and double-blind study, we compared the intubating conditions and haemodynamic responses during rapid tracheal intubation using either suxamethonium or rocuronium with ephedrine pretreatment. We recruited 50 patients and allocated them into 2 groups (n= 25 each; Group S: received suxamethonium 1.5 mg/kg and Group R: received rocuronium 0.6 mg/ kg with ephedrine 100 µg/kg pretreatment. All patients were induced with 2 mg/kg propofol and intubation was attempted at 60 seconds. Haemodynamic responses and quality of intubating conditions were assessed. Results: Both groups were comparable in respect to age, sex, weight, Mallampati grade, Cormack Lehane grade and duration of laryngoscopy. Although both groups had clinically acceptable intubating conditions (good and excellent, there were more number of patients with better intubation score in Group S compared to Group R (p = 0.014. Conclusion: Suxamethonium still continues to be the “gold standard” for providing ideal tracheal intubation conditions. However, in conditions where suxamethonium is contraindicated, rocuronium-ephedrine combination can be used as an alternative to intubate the trachea at 60 seconds.

  1. Use of a positive pressure endoscopic mask to assist with positive pressure ventilation in a morbidly obese patient during fiberoptic intubation: a case report.

    Science.gov (United States)

    De Jarnett, Dewi

    2013-08-01

    Airway management in the morbidly obese, anesthetized patient can be especially challenging. Difficulties in fiberoptic intubation (FOI) can be experienced due to alterations in airway anatomy associated with morbid obesity and the effects of anesthesia. The loss of upper airway muscle tone that occurs during anesthesia compromises the structure of the pharynx, causing a tendency toward airway collapse. This collapsibility can prevent the identification of anatomical structures during FOI, making this advanced airway technique difficult or impossible. The application of positive pressure via endoscopic mask ventilation during FOI can help to stent open collapsible airways and reestablish airway anatomy in morbidly obese patients. Although drawbacks exist, the endoscopic mask may be most effective at accomplishing this goal.

  2. Efficacy of nasotracheal intubation using blind tracheal intubation device combined with end-tidal carbon dioxide monitoring technique in patients with difficult airway%盲探气管插管装置联合呼气末二氧化碳监测用于困难气道患者经鼻气管插管的效果

    Institute of Scientific and Technical Information of China (English)

    严佳; 姜虹

    2012-01-01

    目的 评价盲探气管插管装置联合呼气末二氧化碳监测用于困难气道患者经鼻气管插管的效果.方法 择期经鼻气管插管的口腔颌面外科手术患者60例,性别不限,年龄35-64岁,体重55-75 kg,ASA分级Ⅰ或Ⅱ级,张口度<3 cm,颈部后仰度<30°,Mallampati分级Ⅲ或Ⅳ级,甲颏间 距<6.5 cm,预计为困难气道.采用随机数字表法,将患者随机分为2组(n=30):盲探气管插管装置组(Ⅰ组)和盲探气管插管装置联合呼气末二氧化碳监测(Ⅱ组).Ⅰ组采用盲探气管插管装置进行气管插管;Ⅱ组采用肓探气管插管装置结合呼气末二氧化碳监测进行气管插管.记录气管插管情况、气管插管时间、气管插管期间(鼻衄、心动过速、高血压和低氧血症)和术后(咽痛和声音嘶哑)不良反应的发生情况.结果 2组患者气管插管成功率均为100%.2组均未见心动过速、高血压、低氧血症和声音嘶哑的发生.与Ⅰ组比较,Ⅱ组首次气管插管成功率升高,气管插管时间缩短,鼻衄和咽痛的发生率降低(P<0.05).结论 盲探气管插管装置联合呼气末二氧化碳监测用于困难气道患者经鼻气管插管时可缩短气管插管时间,提高气管插管成功率,减少不良反应的发生.%Objective To evaluate the effiicacy of nasotracheal intubation using blind tracheal intubation device and end-tidal carbon dioxide monitoring technique in patients with difficult airway.Methods Sixty ASA Ⅰ or Ⅱ patients of both sexes,aged 35-60 yr,weighing 55-75 kg,requiring nasotracheal intubation,undergoing selective oral and maxillofacial surgery,were involoved in this study.All of them were expected to have difficuh airway such as mouth opening < 3 cm,neck upward degree < 30° and Mallampati classification Ⅲ or Ⅳ,The patients were randomly divided into 2 groups(n =30):group Ⅰ received tracheal intubation with the blind tracheal intubation device and group H received

  3. Music therapy for reducing agitation and psychotropic medication in nursing home residents with dementia

    DEFF Research Database (Denmark)

    Ridder, Hanne Mette Ochsner

    2015-01-01

    Dementia is a neurocognitive disease with a high risk of social isolation and agitation due to loss of cognitive functions. In nursing home residents with dementia, agitation is the most significant symptom causing patient distress and care- giver burden. Agitation is described as abuse or aggres...... without first trying the efficacy of psychosocial interventions. The aim of this paper is to provide an overview of research on the effectiveness of music therapy on agitation and psychotropic medication....

  4. Unexpected difficult intubation due to subglottic ring

    Directory of Open Access Journals (Sweden)

    Abdulkadir Atım

    2010-03-01

    Full Text Available Airway damages encountered during endotracheal intubationor tracheostomy may cause some complicationssuch as severe dyspnea. Upper airway diagnostic endoscopywas planned to find the etiology of effort dyspnea ina 5 years old girl who had endotracheal intubation beenperformed during newborn period. Her ASA score was 1,and Mallampati score for preoperative airway evaluationwas 1. Physical examination revealed neither dyspneanor stridor while the patient was not exerting effort. Herchest radiograms were normal. She had no history of previoussurgical or anesthetical intervention. In this reportwe presented a difficult intubation during the endoscopicexamination of upper airway in a patient who had dyspneawhile exerting effort.

  5. Molar Intubation for Intra Oral Swellings:Our Experience

    Directory of Open Access Journals (Sweden)

    Meenoti Potdar

    2008-01-01

    Full Text Available Molar intubation is a technique of laryngoscopy that can be used for anticipated difficult intubation in cases where standard laryngoscopy technique is difficult due to presence of any intraoral mass that anatomically hampers laryngoscopy or that bleeds on touch. This technique is very easy, reliable and rewarding but should be practiced on normal patients for easy application in actual difficult cases.

  6. Geospatial Analysis of Pediatric EMS Run Density and Endotracheal Intubation

    Directory of Open Access Journals (Sweden)

    Matthew Hansen

    2016-09-01

    Full Text Available Introduction: The association between geographic factors, including transport distance, and pediatric emergency medical services (EMS run clustering on out-of-hospital pediatric endotracheal intubation is unclear. The objective of this study was to determine if endotracheal intubation procedures are more likely to occur at greater distances from the hospital and near clusters of pediatric calls. Methods: This was a retrospective observational study including all EMS runs for patients less than 18 years of age from 2008 to 2014 in a geographically large and diverse Oregon county that includes densely populated urban areas near Portland and remote rural areas. We geocoded scene addresses using the automated address locator created in the cloud-based mapping platform ArcGIS, supplemented with manual address geocoding for remaining cases. We then use the Getis-Ord Gi spatial statistic feature in ArcGIS to map statistically significant spatial clusters (hot spots of pediatric EMS runs throughout the county. We then superimposed all intubation procedures performed during the study period on maps of pediatric EMS-run hot spots, pediatric population density, fire stations, and hospitals. We also performed multivariable logistic regression to determine if distance traveled to the hospital was associated with intubation after controlling for several confounding variables. Results: We identified a total of 7,797 pediatric EMS runs during the study period and 38 endotracheal intubations. In univariate analysis we found that patients who were intubated were similar to those who were not in gender and whether or not they were transported to a children’s hospital. Intubated patients tended to be transported shorter distances and were older than non-intubated patients. Increased distance from the hospital was associated with reduced odds of intubation after controlling for age, sex, scene location, and trauma system entry status in a multivariate logistic

  7. 双腔气管插管手术患者麻醉复苏期的气道管理探讨%Airway Management of Patients With Double Lumen Endotracheal Intubation During Anesthesia Recovery Period

    Institute of Scientific and Technical Information of China (English)

    刘海军; 覃林基

    2016-01-01

    Nowadays, mechanical ventilation has been widely used in clinic, has become an important measure for treatment of critically ill patients. In intrathoracic surgery, double lumen endotracheal intubation (DLT) is an important means to ensure one lung ventilation, in order to ensure ventilation and endotracheal intubation and extubation process smoothly, do double lumen airway management during the recovery period of anesthesia tracheal intubation in patients with surgery is very important. Based on this, the necessity and speciifc methods of airway management of double lumen intubation surgery patients anesthesia recovery period were discussed.%现如今,机械通气已经被广泛应用到临床上,成为了抢救危重症患者的重要措施。在胸腔内手术中,双腔气管插管(DLT)是确保单侧肺通气的一项重要手段,而为了确保插管、拔管以及通气过程的顺利,做好双腔气管插管手术患者麻醉复苏期的气道管理十分重要。基于此,本文对双腔气管插管手术患者麻醉复苏期的气道管理必要性及具体方法进行了探讨。

  8. Emergent Endotracheal Intubation and Mortality in Traumatic Brain Injury

    Directory of Open Access Journals (Sweden)

    Fine, Philip R

    2008-11-01

    Full Text Available Objective: To determine the relationship between emergent intubation (emergency department and field intubation cases combined and mortality in patients with traumatic brain injury (TBI while controlling for injury severity.Methods: Retrospective observational study of 981 (35.2% intubated, 64.8% not intubated patients with TBI evaluating the association between intubation status and mortality. Logistic regression was used to analyze the data. Injury severity measures included Head/Neck Abbreviated Injury Scale (H-AIS, systolic blood pressure, type of head injury (blunt vs. penetrating, and a propensity score combining the effects of several other potential confounding variables. Age was also included in the model.Results: The simple association of emergent endotracheal intubation with death had an odds ratio (OR of 14.3 (95% CI = 9.4 – 21.9. The logistic regression model including relevant covariates and a propensity score that adjusted for injury severity and age yielded an OR of 5.9 (95% CI = 3.2 – 10.9.Conclusions: This study indicates that emergent intubation is associated with increased risk of death after controlling for a number of injury severity indicators. We discuss the need for optimal paramedic training, and an understanding of the factors that guide patient selection and the decision to intubate in the field. [WestJEM.2008;9:184-189

  9. A novel method to detect accidental oesophageal intubation based on ventilation pressure waveforms

    NARCIS (Netherlands)

    Kalmar, Alain F.; Absalom, Anthony; Monsieurs, Koenraad G.

    2012-01-01

    Background: Emergency endotracheal intubation results in accidental oesophageal intubation in up to 17% of patients. This is frequently undetected thereby adding to the morbidity and mortality. No current method to detect accidental oesophageal intubation in an emergency setting is both highly sensi

  10. Laryngeal Radiation Fibrosis: A Case of Failed Awake Flexible Fibreoptic Intubation

    Directory of Open Access Journals (Sweden)

    Johannes M. Huitink

    2011-01-01

    Full Text Available Awake fibreoptic intubation is accepted as the gold standard for intubation of patients with an anticipated difficult airway. Radiation fibrosis may cause difficulties during the intubation procedure. We present an unusual severe case of radiation induced changes to the larynx, with limited clinical symptoms, that caused failure of the fibreoptic intubation technique. A review of the known literature on radiation fibrosis and airway management is presented.

  11. Predictive value of the tuberculin skin test and QuantiFERON-tuberculosis Gold In-Tube test for development of active tuberculosis in hemodialysis patients

    Science.gov (United States)

    Seyhan, Ekrem Cengiz; Gunluoglu, Gulşah; Gunluoglu, Mehmet Zeki; Tural, Seda; Sökücü, Sinem

    2016-01-01

    BACKGROUND: Hemodialysis (HD) patients are at increased risk of reactivation of latent tuberculosis infection (LTBI) compared with the general population. QuantiFERON-TB Gold (QFT-G) for LTBI detection is more promising than tuberculin skin test (TST) in HD patients. AIM: In our study, we evaluated the value of the TST and QFT-G In-Tube (QFG-IT) test in the development of active tuberculosis (TB), in the HD patients, and in healthy controls. METHODS: The study enrolled 95 HD patients and ninety age-matched, healthy controls. The TST and QFG-IT were performed. All the subjects were followed up 5 years for active TB disease. RESULTS: Compared to the healthy controls, a high prevalence of LTBI was found in the HD patients by QFG-IT (41% vs. 25%). However, no significant difference was detected by TST (32% vs. 31%). Four HD patients and one healthy control progressed to active TB disease within the 5-year follow-up. For active TB discovered subjects, QFG-IT was positive in all, but TST was positive in two (one patient and one healthy control). In HD patients; sensitivity, specificity, positive and negative predictive values of QFG-IT, and TST for active TB was 100% and 25%, 62% and 67%, 10%, and 3%, and 100% and 95%, respectively. Receiver operating curve analysis revealed that the results are significantly different (P = 0.04). CONCLUSION: QFG-IT test is a more useful diagnostic method than TST for detecting those who will progress to active TB in HD patients. PMID:27168859

  12. [Application of Non-intubated Anesthesia in VATS].

    Science.gov (United States)

    Dai, Xiaotan; Song, Pingping; Zhang, Baijiang

    2016-05-20

    Tracheal intubation general anesthesia technique is widely used in video-assisted thoracic surgery (VATS) because it can improve the safety of VATS, but the complications of tracheal intubation can not be avoided. How to develop a "minimally invasive" surgery (including micro anesthesia) has become a hot topic in the field of minimally invasive surgery. Along with the progress of the anesthesia management technology and the risk management in the operation, the technology of non-intubated anesthesia was successfully applied to VATS, namely using local anesthesia to maintain patients intraoperative independent ventilation and intraoperative only mild sedation or fully conscious state of implementation of thoracoscope surgery, therefore is also called awake VATS. The anesthesia method not only reduces the anesthesia injury of tracheal intubation, but also conforms to the idea of rapid rehabilitation surgery. Based on non-intubated anesthesia in VATS in the brief history of development, the anesthesia selection, operation advantages and risks are reviewed in this paper.

  13. Benzodiazepines: Sedation and Agitation.

    Science.gov (United States)

    Gallagher, Catherine

    2016-01-01

    Dental anxiety is common and frequently poses a barrier to necessary dental treatment. The increasing availability of conscious sedation in dental practice has made treatment much more accessible for anxious patients. At present, benzodiazepines are the most commonly used drugs in sedation practice and provide a pleasant experience for most, but not all, patients. An understanding of the mechanism of action of benzodiazepines should inform our practice and deepen our understanding of why and how sedation may fail. CPD/CLINICAL RELEVANCE: As an increasing number of dentists provide sedation for their patients an update on benzodiazepines is timely.

  14. Study on the Optimum Time for First Oral Care among Patients Who Received Tracheal Intubation of Emergency%急诊气管插管患者首次口腔护理适宜时间的研究

    Institute of Scientific and Technical Information of China (English)

    曹海燕; 班博; 刘鹏飞; 柳秋实

    2014-01-01

    目的:探讨急诊气管插管患者首次口腔护理的适宜时间,为临床工作提供依据。方法选取2012年12月-2013年7月于山东省济宁医学院附属医院(第一作者实习单位)急诊就诊并行气管插管的患者235例,将收集的前64例患者作为对照组,并根据对照组的结果将试验组采用随机数字表法分为3组:A组(57例)、B组(60例)和C组(54例),即分别在插管第6 h、第8 h和第10 h介入口腔护理,然后进行采样,与对照组一致。在气管插管即刻、第6h、第8h、第10h和第12h5个时间点进行牙菌斑评分和牙菌斑采样做细菌培养。结果4组不同时间牙菌斑评分和牙菌斑细菌培养结果比较,差异有统计学意义( P0.05);第6 h牙菌斑评分和牙菌斑细菌培养结果A组低于其他3组(P0.05)。结论从牙菌斑评分看,在第8 h介入口腔护理在抑制牙菌斑增长方面要优于第6和第10h;从细菌量看,在第6h和第8h口腔护理短期内抑制细菌增长要优于在第10h。以此结合临床工作中护理人员的工作负担,在第8h进行第一次口腔护理效果较好。%Objective To explore the optimum time for first oral care among patients who received tracheal intubation of emergency. Methods By using convenience sampling,235 patients who received tracheal intubation in the emergency depart-ment of Affiliated Hospital of Jining Medical College from December 2012 to July 2013,were selected as study subjects. The first 64 patients were selected as control group,the remaining patients were selected as experiment group,and were divided into 3 groups:group A(57 cases),group B(60 cases)and group C(54 cases). The first oral care was given 6 h,8 h and 10 h af-ter tracheal intubation for group A,B and C,respectively,the sampling method for experiment group agreed with sampling method for control group. The dental plaques were scored and dental plaque samples were took out for

  15. QuantiFERON-TB Gold In-Tube assay for screening arthritis patients for latent tuberculosis infection before starting anti-tumor necrosis factor treatment.

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    Hyun Lee

    Full Text Available Patients undergoing anti-tumor necrosis factor (TNF treatment are at an increased risk of reactivating a latent tuberculosis infection (LTBI. This study evaluated the effectiveness of the QuantiFERON-TB Gold In-Tube (QFT assay for diagnosing LTBI in arthritis patients undergoing anti-TNF treatment.We enrolled 342 consecutive patients from August 2007 to October 2013: 176 (51.5% patients with ankylosing spondylitis and 166 (48.5% with rheumatoid arthritis. Screening tests included tuberculin skin test (TST and QFT assay. Positive QFT results, regardless of TST results, were considered an indicator for LTBI treatment.Bacillus Calmette-Guérin scars were found in 236 (69.0% patients. Of 342 patients, TST and QFT were positive in 122 (35.7% and 103 (30.1% patients, respectively, and discordant in 101 (29.5% patients. During a median follow-up duration of 41.7 months, five patients (1.5% developed TB in a median of 20.8 months after initiation of anti-TNF treatment (428/100,000 person-years. TB did not occur in 62 TST+/QFT+ patients who received LTBI treatment. Of 41 TST-/QFT+ patients who received LTBI treatment, one (2.4% developed TB 20.5 months after starting anti-TNF treatment (705/100,000 person-years. Of 60 TST+/QFT- patients who did not receive LTBI treatment, two (3.3% developed TB 20.8 and 22.0 months after starting anti-TNF treatment (871/100,000 person-years. Of 179 TST-/QFT- patients, two (1.1% developed TB 7.2 and 22.7 months, respectively, after initiating anti-TNF treatment (341/100,000 person-years. TB incidence rate during the follow-up period did not differ among TST-/QFT+, TST+/QFT-, and TST-/QFT- patients (P = 0.661.QFT might be used instead of TST for diagnosing LTBI in patients before starting anti-TNF therapy in countries, such as Korea, where the TB prevalence is intermediate and the BCG vaccination is mandatory at birth. In the absence of a true gold standard test for LTBI, however, there is still a risk of TB development

  16. Increased risk of endotracheal intubation and heart failure following acute myocardial infarction in patients with urolithiasis: a nationwide population-based study

    Science.gov (United States)

    Lin, Shun-Ku; Liu, Jui-Ming; Chang, Ying-Hsu; Ting, Yuan-Tien; Pang, See-Tong; Hsu, Ren-Jun; Lin, Po-Hung

    2017-01-01

    Background Urolithiasis is a common urinary tract disease worldwide. It has been connected to systemic diseases, including hypertension, diabetes mellitus, metabolic syndrome, and cardiovascular disease. In the current study, we aimed to evaluate the relationship between urolithiasis and the complications of acute myocardial infarction (AMI). Materials and methods Data were obtained from the Longitudinal Health Insurance Database 2005 of the National Health Insurance Research Database. All AMI cases, both those who were hospitalized and those who were treated in the emergency department, were identified using the International Classification of Diseases, ninth revision, Clinical Modification (ICD-9-CM) code. Results A total of 37,052 patients with urinary calculi and 148,209 control subjects were enrolled in this study. The average follow-up period was 9.51 years. The risk of AMI was higher among patients with urolithiasis (adjusted hazard ratio [aHR] 1.07, 95% confidence interval [95% CI] 1.03–1.13). We detected a significant association between urolithiasis and intubation (aHR 1.53, 95% CI 1.36–1.73), intensive care unit treatment (aHR 1.22, 95% CI 1.13–1.32), heart failure (aHR 1.59, 95% CI 1.42–1.78), shock (aHR 1.53, 95% CI 1.32–1.77), and arrhythmias (aHR 1.18, 95% CI 1.06–1.33). Furthermore, certain medical treatments for urolithiasis were found to be related to myocardial infarction (MI). Nonsteroidal anti-inflammatory drugs (NSAIDs) were significantly associated with a high risk of AMI. In contrast, allopurinol, thiazide diuretic, potassium-sparing diuretics, and α-blockers have negative association with AMI. Conclusion Urolithiasis had a significantly increased risk of endotracheal intubation and heart failure following AMI. In addition, urolithiasis was also associated with a high risk of intensive care unit treatment, shock, and arrhythmias after AMI. Medical treatments for urolithiasis may decrease the risk of MI, except the use of NSAIDs

  17. PREDICTORS OF DIFFICULT INTUBATION: STUDY IN KASHMIRI POPULATION

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    Gupta A K

    2009-12-01

    Full Text Available Airway assessment is the most important aspect of Anaesthesia practice as a difficult intubation may be unanticipated. A prospective study was done to compare the efficacy of airway parameters to predict difficult intubation viz; degree of head extension, thyromental distance, inter incisor gap, grading ofprognathism, obesity and modified mallampati test. Six hundred patients with ASA I& ASA II grade were enrolled in study. All patients were preoperatively assessed for airway parameters. Intra-operatively all patients were classified according to Cormack and Lehane laryngoscopic view. Clinical data of each test was collected, tabulated and analyzed to obtain the sensitivity, specificity, positive predictive value & negative predictive value. Results obtained showed incidence of difficult intubation in 3.3%. Head&neck movements had the highest sensitivity (86.36%; high arched palate had highest specificity (99.38%.Head & neck movements had highest sensitivity; high arched palate had highest specificity, however, head & neck movements strongly correlated for patients with difficult intubation.

  18. Haemodynamic response to endotrachial intubation: direct versus video laryngoscopy

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    Amit Kumar Kamewad

    2016-12-01

    Conclusions: Video laryngoscopy did not offer any advantages in terms of haemodynamic response to laryngoscopy and intubation in patients when compared with conventional ones. [Int J Res Med Sci 2016; 4(12.000: 5196-5200

  19. A MODIFIED TECHNIQUE OF RETROGRADE INTUBATION IN A DIFFICULT INTUBATION CASE

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    Murthy

    2014-08-01

    Full Text Available Anaesthesiologists will be facing difficult intubating conditions, anticipated or unanticipated, quite frequently, whenever they anaesthetize patients with facio- maxillary injuries, temporo mandibular joint ankylosis, obesity, pregnancy, congenital air-way abnormalities, etc. A large number of aids are available now for intubating in such difficult situations and a lot of techniques have been described in literature for giving anaesthesia for such patients. (1 Use of Bullard laryngoscope in difficult air-way situation was described by Dullenkopf et al 2003, (2 Lighted Wand by Agro et al 2004, (3 Shikani flexible seeing stylet by Agro et al 2005(4 Blind nasal intubation, L M A, Fiber optic laryngoscope by Levitan et al1999. (5 Glydoscope by Lim et al 2005(6 . In this case report, we have given one more alternate solution for this problem

  20. An innovative approach to orotracheal intubations: the Alexandrou Angle of Intubation position.

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    Alexandrou, Nikolaos A; Yeh, Benson; Barbara, Paul; Leber, Mark; Marshall, Lewis W

    2011-01-01

    Visualization of the vocal cords is paramount during orotracheal intubations. We employed a novel patient position in this derivation study. The Alexandrou Angle of Intubation (AAI) position is defined as a 20°-30° incline where the supine patient's head is elevated in relation to the body and legs. Our study participants were blinded to the goals of the research as well as our novel technique. Using intubation manikins, our participants ranked their preference for visualizing the vocal cords between the Flat, Trendelenburg, and AAI positions. A majority (58.8%) of our study participants preferred the AAI for visualizing the vocal cords over the other two positions. Future studies will reveal whether AAI will play a significant role in emergent airway management.

  1. Appropriate Head Position for Nasotracheal Intubation by Using Lightwand Device (Trachlight)

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    Manabe, Yozo; Iwamoto, Shigeru; Seto, Mika; Sugiyama, Kazuna

    2014-01-01

    The purpose of this study was to determine the relationship between the head position and the subsequent ease of nasotracheal intubation by using the lightwand device Trachlight (TL). Patients requiring nasotracheal intubation were subdivided into 3 groups according to the intubated head position (group S: sniffing position; group E: extension position; and group N: neutral position). The number of attempts, the total intubation time, and the failures of the TL intubation were recorded. Intubation difficulty by means of TL was assessed by the ordinal 6-point scale. Of the 300 patients enrolled in the study, TL intubation was successful in 91.3% of them. There was no significant difference in the success rate of the first attempt between the groups. No correlation between the ordinal scale and the head position was observed. The total intubation time and the ratio of “unsuccessful” cases were not significantly different among the 3 groups. TL is an effective alternative for patients who require nasotracheal intubation. Our study did not determine the most favorable head position for nasotracheal intubation with the TL, so we recommend that nasotracheal intubation with TL be started with the head in the neutral position and then changed to a more appropriate position, if necessary, on an individual basis. PMID:24932977

  2. Delayed Complications of Emergency Airway Management: A Study of 533 Emergency Department Intubations

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    Keim, Samuel M

    2008-11-01

    Full Text Available OBJECTIVES: Airway management is a critical procedure performed frequently in emergency departments (EDs. Previous studies have evaluated the complications associated with this procedure but have focused only on the immediate complications. The purpose of this study is to determine the incidence and nature of delayed complications of tracheal intubation performed in the ED at an academic center where intubations are performed by emergency physicians (EPs.METHODS: All tracheal intubations performed in the ED over a one-year period were identified; 540 tracheal intubations were performed during the study period. Of these, 523 charts (96.9% were available for review and were retrospectively examined. Using a structured datasheet, delayed complications occurring within seven days of intubation were abstracted from the medical record. Charts were scrutinized for the following complications: acute myocardial infarction (MI, stroke, airway trauma from the intubation, and new respiratory infections. An additional 30 consecutive intubations were examined for the same complications in a prospective arm over a 29-day period.RESULTS: The overall success rate for tracheal intubation in the entire study group was 99.3% (549/553. Three patients who could not be orally intubated underwent emergent cricothyrotomy. Thus, the airway was successfully secured in 99.8% (552/553 of the patients requiring intubation. One patient, a seven-month-old infant, had unanticipated subglottic stenosis and could not be intubated by the emergency medicine attending or the anesthesiology attending. The patient was mask ventilated and was transported to the operating room for an emergent tracheotomy. Thirty-four patients (6.2% [95% CI 4.3 - 8.5%] developed a new respiratory infection within seven days of intubation. Only 18 patients (3.3% [95% CI 1.9 - 5.1%] had evidence of a new respiratory infection within 48 hours, indicating possible aspiration pneumonia secondary to airway

  3. Airtraq与GlideScope视频喉镜在颈椎制动患者气管插管中的应用%Tracheal intubation with Airtraq or GlideScope in patients with immobilized cervical spine

    Institute of Scientific and Technical Information of China (English)

    任秀荣; 韩元福; 桂忠诚; 徐鹏飞

    2013-01-01

    Objective To compare the use of the GlideScope, Airtraq and the conventional Macintosh laryngoscope in simulated cervical spine immobilization. Methods Ninety ASAⅠor Ⅱ patients, between 18 and 60 years old, undergoing general anesthesia were randomly assigned to receive intubation using Airtraq (group A), GlideScope (group G) or Macintosh (group M) laryngoscope with each 30. Each patient was provided manual in-line axial stabilization of the head and neck by an experienced assistant. The following data were recorded and analyzed: glottic exposure time, tracheal intubation time, Cormark-Lehane grade, manoeuvre needed to aid tracheal intubation, intubation attempts, failure for tracheal intubation, MAP, HR and complications before and the moment, 1,2,3 min after intubation. Results Compared with group M, the glottic exposure time in group A was longer (P<0. 05), but the tracheal intubation time was shorter in groups A and G (P <0. 05), total duration of intubation was shorter in group G (P<0. 05). More assistance was need and the intubation failure and complication rate was higher in group M(P<0. 05). Patients who were C-L grade I in groups A and G were more than that in group M. Compared with before intubation, MAP and HR in group M were increased than the moment and 1 min after intubation(P<0. 05) and HR were faster that in other two groups after intubation (P<0. 05). Conclusion The Airtraq laryngoscope and GlideScope are good alternatives for tracheal intubation in patients with cervical spine immobilization with better glottic exposure and less intubation failure.%目的 比较Airtraq与GlideScope视频喉镜与普通Macintosh直接喉镜在颈椎制动患者全麻气管插管中的应用效果以及对血流动力学的影响.方法 择期在气管插管全麻下的手术患者90例,ASA Ⅰ或Ⅱ级,年龄18~60岁,随机均分为Airtraq视频喉镜组(A组)、GlideScope视频喉镜(G组)和Macintosh直接喉镜组(M组).麻醉诱导后,采用手法控制

  4. HC视频喉镜与Macintosh直接喉镜引导患儿气管插管术效果的比较%Comparison of HC video-laryngoscope and Macintosh direct laryngoscope for tracheal intubation in pediatric patients

    Institute of Scientific and Technical Information of China (English)

    何伟; 黄梦朦; 刘铁帅; 张冰; 曾睿峰; 上官王宁; 连庆泉; 李军

    2014-01-01

    Objective To compare HC video-laryngoscope and Macintosh direct laryngoscope for tracheal intubation in the pediatric patients.Methods One hundred and twenty pediatric patients,of ASA physical status [or Ⅱ (Mallampati class Ⅰ or Ⅱ),aged 1-6 yr,scheduled for elective surgery under general anesthesia,were randomly divided into 2 groups(n =60 each) using a random number table:HC video-laryngoscope group (group H1) and Macintosh direct laryngoscope group (group M1).Forty pediatric patients,aged 3-6 yr,of ASA physical status Ⅰ or Ⅱ (Mallampati class Ⅲ or Ⅳ,) suspected as having a difficult airway,scheduled for elective surgery under general anesthesia,were randomly divided into 2 groups (n =20 each) using a random number table:HC video-laryngoscope group (group H2) and Macintosh direct laryngoscope group (group M2).After induction of anesthesia,orotracheal intubation was carried out by HC video-laryngoscope (group H1 and H2) or by Macintosh direct laryngoscope (group M1 and M2).The exposure of the glottis was evaluated with Cormack-Lehane classification.The intubation time,rate of successful intubation,and distance between upper and lower incisors when intubation was successful in H2 and M2 groups were recorded.The development of damage to lips,teeth,gums and soft tissues of throat during intubation and hoarseness after operation was recorded.Results Compared with M1 group,no significant change was found in the intubation time,rate of successful intubation at first attempt and Cormark-Lehane grade,and the incidence of damage to lips,teeth,gums and soft tissues of throat during intubation and hoarseness after operation was significantly decreased in group H1.Compared with group M2,the intubation time was significantly shortened,the rate of successful intubation at first attempt was increased,the distance between upper and lower incisors when intubation was successful was reduced,Cormark-Lehane grade was decreased,and the incidence of damage to lips

  5. Factors that Predict Negative Results of QuantiFERON-TB Gold In-Tube Test in Patients with Culture-Confirmed Tuberculosis: A Multicenter Retrospective Cohort Study.

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    Yong-Soo Kwon

    Full Text Available Interferon-γ release assays such as the QuantiFERON-TB Gold In-Tube Test (QFT-GIT are designed to detect Mycobacterium tuberculosis infections, whether latent or manifesting as disease. However, a substantial number of persons with culture-confirmed tuberculosis (TB have negative QFT-GITs. Information on host factors contributing to false-negative and indeterminate results are limited.A multicenter retrospective cohort study was performed with 1,264 culture-confirmed TB patients older than 18 years who were subjected to the QFT-GIT at one of the six hospitals between May 2007 and February 2014. Patients with human immunodeficiency virus infection were excluded. Clinical and laboratory data were collected in South Korea.Of all patients, 87.6% (1,107/1,264 were diagnosed with pulmonary TB and 12.4% (157/1,264 with extrapulmonary TB. The rate of negative results was 14.4% (182/1,264. The following factors were highly correlated with false-negative results in the QFT-GIT: advanced age (age ≥ 65 years, odds ratio [OR] 1.57, 95% confidence interval [CI] 1.03-2.39, bilateral disease as determined by chest radiography (OR 1.75, 95% CI 1.13-2.72, malignancy (OR 2.42, 95% CI 1.30-4.49, and lymphocytopenia (total lymphocyte count < 1.0 × 109/L, OR 1.86, 95% CI 1.21-2.87.Consequently, QFT-GIT results need to be interpreted with caution in patients with these host risk factors such as the elderly, bilateral disease on chest radiography, or malignancy, or lymphocytopenia.

  6. Managing verbal agitation in people with dementia and delirium.

    Science.gov (United States)

    Inkley, Francesca; Goldberg, Sarah

    2016-03-01

    Patients with dementia and delirium in acute hospitals can exhibit verbal agitation, but there is no research on rate of occurrence or how ward staff manage such behaviour. This service evaluation aimed to measure rate of occurrence of verbal agitation in confused older inpatients and understand the management strategies used by staff. An agitation inventory was completed daily by the nursing team for all verbally agitated patients on eight older person wards over two weeks. Six semi-structured interviews were conducted with staff and three hours of non-participant observations were undertaken. A mean 6% (13/223) of patients were verbally agitated each day. Management strategies included trial and error, distraction and engagement, reassurance, communication and familiarity. Staff did not adopt a systematic approach to care planning due to lack of training and support on the ward, as well as scarce resources in terms of staff, space and activities. Research is needed to develop and evaluate interventions that support staff to care for these patients.

  7. Effect of Truview EVO2 laryngoscope in intubation of simulated neck rigidity patients%Truview EVO2喉镜用于模拟颈项强直患者气管插管的效果

    Institute of Scientific and Technical Information of China (English)

    王森; 陈宁; 李金宝; 杨程; 李宏; 邓小明

    2011-01-01

    Objective To evaluate the effect of Truview EV02 laryngoscope in trachea intubation of patients with simulated neck rigidity. Methods One hundred patients, scheduled for elective surgery under general anesthesia requiring orotracheal intubation were enrolled. After intravenous anesthetic induction, a rigid cervical collar was used to simulate the neck rigidity patients. Orotracheal intubation was randomly performed by Truwiew EVO2 and Macintosh laryngoscope in different order. After given the Cormack-Lehane (C-L) grade of laryngeal view, the patient was intubated with the latter laryngoscope. Parameters were recorded, including the laryngeal exposuring and intubation time, success rate for intubation in the first attempt. Results The Truview EVO2 laryngoscope achieved better C-L grade of laryngeal view than Macintosh laryngoscope(P<0. 05). The laryngeal exposuring time of Truview EVO2 laryngoscope was shorter than Macintosh laryngoscope(P<0. 05),but the intubation time was similar. The success rate for intubation in the first attempt of Truview EVO2 laryngoscope was significantly higher than Macintosh laryngoscope(P <0. 05). Conclusion In patients with simulated neck rigidity, the Truview EVO2 laryngoscope was more feasible and effective than Macintosh laryngoscope in orotracheal intubalion, it is valuable in managing difficult airway for restricted neck movements.%评价Truview EVO2喉镜用于模拟颈项强直患者气管插管的效果.方法 择期经口气管插管全麻手术患者100例,静脉麻醉诱导后使用硬质颈托固定其颈部,所有患者随机先后使用Truview EVO2喉镜和Macintosh喉镜显露喉部,并采用后一种喉镜辅助气管插管.记录Cormack-Lehane(C-L)分级,喉部结构显露时间,气管插管完成时间,一次插管成功率等.结果Truview EVO2喉镜C-L分级显著优于Macintosh喉镜(P<0.05),喉部结构显露时间短于Macintosh喉镜(P<0.05),插管一次成功率显著高于Macintosh喉镜(P<0.05);但两

  8. Comparing insertion characteristics on nasogastric tube placement by using GlideScopeTM visualization vs. MacIntosh laryngoscope assistance in anaesthetized and intubated patients

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    Wan Hafsah Wan Ibadullah

    2016-08-01

    Full Text Available Abstract Background and objective: This was a prospective, randomized clinical study to compare the success rate of nasogastric tube insertion by using GlideScopeTM visualization versus direct MacIntosh laryngoscope assistance in anesthetized and intubated patients. Methods: Ninety-six ASA I or II patients, aged 18-70 years were recruited and randomized into two groups using either technique. The time taken from insertion of the nasogastric tube from the nostril until the calculated length of tube had been inserted was recorded. The success rate of nasogastric tube insertion was evaluated in terms of successful insertion in the first attempt. Complications associated with the insertion techniques were recorded. Results: The results showed success rates of 74.5% in the GlideScopeTM Group as compared to 58.3% in the MacIntosh Group (p = 0.10. For the failed attempts, the nasogastric tube was successfully inserted in all cases using rescue techniques. The duration taken in the first attempt for both techniques was not statistically significant; Group A was 17.2 ± 9.3 s as compared to Group B, with a duration of 18.9 ± 13.0 s (p = 0.57. A total of 33 patients developed complications during insertion of the nasogastric tube, 39.4% in Group A and 60.6% in Group B (p = 0.15. The most common complications, which occurred, were coiling, followed by bleeding and kinking. Conclusion: This study showed that using the GlideScopeTM to facilitate nasogastric tube insertion was comparable to the use of the MacIntosh laryngoscope in terms of successful rate of insertion and complications.

  9. Factors Associated with Intubation Time and ICU Stay After CABG

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    Suzanny Flegler

    2015-12-01

    Full Text Available ABSTRACT OBJECTIVE: The aim of this study was to identify factors associated with intubation time and intensive care unit stay after coronary artery bypass grafting with cardiopulmonary bypass. METHODS: This was a retrospective study, whose data collection was performed in the hospital charts of 160 patients over 18 years, who underwent surgery from September 2009 to July of 2013 in a hospital in the state of Espirito Santo, Brazil. RESULTS: The mean age of the subjects was 61.44±8.93 years old and 68.8% were male. Subjects had a mean of 5.17±8.42 days of intensive care unit stay and mean intubation time of 10.99±8.41 hours. We observed statistically significant positive correlation between the following variables: patients' age and intubation time; patients' age and intensive care unit stay; intubation time and intensive care unit stay. CONCLUSION: In conclusion, the study showed that older patients had longer intubation time and increased intensive care unit stay. Furthermore, patients with longer intubation time had increased intensive care unit stay.

  10. Is non-thyroidal illness syndrome a predictor for prolonged weaning in intubated chronic obstructive pulmonary disease patients?

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    Yasar, Zehra; Kirakli, Cenk; Cimen, Pınar; Ucar, Zeynep Zeren; Talay, Fahrettin; Tibet, Gultekin

    2015-01-01

    Introduction: Non-thyroidal illness syndrome (NTIS) is considered to be associated with adverse outcomes in intensive care unit (ICU) patients. In this study, we evaluated the association between NTIS and prolonged weaning in chronic obstructive pulmonary disease (COPD) patients admitted to the ICU. Materials and methods: In total, 125 patients with COPD admitted to our ICU who underwent invasive mechanical ventilation (MV) were enrolled. We collected each patient’s baseline characteristics i...

  11. Bicanalicular versus monocanalicular intubation after failed probing in congenital nasolacrimal duct obstruction

    Science.gov (United States)

    Rajabi, Mohammad Taher; Zavarzadeh, Najmeh; Mahmoudi, Alireza; Johari, Mohammad Karim; Hosseini, Seyedeh Simindokht; Abrishami, Yalda; Rajabi, Mohammad Bagher

    2016-01-01

    AIM To investigate the clinical outcomes of different intubation techniques in the cases of failed primary probing. METHODS This retrospective study was performed on 338 patients with the diagnosis of congenital nasolacrimal duct obstruction with age 1-4y that had failed primary probing. Intubation was performed under light sedation in operating room and the stent was left 3mo in place. Clinical outcome was investigated 3mo after tube removal. RESULTS Bicanalicular intubation method had higher complete and relative success rates compared to monocanalicular intubation (P=0.00). In addition, Monoka intubation had better outcomes compared to Masterka technique (P=0.046). No difference was found between genders but the higher the age, the better the outcomes with bicanalicular technique rather than monocanalicular. CONCLUSION Overall success rate of bicanalicular intubation is superior to monocanalicular technique especially in older ages. Also, based upon our clinical outcomes, Masterka intubation is not recommended in cases of failed probing. PMID:27803865

  12. Self-administered, inhaled methoxyflurane improves patient comfort during nasoduodenal intubation for computed tomography enteroclysis for suspected small bowel disease: a randomized, double-blind, placebo-controlled trial

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    Moss, A., E-mail: dralanmoss@hotmail.co [Department of Gastroenterology and Hepatology, Box Hill Hospital, Melbourne (Australia); Department of Medicine, Monash University, Box Hill Campus, Melbourne (Australia); Parrish, F.J.; Naidoo, P.; Upton, A. [Department of Radiology, Box Hill Hospital, Melbourne (Australia); Prime, H.; Leaney, B. [Department of Radiology, Epworth Eastern Hospital, Melbourne, Victoria (Australia); Gibson, P.R. [Department of Gastroenterology and Hepatology, Box Hill Hospital, Melbourne (Australia); Department of Medicine, Monash University, Box Hill Campus, Melbourne (Australia)

    2011-02-15

    Aim: To determine the efficacy and safety of self-administered, inhaled analgesic, methoxyflurane, used to improve patient comfort during computed tomography enteroclysis (CTE). Materials and methods: A randomized, double-blind, placebo-controlled trial was performed at two Australian hospitals (one tertiary referral public hospital and one private hospital). Patients were randomized to 3 ml methoxyflurane or saline (scented to maintain blindness) via hand-held inhaler. The main outcome measures were patient comfort during each stage of CTE and an overall rating as recorded by patients 1 h post-procedure on a 10 cm visual analogue scale. Patient willingness to undergo repeat CTE, radiologist-rated ease of nasoduodenal intubation, and patient-rated ease of use of the inhaler were also assessed. Results: Sixty patients (mean age 45 years; 41 women) were enrolled; 30 received methoxyflurane and were well matched to 30 receiving placebo. Procedural success was 98%. The mean dose of methoxyflurane consumed was 0.9 ml (SD 0.5). Patient comfort during nasoduodenal intubation was better with methoxyflurane {l_brace}5.0 [95% confidence intervals (CI) 4.0-6.0]{r_brace} than with placebo [2.7 (95% CI 1.8-3.7); p = 0.002, t-test), but there were no significant differences for comfort levels at other times or overall. The inhaler was easy to use, was well tolerated, and there were no episodes of oxygen desaturation, aspiration, or anaphylaxis. Conclusions: Inhalational methoxyflurane safely improves patient comfort during nasoduodenal intubation, but does not improve overall procedure comfort.

  13. Difficult intubation in a patient with carcinoma colon due to tracheobronchopathia osteochondroplastica: An incidental finding or otherwise

    Directory of Open Access Journals (Sweden)

    Ankur Sharma

    2015-04-01

    Conclusion: Awareness of this entity and its anticipation in patients with colorectal carcinoma may help anesthetists to manage similar cases appropriately in the future. Also it shall help in future research being directed to this condition.

  14. Individual music therapy for agitation in dementia: an exploratory randomized controlled trial

    OpenAIRE

    Ridder, Hanne Mette O.; Stige, Brynjulf; Qvale, Liv Gunnhild; Gold, Christian

    2013-01-01

    Objectives: Agitation in nursing home residents with dementia leads to increase in psychotropic medication, decrease in quality of life, and to patient distress and caregiver burden. Music therapy has previously been found effective in treatment of agitation in dementia care but studies have been methodologically insufficient. The aim of this study was to examine the effect of individual music therapy on agitation in persons with moderate/severe dementia living in nursing homes, and to explor...

  15. Submental tracheal intubation for resection of recurrent giant pituitary tumor:a case report

    Institute of Scientific and Technical Information of China (English)

    Zhong Hejiang; Wang Yunling; Yang Tiande

    2011-01-01

    Airway management in the patients who receive transmaxillary approach for resection of giant pituitary tumor presents a clinical challenge to the anesthesiologists. Oral or nasal route for tracheal intubation can interfere with surgical procedures. This report describes submental tracheal intubation for airway management in a patient who underwent resection of recurrent giant pituitary tumor via transmaxillary approach. Submental tracheal intubation is an adaptable and safe alternative technology for airway management during operation.

  16. Failed fibreoptic intubation: 70° rigid nasendoscope and Frova introducer to the rescue

    Directory of Open Access Journals (Sweden)

    Stalin Vinayagam

    2016-01-01

    Full Text Available Endotracheal intubation was successfully accomplished with 70° rigid nasendoscope under video guidance in two patients in whom repeated attempts to secure airway with flexible fibreoptic bronchoscope were unsuccessful. Both patients had compromised airway (laryngeal papillomatosis and a huge thyroid swelling and were uncooperative. Frova intubating introducer was used along with 70° rigid nasendoscope to accomplish tracheal intubation under video guidance.

  17. Submental intubation: A journey over the last 25 years

    Directory of Open Access Journals (Sweden)

    Sabyasachi Das

    2012-01-01

    Full Text Available Airway management in patients with faciomaxillary injuries is challenging due to disruption of components of upper airway. The anesthesiologist has to share the airway with the surgeons. Oral and nasal routes for intubation are often not feasible. Most patients have associated nasal fractures, which precludes use of nasal route of intubation. Intermittent intraoperative dental occlusion is needed to check alignment of the fracture fragments, which contraindicates the use of orotracheal intubation. Tracheostomy in such situations is conventional and time-tested; however, it has life-threatening complications, it needs special postoperative care, lengthens hospital stay, and adds to expenses. Retromolar intubation may be an option, But the retromolar space may not be adequate in all adult patients. Submental intubation provides intraoperative airway control, avoids use of oral and nasal route, with minimal complications. Submental intubation allows intraoperative dental occlusion and is an acceptable option, especially when long-term postoperative ventilation is not planned. This technique has minimal complications and has better patients′ and surgeons′ acceptability. There have been several modifications of this technique with an expectation of an improved outcome. The limitations are longer time for preparation, inability to maintain long-term postoperative ventilation and unfamiliarity of the technique itself. The technique is an acceptable alternative to tracheostomy for the good per-operative airway access.

  18. Submental intubation: a new approach in panfacial trauma.

    Science.gov (United States)

    Gandhi, Monika; Ved, B K

    2014-01-01

    The submental route for endotracheal intubation is an alternative to nasal intubation or tracheo- stomy in the surgical management of patients with complex craniomaxillofacial injuries. The critical indication for submental intubation is the requirement for intra-operative maxillomandibular fixation in the presence of injuries that preclude nasal intubation and in a situation where a tracheostomy is not otherwise required. Maxillomandibular fixation is essential to re-establish dental occlusion for a normal functional result in dentate patients with fractures involving alveolar segments of the jaws. However, maxillomandibular fixation precludes orotracheal intubation. Nasotracheal intubation is often used but is contra-indicated in the presence of skull base fractures and will interfere with the access to certain fracture types. A tracheostomy has a high potential complication rate and in many patients, an alternative to the oral airway is not required beyond the peri-operative period. Submental intuba- tion is a simple and useful technique with low morbidity in selected cases of craniomaxillofacial trauma.

  19. Submental tracheal intubation in oromaxillofacial surgery

    Directory of Open Access Journals (Sweden)

    Sharma Ramesh

    2008-01-01

    Full Text Available Background: Oromaxillofacial surgical procedures present a unique set of problems both for the surgeon and for the anesthesist. Achieving dental occlusion is one of the fundamental aims of most oromaxillofacial procedures. Oral intubation precludes this surgical prerequisite of checking dental occlusion. Having the tube in the field of surgery is often disturbing for the surgeon too, especially in the patient for whom skull base surgery is planned. Nasotracheal intubation is usually contraindicated in the presence of nasal bone fractures seen either in isolation or as a component of Le Fort fractures. We utilized submental endotracheal intubation in such situations and the experience has been very satisfying. Materials and Methods: The technique has been used in 20 patients with maxillofacial injuries and those requiring Le Fort I approach with or without maxillary swing for skull base tumors. Initial oral intubation is done with a flexo-metallic tube. A small 1.5 cm incision is given in the submental region and a blunt tunnel is created in the floor of the mouth staying close to the lingual surface of mandible and a small opening is made in the mucosa. The tracheal end of tube is stabilized with Magil′s forceps, and the proximal end is brought out through submental incision by using a blunt hemostat taking care not to injure the pilot balloon. At the end of procedure extubation is done through submental location only. Results: The technique of submental intubation was used in a series of twenty patients from January 2005 to date. There were fifteen male patients and five female patients with a mean age of twenty seven years (range 10 to 52. Seven patients had Le Fort I osteotomy as part of the approach for skull base surgery. Twelve patients had midfacial fractures at the Le Fort II level, of which 8 patients in addition had naso-ethomoidal fractures and 10 patients an associated fracture mandible. Twelve patients were extubated in the

  20. HAEMODYNAMIC CHANGES DURING NASOTRACHEAL INTUBATION: A COMPARISION BETWEEN DIRECT LARYNGOSCOPIC AND FIBREOPTIC TECHNIQUE

    Directory of Open Access Journals (Sweden)

    Omprakash

    2015-05-01

    Full Text Available Nasotracheal intubation is a skill greatly appreciated by anaesthetists and surgeons in head and neck specialities. The introduction of fibreoptic intubation has revolutionized the anaesthetic management of difficult airway and its increasing use in clinical anaesthesia has drawn attention to the circulatory responses during fibreoptic intubation. The aim of this study was to compare chang es in Heart rate, Systolic and Diastolic blood pressures, SpO 2 and EtCO 2 levels, associated complications and time required to achieve successful nasotracheal intubation with fibreoptic and laryngoscopic technique. 100 patients of ASA grade I & II between 18 - 50 yrs of age undergoing elective surgeries requiring nasotracheal intubation were allocated into two groups. Group I was intubated in the conventional manner using a Macintosh laryngoscope and Group II was intubated using a fibreoptic bronchoscope. Vit al parameters like heart rate, blood pressure ( S ystolic and diastolic, ECG, oxygen saturation, EtCO 2 and N 2 O/Isoflurane % with O 2 were continuously monitored and recorded preoperatively, immediately after induction, at intubation and every 1min for furthe r 5 min. Intubation time was also recorded. Incidence of epistaxis and post - operative sore throat were noted. Nasotracheal intubation was accompanied by significant increases in blood pressure and heart rate compared to post induction values in both group s but there was no significant difference between the two groups. SpO 2 and EtCO 2 were maintained within normal range during both of intubation procedures, although the time required for intubation was longer in fibreoptic bronchoscope group. There was no s ignificant difference in the incidence of epistaxis between the two groups. It was concluded that s t ress response to fibreoptic nasotracheal intubation in similar to nasotracheal intubation facilitated by Macintosh laryngoscope.

  1. Preparing to perform an awake fiberoptic intubation.

    LENUS (Irish Health Repository)

    Walsh, M E

    2012-02-03

    Fiberoptically guided tracheal intubation represents one of the most important advances in airway management to occur in the past thirty years. Perhaps its most important role is in management of the anticipated difficult airway. This is a situation in which the dangers of encountering the life-threatening "can\\'t intubate, can\\'t ventilate" situation can be avoided by placement of an endotracheal tube while the patient is awake. Although skill at the procedure of endoscopy is obviously necessary in this setting, these authors hold that success or failure of the technique frequently depends on the adequacy of preparation. These measures include 1) pre-operative assessment of the patient; 2) careful explanation of what lies in store; 3) "setting the stage"; 4) preparing the equipment to be used; and 5) preparing the patient (antisialogue, sedation, application of topical anesthesia to the upper airway). If these preparatory measures are carried out meticulously, the likelihood of performing a successful and comfortable awake fiberoptic tracheal intubation is greatly increased.

  2. Prednisolone treatment affects the performance of the QuantiFERON gold in-tube test and the tuberculin skin test in patients with autoimmune disorders screened for latent tuberculosis infection

    DEFF Research Database (Denmark)

    Bélard, Erika; Semb, Synne; Ruhwald, Morten;

    2011-01-01

    BACKGROUND: During screening for latent tuberculosis infection (LTBI), before anti-tumor-necrosis-factor-a treatment, most patients are already receiving immunosuppressive therapy. The objective was to evaluate the performance of the QuantiFERON Gold In-Tube (QFT-IT) and the Tuberculin Skin Test....../238 (23%) patients. Chest x-ray was suspect for tuberculosis in 5/236 (2%), and 35/167 (21%) had =1 risk-factors for infection with Mycobacterium tuberculosis. The main finding was a pronounced negative effect on QFT-IT and TST performance associated with prednisolone treatment. During prednisolone...

  3. Application of GlideScope video laryngoscope in patients with foreseen difficulties in tracheal intubation%GlideScope视频喉镜在预见困难气管插管中的应用效果

    Institute of Scientific and Technical Information of China (English)

    潘在礼; 许环航; 谢东进; 黄良诚; 林丽

    2015-01-01

    Objective To compare the effect of GlideScope video laryngoscope and Macintosh direct laryn-goscope intubation for tracheal intubation under general anesthesia. Methods One hundred patients of modified Mal-lampati gradeⅢorⅣfor tracheal intubation under general anesthesia, aged 18 to 60 years old, were randomly divid-ed into GlideScope video laryngoscope group (group G) and Macintosh direct laryngoscope group (group M), with 50 cases in each group. Modified Mallampati grade, Cormack-lehane grade (C/L grade), glottis exposure time, intubation time, mean artery pressure (MAP) and heart rate (HR) before and after induction, as well as intubation-related compli-cations were recorded. Results Compared with group M, C/L grade in group G was significantly lower (C/L gradeⅠ/Ⅱ/Ⅲwere 15/14/1 in group G and 1/25/24 in group M, t=10.999, P=0.000), and the endotracheal tube placement was significantly shorter [(17.6±8.2) s in group G vs (30.8±10.7) s in group M, t=3.491, P=0.000]. Compared with group M, success rate of first intubation, glottis exposure time, MAP and HR changes 1 min after intubation and intuba-tion-related complications in group G showed no statistically significant difference (P>0.05). Conclusion In patients of modified Mallampati grade Ⅲ or Ⅳ with difficulties in tracheal intubation under general anesthesia, GlideScope video laryngoscope results in significantly improved glottis exposure quality and shortened intubation time, compared with Macintosh direct laryngoscope. However, the two methods both have high success rate of first intubation, with similar glottis exposure time, cardiovascular response after intubation and intubation-related complications.%目的 比较全身麻醉下GlideScope视频喉镜和普通Macintosh直接喉镜进行气管插管的效果.方法 选择改良Mallampati评级达到Ⅲ级或Ⅳ级经口气管插管全麻患者100例,年龄18~60岁.按随机数表法分为GlideScope视频喉镜组(G组)和

  4. 两种插管方法用于高位颈椎外伤患者经鼻气管插管的比较%Comparison of nasotracheal intubation between two methods in patients with upper cervical spine injury

    Institute of Scientific and Technical Information of China (English)

    洪英才; 麻伟青

    2013-01-01

    目的 比较使用TruviewEVO2光学喉镜与光导纤维支气管镜在高位颈椎外伤患者经鼻气管插管中的应用情况,包括气管插管时间、心率与收缩压乘积(RPP)以及两种工具插管对血流动力学的影响.方法 选择40例行颈椎手术的高位颈椎外伤(颈1~颈3)患者,随机分为TruviewEV02光学喉镜组(T组)和光导纤维支气管镜组(F组),每组20例.两组麻醉诱导方法和用药相同,分别记录两组患者入室后10 min(T1)、麻醉诱导静脉注药完毕后(T2)、气管插管即刻(T3)及气管插管后5 min(T4)的心率(HR)、收缩压(SBP)、舒张压(DBP)、心率与收缩压乘积(RPP)以及喉部结构暴露时间、气管插管时间.结果 两组均顺利完成气管内插管.组内比较,与T1相比,两组患者T2时的SBP、DBP、RPP均明显下降(P<0.01);与T2相比,两组T3时的HR、SBP、DBP、RPP均明显升高(P<0.01);组间比较,T3时T组的SBP、DBP、RPP明显低于F组(P<0.05或P<0.01);F组的喉部结构暴露时间和气管插管时间均长于T组(P<0.01),其余指标两组间无显著性差异.结论 TruviewEVO2光学喉镜与光导纤维支气管镜经鼻气管插管对患者心血管血流动力均有影响,TruviewEVO2光学喉镜的心血管反应轻,心肌氧耗少,喉部结构暴露时间和气管插管时间短,值得推广应用于高位颈椎外伤患者经鼻气管插管.%Objective To make comparison of nasotracheal intubation between TruviewEV02 optic laryngoscope and fibreoptic bronchoscope in patients with upper cervical spine injury, including intubation time, RPP, and effects of two intubation tools on hemodynamics. Methods Forty patients with upper cervical spine injury ( C1- C3 ) were selected and randomly divided intoTruviewEV02 optic laryngoscope group(T group)and fibreoptic bronchoscope group(F group) with 20 ones in each group. The two groups received the same induction of anesthesia and medication. The following parameters were recorded

  5. Sedation effect of dexmedetomidine on awake intubation in patients with difficult airway%右美托咪定用于困难气道患者清醒气管插管中的镇静作用

    Institute of Scientific and Technical Information of China (English)

    仇琳; 张凌; 纪均

    2013-01-01

    镇静的适宜剂量为1.0 μtg/kg,静脉推注时间为10 min.%Objective:To observe the sedation efficacy and the effect of dexmedetomidine on hemodynamics during awake intubation in patients with difficult airway,and also to compare with midazolam combined with fentanyl.Methods:Sixty patients with difficult airway and Mallampati score≥ Ⅲ were selected and randomly divided into 4 groups(group D1,D2,D3 and MF,n=15) by simple random method.Nasal intubation with fiberoptic bronchoscopy was performed in all patients.Patients in groups D1,D2,D3 were intravenously received 0.5,1.0 and 1.5 μg/kg dexmedetomidine 15 min before intubation respectively.Patients in group MF were intravenously treated with 0.02 mg/kg midazolam and 2.0 μg/kg fentanyl 5 min before intubation.Thyrocricoid puncture was performed by transcricothyroid injection of 2 % lidocaine 1 mg/kg,2 min before intubation.Sedative efficacy was evaluated by Ramsay sedation scores before transcricothyroid injection,intubation scores,post intubation conditions during intubation,and patient satisfaction scores of the awake intubation.Success rate and consumption time for intubation were assessed.Respiratory function,hemodynamics,stress hormone changes and incidence of adverse events were recorded as well.Results:There was no significant difference in success rate and consumption time of intubation among the 4 groups.Ramsay sedation scores were significantly higher than that of before transcricothyroid injection in all groups,when compared with those before induction(P<0.01).Ramsay sedation score was lower,but intubation score,post-intubation conditions and patient satisfaction score were significantly higher in group D1 than those in groups D2,D3,MF (P<0.05).There were no significant differences in groups D2,D3 and MF.Compared with those before induction,heart rate(HR),systolic pressure(SBP)were decreased obviously after administration in all groups(P<0.05 or P<0.01).HR,SBP,the levels of adrenocorticotropic hormone

  6. Experience of monitoring the recurrent laryngeal nerve in thyroid surgery with endotracheal intubation

    Directory of Open Access Journals (Sweden)

    Liang Feng

    2017-01-01

    Full Text Available Purpose:To analysis clinical experience of applying recurrent laryngeal monitoring endotracheal tube (NIM EMG Endotracheal Tube in the surgery of thyroid. Method: A retrospective analysis of 84 patients who underwent endotracheal intubation laryngeal nerve monitoring by thyroid surgery in the Chinese-Japanese Friendship Hospital of Jilin University from March to December in 2015. To summarize the experience of intubation with NIM EMG Endotracheal Tube. Result 77 (91.7%had initial intubation achievement in the 84 patients.FROM the 77 cases we had gotten s atisfactory nerve monitoring signal.Whereas there are 7 cases (8.3% appear abnormal EMG or signal missing, in the 7 cases there is one which being intubated too deep, 3 cases which being intubated too shallow and 3 cases with malrotation intubation.Conclusion: We got the satisfactory signals after adjust1ing the tube by using the visual laryngoscope.

  7. 院前气管插管与颅脑创伤术后肺部感染的关系%The relationship between prehospital endotracheal intubation and the postoperative pulmonary infection in patients with traumatic brain injury

    Institute of Scientific and Technical Information of China (English)

    王辉; 花嵘; 江小伟; 郭晓霞; 王尚静; 李威

    2015-01-01

    Objective To investigate the impacts of prehospital endotracheal intubation on postoperative pulmonary infection in the patients with severe traumatic brain injury.Methods Retrospectively, the clinical data of 284 patients with severe traumatic brain injury admitted in the 97th Hospital of PLA from July 2007 to December 2012 were analyzed.The patients were classified into two groups according to the timing of endotracheal intubation, namely, prehospital intubation group and admission intubation group.The postoperative pulmonary infection incidence, occurrence time, and the duration of treatment of the two groups were studied.Results The incidences of postoperative pulmonary infection in patients intubated before and after admission were 38.0% and 25.2% respectively.Pulmonary infection occurred in the prehospital intubation group was at the (9.9 ± 0.6) d after admission, and in the admission intubation group was at the (11.6 ± 0.3) d after admission.The duration of treatment for postoperative pulmonary infection was (21.2 ± 7.2) days and (14.5 ± 9.0) days respectively.Compared with the patients intubated after admission, patients intubated before admission suffered higher incidence (P < 0.05), earlier onset (P < 0.05), and longer treatment duration of pulmonary infection (P < 0.01).Conclusions Severe traumatic brain injury patients with prehospital endotracheal intubation are more susceptible to pulmonary infection.Avoiding the tracheal injury and bacterial contamination in the procedure could reduce the incidence of pulmonary infection.%目的 探讨重型颅脑损伤患者院前进行气管插管与其术后肺部感染的关系.方法 回顾分析解放军第九七医院2007年1月至2012年12月的284例重型颅脑损伤患者的临床资料,根据插管的时间分为院前气管插管组和院内气管插管组.分析两组患者中术后出现肺部感染的发生率、发生时间的先后、治疗时间的长短.结果 院前气管插管组

  8. Evaluation of safety and usefulness of submental intubation in panfacial trauma surgery

    Science.gov (United States)

    2016-01-01

    Objectives Submental intubation has been advocated as an alternative to classical tracheostomy for certain indicated panfacial trauma surgeries. Surgeons should have various options for airway management in maxillofacial trauma patients. Most maxillofacial injuries involve occlusal derangements, which might require intraoperative occlusal corrections; hence, orotracheal intubation is not ideal. Maxillofacial surgeons generally prefer nasotracheal intubation; however, in cases with concomitant skull base fracture or nasal bone fracture, nasotracheal intubation might not be suitable; in these situations, tracheostomy is typically performed. However, the possible complications of tracheostomy are well known. Due to trauma situations and to avoid the complications of tracheostomy, submental intubation would be an ideal alternative procedure in selected maxillofacial trauma surgery patients. This study aimed to evaluate the safety and usefulness of a submental intubation technique for panfacial trauma surgery. Moreover, we intended to share our experience of submental intubation and to recommend this simple, safe procedure for certain panfacial trauma surgeries. Materials and Methods In five panfacial trauma patients, we performed submental intubation for airway management; the mean time required for the procedure was only eight minutes. Results We were able to execute this procedure safely in a short time without any intraoperative or postoperative complications. Conclusion Submental intubation is a safe and simple technique for airway management in indicated panfacial trauma surgery patients. PMID:27162750

  9. Learning and performance of endotracheal intubation by paramedical students: Comparison of GlideScope® and intubating laryngeal mask airway with direct laryngoscopy in manikins

    Directory of Open Access Journals (Sweden)

    Adil Omar Bahathiq

    2016-01-01

    Full Text Available Background and Aims: GlideScope video laryngoscope (GVL and intubating laryngeal mask airway (I-LMA may be used to facilitate intubation and secure the airway in patients with normal and abnormal airways. The aim of this study was to evaluate whether (GVL and (I-LMA facilitate and improve the tracheal intubation success rate and could be learned and performed easily by paramedic students when compared with Macintosh direct laryngoscopy (DL. Methods: This study was a prospective, randomised crossover trial that included 100 paramedic students. Macintosh DL, I-LMA and GVL were tested in both normal and difficult airway scenarios. Each participant was allowed up to three intubation attempts with each device, in each scenario. The time required to perform tracheal intubation, the success rate, number of intubation attempts and of optimisation manoeuvres and the severity of dental trauma were recorded. Statistical analysis was performed using Chi-square, one-way ANOVA, or Kruskal-Wallis test as appropriate, followed by post hoc test. Results: GVL and I-LMA required less time to successfully perform tracheal intubation, showed a greater success rate of intubation, reduced the number of intubation attempts and optimization manoeuvres required and reduced the severity of dental trauma compared to Macintosh DL in both normal and difficult airway scenarios. Conclusion: GVL and I-LMA provide better airway management than Macintosh DL in both normal and difficult airway scenarios.

  10. Inhaled loxapine: A novel treatment for agitation in psychotic disorders

    Directory of Open Access Journals (Sweden)

    Siwek, Marcin

    2014-10-01

    Full Text Available Psychomotor agitation is a widespread clinical problem both in patients with schizophrenia and BD. It is a highly hazardous condition, imposing significant risks in psychiatric emergency, as expressed by elevated ratios of adverse events and traumatic experiences (both for patients and medical staff. The available anti-agitation drugs have numerous disadvantages. The orally administered medications (even though preferable to patients take hours or even days for the therapeutic effect to emerge (and also there is a risk of exacerbating agitation in between. Although rapid onset of action (15–45 minutes is a noteworthy merit of intramuscular drugs, such an invasive strategy is far too often bound to patients’ anxiety, resistance, and traumatic experiences. The need for novel drug formulations (ideally, both integrating the benefits of injectable and orally administered tranquillizing medications, and free from their disadvantages can be, therefore, clearly grasped. Development of inhaled loxapine exemplifies the attempts to overcome the above-delineated obstacles. As suggested by the available research base, inhaled loxapine seems to be an effective anti-agitation drug in treatment of patients with schizophrenia and BD (with the onset of action similar to the one observed in intramuscular antipsychotics. However, this formulation of loxapine is distinguished by its non-invasive route of administration, as accompanied by markedly low risk of side effects or adverse events.

  11. Reconstruction of soft plate necrosis after endotracheal intubation.

    Science.gov (United States)

    Lee, Hyuck Jae; Lim, So Young; Pyon, Jai-Kyong; Mun, Goo Hyun; Bang, Sa Ik; Oh, Kap Sung

    2014-01-01

    Uvular necrosis after long-term endotracheal intubation has been previously reported, but there have been no reports regarding soft palate necrosis after endotracheal intubation. Recently, we encountered 2 patients who had a high degree of soft palate necrosis following endotracheal intubation during long-term care in the intensive care unit. This study reports noncongenital soft palate cleft caused by endotracheal intubation. Two patients, aged 30 and 38 years, with noncongenital cleft palate were treated with pharyngeal flap and/or palatoplasty at our institution from March 2011 to May 2013. Initially, the patients complained of acquired speech disorder and severe oronasal regurgitation caused by a palatal defect. Speech ability was evaluated preoperatively and postoperatively by a perceptual language test and nasopharyngoscopy. The cleft soft palates of both patients were completely repaired, and the aforementioned symptoms improved after surgery. Postoperative courses were uneventful in both of the cases, and neither patient experienced a recurrence. Although rare, long-term intensive care unit care with endotracheal intubation can cause noncongenital soft palate cleft. In cases with iatrogenic cleft palate that does not heal with conservative treatment, surgical procedures such as pharyngeal flap and palatoplasty can be helpful.

  12. Airtraq与光棒在颈椎制动患者气管插管中的应用比较%Tracheal Intubation using Airtraq or Lightwand in Patients with Cervical Spine Immobilization

    Institute of Scientific and Technical Information of China (English)

    李鹏; 许广民; 刘宇

    2015-01-01

    Objective To compare the use of Airtraq and Lightwand in simulated cervical spine immobilization. Methods Sixty patients,underwent general anesthesia requiring tracheal intubation,were randomly assigned to use Airtraq( group A,n=30) and Lightwand(group L,n=30). Patients was provided manual in-line axial stabilization of the head and neck . Tracheal in-tubation time,times of attempt and manoeuvre needed to aid,luctuations of hemodynamics , and complications were recorded. Re-sult Compared with group A,the times of tracheal intubation and intubation attempts were more in group L,the difference was sta-tistically significant(P<0. 05). There is a hemodynamic fluctuations in group A when after intubation,the difference was statisti-cally significant(P<0. 05). The patients with postoperative sore throat pain was more in group L ,the difference was statistically significant(P<0. 05). Conclusion The Airtraq laryngoscope and Lightwand might be a good alternative for tracheal intubation in patients with cervical spine immobilization. With more stable hemodynamic,lightwand need shorter time but lower success rate than Airtraq.%目的:比较颈椎制动患者全麻气管插管时应用Airtraq视频喉镜与光棒的血流动力学变化及应用效果差异。方法择期经口全身麻醉手术患者60例,随机分为A和L两组。全麻诱导气管内插管,采用手法控制稳定( MIAS)方法头颈制动,使用Airtraq视频喉镜和光棒引导插管。比较两组插管前后血流动力学变化及插管时间、插管次数、有无助手辅助及插管并发症。结果 L组插管时间延长、插管次数多于A组,差异有统计学意义(P<0.05)。 A组插管后心率与平均动脉压较插管前增高,差异有统计学意义( P<0.05)。 L组术后患者咽喉疼痛等咽喉并发症高于A组,差异有统计学意义(P<0.05)。结论在颈椎制动患者中两种插管方法均取得了较高的的成功率,光棒所需时间较长但对血流动力

  13. Temporomandibular joint sounds and disc dislocations incidence after orotracheal intubation.

    Science.gov (United States)

    Rodrigues, Estela T; Suazo, Iván C; Guimarães, Antonio S

    2009-01-01

    The aim of this study was to analyze the temporomandibular joint (TMJ) disc displacement and articular sounds incidence after orotracheal intubation. A prospective cohort study was conducted in the Hospital Universitário do Oeste do Paraná (HUOP), in Cascavel, Brazil. 100 patients (aged 14-74 years, mean 44 years), 34 male and 66 female, in need of surgical procedure with orotracheal intubation were evaluated. The anterior disc displacement with reduction incidence and the nonclassifiable sounds incidence by the Research Diagnostic Criteria Axis I was evaluated in all patients after orotracheal intubation. The patients was evaluated one day before and until two days after the procedure. Eight percent present with anterior disc displacement with reduction and 10% presented nonclassifiable sounds after the orotracheal intubation. There was no correlation of any kind regarding gender related influence in the incidence of disc dislocations (P = 0.2591) and TMJ sounds (P = 0.487). Although anterior disc dislocations and TMJ sounds after anesthetic with orotracheal intubation presented a low incidence (8%-10%), it is recommended that the evaluation of TMJ signs and symptoms be done before the anesthetic procedure to take care with susceptible patients manipulation.

  14. Endotracheal Administration of Sufentanil and Tetracaine During Awake Fiberoptic Intubation.

    Science.gov (United States)

    Ji, Meng; Tao, Jun; Cheng, Min; Wang, Qingli

    2016-01-01

    Combined use of local anesthetics and low-dose opioids enhances the effects of local anesthetics. This study aimed to evaluate the efficacy of combined administration of sufentanil and tetracaine through the cricothyroid membrane during awake nasal intubation using fiberoptic bronchoscopy in patients with difficult airways. Forty patients were divided into 2 groups: group A received endotracheal administration of 25 μg of sufentanil and 2 mL of 1% tetracaine mixture; group B received endotracheal administration of 2 mL 1% tetracaine and routine local anesthetic sprays followed by slow intravenous injection of 25 μg of sufentanil. The results showed that endotracheal intubation was safely completed in all patients and vital signs including blood pressure, heart rate, and pulse oxygen saturation were not significantly different between groups A and B. However, time required for local anesthesia to take effect, time required to complete intubation, cough reflex, patient tolerance during intubation, and hemodynamic indices were significantly better in group A than in group B. In conclusion, our results suggest that endotracheal administration of sufentanil combined with tetracaine is safe, effective, and feasible in the context of awake nasal intubation using fiberoptic bronchoscopy.

  15. [Application of music therapy for managing agitated behavior in older people with dementia].

    Science.gov (United States)

    Sung, Huei-Chuan; Chang, Anne M; Abbey, Jennifer

    2006-10-01

    Older people with dementia may display negative emotions, memory problems, sleep disturbance, and agitated behavior. Among these symptoms, agitated behavior has been identified by families and nursing staff as the care problem that presents the greatest challenge. Several studies have found that music therapy reduced agitated behaviors in those with dementia and recommended use of music as an effective strategy in managing this behavioral problem. Music therapy represents a lower cost, effective care approach that nursing staff can easily learn and apply to those with dementia. Furthermore, reductions in agitated behavior in dementia patients that result from music therapy can also alleviate caregiver stress and burden of care, leading to improvements in the health and quality of life of both dementia patients and their caregivers. This paper aims to introduce the principles and application of music therapy in the management of agitated behavior in those with dementia.

  16. Hemodynamic response to endotracheal intubation using C-Trach assembly and direct laryngoscopy

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    Jayita Sarkar

    2015-01-01

    Full Text Available Purpose: Our objective was to study the pressor response to endotracheal intubation through laryngeal mask airway C-Trach and compare it to the hemodynamic response to intubation with direct laryngoscopy (DL. Materials and Methods: After obtained approval from institutional ethical committee, 100 patients of American Society of Anesthesiologists physical Status I, aged 14-65 years, posted for elective surgery were enrolled in the trial. They were randomly divided into two groups of each 50 patients. Anesthesia technique was standardized and patients of Group I were intubated using DL, while patients of Group II were intubated with the help of C-Trach assembly. Hemodynamic parameters, systemic blood pressure (systolic and diastolic and heart rate were recorded before and after induction of anesthesia and every minute up to 5 min after intubation. Results: Patients of Group II recorded a minimal rise in peak systolic blood pressure (SBP (1.8% and diastolic blood pressure (10.6%. In comparison patients of Group I recorded a significant sustained rise in peak SBP (20.3% and diastolic blood pressure (21.4%. However heart rate changes recorded in the two groups were of equal measure (peak rise of 22.9% in Group I vs. 22.4% in Group II. Conclusion: We conclude that intubation through C-Trach generates a lower pressor response to intubation in comparison to intubation using DL.

  17. Airtraq® versus Macintosh laryngoscope: A comparative study in tracheal intubation

    Science.gov (United States)

    Bhandari, Geeta; Shahi, K. S.; Asad, Mohammad; Bhakuni, Rajani

    2013-01-01

    Background: The curved laryngoscope blade described by Macintosh in 1943 remains the most widely used device to facilitate tracheal intubation. The Airtraq® (Prodol Meditec S.A, Vizcaya, Spain) is a new, single use, indirect laryngoscope introduced into clinical practice in 2005. It has wan exaggerated blade curvature with internal arrangement of optical lenses and a mechanism to prevent fogging of the distal lens. A high quality view of the glottis is provided without the need to align the oral, pharyngeal and tracheal axis. We evaluated Airtraq and Macintosh laryngoscopes for success rate of tracheal intubation, overall duration of successful intubation, optimization maneuvers, POGO (percentage of glottic opening) score, and ease of intubation. Materials and Methods: Patients were randomly allocated by computer-generated random table to one of the two groups, comprising 40 patients each, group I (Airtraq) and group II (Macintosh). After induction of general anesthesia, tracheal intubation was attempted with the Airtraq or the Macintosh laryngoscope as per group. Primary end points were overall success rate of tracheal intubation, overall duration of successful tracheal intubation, optimization maneuvers, POGO score and ease of intubation between the two groups. Results: We observed that Airtraq was better than the Macintosh laryngoscope as duration of successful intubation was shorter in Airtraq 18.15 seconds (±2.74) and in the Macintosh laryngoscope it was 32.72 seconds (±8.31) P < 0.001. POGO was also better in the Airtraq group 100% grade 1 versus 67.5% in the Macintosh group, P < 0.001. Ease of intubation was also better in the Airtraq group. It was easy in 97.5% versus 42.5% in the Macintosh group, P < 0.001. Conclusion: Both Airtraq and Macintosh laryngoscopes are equally effective in tracheal intubation in normal airways. Duration of successful tracheal intubation was shorter in the Airtraq group which was statistically significant. PMID:25885839

  18. A pilot study of the effect of pressure-driven lidocaine spray on airway topical anesthesia for conscious sedation intubation

    Institute of Scientific and Technical Information of China (English)

    JIANG Hai; MIAO Hai-sheng; JIN San-qing; CHEN Li-hong; TIAN Jing-ling

    2011-01-01

    Background Difficult airway remains not only a challenge to the anesthesiologists,but also a life-threatening event to the patients.Awake intubation is the principal choice to deal with difficult airway,and a key point for awake intubation is airway topical anesthesia.Yet,so far there is no ideal topical anesthesia approach for awake intubation.This study aimed at evaluating the effect of pressure-driven (by 10 L/min oxygen flow) lidocaine spray on airway topical anesthesia in order to find a powerful and convenient method for airway topical anesthesia for conscious sedation intubation.Methods Thirty adult patients referred for elective surgery under general anesthesia,aged 18-60 years and Mallampati class Ⅰ or Ⅱ,were recruited for the study.Before topical anesthesia,the observer's assessment of alert and sedation (OAA/S) scale was controlled between 3 and 4 by intravenous midazolam (0.03 mg/kg),propofol (2 mg.kg1·h-1) andremifentanil (0.05 μg.kg-1·min-1).Ten minutes after sedation,topical anesthesia was performed with the pressure-driven lidocaine spray; the driving pressure was achieved by an oxygen flow of 10 L/min.After topical anesthesia,tracheal intubation was performed and the intubation condition was assessed with modified the Erhan's intubation condition score by an experienced anesthesiologist,and a score of less than 10 was considered to be satisfactory.Attempts to intubate the patient were recorded,and the complications such as local anesthetic toxicity,mucosa injury,and respiration depression were also recorded.The mean arterial blood pressure (MAP),heart rate (HR) and pulse oxygen saturation (SpO2) were recorded at different time points before and after intubation.Patients were asked 24 hours after the operation whether they could recall the events during intubation.Results All patients were intubated at the first attempt,the average intubation condition score was 7.0±1.1,from 6 to 10,satisfied intubation condition.MAP and HR increased

  19. 激越/迟滞型抑郁症首次发作患者的认知功能%A study of cognitive function in patients with first-episode agitated and retarded major depressive disorder

    Institute of Scientific and Technical Information of China (English)

    李泾; 吴天诚

    2012-01-01

    Objective: To study the characteristics of cognitive function and influence factors by the neu-ropsychological tests in patients with first-episode agitated and retarded major depressive disorder. Method: 77 first-episode depressive participants were grouped according to the scores of agition and retardation in Hamilton depression scale( HAMD). Three or more points of each item were separately recrudited agitated-group(n = 20) or retarded-group (n = 24), less than three points in both items were non-interactive group (n =33). All participants and normal controls(n =40) were tested by Wisconsin card sorting test( WCST) ,continuous performance test ( CPT) and Wechsler memory test ( WMS) , to record the indexes and correlate with dosage of an-tipsychotics,clinical symptoms. Results:(1)There were wide cognitive impairment in depression patients(P< 0.05 or P <0. 01 ) :(2)A11 indexes of WCST,CPT parameters( number of cancel,number of commission, mean reaction time) and WMS indexes (memory quotient,short-term memory,immediate memory) in agitated and retarded groups were significantly different compared with non-interactive ones( P < 0. 05 or P < 0.01): (3)There were obvious diversities between agitated and retarded groups including non-preservative errors of WCST, number of commission and mean reaction time of CPT, short-term memory of WMS(p <0.05 or P <0. 01) :(4)No significant correlation was found between most of parameters and clinical symptoms or the amounts of psycho-tropic drugs (imipramine-equivalent dose of anti-depressants,diazepam-equivalent dose of sedatives,chlorprom-azine-equivalent dose of antipsychotics). Conclusion: The cognitive dysfunction of agitated depression pa-lients were not the same as those of retarded ones entirely,which supplied a positive evidence for the heterology of major depressive disorder.%目的:探讨激越型和迟滞型抑郁症首次发作患者的认知功能特征及其影响因素. 方法:77例抑郁症首次发作患者根

  20. Modified nasogastric intubation in severe craniocerebral trauma patients%改良鼻饲插管法在重度颅脑损伤患者中的应用

    Institute of Scientific and Technical Information of China (English)

    胡建军

    2014-01-01

    ObjectiveExplore improvements in the treatment of nasal feeding patients with severe traumatic brain injury.MethodsSelect severe traumatic brain injury patients required postoperative gastric tube home patients were randomly divided into control and experimental groups all 68 cases,respectively,using conventional and modified nasogastric intubation,compared to a success rate and patient comfort,observed in patients after nasal effect.Results The modified method,67 patients were disposable cannula using this method is successful and the patient less pain during intubation.ConclusionAfter severe traumatic brain injury through improved nasogastric intubation,a success rate and a substantial increase patient comfort and effective maintenance and use of the normal function of the gastrointestinal tract,prevent malnutrition,and enhance the patient's immune system and reduce complications.%目的:探讨改良鼻饲饮食在重型颅脑损伤患者治疗中的应用效果。方法选择重型颅脑损伤术后需置胃管的患者随机分成对照组和试验组各68例,分别采用传统及改良的鼻饲插管法,对比一次性置管成功率及患者舒适度,观察患者鼻饲后的效果。结果采用改良方法,67例患者插胃管一次性成功,且患者插管时痛苦小。结论重型颅脑损伤后通过改良鼻饲插管法,一次性成功率及患者舒适度大幅提高,有效维护和利用了胃肠道正常功能,避免发生营养不良,增强患者的免疫力,减少并发症。

  1. Managing Agitation Associated with Schizophrenia and Bipolar Disorder in the Emergency Setting

    Directory of Open Access Journals (Sweden)

    Scott L. Zeller, MD

    2016-03-01

    Full Text Available Introduction: Patient agitation represents a significant challenge in the emergency department (ED, a setting in which medical staff are working under pressure dealing with a diverse range of medical emergencies. The potential for escalation into aggressive behavior, putting patients, staff, and others at risk, makes it imperative to address agitated behavior rapidly and efficiently. Time constraints and limited access to specialist psychiatric support have in the past led to the strategy of “restrain and sedate,” which was believed to represent the optimal approach; however, it is increasingly recognized that more patient-centered approaches result in improved outcomes. The objective of this review is to raise awareness of best practices for the management of agitation in the ED and to consider the role of new pharmacologic interventions in this setting. Discussion: The Best practices in Evaluation and Treatment of Agitation (BETA guidelines address the complete management of agitation, including triage, diagnosis, interpersonal calming skills, and medicine choices. Since their publication in 2012, there have been further developments in pharmacologic approaches for dealing with agitation, including both new agents and new modes of delivery, which increase the options available for both patients and physicians. Newer modes of delivery that could be useful in rapidly managing agitation include inhaled, buccal/ sublingual and intranasal formulations. To date, the only formulation administered via a nonintramuscular route with a specific indication for agitation associated with bipolar or schizophrenia is inhaled loxapine. Non-invasive formulations, although requiring cooperation from patients, have the potential to improve overall patient experience, thereby improving future cooperation between patients and healthcare providers. Conclusion: Management of agitation in the ED should encompass a patient-centered approach, incorporating non

  2. Comparison of the Laryngeal View during Tracheal Intubation Using Airtraq and Macintosh Laryngoscopes by Unskillful Anesthesiology Residents: A Clinical Study

    Directory of Open Access Journals (Sweden)

    Carlos Ferrando

    2011-01-01

    Full Text Available Background and Objective. The Airtraq laryngoscope (Prodol Meditec, Vizcaya, Spain is a novel tracheal intubation device. Studies, performed until now, have compared the Airtraq with the Macintosh laryngoscope, concluding that it reduces the intubation times and increase the success rate at first intubation attempt, decreasing the Cormack-Lehane score. The aim of the study was to evaluate if, in unskillful anesthesiology residents during the laryngoscopy, the Airtraq compared with the Macintosh laryngoscope improves the laryngeal view, decreasing the Cormack-Lehane score. Methods. A prospective, randomized, crossed-over trial was carried out on 60 patients. Each one of the patients were intubated using both devices by unskillful (less than two hundred intubations with the Macintosh laryngoscope and 10 intubations using the Airtraq anesthesiology residents. The Cormack-Lehane score, the success rate at first intubation attempt, and the laryngoscopy and intubation times were compared. Results. The Airtraq significantly decreased the Cormack-Lehane score (=0.04. On the other hand, there were no differences in times of laryngoscopy (=0.645; IC 95% 3.1, +4.8 and intubation (=0.62; C95%  −6.1, +10.0 between the two devices. No relevant complications were found during the maneuvers of intubation using both devices. Conclusions. The Airtraq is a useful laryngoscope in unskillful anesthesiology residents improving the laryngeal view and, therefore, facilitating the tracheal intubation.

  3. 压力支持通气模式联合右美托咪定用于气管内插管患者苏醒期的效果%Effect of Pressure Support Ventilation combined with Dexmedetomidine on Recovery Period in Endotracheally Intubated Patients

    Institute of Scientific and Technical Information of China (English)

    周良军; 王寿平; 陈晓彤

    2015-01-01

    before the end of operation. The time of opening eyes after operation and extubation time were recorded. Riker sedation-agitation scale and Ramsay sedation scale were recorded at the time of extubation. MAP and HR were recorded at the time of extubation (T1), 2min after extubation (T2), 5min after extubation (T3), 10min after extubation (T4). Results: Compared with group C,there were no significant differences in the time of opening eyes after operation and extubation time in group D (P>0.05). The score of Riker sedation-agitation scale in most patients in group C was 5 at the time of extubation with fast HR and high MAP. Compared with group C,the incidence ofagitation was significantly decreased in group D (P0.05). Conclusion:PSV combined with dexmedetomidine can prevent cardiovascular adverse reactions and agitation caused by the endotracheal tube during recovery period in endotracheally intubated patients without delayed awakening.

  4. Study on significance of application of dexmedetomidine in reducing agitation and throat pain in patients after general anesthesia%右美托咪定预防全麻术后躁动和咽喉疼痛的作用

    Institute of Scientific and Technical Information of China (English)

    钟剑平; 何绍旋

    2014-01-01

    目的:探讨右美托咪啶在预防全麻术后躁动和咽喉疼痛方面的应用价值,以提高全身麻醉的安全性。方法选取接受全麻手术治疗的患者114例,通过随机数字表法将其分为观察组和对照组各57例。两组均采用相同的药物进行全身麻醉,观察组在手术结束前半个小时静脉泵入右美托咪啶,对照组则静脉泵入相同体积的0.9%氯化钠注射液。对比两组患者恢复自主呼吸的时间和拔除气管插管时间以及术后躁动和咽喉疼痛的发生率。结果两组患者恢复自主呼吸时间、拔除气管插管时间的对比,差异无统计学意义( P ﹥0.05)。在术后躁动方面,观察组0级的有53例,躁动率为7.02%;对照组0级的有34例,躁动率为40.35%。观察组躁动率显著低于对照组( P ﹤0.05)。在术后咽喉疼痛方面,观察组0级的有46例,咽喉疼痛率为19.30%;对照组0级的有30例,咽喉疼痛率为47.37%。观察组咽喉疼痛率显著低于对照组( P ﹤0.05)。结论右美托咪啶对全麻术后躁动和咽喉疼痛具有良好的预防作用,同时不会增加呼吸抑制的风险,值得在临床上推广应用。%Objective Toexploretheapplicationvalueofdexmedetomidineinreducingagitationandthroatpainaftergeneralanesthesia, inordertoimprovethesafetyofanesthesia.Methods Atotalof114patientsunderwentgeneralanesthesiaforoperationinthishospitalwerese-lected for this study,they were divided by random number table method into observation group and control group,each with 57 cases. Patients in these two groups were used with same drug for general anesthesia,patients in observation group were given with intravenous infusion of dexmedeto-midine at half hour before the end of operation,while patients in control group were administrated with intravenous infusion of same volume of 0. 9% sodium chloride solution. The incidence rates of agitation,spontaneous breathing recovery

  5. 右美托咪啶用于饱腹创伤患者清醒插管的效果%Clinical Observation of Dexmedetomidine Used in Awake Intubation in Satiety Patients with Food Intaken

    Institute of Scientific and Technical Information of China (English)

    黄毅然; 李文红; 吴会红; 陈睿

    2013-01-01

    Objective To observe the clinical effects of dexmedetomidine.(Dex) used in awake intubation in satiety patients with food intaken.Methods 30 patients were randomly and equally divided into two groups.Patients in group A received midazolam 30 μg/kg and FentanyL 1 μg/kg,and those in group B received Dex at loading of does 0.6 μg/kg for 15 minutes with the rate of 30 μg/(kg · h),when the patients experession of alertness/Sedation(OAA/S) reached to 3 in the two groups were received 1% tetracaine enough topical anesthetics to the airway,then awake intubation was administered.OAA/S,HR,MAP,SPO2,and RR were recorded before drug adminisration (T0),when QAA/S reached to 3 (T1),and success of intubation (T2).Results HR in group B showed down obviously and it was less than in group A after using the drug (P < 0.05) ; BP in the two groups raised after intubation(P < 0.05),SpO2 in the two group lowered after using the drugs and was higher in group B than in group A (P < 0.05).Conclusion Dex had desirable sedation and analgesia effects and may be used in awake intubation in satiety patients with food intaken alone.%目的 探讨右美托咪啶用于饱腹创伤患者清醒插管的效果.方法 将急诊行气管插管全麻饱腹创伤患者30例随机分为咪达唑仑复合芬太尼组(A组)和右美托咪啶组(B组),每组15例.A组静脉注射芬太尼1μg/kg及咪达唑仑30 μg/kg,B组于15 min内静脉输注右美托咪啶0.6 μg/kg,15 min后改为30μg/(kg·h)维持患者Ramsay镇静评分3~4分,咽喉腔表面麻醉后清醒气管插管.结果 两组一般资料各指标、插管时间比较差异无统计学意义,与A组比较,B组清醒气管插管时MAP降低,HR减慢,呼吸抑制的发生率降低(P<0.05),心动过速、高血压、恶心、呛咳、躁动的发生率降低(P<0.05).结论 右美托咪啶作为一种新型的镇静、镇痛药,应用于饱腹患者清醒气管插管,可减轻插管所致的心脑血管应激反应,对自主呼吸无抑制.

  6. Does ultrasonographic volume of the thyroid gland correlate with difficult intubation? An observational study

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    Basak Ceyda Meco

    Full Text Available BACKGROUND AND OBJECTIVES: Preoperative ultrasonographic evaluation of the thyroid gland done by surgeons could let us foresee airway management challenges. The aim of this observational study was to evaluate the effects of thyroid-related parameters assessed preoperatively by surgeons via ultrasonography and chest X-ray on intubation conditions. METHODS: Fifty patients undergoing thyroid surgery were enrolled. Thyromental distance, Mallampati score, neck circumference and range of neck movement were evaluated before the operation. Thyroid volume, signs of invasion or compression and tracheal deviation on chest X-ray were also noted. The intubation conditions were assessed with Cormack and Lehane score and the intubation difficulty scale. Statistical analyses were done with SPSS 15.0 software. RESULTS: The mean thyroid volume of the patients was 26.38 ± 14 mL. The median intubation difficulty scale was 1 (0-2. Thyromental distance (p = 0.011; r = 0.36; 95% CI 0.582-0.088, Mallampati score (p = 0.041; r = 0.29; 95% CI 0.013-0.526, compression or invasion signs (p = 0.041; r = 0.28; 95% CI 0.006-0.521 and tracheal deviation on chest X-ray (p = 0.041; r = 0.52; 95% CI 0.268-0.702 were correlated with intubation difficulty scale. Also patients were classified into two groups related to their intubation difficulty scale (Group I, n = 19: intubation difficulty scale = 0; Group II, n = 31: 1 < intubation difficulty scale ≤ 5 and difficult intubation predictors and thyroid-related parameters were compared. Only Mallampati score was significantly different between groups (p = 0.025. CONCLUSION: The thyroid volume is not associated with difficult intubation. However clinical assessment parameters may predict difficult intubation.

  7. Experience of media presentations for the alleviation of agitation and emotional distress among dementia patients in a long-term nursing facility.

    Science.gov (United States)

    Chung, Joohyun; Choi, Seong-In; Kim, Jun

    2016-09-01

    Although the cause and the cure for dementia remain unknown, it is clear that environmental factors can offer relief of cognitive impairment and encourage emotional stability. The purpose was to explore dementia patients' experiences of a media presentation including images of nature. Combining a qualitative approach with quantitative data analysis, the project exposed 23 participants to slide show presentations of fascinating natural scenes over 4 weeks. The patients' feelings and experiences of the media presentations were investigated using semistructured interviews and daily chart reviews in which weekly behavioral changes. The experience of natural scenes in dementia patients' everyday atmosphere became a new and positive aspect of life at the long-term nursing facility, although the quantitative data did not significantly change during the project. This treatment could provide dementia patients with a nurturing relationship, making nature a supportive part of their everyday experience.

  8. 经口气管插管患者使用电动牙刷行口腔护理的效果%Effect of electric toothbrush on oral care among patients with orotreacheal intubation

    Institute of Scientific and Technical Information of China (English)

    李凡; 李玉乐; 胡英莉; 史冬雷; 孙红; 周文华; 周瑛; 田丽源; 高健

    2015-01-01

    Objective To study the clinical effect of electric toothbrush on oral care among patients with orotreacheal intubation. Methods A total of 100 cases of orotracheal intubation were randomly divided into two groups, 50 cases in observation group and 50 cases in control group. The patients of observation group used electric toothbrush with chlorhexidine for oral care, and the patients of control group received the traditional oral care method. Results The oral cavity cleanness (80% ofⅠdegree) in the observation group were significantly better than 24% Ⅰdegree cleanness patients of the control group, while the Ⅱ and Ⅲ degree were 16% and 4% of the observation group were lower than 46% and 30% of the control group (χ2 =26. 606, 10. 519, 11. 977;P0. 05). Conclusions The clinical effect of oral care using electric toothbrush with chlorhexidine compared with patients with orotracheal intubation, the former one is better than the traditional oral care method.%目的:探讨经口气管插管患者实施电动牙刷刷洗法进行口腔护理的临床应用效果。方法将100例经口气管插管患者按照随机数字表法分为试验组和对照组,各50例。试验组采用电动牙刷蘸取0.05%醋酸氯己定溶液进行口腔刷洗,对照组患者采用0.9%氯化钠溶液湿棉球擦洗法。结果试验组患者的口腔清洁度Ⅰ度为80%,高于对照组的24%;Ⅱ度、Ⅲ度分别为16%,4%,低于对照组的46%,30%,差异有统计学意义(χ2值分别为26.606,10.519,11.977;P 0.05)。结论对经口气管插管患者采用电动牙刷蘸取0.05%醋酸氯己定溶液进行口腔刷洗方法的效果优于棉球擦洗法。

  9. 刷牙配合冲洗法在ICU经口气管插管病人口腔护理的应用研究%Tooth brushing with mouth washing in oral care for intubated patients in ICU

    Institute of Scientific and Technical Information of China (English)

    林玉珍; 汪海芹; 罗玉珍; 梁锦云; 高明珠

    2012-01-01

    目的 探讨用儿童牙刷刷牙配合冲洗法在经口气管插管病人口腔护理的效果.方法 将268例经口气管插管患者随机分为对照组和实验组各134例,对照组采用传统的生理盐水棉球擦洗行口腔护理,实验组采用儿童牙刷刷牙配合冲洗法和负压吸引行口腔护理,比较两组的治疗效果.结果 对照组患者口腔异味、口腔炎、口腔溃疡、肺部感染分别为58、26、18、14、10例,而实验组仅有16、12、7、6、4例;实验组牙菌斑指数也明显低于对照组,经统计学分析,差异均有统计学意义(P< 0.05).结论 采用儿童牙刷刷牙配合冲洗法对经口气管插管患者行口腔护理能有效减少并发症的发生.%Objective To investigate the effect of tooth brushing witth children's toothbrush plus mouth washing method in oral care for patients undergoing orotracheal intubation.Methods 268 patients undergoing orotracheal intubation were randomly divided into control group and study group, 134 for each group.The control group received conventional oral care with saline cotton ball scrub, while the study group received oral care with tooth brushing with children's toothbrush plus mouth washing and negative pressure attraction.The efficacy was compared between the two groups.Results In the control group,oral odor developed in 58 patients,stomatitis in 26,oral ulcers in 18,and lung infections in 14 but in the study group,the number of patients was 16,12,7,and 6,respectively.The dental plaque index was significantly lower in the study group than in the control group,with a significant statistical difference ( P < 0.05 ).Conclusions Oral care with children's toothbrush plus mouth for patients undergoing orotracheal intubation can effectively reduce the occurrence of complications.

  10. 心脏术后气管插管患者留置胃管方法的研究%Study on the method of detaining gastric tube intubation in patients after cardiac surgery

    Institute of Scientific and Technical Information of China (English)

    柳真; 范晓中

    2013-01-01

    目的:探讨常规胃管留置方法与头偏向一侧法对心脏术后插管患者胃管一次性置入成功率的影响。方法:将100例心脏术后气管插管患者按照胃管留置单双日分为观察组(A组)50例和对照组(B)50例。对照组采用常规胃管留置方法,观察组采用留置胃管时把患者头偏向一侧,即头部与身体呈45度的方法比较两组患者胃管留置一次性的成功率。结果:观察组胃管留置一次性成功率为90%,明显高于对照组的40%( P <0.01)。结论:头偏向一侧留置胃管方法能够显著提高心脏术后气管插管患者胃管留置一次性成功率。%Objective:To explore the routine nasogastric tube method and the head of postoperative patients with gastric tube intubation one-time success rate of placement of the sideways method.Methods:100 cases of postoperative tracheal intubation patients with indwel ing gastric tube equal y divided into observation group (A group) 50 cases and the control group (B) in 50 cases. The control group with routine nasogastric tube method was used in the observation group, the patients with indwel ing gastric tube head to one side, head and body in 45 degrees compared two groups of patients with indwel ing gastric tube one-time success rate Results:observation group nasogastric tube one-time success rate of 90%, higher than 40%in the control group(P<0.01)Conclusion:heads can significantly improve the postoperative tracheal intubation in patients with indwel ing gastric tube indwel ing gastric tube side of the one-time success rate method.

  11. Haemodynamic changes and intubating conditions during tracheal intubation in children under anaesthesia: a comparative study of two induction regiments

    Directory of Open Access Journals (Sweden)

    Katarina Šakić

    2009-02-01

    Full Text Available Aim To compare the haemodynamic changes and intubation conditionsfollowing induction of anaesthesia with alfentanil-propofol-rocuronium with those following alfentanil-propofol combinationin children.Methods A prospective, non-randomized and non blinded trialwas performed in 208 children ( ASA I-II, both gender, aged 2-12years undergoing elective adenoidectomy with or without tonsillectomy.Children scheduled for tonsillectomy or adenotonsillectomyreceived alfentanil 0.02 mg kg-1, propofol 2 mg kg-1 androcuronium 0.45 mg kg-1 before tracheal intubation (R-group.Children scheduled for adenoidectomy received alfentanil 0.02mg kg-1and propofol 3 mg kg-1 before intubation (C-group. Haemodynamicvalues (heart rate, systolic arterial pressure, diastolicarterial pressure, mean arterial pressure were recorded at predeterminedtime intervals before surgical incision. The intubatingconditions were evaluated applying the Copenhagen Scoring System(excellent, good, poor.Results There was no statistical difference in haemodynamicbaseline values, neither prior nor after the intubation betweenthe two groups. There was a statistically significant increase inheart rate, systolic and diastolic arterial pressure after intubationin both groups (p<0.05. Mean arterial pressure after the intubationincreased statistically significantly only in R-group (p=0.001.There was no hypotension, bradycardia, hypoxemia or other complications.Overall intubation conditions were scored excellent in72.3%, good in 21.5% and poor in 6.2% patients. There were nosignificant differences in intubation conditions between the twogroups (p=0.244Conclusion Both induction regiments provided the clinically acceptablehaemodynamics and intubation conditions during trachealintubation in children.

  12. 右美托咪啶对高血压患者全麻围插管期应激反应的影响%Effects of dexmedetomidine on stress response to tracheal intubation in patients with essential hypertension

    Institute of Scientific and Technical Information of China (English)

    王珊珊; 赵明; 何湘平; 徐高兵; 张庆; 谷腾飞

    2011-01-01

    Objective To observe the effects of dexmedetomidine on stress response to tracheal intubation in patients with essential hypertension(EH). Methods Sixty EH patients were randomly divided into three groups of A(dexmedetomidine 1.0 μg/kg, followed by 0. 5 μg · kg-1 · h-1 , plus sufentanil 0. 5 μg/kg injection), B (sufentanil 0. 5 μg/kg injection) and C ( sufentanil 1.0 μg/kg injection) with 20 cases each. Blood pressure(BP) and heart rate(HR) were recorded after getting into operating room(TO), before induction(T1), before intubation(T2) ,at 1 min(T3) and 5 min(T4) after intubation. Plasma norepinephrine(NE), epinephrine(E) and dopamine(DA) were detected at the same times. Results Compared to groups of B and C, BP and HR were stable during intubation in group A (P<0.01). The plasma concentrations of NE, E and DA at T1 were lower in group A than those in groups of B and C (P< 0. 01 ), which in group B were higher at T3 than those at TO (P< 0. 01). Conclusion Dexmedetomidine combined with sufentanil can attenuate the stress response to tracheal intubation in patients with EH.%目的 观察右美托咪啶对高血压患者全麻围插管期应激反应的影响.方法 60例高血压患者随机均分为三组:A组诱导前用右美托咪啶(1.0μg/kg,10min泵完,继以0.5 μg·kg-1·h-1泵至气管插管后5 min)复合舒芬太尼0.5 μg/kg;B组静注舒芬太尼0.5 μg/kg;C组舒芬太尼1.0μg/kg.记录入室(T0)、诱导前(T1)、插管前(T2)、插管后1 min(T3)、5 min(T4)的血压(BP)、心率(HR);同时检测血浆去甲肾上腺素(NE)、肾上腺素(E)和多巴胺(DA)值.结果 A组围插管期BP和HR均较B、C组稳定(P<0.01).A组T1时血浆NE、E、DA值均明显低于B、C两组(P<0.01);B组T3时血浆NE、E、DA值均明显高于T0(P<0.01).结论 右美托咪啶复合舒芬太尼能维持高血压患者全麻诱导及气管插管期间循环功能稳定,抑制气管插管引起的应激反应.

  13. Poisonings Associated with Intubation: US National Poison Data System Exposures 2000-2013.

    Science.gov (United States)

    Beauchamp, G A; Giffin, S L; Horowitz, B Z; Laurie, A L; Fu, R; Hendrickson, R G

    2016-06-01

    Patients may be intubated after exposure to a variety of substances because of respiratory failure, CNS sedation, pulmonary pathology, or cardiovascular instability. However, there is little data describing the types of substances that are associated with endotracheal intubation or the rates of intubation after these exposures. Evaluation of this association may inform future research on intubation after exposures to specific substances and guide poison prevention education. Our objective was to determine which exposures were commonly associated with intubation using the data from National Poison Data System (NPDS). The NPDS tracks data from potential exposures to substances reported to all American Association of Poison Control Centers. We performed a retrospective analysis of NPDS data from January 1st, 2000 to December 31st, 2013 to identify human exposures to substances that were associated with endotracheal intubation. Descriptive statistics were used to analyze the data. There were 93,474 single substance exposures and 228,507 multiple substance exposures that were associated with intubation. The most common exposures to substances that were associated with intubation were atypical antipsychotics (7.4 %) for single exposures and benzodiazepines (27.4 %) for multiple exposures. Within each age group, the most common known exposures to substances were for patients under 6 years, clonidine for single and multiple exposures; for patients aged 6-12 years, clonidine for single exposures and atypical antipsychotics for multiple exposures; for patients aged 13-19 years, atypical antipsychotics for single and multiple exposures; and for patients over 19 years, atypical antipsychotics for single exposures and benzodiazepines for multiple exposures. From 2000-2013, the exposures to substances most commonly associated with intubation varied by single versus multiple exposures and by age. This study helps clarify the exposures to substances that are associated with

  14. 右美托咪定对困难气道患者经鼻插管应激反应的影响%Effect of dexmedetomidine on stress reaction in difficult airway patient with pass nasus intubation

    Institute of Scientific and Technical Information of China (English)

    梁治; 贾建丽; 张晓青; 戚翔; 王秀丽; 徐雪

    2012-01-01

    目的 观察右美托咪定对困难气道患者行经鼻插管应激反应的影响.方法 40例ASAⅡ~Ⅲ级择期手术困难气道患者随机分为2组,每组20例.右美托咪定组(D组)恒速泵入右美托咪定1μg·kg-1,舒芬太尼组(S组)血浆靶控输注舒芬太尼0.6 μg· L-1,达用药时间后纤维支气管镜(FOB)经鼻插管.记录麻醉前(T0)、FOB通过后鼻孔(T1)、窥视会厌(T2)、插管成功即刻(T3)、插管后1min (T4)、插管后3 min(T5)时血压、心率、脉搏血氧饱和度(SpO2)的变化,于T0、T3、T5时点检测血浆去甲肾上腺素、肾上腺素、皮质醇和血糖浓度.术后24 h随访患者,记录声音嘶哑、咽喉疼痛和气管插管知晓的发生情况.结果 2组各时点收缩压、舒张压、平均动脉压无明显变化,且组间比较均无显著差异(P>0.05).与T0时比较,S组T1~T4时心率增高(P<0.05),D组T5时心率降低(P<0.05),T1~T5时D组心率低于S组(P<0.05).与T0时比较,S组T1、T2时SpO2降低(P<0.05),且低于D组(P<0.05).D组各时点激素水平无显著变化(P>0.05),S组皮质醇在T3时高于T0、T5,且与D组比较差异显著(P<0.05).2组咽喉疼痛和声音嘶哑的发生率无显著差异(P>0.05),D组气管插管知晓率低于S组(P<0.05).结论 困难气道患者经鼻插管,应用右美托咪定可有效抑制插管应激反应,降低气管插管知晓率.%AIM To study the effect of dexmedetomidine on stress reaction in difficult airway patient with pass nasus intubation. METHODS Forty ASAⅡ -Ⅲ patients with anticipated difficult airways were randomly divided into 2 groups ( 20 in each). In group D, dexmedetomidine 1 μg ·kg-1 was administrated for 10 minutes, and sufentanil 0.6 μg ·L-1 by target controlled infusion in group S. The blood pressure ( BP) , pulse oxygen saturation (SpO2) and heart rate (HR) were recorded before anesthesia (T0), fibreoptic pass later nostril (T,) , epiglottis (T2) , intubation succeed ( T3) , 1 min

  15. Effec evaluation of oral nursing with oral washing on patients with peroral endotracheal intubation%冲洗法用于经口气管插管患者口腔护理的效果评价

    Institute of Scientific and Technical Information of China (English)

    肖柳红; 李燕娥; 张铭; 程剑英

    2008-01-01

    目的 评价冲洗法用于经口气管插管患者口腔护理的效果,探讨经口气管插管患者合适的口腔护理方法.方法 选取脑外科手术后需停留经口气管插管的患者150例,分为对照组73例与实验组77例,实验组采用冲洗法实施口腔护理,对照组实施传统的口腔护理方法.比较2组患者口腔异味、口腔湿润度及牙菌斑指数情况.结果 实验组的口腔异味发生率、牙菌斑指数显著低于对照组;口腔湿润度显著高于对照组,2组比较差异有统计学意义,P<0.01.结论 口腔冲洗法能有效控制口腔异味了保持患者口腔湿润,有效抑制患者牙菌斑的形成.%Objective We aimed to evaluatd the effect of oral nursing with oral washing on patients with peroral endotracheal intubation and discuss the appropriate oral nursing method for patients with patients with peroral endotracheal intubation. Methods We chose 150 patients with indwelling peroral endotracheal intubation after neurosurgery and divided them into the control group (73 cases) and the test group (77 cases). The test group received oral nursing with oral washing while the control group with routine oral nursing method. We compared the incidence of halitosis, the moist degree of oral cavity and the amount of the tooth fungus spot between the two groups. Results The incidence of halitosis and the amount of the tooth fungus spot in the test group were lower than those of the control group; The moist degree of oral cavity in the test group was higher than that of the control group, P<0.01. Conclusions Oral washing could effectively control halitosis, keep oral cavity moist and prevent the formation of tooth fungus spot.

  16. Optimal nonpharmacological management of agitation in Alzheimer’s disease: challenges and solutions

    Science.gov (United States)

    Millán-Calenti, José Carlos; Lorenzo-López, Laura; Alonso-Búa, Begoña; de Labra, Carmen; González-Abraldes, Isabel; Maseda, Ana

    2016-01-01

    Many patients with Alzheimer’s disease will develop agitation at later stages of the disease, which constitutes one of the most challenging and distressing aspects of dementia. Recently, nonpharmacological therapies have become increasingly popular and have been proven to be effective in managing the behavioral symptoms (including agitation) that are common in the middle or later stages of dementia. These therapies seem to be a good alternative to pharmacological treatment to avoid unpleasant side effects. We present a systematic review of randomized controlled trials (RCTs) focused on the nonpharmacological management of agitation in Alzheimer’s disease (AD) patients aged 65 years and above. Of the 754 studies found, eight met the inclusion criteria. This review suggests that music therapy is optimal for the management of agitation in institutionalized patients with moderately severe and severe AD, particularly when the intervention includes individualized and interactive music. Bright light therapy has little and possibly no clinically significant effects with respect to observational ratings of agitation but decreases caregiver ratings of physical and verbal agitation. Therapeutic touch is effective for reducing physical nonaggressive behaviors but is not superior to simulated therapeutic touch or usual care for reducing physically aggressive and verbally agitated behaviors. Melissa oil aromatherapy and behavioral management techniques are not superior to placebo or pharmacological therapies for managing agitation in AD. Further research in clinical trials is required to confirm the effectiveness and long-term effects of nonpharmacological interventions for managing agitation in AD. These types of studies may lead to the development of future intervention protocols to improve the well-being and daily functioning of these patients, thereby avoiding residential care placement. PMID:26955265

  17. Optimal nonpharmacological management of agitation in Alzheimer's disease: challenges and solutions.

    Science.gov (United States)

    Millán-Calenti, José Carlos; Lorenzo-López, Laura; Alonso-Búa, Begoña; de Labra, Carmen; González-Abraldes, Isabel; Maseda, Ana

    2016-01-01

    Many patients with Alzheimer's disease will develop agitation at later stages of the disease, which constitutes one of the most challenging and distressing aspects of dementia. Recently, nonpharmacological therapies have become increasingly popular and have been proven to be effective in managing the behavioral symptoms (including agitation) that are common in the middle or later stages of dementia. These therapies seem to be a good alternative to pharmacological treatment to avoid unpleasant side effects. We present a systematic review of randomized controlled trials (RCTs) focused on the nonpharmacological management of agitation in Alzheimer's disease (AD) patients aged 65 years and above. Of the 754 studies found, eight met the inclusion criteria. This review suggests that music therapy is optimal for the management of agitation in institutionalized patients with moderately severe and severe AD, particularly when the intervention includes individualized and interactive music. Bright light therapy has little and possibly no clinically significant effects with respect to observational ratings of agitation but decreases caregiver ratings of physical and verbal agitation. Therapeutic touch is effective for reducing physical nonaggressive behaviors but is not superior to simulated therapeutic touch or usual care for reducing physically aggressive and verbally agitated behaviors. Melissa oil aromatherapy and behavioral management techniques are not superior to placebo or pharmacological therapies for managing agitation in AD. Further research in clinical trials is required to confirm the effectiveness and long-term effects of nonpharmacological interventions for managing agitation in AD. These types of studies may lead to the development of future intervention protocols to improve the well-being and daily functioning of these patients, thereby avoiding residential care placement.

  18. Delayed Sequence Intubation

    DEFF Research Database (Denmark)

    Weingart, Scott D; Trueger, N Seth; Wong, Nelson;

    2015-01-01

    preintubation preparation because of delirium. A convenience sample of emergency department and ICU patients was enrolled. Patients received a dissociative dose of ketamine, allowing preoxygenation with high-flow nonrebreather mask or noninvasive positive pressure ventilation (NIPPV). After preoxygenation...

  19. Dental trauma prevention during endotracheal intubation--review of literature.

    Science.gov (United States)

    Mańka-Malara, Katarzyna; Gawlak, Dominika; Hovhannisyan, Anahit; Klikowska, Marta; Kostrzewa-Janicka, Jolanta

    2015-01-01

    Endotracheal intubation is a procedure performed during general anaesthesia with the use of an endotracheal tube in order to maintain a patent airway. This routinely used procedure is connected with a risk of complications within the region of the masticatory system. Trauma of teeth, their surrounding structures and the soft tissue of the oral cavity is observed in app. 1.38 per 1000 procedures. The main causes of this damage are the surgical skills and experience of the surgeon, the anatomical conditions present and the mode of conducting the procedure. In order to reduce the risk of postoperative complications, patients with a high risk of sustaining an injury during endotracheal intubation should be equipped with elastic mouthguards, which reduces the possibility of damage. The scoring in a scale of endotracheal intubation difficulty should be used for qualification for the use of such mouthguards.

  20. Guidelines for Induction and Intubation Sequence Fast in Emergency Service

    OpenAIRE

    Pérez Perilla, Patricia; Pontificia Universidad Javeriana-Hospital Universitario de San Ignacio; Moreno Carrillo, Atilio; Pontificia Universidad Javeriana-Hospital Universitario San Ignacio; Gempeler Rueda, Fritz E.; Pontificia Universidad Javeriana-Hospital Universitario San Ignacio

    2012-01-01

    The rapid sequence intubation (RSI) is a procedure designed to minimize the time spent in securing the airway by endotracheal tube placement in emergency situations in patients at high risk of aspiration. Being clear about this situation, it is unquestionable the importance of education and training related to rapid sequence intubation to be made to the physicians responsible for the recovery rooms, emergency services and paramedics responsible for managing emergencies and disasters field . T...

  1. Modified Technique of Retrograde Intubation in TMJ Ankylosis

    Directory of Open Access Journals (Sweden)

    Shaila Kamat

    2008-01-01

    Full Text Available We are presenting a case report on the anaesthetic management of a case of ankylosis of temporomandibular joint for corrective surgery in a 7 year old child. Anticipated difficult airway in paediatric population has always been a perplexing problem, awake fibreoptic intubation almost impossible due to obvious difficulties with co-operation. Here we are describing a new approach to this problem, in which the patients were kept under GA with spontaneous ventilation while retrograde intubation was done quite comfortably by the conventional method.

  2. Correlation between oro and hypopharynx shape and position with endotracheal intubation difficulty

    Directory of Open Access Journals (Sweden)

    Daher Rabadi

    2014-12-01

    Full Text Available Background and objective: Prediction of intubation difficulty can save patients from major preoperative morbidity or mortality. The purpose of this paper is to assess the correlation between oro-hypo pharynx position, neck size, and length with endotracheal intubation difficulty. The study also explored the diagnostic value of Friedman Staging System in prediction cases with difficult intubation. Method: The consecutive 500 ASA (I, II adult patients undergoing elective surgery were evaluated for oro and hypopharynx shape and position by modified Mallampati, Cormack and Lehane score as well as Friedman obstructive sleep apnea classification systems. Neck circumference and length were also measured. All cases were intubated by a single anesthesiologist who was uninformed of the above evaluation and graded intubation difficulty in visual analog score. Correlation between these findings and difficulty of intubation was assessed. Sensitivity, Specificity, Positive and Negative Predictive Values were also reported. Results: Cormack-Lehane grade had the strongest correlation with difficulty of intubation followed by Friedman palate position. Friedman palate position was the most sensitive and had higher positive and negative predictive values than modified Mallampati classification. Cormack-Lehane grade was found to be the most specific with the highest negative predictive value among the four studied classifications. Conclusion: Friedman palate position is a more useful, valuable and sensitive test compared to the modified Mallampati screening test for pre-anesthetic prediction of difficult intubation where its involvement in Multivariate model may raise the accuracy and diagnostic value of preoperative assessment of difficult airway.

  3. Dexmedetomidine versus Remifentanil for Sedation during Awake Fiberoptic Intubation

    Directory of Open Access Journals (Sweden)

    Davide Cattano

    2012-01-01

    Full Text Available This study compared remifentanil and dexmedetomidine as awake fiberoptic intubation (AFOI anesthetics. Thirty-four adult ASA I-III patients were enrolled in a double-blinded randomized pilot study to receive remifentanil (REM or dexmedetomidine (DEX for sedation during AFOI (nasal and oral. Thirty patients completed the study and received 2 mg midazolam IV and topical anesthesia. The REM group received a loading dose of 0.75 mcg/kg followed by an infusion of 0.075 mcg/kg/min. The DEX group received a loading dose of 0.4 mcg/kg followed by an infusion of 0.7 mcg/kg/hr. Time to sedation, number of intubation attempts, Ramsay sedation scale (RSS score, bispectral index (BIS, and memory recall were recorded. All thirty patients were successfully intubated by AFOI (22 oral intubations/8 nasal. First attempt success rate with AFOI was higher in the REM group than the DEX group, 72% and 38% (P=0.02, respectively. The DEX group took longer to attain RSS of ≥3 and to achieve BIS <80, as compared to the REM group. Postloading dose verbal recall was poorer in the DEX group. Dexmedetomidine seems a useful adjunct for patients undergoing AFOI but is dependent on dosage and time. Further studies in the use of dexmedetomidine for AFOI are warranted.

  4. The impact of bronchoscopy -guided nasal intubation in patients with mechanical ventilation%纤支镜引导下经鼻行气管插管对机械通气患者的影响研究

    Institute of Scientific and Technical Information of China (English)

    毛秀莲; 徐振虎; 曾唯波

    2015-01-01

    Objective To investigate the impact of bronchoscopy -guided nasal intubation in patients with mechanical ventilation.Methods Patients with the number of 120 with mechanical ventilation in hospital from September 2012 to August 2013 were divided randomly into 2 groups.The treatment group of 60 patients received bronchoscopy -guided tracheal intubation,and the control group with 60 patients conduc-ted laryngoscope endotracheal intubation through the mouth.All the patients of the 2 groups received routing nursing.Comparing the incidence of ventilator -associated pneumonia and the success rate of withdraw machine of the 2 groups.Results The incidence of ventilator -associat-ed pneumonia was 6.7% in the treatment group while 26.7 in the control group(χ2 =8.64,P <0.05).The success rate of withdraw machine of the treatment group was 91.7% compared with 68.3% of thecontrol group(χ2 =10.21,P <0.05).Conclusion Bronchoscopy -guided nasal intubation can not be only reduce the incidence of ventilator -associated pneumonia,but also improve the success rate of weaning ma-chine,worthy of clinical application.%目的:探讨纤支镜引导下经鼻行气管插管对机械通气患者的影响。方法将本院2012年9月~2013年8月气管插管行机械通气的患者120例随机分为试验组和对照组,每组各60例。其中,试验组患者在纤支镜引导下经鼻行气管插管,对照组在喉镜下经口腔行气管插管,2组患者均按照气管插管接呼吸机辅助通气护理常规进行护理。观察2组患者呼吸机相关性肺炎的发生率及撤机成功率的情况。结果试验组患者呼吸机相关性肺炎发生率为6.7%,对照组为26.7%,2组比较差异具有统计学意义(χ2=8.64,P <0.05);试验组患者撤机成功率为91.7%,对照组为68.3%,2组比较差异具有统计学意义(χ2=10.21,P <0.05)。结论纤支镜引导下经鼻行气管插管不仅可降低呼吸机相关

  5. Attenuation of Hemodynamic Responses to Intubation by Gabapentin in Coronary Artery Bypass Surgery: a Randomized Clinical Trial.

    Science.gov (United States)

    Marashi, Seyed Mojtaba; Saeedinia, Seyed Mostafa; Sadeghi, Mostafa; Movafegh, Ali; Marashi, Shaqayeq

    2015-12-01

    A varieties of medications have been suggested to prevent hemodynamic instabilities following laryngoscopy and endotracheal intubation. This study was conducted to determine the beneficial effects of gabapentin on preventing hemodynamic instabilities associated with intubation in patients who were a candidate for coronary artery bypass surgery (CABG). This double blinded randomized, parallel group clinical trial was carried out on 58 normotensive patients scheduled for elective CABG under general anesthesia with endotracheal intubation in Shariati Hospital. Patients were randomly allocated to two groups of 29 patients that received 1200 mg of gabapentin in two dosages (600 mg, 8 hours before anesthesia induction and 600 mg, 2 hours before anesthesia induction) as gabapentin group or received talc powder as placebo (placebo group). Heart rate, mean arterial pressure, systolic and diastolic blood pressure were measured immediately before intubation, during intubation, immediately after intubation, 1 and 2 minutes after tracheal intubation. Inter-group comparisons significantly showed higher systolic and diastolic blood pressure, mean arterial pressure and heart rate immediately before intubation, during intubation, immediately after intubation, 1 and 2 minutes after tracheal intubation in the placebo group in comparison to gabapentin group. The median of anxiety verbal analog scale (VAS) at the pre-induction room in gabapentin and placebo groups were 2 and 4, respectively that was significantly lower in the former group (P. value =0.04 ); however, regarding median of pain score no difference was observed between them (P. value =0.07). Gabapentin (1200 mg) given preoperatively can effectively attenuate the hemodynamic response to laryngoscopy, intubation and also reduce preoperative related anxiety in patients who were a candidate for CABG.

  6. Experience with the GlideScope videolaryngoscopy for tracheal intubation in patients with cervical spine immobilization%GlideScope视频喉镜在颈椎活动受限患者气管插管中的应用体会

    Institute of Scientific and Technical Information of China (English)

    李永华; 胡永初; 孙彭龄; 朱秋峰; 石学银; 袁红斌

    2010-01-01

    Objective To describe the use of the GlideScope for patients with cervical spine immobilization. Methods 84 selective operation patients (ASA Ⅰ-Ⅱ) with cervical spine injury or severe cervical spondylosis were assigned to intubation by GlideScope videolaryngoscopy via mouth cavity after intravenous introduced general anesthesia. Prior to intubatiou all patients were given a Cormack grade by a senior anaesthetist using a Macintosh laryngoscopy. The patient was then intubated using GlideSeope videolaryngoseopy. The procedure time of intubation, number of intubating times and the side-effects were recorded. HR, SBP, DBP,MAP were measured before (T_1) and after (T_2) anesthesia induction, at the beginning (T_3), 1 minute (T_4) and 3 minutes (T_5) after tracheal intubation. Results In the GS group, Cormaek grade was improved in the majority (71/84) of patients (P<0.05). The success rate was 97.6%. The procedure time of intubation was 12 s-135 s, and the average time of intuation was (28.7±9.2)s.Intubation succeed one time in 78 patients, twice in 4 patients, and two other patients were turned to fibreoptic intubation. During the intubafion, the HR, SBP, DBP were stable. No injury of respiratory tract was observed. Conclusion GlideScope videolaryngoscopy introducing intubation seems a useful device in patients with cervical spine immobilization for its high successful rate, rapid intubation and excellent reliability.%目的 介绍新型插管工具GlideScope视频喉镜在颈椎活动受限患者插管中的应用.方法 84例择期或急诊颈椎手术患者,ASAI~II级,术前存在颈椎外伤或严重的颈椎病,在快速静脉全麻诱导后先用Macintosh喉镜暴露声门进行Comack评级,然后运用视频喉镜进行插管,记录插管操作时间、次数和并发症,并测量诱导前(T_1)、诱导后(T_2)、插管时(T_3)、插管后1min(T_4)、气管插管后3 min(T_5)的心率(HR)、收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP).结果 Glide

  7. Retromolar Intubation:An alternative non invasive technique for airway management in maxillofacial trauma

    Directory of Open Access Journals (Sweden)

    Uthkarsha Lokesh

    2013-10-01

    Full Text Available Airway management during surgery in patients with complex maxillofacial trauma has always been a challenge for anesthesiologists, as the surgeon and the anesthesiologist share the same limited space. The necessity of intraoperative restoration of dental occlusion by intermaxillary fixation (IMF makes the presence of oral endotracheal tube unfeasible.The purpose of our study is to evaluate the Retromolar intubation is non-invasive technique of securing airway in patients with panfacial trauma. It avoids the complications of submental intubation and tracheostomy.This review article emphasizes on the use of the retromolar intubation technique in certain cases of maxillofacial trauma

  8. Avoidance of neuromuscular blocking agents may increase the risk of difficult tracheal intubation: a cohort study of 103,812 consecutive adult patients recorded in the Danish Anaesthesia Database

    DEFF Research Database (Denmark)

    Lundstrøm, L H; Møller, A M; Rosenstock, C;

    2009-01-01

    by direct laryngoscopy was retrieved from the Danish Anaesthesia Database. We used an intubation score based upon the number of attempts, change from direct laryngoscopy to a more advanced technique, or intubation by a different operator. We retrieved data on age, sex, ASA physical status classification...

  9. DEXMEDETOMIDINE FOR ATTENUATION OF PRESSOR RESPONSE OF LARYNGOSCOPY AND INTUBATION

    Directory of Open Access Journals (Sweden)

    Priti Kolarkar

    2015-02-01

    Full Text Available BACKGROUND: Laryngoscopy and tracheal intubation causes intense autonomic reflex responses consisting of increased circulating catacholamines, tachycardia, hypertension, myocardial oxygen demand, and dysarrythmias. To obtund haemodynamic response lignocaine, opiods, nitroprusside, nitroglycerine, vearpamil, nifedipine, esmolol, clonidine and recently, dexmedetomidine have been stu died. AIMS AND OBJECTIVES: We investigated whether dexmedetomidine a α2 agonist could attenuate sympathoadrenal response (Heart rate and MAP to laryngoscopy and intubation. MATERIALS AND METHODS: Eighty patients, ASA grade I/II, undergoing routine general anesthesia were randomly premedicated by i . v . dexmedetomidine 0.6μg or saline. Heart rate (HR, mean arterial pressure (MAP, were measured before, after the premedication, after thiopental, after succinylcholine at laryngoscopy, immediately after intuba tion and then 1 min. 3 min. and 5 min after intubation. STATISTICAL ANALYSIS: Descriptive and inferential statistics using chi - square test, z - test and wilcoxon sign rank test was done. Software used in the analysis was SPSS 17.0 version and Graph Pad Prism 5.0. Data was reported as mean value ± SD & p - value <0.05 is considered as level of significance. RESULTS: The demographic profile was comparable . After intubation the MAP in the control group (z=.5.35, p=<0.05 at laryngoscopy and z=9.95, p< 0.05 after intubation was higher than that in the dexmedetomidine group (z=8, p=0.000 and exceeded the baseline value(p<0.05 The heart rate also showed less fluctuation in the dexmedetomidine group than in the control group. Though there was rise in bot h the groups, it was more in control group than dexmedetomidine group (z=7.73, p<0.05 at laryngoscopy and z=9.22, p<0.05 after intubation . Thus the pressor response to laryngoscopy and intubation were effectively decreased by dexmedetomidine and were high ly significant on comparison (p<0.05 . CONCLUSION: i v

  10. A comparison of sevoflurane versus propofol for tracheal intubation in children

    Directory of Open Access Journals (Sweden)

    Viren Darji

    2014-07-01

    Full Text Available The study was conducted in 60 ASA I Children, 4-12 years of age, of either sex undergoing elective surgery. All patients were premedicated with I.V. Midazolam 0.02 mg/kg, Inj. Fentanyl 2μg/kg and Glycopyrolate 0.05mg/kg. 10 minutes before surgery. Patients were randomly divided into two groups. Group S (SEVOFLURANE 8%+40% O 2 +60%N 2 O and Group P (I.V. Propofol 1%w/v .Centralization of pupils and miosis were used as end points for intubation. Anesthesia was maintained with O 2 , nitrous oxide and sevoflurane. Induction time, Quality of Intubation, Hemodynamic response and complications during endotracheal intubation in children with inhalational induction with Sevoflurane versus and complications during endotracheal intubation studied. Conclusion: In premedicated children both sevoflurane and propofol provides good quality of anesthesia for intubation. Induction time and Hemodynamic response was less in propofol than sevoflurane. Quality of intubating condition was better with propofol than sevoflurane .So Propofol is better than Sevoflurane for tracheal intubation in Children. However Sevoflurane is acceptable alternative in patients with difficult venous access

  11. 七氟醚-咪达唑仑-瑞芬太尼麻醉诱导用于颈部制动患者无肌松药气管插管的可行性%Feasibility of induction with sevoflurane-midazolam-remifentanil for tracheal intubation without muscle relaxants in neck brake patients

    Institute of Scientific and Technical Information of China (English)

    邵雪泉; 吴方璞; 潘中心; 兰允平; 徐玲; 占霖森; 杨淑芬; 余功敏; 黄莉; 郑丽花

    2010-01-01

    目的 评价七氟醚-咪达唑仑-瑞芬太尼麻醉诱导用于颈部制动患者无肌松药气管插管的可行性.方法 颈椎骨折伴脱位拟在全麻下手术患者40例,年龄13~68岁,ASA分级Ⅰ~Ⅲ级.静脉注射咪达唑仑0.03 mg/kg,面罩吸入5%七氟醚,每30 s递减1%,直至3%.待患者睫毛反射消失时,45 s内缓慢静脉注射瑞芬太尼2μg/kg,30 s后停止吸入七氟醚,气管插管后行机械通气.记录睫毛反射消失时间,采用Viby-Mogensen评分法评价气管插管条件.结果 睫毛反射消失时间(69±4)s,一次气管插管成功率为100%,喉镜置入顺利,声门暴露基本良好.3例患者气管插管时出现轻微呛咳.气管插管条件优良率100%.所有患者SpO2均>95%,气管插管前至气管插管后3 min BIS值40~55.结论 七氟醚-咪达唑仑-瑞芬太尼麻醉诱导迅速而平稳,可提供良好的气管插管条件,适用于颈部制动患者无肌松药气管插管,安全可行.%Objective To evaluate the feasibility of induction with sevoflurane-midazolam-remifentail for tracheal intubation without muscle relaxants in neck brake patients.Methods Forty ASA Ⅰ or Ⅱ patients with cervical spine fracture with dislocation,aged 13-68 yr,scheduled for surgery under general anesthesia,were enrolled in this study.Anesthesia was induced with iv injection of midazolam 0.03 mg/kg and inhalation of 5%sevoflurane through a mask.Sevoflurane was inhaled at the initial concentration of 5%,followed by decrement of 1% every 30 s until 3%.When the eyelash reflex disappeared,remifentanil 2 μg/kg was injected slowly over 45s and 30 s later sevoflurane inhalation was stopped.The patients were mechanically ventilated after tracheal intubation.The time of disappearance of eyelash reflex was recorded.The intubation condition was evaluated using VibyMogensen score.Results All patients were successfully intubated at the first attempt.The time period from sevoflurane inhalation to disappearance of eyslash

  12. Orotracheal Intubation Using the Retromolar Space: A Reliable Alternative Intubation Approach to Prevent Dental Injury

    Directory of Open Access Journals (Sweden)

    Linh T. Nguyen

    2016-01-01

    Full Text Available Despite recent advances in airway management, perianesthetic dental injury remains one of the most common anesthesia-related adverse events and cause for malpractice litigation against anesthesia providers. Recommended precautions for prevention of dental damage may not always be effective because these techniques involve contact and pressure exerted on vulnerable teeth. We describe a novel approach using the retromolar space to insert a flexible fiberscope for tracheal tube placement as a reliable method to achieve atraumatic tracheal intubation. Written consent for publication has been obtained from the patient.

  13. Complications from submental endotracheal intubation: a prospective study and literature review.

    Science.gov (United States)

    de Toledo, Guilherme Lacerda; Bueno, Sebastião Cristian; Mesquita, Ricardo Alves; Amaral, Márcio Bruno Figueiredo

    2013-06-01

    Submental endotracheal intubation, as compared to the use of tracheotomy, is an alternative for the surgical management of maxillofacial trauma, as described by Altemir FH (The submental route for endotracheal intubation: a new technique. J Maxillofac Surg 1986; 14: 64). Although the submental endotracheal intubation is a useful technique, a wide range of complications have been reported in the literature. The core aim of this article is to present additional data from 17 patients who have undergone submental endotracheal intubation and who have received at least 6 months of postoperative follow up. A prospective study was carried out on patients who suffered maxillofacial trauma between 2008 and 2011. Age, gender, etiology of trauma, fracture type, complications, and follow up were evaluated. Case series, as well as retrospective and prospective studies regarding submental endotracheal intubation in maxillofacial trauma, were also reviewed. This study demonstrated a low rate of complications in submental endotracheal intubation and no increase in operative time within the evaluated sample. The submental endotracheal intubation may be considered a simple, secure, and effective technique for operative airway control in major maxillofacial traumas.

  14. Effect of sonic agitation, manual dynamic agitation on removal of Enterococcus faecalis biofilm

    Directory of Open Access Journals (Sweden)

    Rajshekhar Chatterjee

    2015-01-01

    Full Text Available Objectives: The aim of the study was to compare manual dynamic agitation with sonic agitation on removal of intra radicular Enterococcus faecalis (E. faecalis biofilm. Material and Methods: Extracted mandibular premolars for orthodontic purpose were sectioned at cervical level and divided into three groups (n = 30. The root canals were instrumented using Protaper rotary instruments up to apical file F4. Roots were sterilized and E. faecalis bacteria were incubated within their root canal space for four weeks. Confirmation of biofilm was done using scanning electron microscopy and Gram staining. All groups were irrigated with side vented needle by using three percent sodium hypochlorite (NaOCl for 60 seconds. Two experimental groups were agitated with manual dynamic agitation (with master gutta-percha cone and sonic agitation (EndoActivator. Remaining bacteria were collected using sterile paper point, which were incubated inside brain-heart infusion (BHI broth to check turbidity. The turbid broth was streaked on blood agar plate for colony counts. Result: Both experimental groups showed highly significant difference in their mean colony count when compared with control group; with P < 0.001. Conclusion: Passive sonic agitation with EndoActivator has proven to be the best irrigating system followed by manual dynamic agitation and conventional needle irrigation.

  15. The difficult intraoperative nasogastric tube intubation: A review of the literature and a novel approach.

    Science.gov (United States)

    Ching, Yiu-Hei; Socias, Stephanie M; Ciesla, David J; Karlnoski, Rachel A; Camporesi, Enrico M; Mangar, Devanand

    2014-01-01

    Nasogastric tube intubation of a patient under general anesthesia with an endotracheal tube in place can pose a challenge to the most experienced anesthesiologist. Physiologic and pathologic variations in a patient's functional anatomy can present further difficulty. While numerous techniques to the difficult nasogastric tube intubation have been described, there is no consensus for a standard approach. Therefore, selecting the most appropriate approach requires a working knowledge of the techniques available, mindful consideration of individual patient and clinical factors, and the operator's experience and preference. This article reviews the relevant literature regarding various approaches to the difficult nasogastric tube intubation with descriptions of techniques and results from comparative studies if available. Additionally, we present a novel approach using a retrograde technique for the difficult intraoperative nasogastric tube intubation.

  16. Determinants of Success and Failure in Prehospital Endotracheal Intubation

    Directory of Open Access Journals (Sweden)

    Lucas A. Myers

    2016-09-01

    Full Text Available Introduction: This study aimed to identify factors associated with successful endotracheal intubation (ETI by a multisite emergency medical services (EMS agency. Methods: We collected data from the electronic prehospital record for all ETI attempts made from January through May 2010 by paramedics and other EMS crew members at a single multistate agency. If documentation was incomplete, the study team contacted the paramedic. Paramedics use the current National Association of EMS Physicians definition of an ETI attempt (laryngoscope blade entering the mouth. We analyzed patient and EMS factors affecting ETI. Results: During 12,527 emergent ambulance responses, 200 intubation attempts were made in 150 patients. Intubation was successful in 113 (75%. A crew with paramedics was more than three times as likely to achieve successful intubation as a paramedic/emergency medical technician-Basic crew (odds ratio [OR], 3.30; p=0.03. A small tube (≤7.0 inches was associated with a more than 4-fold increased likelihood of successful ETI compared with a large tube (≥7.5 inches (OR, 4.25; p=0.01. After adjustment for these features, compared with little or no view of the glottis, a partial or entire view of the glottis was associated with a nearly 13-fold (OR, 12.98; p=0.001 and a nearly 40-fold (OR, 39.78; p<0.001 increased likelihood of successful intubation, respectively. Conclusion: Successful ETI was more likely to be accomplished when a paramedic was partnered with another paramedic, when some or all of the glottis was visible and when a smaller endotracheal tube was used.

  17. A comparison of tracheal intubation using the Airtraq or the Macintosh laryngoscope in routine airway management: A randomised, controlled clinical trial.

    LENUS (Irish Health Repository)

    Maharaj, C H

    2006-11-01

    The Airtraq laryngoscope is a novel single use tracheal intubation device. We compared the Airtraq with the Macintosh laryngoscope in patients deemed at low risk for difficult intubation in a randomised, controlled clinical trial. Sixty consenting patients presenting for surgery requiring tracheal intubation were randomly allocated to undergo intubation using a Macintosh (n = 30) or Airtraq (n = 30) laryngoscope. All patients were intubated by one of four anaesthetists experienced in the use of both laryngoscopes. No significant differences in demographic or airway variables were observed between the groups. All but one patient, in the Macintosh group, was successfully intubated on the first attempt. There was no difference between groups in the duration of intubation attempts. In comparison to the Macintosh laryngoscope, the Airtraq resulted in modest improvements in the intubation difficulty score, and in ease of use. Tracheal intubation with the Airtraq resulted in less alterations in heart rate. These findings demonstrate the utility of the Airtraq laryngoscope for tracheal intubation in low risk patients.

  18. Comparison of the Ambu Aura-i with the Air-Q Intubating Laryngeal Airway as A Conduit for Fiberoptic-guided Tracheal Intubation in Children with Ear Deformity.

    Science.gov (United States)

    Zhi, Juan; Deng, Xiao-Ming; Yang, Dong; Wen, Chao; Xu, Wen-Li; Wang, Lei; Xu, Jin

    2016-12-20

    Objective To compare the Ambu Aura-i with the Air-Q intubating laryngeal airway for fiberoptic-guided tracheal intubation in ear deformity children.Methods Totally 120 children who were scheduled for elective auricular reconstruction surgery requiring general anaesthesia with tracheal intubation were enrolled in this prospective study. They were randomized to receive either the Ambu Aura-i (Aura-i group) or Air-Q (Air-Q group). The time for successful tracheal intubation was assessed. The attempts for successful device insertion, leak pressures, cuff pressures, fiberoptic grade of laryngeal view, time for removal of the device after endotracheal intubation, and complications were recorded. Results Device placement, endotracheal intubation, and removal after endotracheal intubation were successful in all patients. The Air-Q group required longer time than the Aura-i group in device placement[(14.1±7.2) s vs. (10.8±5.2) s, PAura-i group). The leak pressure was (20.5±4.8) cmH2O in the Air-Q group and (22.2±5.0) cmH2O in the Aura-i group (PAura-i group (PAura-i group. Conclusion Both Ambu Aura-i and Air-Q intubating laryngeal airway are effective conduits for beroptic-guided tracheal intubation, with advantages including simple operation, high success rate, and fewer complications, especially the Ambu Aura-i.

  19. Effect of rigid cervical collar on tracheal intubation using Airtraq®

    Directory of Open Access Journals (Sweden)

    Padmaja Durga

    2014-01-01

    Full Text Available Background and Aims: Cervical spine immobilisation with rigid cervical collar imposes difficulty in intubation. Removal of the anterior part of the collar may jeopardize the safety of the cervical spine. The effect of restricted mouth opening and cervical spine immobilisation that result from the application of rigid cervical collar on intubation using Airtraq ® was evaluated. Methods: Seventy healthy adults with normal airways included in the study were intubated Using Airtraq® with (group C and without rigid cervical collar (group NC. The ease of insertion of Airtraq ® into the oral cavity, intubation time, intubation difficulty score (IDS were compared using Wilcoxon sign ranked test and McNemar test, using SPSS version 13. Results: Intubation using Airtraq ® was successful in the presence of the cervical collar in 96% which was comparable to group without collar (P = 0.24. The restriction of mouth opening resulted in mild difficulty in insertion of Airtraq ® . The median Likert scale for insertion was - 1 in the group C and + 1 in group NC (P < 0.001. The intubation time was longer in group C (30 ± 14.3 s vs. 26.9 ± 14.8 s compared to group NC. The need for adjusting manoeuvres was 18.5% in group C versus 6.2% in group NC (P = 0.003 and bougie was required in 12 (18.5% and 4 (6.2% patients in group C and NC, respectively, to facilitate intubation (P = 0.02. The modified IDS score was higher in group C but there was no difference in the number of patients with IDS < 2. Conclusion: Tracheal intubation using Airtraq ® in the presence of rigid cervical collar has equivalent success rate, acceptable difficulty in insertion and mild increase in IDS.

  20. The duration of fibre-optic intubation is increased by cricoid pressure. A randomised double-blind study

    DEFF Research Database (Denmark)

    Arenkiel, Bjørn; Smitt, M; Olsen, K S

    2013-01-01

    In some categories of patients, a rapid sequence induction using a fibre-optic method may be indicated. The aim of the present study was to examine the effect of cricoid pressure (CP) on the duration of fibre-optic intubation. The hypothesis was that CP would prolong the intubation time....

  1. Comparative study of different method of oral care for patients with orotracheal intubation%不同口腔护理方法在经口气管插管患者中的对比研究

    Institute of Scientific and Technical Information of China (English)

    陈莉; 王冬梅; 叶祖峰; 宾文凯

    2012-01-01

    目的 探讨经口气管插管患者口腔护理的有效方法,观察应用美容小喷瓶喷雾法的临床效果.方法 选取我院急诊科2009年6月~2011年6月经口气管插管患者142例,随机分为两组,对照组采用传统口腔护理方法;实验组采用口腔冲洗及擦拭后使用美容小喷瓶将口泰(复方洗必泰含漱液)雾化喷洒在口腔内,定期观察并记录发生口臭、口腔炎症和呼吸机相关性肺炎(VAP)的病例数.结果 对照组口臭36例,口腔感染18例,VAP 22例;实验组口臭12例,口腔感染9例,VAP 18例,两组差异有显著意义(P<0.05).结论 实验组采用的口腔护理法能有效地提高经口气管插管患者的口腔护理质量,在预防患者口臭、口腔感染和VAP中效果显著,避免了传统口腔护理法易使患者发生误吸及意外拔管的危险,增加了病人的舒适度,降低了治疗成本.%Objective To study the effective way of orotracheal intubation for patients with oral care,and to observe the clinical effect of the small beauty bottle spray. Method 142 cases of intubation were selected in the hospital emergency department from June2009 to June2011 and randomly divided into two groups,the control group was given traditional method of oral care,the experimental group was given innovative method. Koutai spray was atomized spray in the mouth after washed and wipped the mouth with a small beauty spray bottle. The occurrence of bad breath,oral infection and ventilator-associated pneumonia (VAP) of the number of cases wand regularly observed and recorded between the two groups. Result 36 cases bad breath, 18 cases oral infection and 22 cases of VAP was observed in control group. In the experimental group,12 case of bad breath,9 cases of oral infection and 18 cases of VAP was observed. There was significant difference between experimental group and control group(P<0. 05). Conclusion Innovative oral care method can effectively improve the orotracheal intubation

  2. Application of different concentrations of chlorhexidine oral care solution in patients with orotracheal intubation%不同浓度氯己定口腔护理液在经口气管插管患者中的应用

    Institute of Scientific and Technical Information of China (English)

    陆舞英; 雍萱; 孙四美

    2016-01-01

    Objective To study application effectiveness of different concentrations of chlorhexidine oral care solu-tion in patients with orotracheal intubation.Methods A total of 120 patients who were admitted to the general in-tensive care unit (ICU)of a hospital and undergoing mechanical ventilation via orotracheal intubation for >48 hours between January 2012 and December 2013 were included in the study,they were divided randomly into three groups,40 in each group.Trial group,control group I,and control group II were provided with 2%,0.2%,and 0.12% chlorhexidine oral care solution,respectively.Differences in halitosis,oral mucosal infection,onset time and incidence of ventilator-associated pneumonia (VAP ) among three groups were observed and compared. Results There were significant difference in incidence of VAP and early-onset VAP between trial group and control group I,trial group and control group II,respectively(both P <0.05 );incidence of VAP in control group II was higher than trial group(47.50% vs 20.00%,P =0.009).Conclusion 2% chlorhexidine oral rinsing and swabbing can effectively reduce incidence of VAP in patients with orotracheal intubation.%目的:探讨不同浓度氯己定口腔护理液在经口气管插管患者中的应用效果。方法2012年1月—2013年12月某院综合 ICU 收治的经口气管插管行机械通气时间>48 h 以上患者,共纳入120例符合条件患者,随机分为3组,每组各40例。使用不同浓度氯己定口腔护理液应用于各组患者:试验组(2%)、对照组Ⅰ(0.2%)、对照组Ⅱ(0.12%)。观察并比较3组患者在口臭、口腔黏膜感染、呼吸机相关肺炎(VAP)发生时间及 VAP 发病率的差异。结果试验组与对照组Ⅰ、对照组Ⅱ患者的 VAP、早发 VAP 的发病率比较差异有统计学意义(均 P <0.05);进一步两两比较,对照组Ⅱ患者 VAP 发病率高于试验组(47.50% VS 20.00%,P =0.009

  3. Research of music therapy on improving comfort degree of patients with awake tracheal intubation%音乐疗法对提高清醒气管内插管术中患者舒适度的研究

    Institute of Scientific and Technical Information of China (English)

    谢明亮; 车灵; 李海珍; 孙建明; 李学安; 胡丽华

    2014-01-01

    Objective To explore the effect of music therapy on improving comfort degree of patients with awake tracheal intubation. Methods 100 patients underwent awake tracheal intubation were randomly divided into study group and control group,50 cases in each.The study group was used music therapy research,control group was not used music therapy. Results The heart rate,systolic blood pressure of two groups before intubation had no significant difference;the heart rate and systolic blood pressure of study group after music therapy[(82.16±5.59)times/min, (118.44±6.05)mm Hg]were lower than those of control group[(96.64±5.67)times/min,(129.37±6.76)mmHg],the difference was statistically significant(P < 0.05).The anxiety score of the study group and control group during tracheal intubation was (27.04±5.16),(40.16±6.52) respectively,the difference was significant(t=5.368,P<0.05).In study group of 50 cases, grade 0 in 38 cases(76%),9 cases of grade Ⅰ(18%),3 cases of gradeⅡ(6%), 0 case of gradeⅢ;In control group of 50 cases,grade 0 in 13 cases(26%),22 cases of gradeⅠ(44%),6 cases of gradeⅡ(12%),9 cases of gradeⅢ(18%).the pain degree of study group significantly relieved pain. Conclusion Application of music therapy is helpful to improve the comfort of patients with tracheal intubation.%目的:观察音乐疗法对提高清醒气管内插管术中患者舒适度的作用。方法将100例接受清醒气管内插管患者随机分为研究组和对照组,各50例。研究组采用音乐疗法进行研究,对照组采用无音乐疗法。结果插管前两组患者的心率、收缩压比较,差异无统计学意义;研究组音乐疗法后插管中心率(82.16±5.59)次/min、收缩压(118.44±6.05)mm Hg均低于对照组(96.64±5.67)次/min、(129.37±6.76)mm Hg,差异有统计学意义(P<0.05)。两组患者气管插管中焦虑情况比较,患者焦虑评分分别为研究组(27.04±5.16),对照组(40.16±6.52),

  4. Retrograde intubation in a case of ankylosing spondylitis posted for correction of deformity of spine

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    Raval Chetankumar

    2010-01-01

    Full Text Available Ankylosing spondylitis (AS patients are most challenging. These patient present the most serious array of intubation and difficult airway imaginable, secondary to decrease or no cervical spine mobility, fixed flexion deformity of thoracolumbar spine and possible temporomandibular joint disease. Sound clinical judgment is critical for timing and selecting the method for airway intervention. The retrograde intubation technique is an important option when fiberoptic bronchoscope is not available, and other method is not applicable for gaining airway access for surgery in prone position. We report a case of AS with fixed flexion deformity of thoracic and thoracolumbar spine, fusion of posterior elements of cervical spine posted for lumbar spinal osteotomy with anticipated difficult intubation. An awake retrograde oral intubation with light sedation and local block is performed.

  5. Rapid sequence intubation in the neonate.

    Science.gov (United States)

    Bottor, Lottie T

    2009-06-01

    Rapid sequence intubation (RSI) is premedication prior to intubation that includes atropine, a sedative, and a neuromuscular blockage. Rapid sequence intubation is infrequently performed in neonates despite evidence that it is safe and effective. Neonates that experience endotracheal intubation often display apnea and cardiac arrhythmias, decreased or obstructed nasal airflow, increased systolic blood pressure, and decreased heart rate and transcutaneous oxygen tension. Infants can also experience increased anterior fontanel pressure, which can place them at greater risk for intraventricular hemorrhage. Rapid sequence intubation has been shown to facilitate better intubation conditions including no movement from the infant and better visualization of the airway. Infants receiving RSI were successfully intubated twice as fast as infants who were not premedicated. Infants with premedication also had fewer changes in baseline heart rate. Neonatal RSI can be easily and safely performed in the neonate. Knowledge and skill allow for the best conditions when intubating the infant. Future research must focus on the best combination of medications for RSI in the neonate.

  6. DEXMEDETOMIDINE AND FENTANYL FOR ENDOTRACHEAL INTUBATION: A COMPARATIVE STUDY

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    Vishwanath R

    2015-10-01

    Full Text Available Severe cardiovascular response in the form of tachycardia and hypertension occur during induction of general anaesthesia and endotracheal intubation. This can cause deleterious effects in hypertensive and other cardiovascular disease patients. Alpha-2 (α-2 agonists are increasingly used as adjuncts in anaesthesia. Nowadays, dexmedetomidine, α-2 adrenoreceptor agonist, is gaining popularity for its sympatholytic, sedative, anaesthetic sparing and haemodynamic stabilizing properties without significant respiratory depression. The stable hemodynamic and decreased oxygen consumption due to enhanced sympathoadrenal stability make dexmedetomidine very useful pharmacologic agent. The present study was undertaken to compare the effectiveness of dexmedetomidine and fentanyl in attenuating the response to laryngoscopy and endotracheal intubation during general anaesthesia. We enrolled 100 patients in age range 18-50 years of ASA I-II, and of either sex undergoing elective operation of short duration. Patients were randomly selected and allocated into two Groups. Group D: Received dexmedetomidine 1μg/kg intravenous (IV bolus and Group F: received fentanyl 1μg/kg IV bolus 10min before induction. All patients were induced with thiopentone sodium and vecuronium. Patients in both the Groups were continuously monitored for heart rate, systolic, diastolic and mean arterial pressure (MAP and data recorded. After induction and intubation HR, SBP, DBP and MAP were significantly lower in Group D than Group F (P<0.004, P=0.00, P<0.04, P<0.006 respectively. The need for thiopentone was decreased by 9% in the dexmedetomidine Group as compared to the fentanyl Group. Post-operative sedation and pain scores were comparably less in Group D than Group F. We conclude, Preoperative infusion of 1μg/kg of both dexmedetomidine and fentanyl are effective in attenuating the sympathetic responses to laryngoscopy and tracheal intubation however, dexmedetomidine blunts this

  7. Non-intubated laparoscopic repair of giant Morgagni’s hernia for a young man

    Science.gov (United States)

    Zhang, Miao; Wang, Heng; Liu, Dong; Pan, Xuefeng; Wu, Wenbin; Hu, Zhengqun

    2016-01-01

    An asymptomatic patient was admitted as his chest photograph and computed tomography scans showed a giant Morgagni’s hernia (MH). And it was repaired by laparoscopic approach under epidural anesthesia without endotracheal intubation. The hernia content of omentum was repositioned back into the abdominal cavity, and the diaphragmatic defect was repaired with composite mesh. Which indicated that non-intubated laparoscopic mesh repair via epidural anesthesia is reliable and satisfactory for MH. PMID:27621903

  8. A randomized controlled study to evaluate and compare Truview blade with Macintosh blade for laryngoscopy and intubation under general anesthesia

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    Ramesh T Timanaykar

    2011-01-01

    Full Text Available Background: The Truview EVO2 TM laryngoscope is a recently introduced device with a unique blade that provides a magnified laryngeal view at 42° anterior reflected view. It facilitates visualization of the glottis without alignment of oral, pharyngeal, and tracheal axes. We compared the view obtained at laryngoscopy, intubating conditions and hemodynamic parameters of Truview with Macintosh blade. Materials and Methods: In prospective, randomized and controlled manner, 200 patients of ASA I and II of either sex (20-50 years, presenting for surgery requiring tracheal intubation, were assigned to undergo intubation using a Truview or Macintosh laryngoscope. Visualization of the vocal cord, ease of intubation, time taken for intubation, number of attempts, and hemodynamic parameters were evaluated. Results: Truview provided better results for the laryngeal view using Cormack and Lehane grading, particularly in patients with higher airway Mallampati grading (P < 0.05. The time taken for intubation (33.06±5.6 vs. 23.11±57 seconds was more with Truview than with Macintosh blade (P < 0.01. The Percentage of Glottic Opening (POGO score was significantly higher (97.26±8 in Truview as that observed with Macintosh blade (83.70±21.5. Hemodynamic parameters increased after tracheal intubation from pre-intubation value (P < 0.05 in both the groups, but they were comparable amongst the groups. No postoperative adverse events were noted. Conclusion: Tracheal intubation using Truview blade provided consistently improved laryngeal view as compared to Macintosh blade without the need to align the oral, pharyngeal and tracheal axes, with equal attempts for successful intubation and similar changes in hemodynamics. However, the time taken for intubation was more with Truview.

  9. The comparative observation of Shikani in intubation for the patients with simulated cervical spine injury%视可尼视频喉镜与Macintosh喉镜用于模拟颈椎损伤病人气管插管的对比观察

    Institute of Scientific and Technical Information of China (English)

    万磊; 洪方晓; 丁冠男; 田鸣

    2015-01-01

    Objective To compare the clinical application of the Macintosh and Shikani in intubation for the patients with simulated cervi-cal spine injury using Ambu rigid collar. Methods 80 patients undergoing general anesthesia who required tracheal intubation were randomly as-signed to two groups:Shikani(S,n=40)and Macintosh(M,n=40). After induction of anesthesia,the neck of the patients was immobilized with Ambu rigid collar,and the tracheal intubation was performed by an experienced anesthetist who was familiar with each of these two devices. The duration of the successful attempt and visualized glottis was recorded. The success rate for intubation in the first attempt and the overall success rate for intubation were recorded too. The number of cardiovascular adverse events during tracheal intubation were observed. Results The dura-tionofthesuccessfultrachealintubationattemptswas30.65±8.22s(S)and42.48±8.32s(M)respectively. Thereweresignificantdifference between two groups( P 0. 05). Conclusion The duration of the successful tracheal intubation attempts and the number of cardiovascular adverse events during tracheal intubation of Shikani were shorter and lower compared with the Macintosh. Therefore,it is a safe and effective mean in the intubation for the patients simulated cervical spine injury using Ambu rigid collar.%目的:对比观察视可尼( Shikani)视频喉镜和Macintosh喉镜用于Ambu颈托固定模拟颈椎损伤病人气管插管的临床效果。方法随机选取拟行择期手术需全身麻醉气管插管的80例患者,随机分为Shikani( S组,n=40)和Macintosh组(M组,n=40),麻醉诱导后,使用Ambu颈托固定颈椎,由熟练掌握该两种工具的同一麻醉医师完成气管插管,记录各组成功插管持续的时间、声门暴露时间、一次插管成功率、总插管成功率。记录并比较插管过程中心血管不良事件的发生次数。结果两组成功插管时间分别为30.65±8.22 s( S

  10. Improving rigid fiberoptic intubation: a comparison of the Bonfils Intubating Fiberscope™ with a novel modification

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    Nicholas Thomas A

    2010-05-01

    Full Text Available Abstract Background The Bonfils intubating fiberscope has a limited upward tip angle of 40° and requires retromolar entry into the hypopharynx. These factors may make its use less desirable when managing the difficult airway because most anesthesia providers are well versed in midline oral intubation rather than the lateral retromolar approach. The Center for Advanced Technology and Telemedicine at the University of Nebraska Medical Center has developed a novel fiberscope with a more anterior 60° curve to allow for easier midline insertion and intubation. The objective of this work was to evaluate the novel fiberscope, in comparison to the Bonfils intubating fiberscope, in terms of use and function in difficult airway intubation. Methods Twenty-two anesthesia providers participated in simulated intubations of a difficult airway mannequin to compare the Bonfils intubating fiberscope with the novel curved Boedeker intubating fiberscope. The intubations were assessed based upon the following variables: recorded Cormack Lehane airway scores, requests for cricoid pressure, time to intubation, number of intubation attempts and success or failure of the procedure. Results Participants using the Bonfils fiberscope recorded an average Cormack Lehane (CL airway score of 1.67 ± 1.02 (median = 1; with the novel fiberscope, the recorded average airway grade improved to 1.18 ± 0.50 (median = 1. The difference in airway scores was not statistically significant (p = 0.34; Fishers Exact Test comparing CL grades 1&2 vs. 3&4. There was, however, a statistically significant difference in intubation success rates between the two devices. With the Bonfils fiberscope, 68% (15/22 of participants were successful in intubation compared to a 100% success rate in intubation with the novel fiberscope (22/22 (p = 0.008. After the intubation trial, the majority of participants (95% indicated a preference for the novel fiberscope (n = 20. Conclusions With this data, we can

  11. A COMPARISON OF PROPOFOL WITH SEVOFLURANE AND PROPOFOL ALONE FOR INDUCTION AND INTUBATION

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    Manjunath

    2015-11-01

    Full Text Available STUDY OBJECTIVE: We aimed to study propofol with sevoflurane and propofol alone in evaluating intubating conditions, hemodynamic response during induction and intubation and induction side effects in adult patients undergoing various elective surgical procedures without muscle relaxants. DESIGN: Prospective randomized study. SETTING: Operation theatre of a teaching institute. PATIENTS: The study population consists of 60 ASA I & II, non-obese, adult patients aged between 20-40yrs coming for elective surgical procedures under General Anaesthesia and had Mallampatti class I airway anatomy, 30 of these patients receive propofol alone–“GROUP A” and 30 of who receive propofol with sevoflurane–“GROUP B”. MEASUREMENTS AND RESULTS: The heart rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure before and after induction and post-intubation at 1, 3 and 5 minutes were recorded. Time to induction in seconds (Start of anaesthetic until loss of eye lash reflex, induction side effects like breath holding, cough, excitatory movements, laryngospasm and others (Bradycardia, hypoxia, hyperthermia, hypothermia and injection site pain were noted. Intubating conditions were better in Group-B than in Group-A, Group-B patients had significantly had more clinically acceptable intubating conditions than Group-A. There was no significant difference in heart rate after induction and intubation between the two groups, except 3min after intubation in Group-A there is significantly low heart rate. There was significant in reduction in systolic blood pressure after induction and intubation in Group-A, however there was no significant difference in diastolic blood pressure and mean arterial pressure between two groups. Induction time is significantly less in Group-A patients when compared to Group-B patients and there was no significant difference in induction side effects between two groups. CONCLUSION: Combination of inhalational 4

  12. 经口气管插管患者口腔护理研究的文献分析%Literature analysis on oral care research of orotracheal intubated patients

    Institute of Scientific and Technical Information of China (English)

    温淼淼; 赵梅珍; 曾铁英

    2014-01-01

    目的 了解我国经口气管插管患者口腔护理研究的进展情况,明确存在的问题,为今后的研究方向提供参考.方法 检索截至2013年12月的CNKI、万方、维普和CBM 4个数据库中有关经口气管插管患者口腔护理研究的文献,并采用文献计量学分析方法对检索结果进行系统分析.结果 共纳入1997年至2013年符合标准的文献309篇,主要收录于22种护理专业期刊中.经口气管插管患者口腔护理方法可大体归纳为5种:冲洗加擦洗法(95篇),传统棉球(棉棒)擦拭和/或纱布(球)擦拭法(58篇),牙刷刷洗法(54篇),冲洗法(51篇),喉镜协助法(7篇).54篇文献使用传统棉球作为护理工具,55篇文献使用牙刷,其中儿童(软毛)牙刷29篇,普通牙刷14篇,电动牙刷12篇.口腔护理溶液主要有生理盐水(49篇)、中药溶液(36篇)、氯己定(36篇)、抗生素(12篇)、聚维酮碘(17篇)、碳酸氢钠(9篇)等.结论 经口气管插管患者的口腔护理已经引起护理研究者的重视,但口腔护理方法、频次及护理工具的使用仍欠规范.今后需加强护理人员的系统培训,提高科研工作者的科研能力,开展大样本、高质量的研究,制定全国性口腔护理指南,提高我国危重患者口腔护理水平.%Objective To know the progress of research in oral care of orotracheal intubated patients in China and to analyze the existing problems as well as provide the reference for further study.Methods Databases of CNKI,Wanfang,VIP and CBM were searched for literature on oral care for the orotracheal intubated patients by the end of December 2013,and the methods of bibliometrics were used to analyze the research results.Results Three hundred and nine articles that met the inclusion and exclusion criteria from 1997 to 2013 were collected.These papers were mainly included in 22 kinds of nursing journals.The methods of oral care for orotracheal intubated patients could be classified into five types

  13. Sensitivity of palm print, modified mallampati score and 3-3-2 rule in prediction of difficult intubation

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    Ata Mahmoodpoor

    2013-01-01

    Full Text Available Background: This study evaluated the performance of modified Mallampati score, 3-3-2 rule and palm print in prediction of difficult intubation. Methods: In a prospective descriptive study, data from 500 patients scheduled for elective surgery under general anesthesia were collected. An anesthesiologist evaluated the airway using mentioned tests and another anesthesiologist evaluated difficult intubation. Laryngoscopic views were determined by Cormack and Lehane score. Grades 3 and 4 were defined as difficult intubation. Sensitivity, specificity, positive predictive value, negative predictive value and Youden index were determined for all tests. Results: Difficult intubation was reported in 8.9% of the patients. There was a significant correlation between body mass index and difficult intubation (P : 0.004; however, other demographic characteristics didn′t have a significant correlation with difficult intubation. Among three tests, palm print was of highest specificity (96.46% and modified Mallampati of highest sensitivity (98.40%. In a combination of the tests, the highest specificity, sensitivity and Youden index were observed when using all three tests together. Conclusions: Palm print has a high specificity for prediction of difficult intubation, but the best way for prediction of difficult intubation is using all three tests together.

  14. A COMPARATIVE CLINICAL EVALUATION OF INTUBATING CONDITIONS AND HAEMODYNAMIC EFFECTS AFTER ADMINISTRATION OF SUCCINYL CHOLINE & ROCURONIUM BROMIDE

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    Abhishek

    2015-04-01

    Full Text Available BACKGROUND: Rapid and safe endotracheal intubation is of paramount importance in practice of general anesthesia . Succinylcholine chloride , a depolarizing muscl e relaxant due to its quick onset of action and excellent intubating conditions has remained a muscle relaxant of choice . Rocuronium was proved to be safe alternative to Succinylcholine for endotracheal intubation . AIMS : Study was conducted to evaluate & c ompare the onset time , clinical duration and intubating condition of Succinylcholine and Rocuronium Bromide and Haemodynamic changes caused by these agents . METHODS & MATERIALS : 80 patients were randomly divided into two groups . Group - 1 , Succinylcholine ( 1 . 5mg/kg and group - 2 Rocuronium Bromide ( 0 . 6mg/kg . After 60 sec of administration of muscle relaxant , intubating conditions were judged according to scoring system by Cooper et al . 1 Onset time and duration of action was noted . Hemodynamic parameters ( H eart rate , Systolic Blood Pressure , Diastolic Blood Pressure , Mean Atrial pressure and SPO 2 were monitored before intubation , during intubation and just after intubation at 1 , 2 and 5 minutes . RESULTS : The mean onset time and duration of action was signi ficantly longer for Rocuronium ( 95 . 15±9 . 47 seconds than Succinylcholine ( 59 . 80±14 . 30 seconds and Rocuronium ( 42 . 60±13 . 15 minutes than Succinylcholine ( 5 . 10±2 . 35 minutes . Intubating conditions was excellent in 35 ( 87% and good in 5 ( 12 . 5% patients in su ccinylcholine whereas , in Rocuronium produced excellent intubation in only 23 ( 57 . 5% patients and good intubation in 14 ( 35% patients . The heart rate increased significantly after induction ( maximum at 1 minute with both Rocuronium ( 98 . 75±15 . 53 and Succi nylcholine ( 112 . 75±15 . 89 . But it gradually declined towards normal and change in heart rate with either drug was not significant at 5 minutes . The mean blood pressure increased significantly after induction

  15. An economical model for mastering the art of intubation with different video laryngoscopes.

    Science.gov (United States)

    Trivedi, Jitin N

    2014-07-01

    Video laryngoscope (VL) provides excellent laryngeal exposure in patients when anaesthesiologists encounter difficulty with direct laryngoscopy. Videolaryngoscopy, like flexible fibreoptic laryngoscopy demands a certain level of training by practitioners to become dexterous at successful intubation with a given instrument. Due to their cost factors, VLs are not easily available for training purposes to all the students, paramedics and emergency medical services providers in developing countries. We tried to develop a cost-effective instrument, which can work analogous to various available VLs. An inexpensive and easily available instrument was used to create an Airtraq Model for VL guided intubation training on manikin. Using this technique, successful intubation of manikin could be achieved. The Airtraq Model mimics the Airtraq Avant(®) and may be used for VL guided intubation training for students as well as paramedics, and decrease the time and shorten the learning curve for Airtraq(®) as well as various other VLs.

  16. An economical model for mastering the art of intubation with different video laryngoscopes

    Directory of Open Access Journals (Sweden)

    Jitin N Trivedi

    2014-01-01

    Full Text Available Video laryngoscope (VL provides excellent laryngeal exposure in patients when anaesthesiologists encounter difficulty with direct laryngoscopy. Videolaryngoscopy, like flexible fibreoptic laryngoscopy demands a certain level of training by practitioners to become dexterous at successful intubation with a given instrument. Due to their cost factors, VLs are not easily available for training purposes to all the students, paramedics and emergency medical services providers in developing countries. We tried to develop a cost-effective instrument, which can work analogous to various available VLs. An inexpensive and easily available instrument was used to create an Airtraq Model for VL guided intubation training on manikin. Using this technique, successful intubation of manikin could be achieved. The Airtraq Model mimics the Airtraq Avant ® and may be used for VL guided intubation training for students as well as paramedics, and decrease the time and shorten the learning curve for Airtraq ® as well as various other VLs.

  17. A novel method using Seldinger's technique for submental intubation in major craniomaxillofacial fractures: A case series.

    Science.gov (United States)

    Saheb, Shaik Mastan; Nath, Vemuri Nagendra; Kumar, K Phani; Padmaja, Pilli Parama Geetha

    2014-01-01

    Airway management is a challenge to anesthesiologists particularly in maxillofacial surgeries. The oral tracheal tube is unsuitable because it interferes with the surgical field and prevents dental occlusion. Nasotracheal intubation may not always be possible due to structural deformity or trauma to the nasal bones. Tracheostomy and submental intubation have their drawbacks. To overcome these shortcomings we used Percutaneous Dilatational Tracheostomy Kit (PDTK) to modify the technique of submental intubation. Serial dilatations were performed over the guide wire before passing the tracheal tube by submental route, using the PDT kit in four patients. Submental intubation could be achieved in all the four cases with this technique and there were no associated complications. Seldinger's technique is a simple and easy technique with minimal bleeding, imperceptible scar, and more importantly anesthesiologists feel more comfortable because of their familiarity with the Seldinger technique.

  18. Catastrophic neurological complications of emergent endotracheal intubation: report of 2 cases.

    Science.gov (United States)

    Oppenlander, Mark E; Hsu, Forrest D; Bolton, Patrick; Theodore, Nicholas

    2015-05-01

    Although exceedingly rare, catastrophic neurological decline may result from endotracheal intubation of patients with preexisting cervical spine disease. The authors report on 2 cases of quadriplegia resulting from emergent endotracheal intubation in the intensive care unit. A 68-year-old man with ankylosing spondylitis became quadriplegic after emergent intubation. A new C6-7 fracturedislocation was identified, and the patient underwent emergent open reduction and C4-T2 posterior fixation and fusion. The patient remained quadriplegic and ultimately died of pneumonia 1 year later. This is the first report with radiographic documentation of a cervical fracture-dislocation resulting from intubation in a patient with ankylosing spondylitis. A 73-year-old man underwent posterior C6-T1 decompression and fixation for a C6-7 fracture. On postoperative Day 12, emergent intubation for respiratory distress resulted in C6-level quadriplegia. Imaging revealed acute spondyloptosis at C6-7, and the patient underwent emergent open reduction with revision and extension of posterior fusion from C-3 to T-2. He remained quadriplegic and ventilator dependent. Five days after the second operation, care was withdrawn. This is the first report of intubation as a cause of significant neurological decline related to disruption of a recently fixated cervical fracture. Risk factors are identified and pertinent literature is reviewed for cases of catastrophic neurological complications after emergent endotracheal intubation. Strategies for obtaining airway control in patients with cervical spine pathology are also identified. Awareness of the potential dangers of airway management in patients with cervical spine pathology is critical for all involved subspecialty team members.

  19. Efficacy and safety of Lamotrigine in treatment of patients with Alzheimer's disease accompanied with agitation behaviors%拉莫三嗪治疗阿尔茨海默病伴发激越行为患者的疗效和安全性

    Institute of Scientific and Technical Information of China (English)

    王曙光; 钱志梅; 李斌

    2015-01-01

    Objective:To explore efficacy and safety of Lamotrigine in treatment of patients with Alzheimer's disease accompa-nied with agitation behaviors. Methods:50 cases of Alzheimer's disease with agitation behaviors were randomly divided into treatment group and control group with 25 cases in each group. The treatment group was given Lamotrigine 50 ~200 mg/d, while the control group was given empty capsules. The two groups were treated for 6 weeks. Cohen-Mansfield agitation inventory ( CMAI) was used to evaluate the agitation behaviors;minimum mental state examination ( MMSE) was applied to assess intelligent states;and treatment e-mergent symptom scale ( TESS) , related electrocardiogram ( ECG) and laboratory tests were used to assess adverse reactions. The effi-cacies and safety of the two groups were compared. Results:There was a significant difference in the CMAI score of treatment goup be-fore and after the treatment (P0. 05). Conclusions:Lamotrigine for the agitation behaviors in Alzheimer's disease is safe and effective.%目的::观察拉莫三嗪治疗阿尔茨海默病伴发激越行为患者的疗效和安全性。方法:将50例阿尔茨海默病伴发激越行为患者随机分为治疗组和对照组,每组各25例。治疗组患者给予拉莫三嗪50~200 mg/d治疗;对照组患者给予空胶囊,疗程6周。用CMAI评价激越行为,MMSE评分评价智能状态,用TESS、心电图和实验室检查评定患者不良反应,比较两组患者的疗效和安全性。结果:两组患者治疗后比较CMAI有显著差异(P0.05)。结论:拉莫三嗪治疗阿尔茨海默病伴发激越行为患者安全有效。

  20. General Anesthesia with Preserved Spontaneous Breathing through an Intubation Tube

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    V. V. Moroz

    2010-01-01

    Full Text Available Objective: to study whether spontaneous patient breathing may be preserved during elective operations under general anesthesia with tracheal intubation. Subjects and methods. One hundred and twelve patients undergoing elective surgeries under general endotracheal anesthesia were randomized into 2 groups: 1 patients who had forced mechanical ventilation in the volume-controlled mode and 2 those who received assisted ventilation as spontaneous breathing with mechanical support. Conclusion. The study shows that spontaneous breathing with mechanical support may be safely used during some surgical interventions in patients with baseline healthy lungs. Key words: Pressure Support, assisted ventilation, spontaneous breathing, general anesthesia, lung function.

  1. Optimal nonpharmacological management of agitation in Alzheimer’s disease: challenges and solutions

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    Millán-Calenti JC

    2016-02-01

    Full Text Available José Carlos Millán-Calenti,1 Laura Lorenzo-López,1 Begoña Alonso-Búa,1 Carmen de Labra,2 Isabel González-Abraldes,1 Ana Maseda1 1Gerontology Research Group, Department of Medicine, Faculty of Health Sciences, Universidade da Coruña, A Coruña, Spain; 2Research, Development and Innovation Department, Gerontological Complex La Milagrosa, Provincial Association of Pensioners and Retired People (UDP from A Coruña, A Coruña, Spain Abstract: Many patients with Alzheimer’s disease will develop agitation at later stages of the disease, which constitutes one of the most challenging and distressing aspects of dementia. Recently, nonpharmacological therapies have become increasingly popular and have been proven to be effective in managing the behavioral symptoms (including agitation that are common in the middle or later stages of dementia. These therapies seem to be a good alternative to pharmacological treatment to avoid unpleasant side effects. We present a systematic review of randomized controlled trials (RCTs focused on the nonpharmacological management of agitation in Alzheimer’s disease (AD patients aged 65 years and above. Of the 754 studies found, eight met the inclusion criteria. This review suggests that music therapy is optimal for the management of agitation in institutionalized patients with moderately severe and severe AD, particularly when the intervention includes individualized and interactive music. Bright light therapy has little and possibly no clinically significant effects with respect to observational ratings of agitation but decreases caregiver ratings of physical and verbal agitation. Therapeutic touch is effective for reducing physical nonaggressive behaviors but is not superior to simulated therapeutic touch or usual care for reducing physically aggressive and verbally agitated behaviors. Melissa oil aromatherapy and behavioral management techniques are not superior to placebo or pharmacological therapies for

  2. Comparison of glottic visualisation and ease of intubation with different laryngoscope blades

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    Atul P Kulkarni

    2013-01-01

    Full Text Available Context: Literature suggests glottic view is better with straight blades while tracheal intubation is easier with curved blades. Aims: To compare glottic view and ease of intubation with Macintosh, Miller, McCoy blades and the Trueview® laryngoscope. Settings and Design: This prospective randomised study was undertaken in operation theatres of a 550 bedded tertiary referral cancer centre after approval from the Institutional Review Board. Methods: We compared the Macintosh, Miller, McCoy blades and the Trueview® laryngoscope for glottic visualisation and ease of tracheal intubation; in 120 patients undergoing elective cancer surgery; randomly divided into four groups. After induction of anaesthesia laryngoscopy was performed and trachea intubated. We recorded: Visualisation of glottis (Cormack Lehane grade, ease of intubation, number of attempts; need to change the blade and need for external laryngeal manipulation. Statistical Analysis: Demographic data, Mallampati classification were compared using the Chi-square test. A P<0.05 was considered significant. Results: Grade 1 view was obtained most often (87% patients with Trueview® laryngoscope. Intubation was easier (Grade 1 with Trueview® and McCoy blades (93% each. Seven patients needed two attempts; one patient in Miller group needed three attempts. No patient in McCoy and Trueview® Groups required external laryngeal manipulation. Conclusions: We found that in patients with normal airway glottis was best visualised with Miller blade and Trueview® laryngoscope however, the trachea was more easily intubated with McCoy and Macintosh blades and Trueview® laryngoscope.

  3. 过氧化氢在经口气管插管患者口腔护理中的应用%Application of hydrogen peroxide in nursing care for the oral cavities of the patients with orotracheal intubation

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    刘春香; 祝立阳; 莫伟梅; 林琦; 韦涌初; 黎冬梅; 朱旭

    2013-01-01

    目的 探讨过氧化氢对经口气管插管患者预防感染性并发症的效果.方法 将90例经口气管插管机械通气患者随机分为A、B、C三组,每组各30例.A组患者采用3%过氧化氢溶液棉球擦洗联合0.9%氯化钠溶液冲洗口腔;B组采用0.9%氯化钠溶液冲洗口腔;C组按常规采用0.9%氯化钠溶液棉球进行口腔擦洗,均每日2次.观察三组患者口咽部细菌数、口腔pH值和清洁度及口腔感染的发生率.结果 三种方法护理口腔后,A、B、C三组口咽部细菌数均减少[分别为(306.70±15.57),(436.10±19.14),(762.33±28.46) cfu/平皿;F=116.5;P<0.05],以A组最明显;三组方法护理后患者口腔pH值均升高[(6.70 ±0.085),(6.41 ±0.102),(6.35±0.076)],三组比较差异有统计学意义(F=4.415;P<0.05),且以A组升高最明显;三组患者牙菌斑发生率(16.67%,40.00%,33.33%)及口腔感染发生率(10.00%,20.00%,33.33%)比较,差异无统计学意义(x2值分别为4.127,4.937;P>0.05),三组患者口臭的发生率以A组最低(20.00%,43.33%,56.67%),三组比较差异有统计学意义(x2=8.61,P<0.05).结论 应用3%过氧化氢溶液棉球擦洗联合0.9%氯化钠溶液冲洗经口气管插管患者口腔预防感染性并发症效果较好.%Objective To explore the effect of hydrogen peroxide on the prevention of the infectious complication in the patients with orotracheal intubation.Methods Ninety patients with orotracheal intubation for mechanical ventilation were randomly divided into three groups,each with 30 cases.The oral cavities of the patients in Group A were washed with cotton balls soaked by 3% hydrogen peroxide solution and rinsed with normal saline (0.9% sodium chloride solution) ;those of the patients in Group B were rinsed with normal saline alone;and those of the patients in Group C were washed conventionally with cotton balls soaked by normal saline.The oral care was conducted twice daily in each

  4. A COMPARATIVE STUDY ON ROLE OF GUM ELASTIC BOUGIE WITH AIRTRAQ OPTICAL LARYNGOSCOPE FOR ENDOTRACHEAL INTUBATION: AID OR IMPEDIMENT

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    Eeshwar Rao Madishetti

    2016-09-01

    Full Text Available AIMS This study aims to compare endotracheal intubation using the Airtraq with bougie vs. the Airtraq without bougie with respect to: Time for intubation, Ease of intubation, Maneuvers employed to facilitate intubation, Number of attempts. MATERIALS AND METHODS This randomised prospective study was done with Seventy five patients undergoing elective surgery under general anaesthesia. 37 patients in group Airtraq (A and 38 patients in group AB were studied. RESULTS All the demographic details of the patients ASA Physical status and airway parameter are insignificant in both groups, i.e. they are similar. There is no significant differences in the mean inter-incisor distance and the mean Thyro-Mental Distance between the study groups. The distribution of patients according to Modified Mallampati Class in the two groups were similar. When the two groups were compared with respect to the number of patients in each group requiring particular maneuvers to optimise glottic view and facilitate intubation, no statistical difference was observed. However, there was a statistically and clinically significant difference when the two groups were compared with respect to the number of patients requiring various maneuvers to optimise the glottic view to facilitate intubation. Four of seven patients in group Airtraq (A who had trauma had also required additional maneuvers to facilitate intubation. One of these four had a grade 3 Cormack-Lehane view despite maneuvers and a second attempt was needed in two patients. In our study, trauma was observed more frequently in Airtraq (A group. Its greater frequency in group Airtraq (A as compared to Airtraq with bougie (AB was both statistically and clinically significant. Majority of the patients in group AirtraqTM with bougie (AB were intubated easily, but proportion did not reach statistical significance when compared with group Airtraq. TM CONCLUSION The Gum Elastic Bougie aids intubation with the Airtraq avoiding

  5. 可视喉镜插管对困难气道老年患者血流动力学和咽喉并发症的影响%EFFECTS OF TRACHEAL INTUBATION UNDER VIDEO LARYNGOSCOPE ON HEMODY-NAMIC RESPONSE AND LARYNGOPHARYNGEAL COMPLICATIONS IN ELDERLY PA-TIENTS WITH DIFFICULT AIRWAY

    Institute of Scientific and Technical Information of China (English)

    郭敏; 张良清; 李经纬; 姚爱军

    2015-01-01

    Objective To evaluate the effects of video laryngoscope fortracheal intubation on hemodynamic response and laryngopharyngeal complications in the elderly patients with difficult airway .Methods 80 elderly pa-tients undergoing tracheal intubation were randomly divided into four groups : the first direct laryngoscope group (Group A), the video laryngoscope group (Group B), the second direct laryngoscope group (Group C ), the second video laryngoscopegroup (Group D).The patients were intubated by young doctors (Groups A, B by surgeons;Groups C, D by anesthesiologists) using direct or video laryngoscope .The intubation time,changes of the rate -pres-sure product ( RPP) ,the case number of successful intubation at thefirst time and laryngopharyngeal complications af -ter the operation were recorded .Results Compared with Groups A andC , the intubation time , RPP and the inci-dence of sore throats in Groups B and D were significantly reduced , but the rates of successful intubationwere signifi-cantly increased at thefirst time (p<0.05).Compared with Group B, intubation time, RPP and the incidence of sore throats in Group D were significantly decreased , but the rate of successful intubationwas significantly increased at the -first time (p<0.05).Conclusion Video laryngoscope for tracheal intubation can reduce the hemodynamic response and incidence of postoperative sore throats in elderly patients with difficult airway .%目的:评价可视喉镜对老年困难气道患者血流动力学及咽喉并发症的影响。方法80例全麻插管困难老年患者,随机分四组:直视喉镜1组(A组),可视喉镜1组(B组),直视喉镜2组(C组),可视喉镜2组(D组)。由年轻医师(A、B组:外科医师;C、D组:麻醉医师)用直视或可视喉镜气管插管,记录插管时间,心率血压乘积( Rate-pressure Product ,RPP)变化及首次插管成功例数、术后咽喉并发症。结果与A、C组比较,B、D组插

  6. Effects of Agitation and Storage Temperature on Measurements of Hydration Status

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    Adams

    2015-12-01

    Full Text Available Background Hypohydration can have significant implications on normal physiological functions of the body. Objectives This study aimed to determine the impact of agitation, storage temperature, and storage time on urine osmolality compared to the criterion control. Patients and Methods We used a descriptive diagnostic validity test design. To investigate agitation, we recruited 75 healthy individuals (males = 41, females = 34; mean age = 22 ± 5 years; mean self-reported height = 172 ± 23 cm and mass = 77 ± 17 kg who provided one or more samples (total = 81. The independent variables were agitation (vortex, hand shaken, no agitation and temperature (room temperature, freezer, and refrigerator type. Participants completed informed consent, a health questionnaire and were asked to provide a urine sample, which was split and labeled according to agitation type or storage temperature. Urine osmolality was used to determine hydration status at two time points (within 2 hours [control], 48 hours. We used t-tests to determine the difference between each condition and the control and calculated percent error for each condition. Results No significant differences for no agitation (t79 = -0.079, P = 0.937, hand shaken (t79 = 1.395, P = 0.167 or vortex mixed (t79 = -0.753, P = 0.453 were identified when compared to the criterion control. No significant differences for room temperature (t82 = -0.720, P = 0.474, refrigerator (t82 = -2.697, P = 0.008 or freezer (t82 = 2.576, P = 0.012 were identified when compared to the criterion control. Conclusions Our findings suggest agitation of urine specimen is not necessary and samples do not require refrigeration or freezing if assessed within 48 hours. Analysis within two hours of collection is not necessary and samples can be stored for up to 48 hours without impacting the hydration status of the sample.

  7. BMI as a Predictor for Potential Difficult Tracheal Intubation in Males

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    Alberto A Uribe

    2015-06-01

    Full Text Available Introduction: Difficult tracheal intubation is a common source of mortality and morbidity insurgical and critical care settings. The incidence reported of difficult tracheal intubation is 0.1 to 13%and reaches 14% in the obese population. The objective of our retrospective study was to investigateand compare the utility of BMI as indicator of difficult tracheal intubation in males and females.Material and methods: We performed a retrospective chart review of patients who underwentabdominal surgeries with ASA I to V under general anesthesia requiring endotracheal intubation. Thefollowing information was obtained from medical records for analysis: gender, age, height, weight,BMI, length of patient stay in the Post Anesthesia Care Unit (PACU, past medical history of sleepapnea, Mallampati score, and the ASA classification assigned by the anesthesia care providerperforming the endotracheal intubation.Results: Of 4303 adult patients, 1970 (45.8% men and 2333 (54.2% women, were enrolled in thestudy. Within this group, a total of 1673 (38.9% patients were morbidly obese. The average age of thestudy group was 51.4 ± 15.8 and the average BMI was 29.7 ± 8.2 kg/m². The overall incidence of theencountered difficult intubations was 5.23%, or 225 subjects. Thus, our results indicate that BMI is areliable predictor of difficult tracheal intubation predominantly in the male population; another strongpredictor, with a positive linear correlation, being the Mallampati score.Conclusions: In conclusion, our data shows that BMI is a reliable indicator of potential difficult trachealintubation only in male surgical patients.

  8. Endotracheal intubation skill acquisition by medical students

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    Henry E. Wang MD MS

    2011-08-01

    Full Text Available During the course of their training, medical students may receive introductory experience with advanced resuscitation skills. Endotracheal intubation (ETI – the insertion of a breathing tube into the trachea is an example of an important advanced resuscitation intervention. Only limited data characterize clinical ETI skill acquisition by medical students. We sought to characterize medical student acquisition of ETI procedural skill.11Presented as a poster discussion on 17 October 2007 at the annual meeting of the American Society of Anesthesiologists in San Francisco, CA.The study included third-year medical students participating in a required anesthesiology clerkship. Students performed ETI on operating room patients under the supervision of attending anesthesiologists. Students reported clinical details of each ETI effort, including patient age, sex, Mallampati score, number of direct laryngoscopies and ETI success. Using mixed-effects regression, we characterized the adjusted association between ETI success and cumulative ETI experience.ETI was attempted by 178 students on 1,646 patients (range 1–23 patients per student; median 9 patients per student, IQR 6–12. Overall ETI success was 75.0% (95% CI 72.9–77.1%. Adjusted for patient age, sex, Mallampati score and number of laryngoscopies, the odds of ETI success improved with cumulative ETI encounters (odds ratio 1.09 per additional ETI encounter; 95% CI 1.04–1.14. Students required at least 17 ETI encounters to achieve 90% predicted ETI success.In this series medical student ETI proficiency was associated with cumulative clinical procedural experience. Clinical experience may provide a viable strategy for fostering medical student procedural skills.

  9. Role of melatonin in attenuation of haemodynamic responses to laryngoscopy and intubation

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    Priyamvada Gupta

    2016-01-01

    Full Text Available Background and Aims: Laryngoscopy and endotracheal intubation are considered as potent stimuli which lead to an increase in heart rate and blood pressure. Melatonin (N-acetyl-5-methoxytryptamine has been studied for pre-operative anxiolysis and sedation in Intensive Care Unit. We made a hypothesis that melatonin can provide haemodynamic stability during laryngoscopy and intubation when given 120 min before the procedure. Methods: Sixty American Society of Anesthesiologists physical status Grade I and II patients of either gender, 20-45 years old, 40-65 kg body weight, scheduled to undergo elective surgical procedures under general anaesthesia were assigned into two equal groups - Group C (control and Group M (melatonin. They received oral placebo or melatonin tablets 6 mg, respectively, 120 min before surgery. The haemodynamic parameters were recorded preoperatively, during laryngoscopy and endotracheal intubation and thereafter at 1, 3, 5 and 10 min. Unpaired t-test was used for between-group comparison of ratio and interval scale data. For within-group comparison of ratio and interval scale data, repeated-measures ANOVA and post hoc Bonferroni t-tests were used. Results: It was observed that in the control group, there was a significant increase in heart rate and blood pressure at laryngoscopy and intubation and persisted till 10 min post-intubation. In melatonin group, there was an insignificant increase in heart rate at the time of laryngoscopy and intubation which however settled within 1 min post-intubation. Conclusion: Melatonin is an effective drug for attenuation of cardiovascular responses to laryngoscopy and endotracheal intubation.

  10. Role of melatonin in attenuation of haemodynamic responses to laryngoscopy and intubation

    Science.gov (United States)

    Gupta, Priyamvada; Jethava, Durga; Choudhary, Ruchika; Jethava, Dharam Das

    2016-01-01

    Background and Aims: Laryngoscopy and endotracheal intubation are considered as potent stimuli which lead to an increase in heart rate and blood pressure. Melatonin (N-acetyl-5-methoxytryptamine) has been studied for pre-operative anxiolysis and sedation in Intensive Care Unit. We made a hypothesis that melatonin can provide haemodynamic stability during laryngoscopy and intubation when given 120 min before the procedure. Methods: Sixty American Society of Anesthesiologists physical status Grade I and II patients of either gender, 20–45 years old, 40–65 kg body weight, scheduled to undergo elective surgical procedures under general anaesthesia were assigned into two equal groups - Group C (control) and Group M (melatonin). They received oral placebo or melatonin tablets 6 mg, respectively, 120 min before surgery. The haemodynamic parameters were recorded preoperatively, during laryngoscopy and endotracheal intubation and thereafter at 1, 3, 5 and 10 min. Unpaired t-test was used for between-group comparison of ratio and interval scale data. For within-group comparison of ratio and interval scale data, repeated-measures ANOVA and post hoc Bonferroni t-tests were used. Results: It was observed that in the control group, there was a significant increase in heart rate and blood pressure at laryngoscopy and intubation and persisted till 10 min post-intubation. In melatonin group, there was an insignificant increase in heart rate at the time of laryngoscopy and intubation which however settled within 1 min post-intubation. Conclusion: Melatonin is an effective drug for attenuation of cardiovascular responses to laryngoscopy and endotracheal intubation. PMID:27761033

  11. Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults.

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    Frerk, C; Mitchell, V S; McNarry, A F; Mendonca, C; Bhagrath, R; Patel, A; O'Sullivan, E P; Woodall, N M; Ahmad, I

    2015-12-01

    These guidelines provide a strategy to manage unanticipated difficulty with tracheal intubation. They are founded on published evidence. Where evidence is lacking, they have been directed by feedback from members of the Difficult Airway Society and based on expert opinion. These guidelines have been informed by advances in the understanding of crisis management; they emphasize the recognition and declaration of difficulty during airway management. A simplified, single algorithm now covers unanticipated difficulties in both routine intubation and rapid sequence induction. Planning for failed intubation should form part of the pre-induction briefing, particularly for urgent surgery. Emphasis is placed on assessment, preparation, positioning, preoxygenation, maintenance of oxygenation, and minimizing trauma from airway interventions. It is recommended that the number of airway interventions are limited, and blind techniques using a bougie or through supraglottic airway devices have been superseded by video- or fibre-optically guided intubation. If tracheal intubation fails, supraglottic airway devices are recommended to provide a route for oxygenation while reviewing how to proceed. Second-generation devices have advantages and are recommended. When both tracheal intubation and supraglottic airway device insertion have failed, waking the patient is the default option. If at this stage, face-mask oxygenation is impossible in the presence of muscle relaxation, cricothyroidotomy should follow immediately. Scalpel cricothyroidotomy is recommended as the preferred rescue technique and should be practised by all anaesthetists. The plans outlined are designed to be simple and easy to follow. They should be regularly rehearsed and made familiar to the whole theatre team.

  12. Effectiveness of sevoflurane or propofol combined with remifentanil for intubation without muscle relaxants

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    Tülay T. Peker

    2011-06-01

    Full Text Available We aimed to investigate the reliability of the hypothesis that whether sevoflurane-remifentanil could offer equivalent intubation conditions with propofol-remifentanil in the absence of muscle relaxants.Materials and methods: Total of 80 patients of ASA grades I and II scheduled for elective surgery were randomly allocated into two groups. Patients in group I received an infusion of remifentanil 1 mcg/kg/min and inhalation of sevoflurane 8% until the Bispectral index (BIS being less than 60. Patients in group II received a co-infusion of remifentanil 1 mcg/kg/min and propofol 1 mg/kg/min until BIS is <60. Intubation was attempted when BIS is <60. Intubation conditions were assessed as optimal, good, marginal, and poor using jaw relaxation, vocal cord opening, and limb movement. The heart rate and mean arterial blood pressure (ABP were recorded before and during the induction, and thereafter, 1, 2 and 5 minutes following intubation. The time for BIS to be <60 was recorded.Results: Optimal intubation conditions were achieved more often in group II than in group I (90% versus 45%, p=0.002. The ratio of patients showing optimal or good intubating conditions was 80% in group I and 100% in group II (p=0.035. Time required for BIS to be <60 was shorter in group II than in group I (47.1±27.2 sec vs. 111.9±60.6 sec, p<0.001. In both groups, there was a decrease in heart rate and mean ABP compared to baseline.Conclusion: Under BIS monitorization, propofol-remifentanil combination offered better intubation conditions and shorter anesthesia induction period compared with sevoflurane-remifentanil. J Clin Exp Invest 2011;2(2:138-43

  13. Effects of the Patients with Cervical Spinal Cord Injury undergoing Tracheal Intubation with Cervical Spine Manual-in-line Immobilizationunder Videolaryngoscopy%可视喉镜下手工中立位气管插管对颈髓损伤患者的影响

    Institute of Scientific and Technical Information of China (English)

    伍元川; 姚爱军; 熊珠取

    2013-01-01

    目的:观察可视喉镜下手工中立位全麻气管插管对颈椎颈髓手术患者术中血流动力学以及术后并发症的影响.方法:选择60例全麻手术患者,随机分为两组,每组30例,即直视喉镜组(对照组),手工中立位可视喉镜组(研究组).对两组患者分别使用直视喉镜、手工中立位可视喉镜进行气管插管,比较两组患者首次插管成功率、围插管期血流动力学及术后24h咽喉部并发症发生率.结果:与直视喉镜组比较,可视喉镜组首次插管成功率明显提高(P <0.05)、围插管期血流动力学波动幅度更小(P <0.05),术后咽喉部并发症发生率降低(P <0.05).结论:与直接喉镜相比,手工中立位可视喉镜可以缩短气管插管的用时,改善围插管期血流动力学波动,减轻咽喉部的损伤.%Objective: To investigate the effects of postoperative laryngopharyngeal complications of the patients with cervical spine surgery undergoing tracheal intubation with cervical spine manual-in-line immobilization under videolaryngoscopy. Method: 60 patients requiring general anesthesia were randomly divided into two groups( n = 30 each ), namely, direct laryngoscopy group ( group A ), videolaryngoscopy group ( group B ). Patients were randomly allocated to intubation with videolaryngoscopy or direct laryngoscopy. The number of intubation attempts, hemodynamic parameters and the incidence of postoperative laryngopharyngeal complications were recorded. Result: Compared with group A, patients' airways were successfully managed on the first attempt in group B ( P<0. 05 ), hemodynamic instability were better during intubation ( P<0. 05 ), and the incidence of postoperative laryngopharyngeal complications decreased ( P<0. 05 ). Conclusion : Compared with direct laryngoscopy, cervical spine manual-in-line immobilization under videolaryngoscopy can improve the speed or ease of intubations and attenuate the laryngopharyngeal injury.

  14. Effect of fiberoptic intubation on myocardial ischemia and hormonal stress response in diabetics with ischemic heart disease

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    Nashwa Nabil Mohamed

    2014-01-01

    Conclusion: The optimum use of fiberoptic bronchoscope with avoidance of jaw thrust maneuver attenuates the hemodynamic response to intubation which is beneficial in diabetic patients with ischemic heart disease. Stress response hormones showed no statistically significant difference between groups.

  15. Comparison of Transcanalicular Multidiode Laser Dacryocystorhinostomy with and without Silicon Tube Intubation

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    Yildiray Yildirim

    2016-01-01

    Full Text Available Aim. To compare the surgical outcomes of surgery with and without bicanalicular silicon tube intubation for the treatment of patients who have primary uncomplicated nasolacrimal duct obstruction. Methods. This retrospective study is comprised of 113 patients with uncomplicated primary nasolacrimal duct obstruction. There were 2 groups in the study: Group 1 (n=58 patients underwent transcanalicular diode laser dacryocystorhinostomy surgery with bicanalicular silicon tube intubation and Group 2 (n=55 patients underwent transcanalicular diode laser dacryocystorhinostomy surgery without bicanalicular silicon tube intubation. The follow-up period was 18.42±2.8 months for Group 1 and 18.8±2.1 months for Group 2. Results. Success was defined by irrigation of the lacrimal system without regurgitation and by the absence of epiphora. Success rates were 84.4% for Group 1 and 63.6% for Group 2 (P=0.011. Statistically a significant difference was found between the two groups. Conclusion. The results of the study showed that transcanalicular diode laser dacryocystorhinostomy surgery with bicanalicular silicon tube intubation was more successful than the other method of surgery. Consequently, the application of silicone tube intubation in transcanalicular diode laser dacryocystorhinostomy surgery is recommended.

  16. ICU 经口气管插管口腔护理实践指引的制订及临床应用%Clinical Application and Design of the Nursing Practice Guideline for Orally Intubated Patients in ICU

    Institute of Scientific and Technical Information of China (English)

    徐建宁; 冯洁惠

    2016-01-01

    Objective To establish a clinical nursing practice guideline for orally intubated patients in ICU,and to discuss its application effect.Methods Through cases review,interviews with medical person-nel and literature review,the common problems of oral care were analyzed and concluded.The practice guideline was formulated based on evidence-based guidelines,the nosocomial infection regulation and clini-cal practice demands.By convenience sampling,127 cases were selected,in which lives in the floors of odd numbers were selected as control group,and applied with conventional nursing,while the others were se-lected as observation group,and applied with oral care based on guideline.The scores of Beck Oral Assess-ment Scale (BOAS)on days 1,3,and 5 before oral care and the incidence of ventilator-associated pneumo-nia (VAP)were compared between the two groups.Results The score of BOAS on day 3 and 5 before oral care and the incidence of VAP in the observation group were significantly lower than those of the control group (all P <0.05).Conclusions The clinical guideline is feasible and effective to guide oral care practice for orally intubated patients in ICU,which is worth for clinical application.%目的:制订 ICU 经口气管插管口腔护理实践指引(以下简称“指引”),探讨其应用效果.方法通过查阅病历资料、访谈医护人员及检索文献等方法,归纳分析经口气管插管口腔护理实践中的常见问题,并依据文献指南、医院内感染制度及临床实践需求制订“指引”.2014年1-10月,便利抽取浙江大学医学院附属第一医院综合 ICU 两个护理单元的127例经口气管插管患者为研究对象,其中单号楼层为对照组,采用常规口腔护理方法;双号楼层为观察组,在对照组基础上应用“指引”进行口腔护理.比较两组患者第1、3、5天当日首次口腔护理前的 Beck 口腔评分(Beck oral assessment scale,BOAS)及

  17. Assessment of haemodynamic stability with intubating dose of intravenous rocuronium bromide versus vecuronium bromide in predominantly stenotic valvular cardiac surgery patients

    Directory of Open Access Journals (Sweden)

    Priyanka Bhagade

    2016-08-01

    Conclusions: The present study showed that Rocuronium had maintained excellent cardiovascular stability for the dose given to the patient. There was no statistically significant increase in heart rate, systolic, diastolic and mean arterial blood pressure after administration of Rocuronium as compared to vecuronium in the study. [Int J Res Med Sci 2016; 4(8.000: 3219-3223

  18. Comparative efficacy of Combination of Propofol or Thiopental with Remifentanil on Tracheal Intubation without Muscle Relaxants

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    k Naseri

    2007-10-01

    Full Text Available Introduction & Objective: In some medical situations administration of muscle relaxants after intravenous anesthetics for tracheal intubation may be unnecessary or sometimes could be hazardous. In such situations, replacing an alternative drug for the facilitation of tracheal intubation is obvious. Remifentanil is a short acting opioid drug which may be useful in solving this problem. The aim of this study was to compare the effects of propofol or thiopental in combination with remifentanil in the absence of muscle relaxants on larengoscopy and intubation conditions in general anesthesia. Materials & Methods: This is a randomized double-blind clinical trial which was performed in 1386 in Be’sat hospital of Sanandaj. Forty two ASA 1 and 2 patients recruited to receive propofol, 2 Mg/Kg, or thiopental, 5Mg/K. All patients received lidocaine, 1.5 Mg/Kg, and remifentanil, 2.5 µg/Kg, 30 seconds before anesthetics administration. larengoscopy and tracheal intubation were done 90 seconds after induction of anesthesia. On the basis of mask ventilation, jaw relaxation, vocal cords position and patient's response to intubations and endotracheal tube cuff inflation the intubation conditions were assessed and recorded as excellent, good ,acceptable or poor. The mean arterial pressure and heart rate were measured before and after anesthetics administration and also 45 seconds and two and five minutes after intubations. Data were analyzed by X2, fisher exact test ant student T-test using SPSS software. Results: Excellent or good larengoscopy and intubation conditions were observed in 9 (%42.9 of thiopental patients and 20 (%95.2 of propofol patients (p<0.05. Mean arterial pressure and heart rate decreased more significantly in propofol group in comparison with the thiopental group (p<0.05. Conclusion: Combination of remifentanil and propofol or thiopental could facilitate ventilation via face mask in all patients. Although combination of propofol and

  19. Submental Intubation Including Extubation: Airway Complications of Maxillomandibular Fixation

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    Santosh Kumar Yadav

    2012-01-01

    Full Text Available Hernandez first described the submental route for endotracheal intubation in 1986 as an alternative airway maneuver for maxillofacial procedures. Since that time, several case studies have been performed demonstrating the efficacy of the submental approach. This method was recently implemented in the case of a patient with altered nasal anatomy who sustained a mandibular fracture necessitating maxillomandibular fixation. Unlike most of the cases described in the literature, this patient’s operative course was confounded by the need to extubate through the submental tunnel. The patient tolerated the procedure well and was able to avoid other forms of surgical airway.

  20. Risperidone in the management of agitation and aggression associated with psychiatric disorders.

    NARCIS (Netherlands)

    Deyn, P.P. de; Buitelaar, J.K.

    2006-01-01

    OBJECTIVE: This review provides an overview of the prevalence and treatment of agitation and aggression, and focuses on the use of risperidone to treat these symptoms in patients from different age groups. METHODS: MEDLINE and EMBASE databases were used to identify controlled studies of risperidone

  1. EFFECTS OF ALFENTANIL AND ESMOLOL ON HEMODYNAMIC AND CATECHOLMINE RESPONSE TO TRACHEAL INTUBATION

    Institute of Scientific and Technical Information of China (English)

    1999-01-01

    Objective.To compare the effects of alfentanil and esmolol on hemodynamic and catecholamine response to tracheal intubation.Methods.hiry-five adult patients were randomly allocated to one of three groups,Grup A(control group),Group B(esmolol group)and Group C(alfentanil group).The patients received either 2 mg/kg esmolol(inGroup B)or 30 μg/kg alfentanil(in GroupC)before intubation.Tracheal intubation was performed with 4 mg/kg thiopental and 0.1 mg/kg vecuronium and 3% isoflurane.Systolic blood pressure(SBP),diastolic blood pressure(BP),mean blood pressure(MBP),heart rate(HR),norepinephrine(NE),epinephrine(E)and dopamine(DA)were measured before and after intubation.Results.The control group had a baeline SBP of 149±23 mmHg while Groups B,C had a baseline SBP of 148±23,and 150±21mmHg,respectively(P>0.05).Three min after tracheal intubation,the control group SBP increased to 160±30 mmHg and Group B remained at the baseline level,14±5 mmHg,and Group C significantly decreased to 91±22 mmHg(P<0.01).Two min after intubation HR in Group B increased significantly but 3 min after intubation HR in Groups B and C were significantly lower than that of contrl group(P<0.05).NE in Groups A and B increased significantly to 5.75±3.51 and 6.75±3.30 nmol/L 3 min after intubation(P<0.01).In Group C,3 min after intubation NE was not significantly differnt from the basline but E decreased significantly(P<0.01).Conclusion.2 ?g/kg esmolol can moerate the hemodynamic response to tracheal intubation to a certain extent and 30μg/kg alfentanil can completely attenuate the hemodynamic and catecholamine responses.

  2. LMA C Trach aided endotracheal intubation in simulated cases of cervical spine injury: A series of 30 cases

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    Deepshikha C Tripathi

    2013-01-01

    Full Text Available Background: Laryngeal mask airway (LMA C Trach is a novel device designed to intubate trachea without conventional laryngoscopy. The aim of the study was to evaluate the clinical efficacy of C trach in the simulated scenario of cervical spine injury where conventional laryngoscopy is not desirable. Methods: This prospective pilot study was carried out in 30 consenting adults of either gender, ASAPS I or II, scheduled for surgery requiring endotracheal intubation. An appropriate sized rigid cervical collar was positioned around the patient′s neck to restrict the neck movements and simulate the scenario of cervical spine injury. After induction of anesthesia, various technical aspects of C Trach facilitated endotracheal intubation, changes in hemodynamic variables, and complications were recorded. Results: Mask ventilation was easy in all the patients. Successful insertion of C Trach was achieved in 27 patients at first attempt, while 3 patients required second attempt. Majority of patients required one of the adjusting maneuvers to obtain acceptable view of glottis (POGO score >50%. Intubation success rate was 100% with 26 patients intubated at first attempt and the rest required second attempt. Mean intubation time was 69.8±27.40 sec. With experience, significant decrease in mean intubation time was observed in last 10 patients as compared to first 10 (46±15.77 sec vs. 101.3±22.91 sec. Minor mucosal injury was noted in four patients. Conclusion: LMA C Trach facilitates endotracheal intubation under direct vision and can be a useful technique in patients with cervical spine injury with cervical collar in situ.

  3. A STUDY OF PREDICTION OF DIFFICULT INTUBATION USING MALLAMPATI AND WILSON SCORE CORRELATING WITH CORMACK LEHANE GRADING

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    Vaishali Chandrashekhar

    2015-06-01

    Full Text Available BACKGROUND : This study was carried out to evaluate usefulness of preoperative Mallampati & Wilson’s score grading as a predictor for difficult laryngoscopy & intubation . AIMS : To determine the accuracy of the modified Mallampati test and Wilson score for predicting difficult tracheal intubation and correlation with Cormack Lehane grading . METHODS : This prospective randomized cross sectional Study carried out in 200 patients , posted for surgical procedure under GA with ETT intubation. Preoperative airway assessment using Mallampati grading (MPG & Wilson score done. Conventional anesthesia t echnique followed. Cormack Lehane grading done at laryngoscopy & correlated with previous scores for each patient. RESULTS : A MPG of I/II was found in 140 patients (70% , while 60 patients (30% were class III/IV. 138 patients (69% had a Wilson score of 0 /1 , while 60(30% had a score of 2/3 and 2 patients (1% scored ≥4. One hundred & eighty patients (90% were classified as Cormack - Lehane grade I/II , while 20 patients (10% were considered grade III/IV. Of the 60 patients with a Wilson score of 2/3 , 6 cas es (10% two attempts were required and in 2 cases (3.3% in spite of more than two attempts intubation proved impossible with the conventional laryngoscope , articulated McCoy blade was used. Two patients with a Wilson score ≥4 were intubated with gum elas tic bougie , using articulated McCoy blade. Overall , out of 200 , in 6 patients (3% two attempts of intubation was required and 4 patients (2% intubation required the use of some kind of gadget other than conventional laryngoscope and more than 2 attempts. The correlation between the Cormack - Lehane classification and the number of endotracheal intubation attempts showed that of the 180 patients with I / II grade , 4 patients (1.3% two attempts were required. Of the 20 patients classified as Cormack - Lehane III/IV , 4 cases (20% intubation proved impossible with conventional technique. This

  4. Laryngoscope and a new tracheal tube assist lightwand intubation in difficult airways due to unstable cervical spine.

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    Cai-neng Wu

    Full Text Available The WEI Jet Endotracheal Tube (WEI JET is a new tracheal tube that facilitates both oxygenation and ventilation during the process of intubation and assists tracheal intubation in patients with difficult airway. We evaluated the effectiveness and usefulness of the WEI JET in combination with lightwand under direct laryngoscopy in difficult tracheal intubation due to unstable cervical spine.Ninety patients with unstable cervical spine disorders (ASA I-III with general anaesthesia were included and randomly assigned to three groups, based on the device used for intubation: lightwand only, lightwand under direct laryngoscopy, lightwand with WEI JET under direct laryngoscopy.No statistically significant differences were detected among three groups with respect to demographic characteristics and C/L grade. There were statistically significant differences between three groups for overall intubation success rate (p = 0.015 and first attempt success rate (p = 0.000. The intubation time was significantly longer in the WEI group (110.8±18.3 s than in the LW group (63.3±27.5 s, p = 0.000 and DL group (66.7±29.4 s, p = 0.000, but the lowest SpO2 in WEI group was significantly higher than other two groups (p<0.01. The WEI JET significantly reduced successful tracheal intubation attempts compared to the LW group (p = 0.043. The severity of sore throat was similar in three groups (p = 0.185.The combined use of WEI JET under direct laryngoscopy helps to assist tracheal intubation and improves oxygenation during intubation in patients with difficult airway secondary to unstable spine disorders.Chinese Clinical Trial Registry ChiCTR-TRC-14005141.

  5. Endotracheal intubation - A life saving procedure, still potential hazardous to upper airway: A case report.

    Science.gov (United States)

    Afreen, Mahrukh; Ansari, Murtaza Ahsan

    2015-12-01

    Endotracheal intubation plays a key role in the management of upper airway obstruction in emergency situations. It is non-invasive and easily learned technique by medical professionals as compared to other more skilled, surgical procedures, e.g., tracheostomy and cricothyrotomies etc. But prolonged intubation may result in numerous complications, most notorious being tracheoesophageal fistula and narrowing of subglottic area. We report a profile of a patient who had been diagnosed as case of Guillian-Barre Syndrome, had difficulty in breathing due to paralysis of respiratory muscles. The patient was admitted in Medical Intensive Care Unit (MICU) for 40 days and was kept on artificial breathing through endotracheal intubation, which remained in place for 19 days. Later tracheostomy was performed. Patient ultimately developed severe subglottic stenosis and became dependent on tracheostomy tube.

  6. High body mass index is a weak predictor for difficult and failed tracheal intubation: a cohort study of 91,332 consecutive patients scheduled for direct laryngoscopy registered in the Danish Anesthesia Database

    DEFF Research Database (Denmark)

    Lundstrøm, Lars Hyldborg; Møller, Ann M; Rosenstock, Charlotte

    2009-01-01

    by direct laryngoscopy was retrieved from the Danish Anesthesia Database. A four-point scale to grade the tracheal intubation was used. Age, sex, American Society of Anesthesiologists physical status classification, priority of surgery, history of previous DTI, modified Mallampati-score, use...

  7. Kinetics of the QuantiFERON-TB Gold In-Tube test during treatment of patients with sputum smear-positive tuberculosis in relation to initial TST result and severity of disease

    DEFF Research Database (Denmark)

    Idh, Jonna; Abate, Ebba; Westman, Anna

    2010-01-01

    The QuantiFERON-TB Gold In-Tube test (QFN) measures interferon-gamma production in response to Mycobacterium tuberculosis antigens. Our aim was to assess the kinetics of the QFN and initial tuberculin skin test (TST) result in relation to severity of disease in a tuberculosis (TB) endemic area...

  8. [Difficult Ventilation Requiring Emergency Endotracheal Intubation during Awake Craniotomy Managed by Laryngeal Mask Airway].

    Science.gov (United States)

    Matsuda, Asako; Mizota, Toshiyuki; Tanaka, Tomoharu; Segawa, Hajime; Fukuda, Kazuhiko

    2016-04-01

    We report a case of difficult ventilation requiring emergency endotracheal intubation during awake craniotomy managed by laryngeal mask airway (LMA). A 45-year-old woman was scheduled to receive awake craniotomy for brain tumor in the frontal lobe. After anesthetic induction, airway was secured using ProSeal LMA and patient was mechanically ventilated in pressure-control mode. Patient's head was fixed with head-pins at anteflex position, and the operation started. About one hour after the start of the operation, tidal volume suddenly decreased. We immediately started manual ventilation, but the airway resistance was extremely high and we could not adequately ventilate the patient. We administered muscle relaxant for suspected laryngospasm, but ventilatory status did not improve; so we decided to conduct emergency endotracheal intubation. We tried to intubate using Airwayscope or LMA-Fastrach, but they were not effective in our case. Finally trachea was intubated using transnasal fiberoptic bronchoscopy. We discuss airway management during awake craniotomy, focusing on emergency endotracheal intubation during surgery.

  9. A COMPARATIVE STUDY OF INTUBATING CONDITIONS AND HAEMODYNAMIC EFFECTS FOLLOWING VECURONIUM, ROCURONIUM AND ITS COMBINATION

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    Kalpana

    2014-12-01

    Full Text Available BACKGROUND: Vecuronium has a slow onset of action (2-3 mins which limits its use in situations requiring rapid establishment of airway. Rocuronium can provide good intubating conditions within 90sec but it is not used routinely because of its high cost. Combination of rocuronium with vecuronium is known to produce synergism without producing any side effects. This study was under taken to evaluate the clinical benefits of the combination of rocuronium and vecuronium in terms of better haemodynamics and acceptable intubating conditions over individual drugs. METHODS: 90 ASA grade I & II patients in the age group 20-60 years of either sex scheduled for elective surgeries were randomly allocated into three groups - group V, group R, group RV with the sample size of 30 in each. After induction with fentanyl-propofol-nitrous oxide-oxygen, group V received vecuronium 0.08 mg/kg, group R received rocuronium 0.6 mg/kg and group RV received a combination of rocuronium 0.3 mg/kg with vecuronium 0.04 mg/kg. Intubation was attempted at 90sec after administration of muscle relaxant and scored according to four step scale proposed by Goldberg and colleagues. Heart rate and blood pressure were recorded before and after induction, after administration of muscle relaxant, and at 1, 2, 3, 5 and 10 minutes after intubation. RESULTS: Rocuronium and the combination group produced acceptable intubating conditions in 93.3% patients which was significantly better than that of vecuronium group (acceptable intubating conditions only in 13.3%. There were no significant changes in heart rate and mean arterial pressure (MAP in the three groups. CONCLUSION: The combination of rocuronium and vecuronium can provide clinically comparable conditions for tracheal intubation as rocuronium alone without compromising haemodynamic stability, thus, can be an economic alternative to rocuronium for rapid sequence induction.

  10. Topical airway anesthesia for awake fiberoptic intubation: Comparison between airway nerve blocks and nebulized lignocaine by ultrasonic nebulizer

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    Babita Gupta

    2014-01-01

    Full Text Available Overview: Awake fiberoptic bronchoscope (FOB guided intubation is the gold standard of airway management in patients with cervical spine injury. It is essential to sufficiently anesthetize the upper airway before the performance of awake FOB guided intubation in order to ensure patient comfort and cooperation. This randomized controlled study was performed to compare two methods of airway anesthesia, namely ultrasonic nebulization of local anesthetic and performance of airway blocks. Materials and Methods: A total of 50 adult patients with cervical spine injury were randomly allocated into two groups. Group L received airway anesthesia through ultrasonic nebulization of 10 ml of 4% lignocaine and Group NB received airway blocks (bilateral superior laryngeal and transtracheal recurrent laryngeal each with 2 ml of 2% lignocaine and viscous lignocaine gargles. FOB guided orotracheal intubation was then performed. Hemodynamic variables at baseline and during the procedure, patient recall, vocal cord visibility, ease of intubation, coughing/gagging episodes, and signs of lignocaine toxicity were noted. Results: The observations did not reveal any significant differences in demographics or hemodynamic parameters at any time during the study. However, the time taken for intubation was significantly lower in Group NB as compared with the Group L. Group L had an increased number of coughing/gagging episodes as compared with Group NB. Vocal cord visibility and ease of intubation were better in patients who received airway blocks and hence the amount of supplemental lignocaine used was less in this group. Overall patient comfort was better in Group NB with fewer incidences of unpleasant recalls as compared with Group L. Conclusion: Upper airway blocks provide better quality of anesthesia than lignocaine nebulization as assessed by patient recall of procedure, coughing/gagging episodes, ease of intubation, vocal cord visibility, and time taken to intubate.

  11. ATTENUATION OF HAEMODYNAMIC RESPONSE TO LARYNGOSCOPY AND ENDOTRACHEAL INTUBATION USING INTRA-ORAL IVABRADINE: A CLINICAL STUDY

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    Raghuram

    2014-08-01

    Full Text Available BACKGROUND AND OBJECTIVES: Rapid and dramatic hemodynamic changes which adversely affect the patient may occur during laryngoscopy and intubation. The present study evaluates the effect of oral ivabradine on the hemodynamics during laryngoscopy and endotracheal intubation in patients undergoing surgical procedures under general anesthesia. METHODS: A prospective randomized, single blinded study was conducted in 50 ASA- I adult patients undergoing various procedures under general anesthesia. The patients were randomly divided into two groups. Patients in group I (test group (n=25 received oral Ivabradine, 5mg one tab at 6.00pm on the evening before the day of surgery and one 5mg tab one hour before intubation. Patients in group II (control group (n=25 received placebo. Hemodynamic variables were recorded from pre-operative period to 10 minutes after intubation. RESULTS: There was not a very significant increase in the hemodynamic parameters in response to laryngoscopy and intubation in the Test group, when compared to the control group and the minimal raise also returned to baseline immediately within a minute. INTERPRETATIONS AND CONCLUSION: Ivabradine is an extremely useful drug to prevent abnormal increase in heart rate and minimizes the extent of hypertension seen during laryngoscopy and endotracheal intubation

  12. Diazepam or midazolam for orotracheal intubation in the ICU?

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    Lísia Gehrke

    2015-02-01

    Full Text Available Objective: to compare clinical and cost effectiveness of midazolam and diazepam for urgent intubation. Methods: patients admitted to the Central ICU of the Santa Casa Hospital Complex in Porto Alegre, over the age of 18 years, undergoing urgent intubation during 6 months were eligible. Patients were randomized in a single-blinded manner to either intravenous diazepam or midazolam. Diazepam was given as a 5 mg intravenous bolus followed by aliquots of 5 mg each minute. Midazolam was given as an intravenous bolus of 5 mg with further aliquots of 2.5 mg each minute. Ramsay sedation scale 5-6 was considered adequate sedation. We recorded time and required doses to reach adequate sedation and duration of sedation. Results: thirty four patients were randomized, but one patient in the diazepam group was excluded because data were lost. Both groups were similar in terms of illness severity and demographics. Time for adequate sedation was shorter (132 ± 87 sec vs. 224 ± 117 sec, p = 0.016 but duration of sedation was similar (86 ± 67 min vs. 88 ± 50 min, p = 0.936 for diazepam in comparison to midazolam. Total drug dose to reach adequate sedation after either drugs was similar (10.0 [10.0-12.5] mg vs. 15.0 [10.0-17.5] mg, p = 0.248. Arterial pressure and sedation intensity reduced similarly overtime with both drugs. Cost of sedation was lower for diazepam than for midazolam (1.4[1.4-1.8] vs. 13.9[9.4-16.2] reais, p <0.001. Conclusions: intubation using intravenous diazepam and midazolam is effective and well tolerated. Sedation with diazepam is associated to a quicker sedation time and to lower costs.

  13. 阻塞性睡眠呼吸暂停低通气综合征患者行悬雍垂颚咽成形术的经鼻气管插管方式%Effects of different nasotracheal intubations in obstructive sleep apnea hypopnea syndrome patients with uvulopalatopharyngoplasty

    Institute of Scientific and Technical Information of China (English)

    刘炜烽; 何荷番; 谢文锡; 翁培清; 李师阳

    2012-01-01

    Objective To explore the safe and effective way of nasotracheal intubations in obstructive sleep apnea hypopnea syndrome patients with uvulopalatopharyngoplasty.Methods Upon the approval of the Ethics Committee at Second Affiliated Hospital of Fujian Medical University,from August 2008 to November 2011,90 sleep apnea hypopnea syndrome patients were randomly divided into 3 groups (n =30 each):GlideScope (G),fiberoptic bronchoscope (F) and combination of Glidescope with fiberoptic bronchoscope (G + F).The parameters of tracheal intubation time,placement of endotracheal intubation,tracheal injury and complications were recorded.Also systolic blood pressure (SBP),diastolic blood pressure (DBP),mean arterial pressure (MAP) and heart rate (HR) were recorded at post-induction,the moment of tracheal intubation and post-intubation 1,3,5 min.Rate pressure product (RPP) was calculated at all timepoints as the product of heart rate and SBP during observation.Results All of them underwent successful endotracheal intubation.There were 24 successful cases of intubation during the first attempt in Group G with a success rate of 80% ; 27 patients successful during the first attempt in group F with a success rate of 90% ; all in group G + F successful during the first attempt with a success rate of 100%.The rates were significantly different in 3 groups ( P < 0.05 ).Groups G and F patients with failed intubation during the first attempt were of Mallampati Ⅲ/Ⅳ-After induction,SBP,DBP,MAP and RPP were lower in 3 groups ( P < 0.05 ) while HR change was not obvious.Compared with the after induction,the moment of tracheal intubation and after intubation 1 min,3 groups of patients with SBP,DBP,MAP,HR and RPP increased ( P < 0.05 ).Groups F and G + F after intubation in intubated patients and 1 min of SBP,DBP,MAP,HR,RPP were higher than G group ( P < 0.05 ).No difference existed between groups F and G + F.Three groups showed no serious tracheal injury,laryngeal edema

  14. 舒芬太尼联合曲马多对全麻苏醒期躁动与寒战的预防作用%Preventive Effects of Sufentanil Combined with Tramadol on Agitation and Shivering of Patients with General Anesthesia during Recovery Period

    Institute of Scientific and Technical Information of China (English)

    许先成; 冯慧; 柯昌斌

    2011-01-01

    Objective To observe the preventive effects of sufentanil combined with tramadol on agitation and shivering of patients with general anesthesia during recovery period. Methods One hundred and twenty patients underwent general anesthesia with the same way were randomly divided into sufentanil group (group S), sufentanil combined with tramadol group (group ST) ,tramadol group(group T) and control group(group C) ,n =30. The four groups were given intravenous injection with sufentanil (0. 15 μg · kg - 1 ), sufentanil ( 0. 1 μg · kg - 1 ) combined tramadol ( 1 mg· kg - 1 ), tramadol ( 2 mg·kg-1) ,equal volum of physiological saline at 30 min before operation termination,respectively. The incidence of agitation and shivering in patients were recorded during recovery from general anesthesia by a single blind method. Results Compared with group C,the incidence of agitation and shivering in the other three groups were decreased as well as the pain score. The agitation and shivering incidences in group ST were correspondingly lower than that of group S and that of group T,and the pain score in gorup ST were lower than both group S and group T. Conclusion Pretreated with low dose of sufentanil and tramadol could alleviate the post-operation pain and prevent the agitation and shivering effectively during recovery from general anesthesia, and make the anesthesia recovery more stable.%目的:观察舒芬太尼联合曲马多对全麻苏醒期躁动与寒战的预防作用.方法:全麻下择期开腹手术患者120例随机均分为:舒芬太尼组、联合组、曲马多组及对照组,各组均采用相同的麻醉方案,分别于手术结束前3min静注舒芬太尼0.15μg·kg-1、舒芬太尼0.1μg·kg-1+曲马多1mg·kg-1、曲马多2 mg·kg-1、等量0.9%氯化钠溶液.盲法记录患者苏醒期躁动与寒战情况.结果:与对照组比较,舒芬太尼组、联合组、曲马多组苏醒期躁动与寒战发生数均显著减少,疼痛评分明显降

  15. Effects of Sevoflurane and Desflurane Anesthesia on Recovery and Agitation in Children Undergoing Strabismus Surgery

    Directory of Open Access Journals (Sweden)

    Meziyet Sarac Ahrazoglu

    2012-08-01

    Full Text Available Purpose: We aimed to compared the effects of sevoflurane and desflurane anesthesia on recovery and early agitation in children undergoing strabismus surgery in our study. Method: Totally 42 patients undergoing elective strabismus surgery who between the ages of 2-10, ASA I-II were included this study. The patients were classified into two groups randomly. Induction of anesthesia was provided with 50% nitrous oxide, 50% oxygen and 6-8% sevoflurane in both groups. Maintenance of anesthesia was provided with sevoflurane 1-2% in Group I and desflurane 4-6% in Group II. The operation time, extubation, eye opening, obeying the verbal commands and orientation times and nausea-vomiting, laryngospasm and other adverse affects were recorded. Postoperative recovery (Modified Aldrete Emergence Score and agitation (Pediatric Anesthesia Delirium Scale and Watcha Behaviour Scale situation were recorded. Results: Patient’s demographic data and hemodynamic parameters were similar between the groups. Extubation, eye opening, obeying the verbal commands, orientation times were shorter in desflurane group than sevoflurane group(p< 0.05. Postoperative recovery and agitation scores were similar in two groups. Conclusion: In children, it was concluded that desflurane anesthesia may be preferred to sevoflurane because of shorter extubation, eye-opening, obeying the verbal commands and orientation times, but it did not reduce postoperative agitation. [Cukurova Med J 2012; 37(4.000: 186-192

  16. Management of Agitation Following Aneurysmal Subarachnoid Hemorrhage: Is There a Role for Beta-Blockers?

    Directory of Open Access Journals (Sweden)

    Fayaz Ibrahim

    2012-01-01

    Full Text Available Introduction. Stroke is a leading cause of mortality and morbidity in the United States. About 20% of the stroke is hemorrhagic and about 50% of these is due to aneurysmal subarachnoid hemorrhage. A troublesome neuropsychiatric complication of subarachnoid hemorrhage is agitation/aggression. Case Presentation. A 45-year-old man with no prior psychiatric history, sustained subarachnoid hemorrhage. After initial stabilization for 2 days, he underwent craniotomy and clipping of anterior cerebral communicating artery aneurysm. Treatment was continued with labetalol, nimodipine, and levetiracetam. Beginning postoperative day 4, patient developed episodes of confusion and agitation/aggression. Switching of Levetiracetam to valproate did not show any improvement. Psychiatry team tried to manage him with intense nursing intervention and different medications like olanzapine, valproate, lorazepam, and haloperidol. However, patient continued to be agitated and aggressive. Switching from labetalol to metoprolol resulted in dramatic improvement within 3 days. Discussion. Antipsychotics and benzodiazepines are often not sufficiently effective in the control of agitation/aggression in patients with traumatic brain injury and similar conditions. Our case report and the literature review including a cochrane review suggests that beta-blockers may be helpful in this situation.

  17. Facilitating Endotracheal Intubation in Difficult Cases Using an External Magnet

    Directory of Open Access Journals (Sweden)

    Mahin Seyedhejazi

    2015-04-01

    Full Text Available Difficult airway is conventionally defined as a medical scenario in which a trained examiner faces difficulty in either facemask ventilation or tracheal intubation (1. Unlike difficult intubation, the incidence of difficult mask ventilation in adults is considerable (2, 3. Anesthesiologists and those who practice intubation should be familiar with the management of airway and be able to recognize and identify potentially difficult airways including congenital craniofacial deformities with micrognathia (e.g. Pier Robin, Treacher Collins, Goldenhar's, and Crouzon's syndromes and metabolic diseases causing the deposition of accumulated by-products (e.g., Hurler's, Morquio's, and Beckwith-Wiedemann syndromes. Cormack and Lehane grades 3 and 4 at laryngoscopy are an indication for advanced techniques for intubation. Laryngeal mask airway (LMA and fiberscope with a directable tip are useful and important modalities in handling difficult airway and intubation (5. Even normal pediatric airway could become critical due to the anatomical and physiological differences between pediatric and adult airway; this particularly becomes a concern in infants, i.e. children younger than one year old. This hazard is augmented in the presence of congenital or acquired difficulties affecting airway. Consequently, proper preoperative assessment is considered as the cornerstone of pediatric difficult airway management. Every anesthetic plan should be tailored according to patients considering the scenario and also the expertise of the practitioner. Opting for spontaneous respiration maintenance and intervening in a step-wise manner are strongly suggested (6. Multiple airway devices have been and are developed that all of which can be placed under direct vision or blindly; most of these devices consistently both provide and maintain safe oxygenation and ventilation. Furthermore, a wide range of ancillary devices have also been introduced to be of assistance in the

  18. Retrograde Intubation in Temporomandibular Joint Ankylosis-A Double Guide Wire Technique

    Directory of Open Access Journals (Sweden)

    Vitha K Dhulkhed

    2008-01-01

    Full Text Available Intubating a patient with temporomandibular joint ankylosis is always a challenge particularly when fibreoptic laryngo-scope is not available. In a 20-year-old male patient we successfully carried out endotracheal intubation with 7 mm portex cuffed PVC tube with the help of two flexible J tipped guide wires. One guide wire was passed into the airway from cricothyroid puncture site and another from subcricoid site. Both were brought out through the nose. The first guide wire was used for retracting the epiglottis and the second as a guide for passing the endotracheal tube.

  19. Evaluating and monitoring sedation, arousal, and agitation in the ICU.

    Science.gov (United States)

    Sessler, Curtis N; Riker, Richard R; Ramsay, Michael A

    2013-04-01

    Optimal management of patient comfort and sedative drug therapy for intensive care unit (ICU) patients includes establishing a goal of therapy-often defined by a desired level of consciousness, with titration of medications to achieve this target. An assessment of the level of consciousness is best performed using a simple tool, such as a sedation scale that relies on observation of the patient to assign a level of conscious that ranges from alert to unarousable. Many sedation scales incorporate observation of the patient's response to stimulation, which typically escalates from simply calling the patient's name to physical stimulation. Many such tools also incorporate an assessment of the presence and intensity of agitated behavior. Implementation of sedation scales has been associated with improved outcomes, and the frequent assessment of level of consciousness using a sedation scale is strongly recommended in clinical practice guidelines. Further, selection of a sedation scale that has been demonstrated to be valid and reliable in your patient population is endorsed. Objective measures of consciousness, such as devices that use processed electroencephalography, are less well established for routine ICU management and are recommended only for selected situations.

  20. Midazolam Versus Ketamine in the Management of Emergence Agitation in Children Undergoing Lower Abdominal and Limb Surgeries

    Directory of Open Access Journals (Sweden)

    Danesh H

    2012-02-01

    Full Text Available Background: Emergence agitation (EA is a post-anesthetic problem which interferes with a child's recovery and presents a challenge in terms of assessment and management. In this study, we compared the effects of midazolam and ketamine as premedication in the management of EA in children aged 1-6 years.Methods: In this prospective, randomized clinical trial study, 58 children aged 1-6 years who were undergoing general anesthesia for elective surgery in Alzahra Hospital in Isfahan during 2008 until 2009. The patients were randomly assigned to receive 0.1 mg/kg midozolam (28 or 0.5 mg/kg ketamine (29 by IV route in the premedication room. All patients received a standardized anesthetic regimen and isoflurane was used for the maintenance of anesthesia. The incidence and severity of agitation (agitation score, severity of pain (pain score, anesthesia, recovery and extubation durations were recorded postoperatively.Results: The prevalence of agitation in midazolam (21.4% was lower than ketamine group (34.5%; P0.05.Conclusion: The study showed that midazolam could reduce the frequency of agitation better than ketamine but both drugs were able to reduce the severity of agitation after short-time surgeries in young children.

  1. Comparison between GlideScope and Macintosh laryngoscope for double-lumen endobronchial tube intubation in patients with difficult glottis exposure%声门显露困难者使用GlideScope可视喉镜行双腔支气管插管的可行性研究

    Institute of Scientific and Technical Information of China (English)

    承耀中; 孙莉; 武小勇; 丁超; 郑春京; 赵桂军

    2011-01-01

    Objective To compare the use of GlideScope and conventional Macintosh laryngoscope in difficult glottis exposure during surgery on malignant chest tumors. Methods Forty Mallampati M and ]V patients during surgery on malignant chest tumors were recruited to our randomized controlled trial. Group G (ra =20)had endobronchial intubation performed using GlideScope and Group M (n =20) underwent en-dobronchial intubation using a Macintosh laryngoscope. The best laryngeal view, difficulty of the tracheal intubation, time taken for successful endobronchial intubation, manoeuvre needed to aid tracheal intubation were recorded. Results The median Cormack and Lehane grade was significantly better in Group G than in Group M. Group G had a significantly shorter endobronchial intubation time than Group M[ ( mean 51. 3 ± SD 23. 4) s vs (mean 66. 2 ± SD 26. 6) s ,P <0. 05 ) ]. Conclusion The GlideScope improved the laryngeal view and decreased time for endobronchial intubation as compared with the Macintosh laryngoscope in patients with difficult glottis exposure. The GlideScope may be a good alternative for managing the difficult airway.%目的 观察与普通喉镜相比,GlideScope 可视喉镜用于Mallampati评分Ⅲ~Ⅳ级的胸部肿瘤患者行双腔支气管插管时的可行性和临床应用价值.方法 选择40例术前评估Mallampati评分Ⅲ~Ⅳ级的食管癌或者肺癌患者,随机分为G组和M组,每组20例,分别采用GlideScope 视频喉镜和普通直接喉镜进行双腔支气管插管,记录插管一次成功的人数、需要环状软骨压迫的人数以及声门暴露程度,并记录气管插管时间.结果 声门显露情况:Cormack &Lehanef分级:M组Ⅰ级2例,Ⅱ级1例,Ⅲ级12例,Ⅳ级5例,G组声门显露明显改善,其中Ⅰ级16例,Ⅱ级4例,Ⅲ级0例,Ⅳ级0例.两组患者的一次插管成功率分别为:G组90.0%,M组50.0%,G组显著高于M组(P<0.05);需要喉部按压的例数:G组2例次,M组18例次.两

  2. ATTENUATION OF CARDIOVASULAR RESPONSES TO LARYNGOSCOPY AND INTUBATION BY INTRAVENOUS METOPROLOL

    Directory of Open Access Journals (Sweden)

    Gurudatta

    2014-05-01

    Full Text Available The cardiovascular responses to laryngoscopy and intubation may become hazardous in patients with compromised cardiovascular system, such as hypertension, ischemic heart diseases or cerebrovascular diseases. Attenuation of this response is extremely important. Intravenous Metoprolol 4mg was given 5 minutes before induction of Anesthesia for the attenuation of cardiovascular responses. AIM: To observe the occurrence of tachycardia hypertensive (pressor responses that occurs at the time of laryngoscopy and intubation. In the present study an attempt was made to attenuate these responses by I.V. Metoprolol 4mg. METHODS: One hundred patients of ASA physical status 1 or 2 divided into 2 groups – study and control. The study group received intravenous metoprolol 4 mg before laryngoscopy and intubation and the control group did not receive the metoprolol injection. The changes in heart rate, mean arterial pressures and rate pressure product before, during and after laryngoscopy and intubation were evaluated and compared between the two groups. The statistical analysis done using Chi-square test and two samples‘t’ test. RESULTS: The cardiovascular responses laryngoscopy and intubation were significantly attenuated (P > 0.001 by intravenous Metoprolol.

  3. Comparison of the Airtraq and Truview laryngoscopes to the Macintosh laryngoscope for use by Advanced Paramedics in easy and simulated difficult intubation in manikins.

    LENUS (Irish Health Repository)

    Nasim, Sajid

    2009-01-01

    Paramedics are frequently required to perform tracheal intubation, a potentially life-saving manoeuvre in severely ill patients, in the prehospital setting. However, direct laryngoscopy is often more difficult in this environment, and failed tracheal intubation constitutes an important cause of morbidity. Novel indirect laryngoscopes, such as the Airtraq and Truview laryngoscopes may reduce this risk.

  4. The Comparison of Mallampati Test in Supine and Sitting Position in Traditional Approach and During Phonation for Predicting of Difficult Laryngoscopy and Intubation

    Directory of Open Access Journals (Sweden)

    A Meysamie

    2012-09-01

    Full Text Available Background: Inadequate ventilation, esophageal intubation and difficult intubation are the most common adverse respiratory outcomes in patient undergoing anesthesia .The aim of this study was to compare Mallampati test in supine and sitting positions in traditional approach and during phonation for predicting difficult laryngoscopy and intubation. Methods: In this study performed in Imam Khomeini Hospital in Tehran, Iran, Mallampati test was performed on 661 patients who met the inclusion criteria for the study. The test was done in supine and sitting positions with and without phonation by a rater who was blind to Mallampati test. Subsequently, laryngoscopy view and difficult intubation were evaluated in the four aforesaid positions by Mallampati test for predicting difficult laryngoscopy and intubation. For each situations, sensitivity, specificity, positive and negative predictive values and accuracy were calculated.Results: Overall, 28 (4.2% patients had difficult laryngoscopy and 9 (1.4% patients had difficult intubation. The highest sensitivity for Mallampati test in predicting difficult laryngoscopy and intubation was in supine and sitting positions without phonation, and the highest specificity was seen in sitting position with phonation. Negative predictive values were more than 95% in all different positions for Mallampati tests and the highest positive predictive value was seen in supine position with phonation.Conclusion: According to our findings, the highest correlation between Mallampati test and different positions in predicting difficult laryngoscopy and intubation was seen in supine position with phonation. Phonation improved Mallampati score in supine rather than sitting position.

  5. Clinical Effects of Two Oral Care Methods on Orotracheal Intubation Patients:A Meta Analysis%经口气管插管患者2种口腔护理的效果Meta分析

    Institute of Scientific and Technical Information of China (English)

    王叶; 柳书悦; 郭艳; 覃惠英

    2014-01-01

    目的:比较牙刷+冲洗法与棉球擦拭法用于经口气管插管患者口腔护理的效果。方法根据研究目的确定检索关键词,采用计算机检索国内外大型数据库,同时追踪文献综述和参考文献以防漏检。根据文献纳入、排除标准对检出文献进行筛选,确定最终纳入文献。对纳入文献按Cochrance协作网提供的Meta分析对其进行定量综合分析,比较2种不同口腔护理方法的护理效果。结果共21篇文献2494例患者符合纳入标准,牙刷+冲洗法组呼吸机相关性肺炎发生率较棉球擦拭法组低,合并RR值为0.49,95%CI为(0.39,0.62);牙刷+冲洗法组口腔异味发生率较棉球擦拭法组低,合并RR值为0.29,95%CI为(0.21,0.41);牙刷+冲洗法组口腔溃疡发生率较棉球擦拭法组低,合并RR值为0.40,95%CI为(0.29,0.57);牙菌斑指数存在异质性(P<0.001),亚组分析均显示牙刷+冲洗法组牙菌斑指数较棉球擦拭法组少;机械通气时间在使用牙刷+冲洗法与使用棉球擦拭法进行口腔护理的患者间的差异无统计学意义(P=0.15),合并WMD的值为-1.02,95%CI为(-2.41,0.37)。结论牙刷+冲洗法较棉球擦拭法对经口气管插管患者口腔护理的效果好,但对机械通气时间的影响不能确定。%Objective To compare the different effects of toothbrush-irrigation and wiping with cotton ball for oral care of orotracheal intubation patients. Methods Computer retrieval was conducted in large databases at home and abroad, meanwhile literature review and references were tracked for undetected literatures. According to the inclusion and exclusion criteria, the included studies were determined then Meta analysis was carried out for comprehensive and quantitative analysis for different effects of oral care methods. Results Totally 21 studies (2 494 patients) were included for Meta-analysis. The incidence of VAP [Combined RR=0

  6. Warming Endotracheal Tube in Blind Nasotracheal Intubation throughout Maxillofacial Surgeries

    Directory of Open Access Journals (Sweden)

    Hamzeh Hosseinzadeh

    2013-12-01

    Conclusion: In conclusion, our study showed that using an endotracheal tube softened by warm water could reduce the incidence and severity of epistaxis during blind nasotracheal intubation; however it could not facilitate blind nasotracheal intubation.

  7. A novel and simple method for endotracheal intubation of mice

    NARCIS (Netherlands)

    Spoelstra, E. N.; Ince, C.; Koeman, A.; Emons, V. M.; Brouwer, L. A.; van Luyn, M. J. A.; Westerink, B. H. C.; Remie, R.

    2007-01-01

    Endotracheal intubation in mice is necessary for experiments involving intratracheal instillation of various substances, repeated pulmonary function assessments and mechanical ventilation. Previously described methods for endotracheal intubation in mice require the use of injection anaesthesia to im

  8. COMPARATIVE STUDY OF EFFECT OF INTRAVENOUS MAGNESIUM SULPHATE AND INTRAVENOUS FENTANYL IN ATTENUATING THE HAEMODYNAMIC RESPONSES TO LARYNGOSCOPY AND INTUBATION

    Directory of Open Access Journals (Sweden)

    Patta

    2016-07-01

    Full Text Available AIM To compare the haemodynamic response to laryngoscopy and intubation with intravenous MgSO4 and intravenous fentanyl. METHODS Fifty adult patients were divided into two groups randomly into group M and group F. Patients of group M received 30 mg/kg body weight of IV MgSO4 and group F received IV fentanyl 1.5 µg/kg 5 minutes before intubation. RESULTS IV Fentanyl showed greater degree of haemodynamic stability i.e. rise in heart rate, mean arterial pressure during laryngoscopy and intubation compared to IV MgSO4. IV fentanyl showed side effects like respiratory depression, nausea and vomiting. CONCLUSION IV fentanyl is a better drug in controlling haemodynamic response to laryngoscopy and intubation.

  9. Study of dexmedetomidine on prevention of the cardiovaseular response during intubation and extubation in old aged patients in general anesthesia%右美托咪定预防老年患者全麻中气管插管及拔管时心血管反应的临床观察

    Institute of Scientific and Technical Information of China (English)

    马志军; 王清涛; 臧颖卓

    2015-01-01

    目的:讨右美托咪定(dxemdeetomidine,Dex)预防老年患者全麻期间气管插管和拔管时心血管反应的临床疗效及安全性。方法择美国麻醉医师协会分级(ASA)Ⅰ-Ⅱ级的老年患者80例,随机分为观察组(右美托咪定组)和对照组,每组40例。两组患者均采用相同的全身麻醉诱导和维持,麻醉诱导前10 min,观察组静脉注射右美托咪定1μg /kg,对照组注射相同容量的0.9%氯化钠注射液,注射时间10min。观察并记录两组麻醉诱导前、插管后即刻、插管后2min、拔管后即刻及拔管后2min时的收缩压(SBP)、舒张压(DBP)、心率(HR)的变化。结果察组拔管期间心血管反应稳定,观察组收缩压、舒张压、心率在插管后即刻,插管后2min、拔管后即刻及拔管后2min均明显低于对照组(P<0.05)。与同组诱导前比较,对照组在相同时间点的SBP,DBP,H R均升高(P<0.05),且观察组发生不良反应情况明显低于对照组。结论美托咪定能有效减轻气管插管及拔管时老年全麻患者心血管应激反应。%ObjeetiveTo investigate the clinical eeffcts and saefty of dexmedetomidine(Dex) on pervention of the cadriovascular response during intubation and extubation in old aged patients in general naesthesia.Method 80 elective old aged patients,ASA gardeⅠ-Ⅱ,were randomly allocated to two groups, observation group(Dex group) and control group, with 40 cases each. The patients in the two groups were treated by the same anesthesia induction and maintenance.10 minutes before induction of anesthesia,the patients in observation group were given intravenous injection of dex medetomidine 1μg / kg,while the control group were given intravenous injection of same amount of normal saline.The injection was finished in 10 min. Before anesthesia induction ,at the time of intubation and extubation,and 2 min after intubation and extubation,systolic blood pressure ( SBP ),diastolic

  10. Extreme Sensitivity of Botulinum Neurotoxin Domains Toward Mild Agitation

    Science.gov (United States)

    2009-09-01

    stirring, as was carboxypeptidase B, another zinc-containing enzyme. However, the metalloproteins anthrax lethal factor and alcohol dehydrogenase were...subjected to identical agitation conditions. Being metalloproteins , these BoNT LCs were again extremely sensitive to mechanical agitation when compared with

  11. COMPARISON OF UPPER LIP BITE TEST WITH MODIFIED MALLAMPATI TEST AND THYROMENTAL DISTANCE FOR PREDICTING DIFFICULTY IN ENDOTRACHEAL INTUBATION: A PROSPECTIVE STUDY

    Directory of Open Access Journals (Sweden)

    Prakash T. S. N

    2016-09-01

    Full Text Available BACKGROUND The significance of difficult or failed tracheal intubation was well recognised as a major cause of morbidity and mortality in anaesthetic practice as per ASA closed claim study. The need to predict potentially difficult tracheal intubation has received more importance, but with limited success. Unanticipated difficult intubation is a risk to patient’s life and a challenge to the skill of the anaesthesiologist. Many anatomical and pathological variables have been identified and have been suggested to be useful in anticipating a difficult airway. These factors have limitations because of wide variations in the incidence of difficult intubation, interobserver variability and inadequate statistical power of the currently measured variables. METHODS After obtaining institutional ethical committee clearance and written informed consent, the present study was conducted in 200 patients aged between 16 yrs. and 65 yrs. at King George Hospital, Andhra Medical College, Visakhapatnam, in the Department of Anaesthesiology. All the 200 patients undergoing elective surgical procedures under general anaesthesia were enrolled in the study. A thorough preanaesthetic evaluation was carried out in all the patients and the procedure was explained in detail to the patients. RESULTS Of the entire two hundred patients, a total of ten patients had difficult intubation, all of them had Cormack-Lehane class III on laryngoscopy. None of them had Cormack-Lehane class IV on laryngoscopy. The incidence of difficult intubation was 5% in the present study. There were no cases of failed intubation. One hundred and eighty seven patients predicted to be easy for intubation by ULBT (i.e. patients who had ULBT class I and II out of whom, however, we encountered difficult intubation in 5 patients. Out of the eight patients predicted to have difficult airway by ULBT III, only one patient had CL III difficult airway and subsequently difficult intubation. CONCLUSIONS MMT

  12. Application of electric toothbrush in the prevention of oral infection in ICU patients with tracheal intubation%ICU气管插管患者应用电动牙刷预防口腔感染的研究

    Institute of Scientific and Technical Information of China (English)

    张文静; 曲媛; 薛军; 冯丽伟; 张璐

    2016-01-01

    目的:探讨电动牙刷对重症监护病房(ICU)气管插管患者预防口腔感染的效果,以减少口腔感染率。方法选择2012年6月-2014年12月于医院ICU经口气管插管患者398例,按照患者个人意愿分为观察组和对照组,每组199例,对照组采用常规口腔干预,观察组采用电动牙刷刷洗进行干预,两组患者均连续干预7d,检测患者口腔细菌阳性率,观察患者口腔异味和口腔残留物次数,黏膜损伤发生率和口腔感染率及牙菌斑平均指数。结果观察组患者7d干预中口腔细菌阳性率为2.01%、口腔异味139次占4.99%、无口腔残留物,对照组患者干预中口腔细菌阳性率为35.00%、口腔异味1356次占48.67%、口腔残留物418次占15.00%,观察组患者各项数据均低于对照组,差异有统计学意义(P<0.01);观察组口腔黏膜损伤率为1.01%,低于对照组13.06%,差异有统计学意义(P<0.05);观察组无口腔感染,对照组口腔感染率为3.52%,差异有统计学意义(P<0.05);干预前两组患者牙菌斑平均指数比较,差异无统计学意义,干预后观察组牙菌斑平均指数与对照组比较差异有统计学意义(P<0.01),且低于对照组。结论电动牙刷刷牙可明显降低患者口腔细菌阳性率、减少口腔异味和口腔残留物,能有效去除牙菌斑,减少口腔黏膜损伤率和口腔感染率%OBJECTIVE To investigate the effect of electric toothbrush on the prevention and control of oral infec‐tion in ICU patients with tracheal intubation ,so as to reduce the incidence of oral infections .METHODS A total of 398 cases of patients with tracheal intubation from Jun .2012 to Dec .2014 in ICU of our hospital were selected , and divided into observation group and control group ,according to the random number table method ,with 199 ca‐ses in each group .Patients in control group

  13. Effects of Tween 80 on cellulase stability under agitated conditions.

    Science.gov (United States)

    Okino, Shohei; Ikeo, Makoto; Ueno, Yoshiki; Taneda, Daisuke

    2013-08-01

    The mechanism of the increase in the hydrolysis rate and yield by the addition of Tween 80 to the hydrolysis reaction of filter paper was investigated under static and agitated conditions. The increase in the hydrolysis rate by addition of Tween 80 was observed under the agitated condition only. The effects of Tween 80 on the changes in the protein concentration of individual cellulase components were investigated in the absence of substrates. Agitation of the enzyme solution resulted in the drastic decrease of SDS-PAGE bands intensity of CBH2 (cellobiohydrolase 2). The addition of Tween 80 prevented this. Thus, the Tween 80 functions to stabilize instable cellulase components under the agitated condition. Moreover, addition of Tween 80 completely suppressed the decrease of CBH2 intensity by agitation at 30°C. Results suggest that Tween 80 stabilizes instable cellulase components not only during hydrolysis, but during enzyme production also.

  14. Research on hemodynamic response to endotracheal intubation in hypertensive patients of different dopamine D1 receptor genotypes%不同多巴胺D1受体基因型高血压患者气管插管反应的研究

    Institute of Scientific and Technical Information of China (English)

    王军; 王志萍; 黄东晓; 孙含哲; 穆会君

    2011-01-01

    研究不同多巴胺D1受体(DRD1)基因型48A/G原发性高血压患者全麻气管插管心血管反应.方法原发性高血压患者120例,ASAⅡ或Ⅲ级,按照基因型进行分组,A、C组为AG/GG型,B组为AA型,每组40例.C组气管插管前10 s静注乌拉地尔25 mg.于诱导前、诱导后、插管后0、1.5、5 min测定SBP、DBP、HR和ECG.结果 与诱导前比较,A、B组插管后0、1.5、5min SBP、DBP升高,HR显著增快(P<0.05或P<0.01),C组SBP、DBP升高不明显.插管后0、1.5、5 min A组DBP明显高于、HR快于B、C组(P<0.05或P<0.01).A组气管插管时心律失常发生率明显多于B、C组(P<0.05).结论AG/GG型原发性高血压患者气管插管时血流动力学变化明显,麻醉诱导前静注乌拉地尔可以起到预防作用.%Objective To investigate hemodynamic response to endotracheal intubation under general anesthesia in patients of different dopamine D1 receptor -48A/G genotypes with essential hypertension (EH). Methods One hundred and twenty patients with EH (ASA Ⅱ or Ⅲ) undergoing abdominal surgery were divided into three groups according to dopamine Dl receptor genotypes. The patients in group A and C were AG + GG genotype, and those in group B were AA genotype. 25mg Urapidil was intravenously injected 10s before intubation in group C. SBP, DBP, HR and ECG were recorded before and after induction, 0 min, 1. 5 min and 5 min after intubation. Results Compared with baseline level before induction, SBP, DBP and HR at 0 min, 1. 5 min, 5 min after intubation increased significantly in group A and B (P<0. 05 or P<0. 01), whereas SBP.DBP did not increase significantly in group C. DBP and HR in group A increased more significantly at 0 min, 1. 5 min, 5 min after intubation compared with group B and C (P<0. 05 or P<0. 01). The incidence of cardiac arrhythmias in group A was higher than that in group B and C (P<0. 05). Conclusion EH patients of AG/GG genotype show significant hemodynamic fluctuation during

  15. Effects of oral clonidine premedication on haemodynamic response to laryngoscopy and tracheal intubation: a clinical trial.

    Science.gov (United States)

    Talebi, H; Nourozi, A; Fateh, S; Mohammadzadeh, A; Eghtesadi-Araghi, P; Jabbari, S; Kalantarian, M

    2010-12-01

    The objective of this study was to evaluate the efficacy of pre-anesthetic orally administration of clonidine on pulse rate and blood stress response to laryngoscopy and tracheal intubation. In a double-blinded, randomized study, 274 ASA I and II subjects with age of 18 to 45 years scheduled for elective surgery under general anesthesia were enrolled. They were randomly allocated to receive oral clonidine (0.2 mg) or placebo as premedication 90-120 min before surgery. All the patients received Succinylcholine (1.5 mg kg(-1)) after induction of anesthesia with Fentanyl (50 microg) and Thiopentone (5 mg kg(-1)). The anesthesia was maintained with halothane (1.5 Mac) in 50% mixture of N2O/O2. Heart rate and systolic blood pressure were recorded before, immediately after and then every 5 min after intubation until 20 min. The Clonidine group showed a significant superiority over placebo in the prevention of increase in systolic blood pressure as well as heart rate over the intubation. A significant difference was observed in both heart rate and systolic blood pressures were significantly higher in Control group at three subsequent measurements following intubation. The results of this study suggest that orally administered clonidine in preanesthetic period, provides more haemodynamic stability and attenuates the stress response to laryngoscopy and intubation.

  16. The temporary effect of short-term endotracheal intubation on vocal function.

    Science.gov (United States)

    Paulauskiene, Iveta; Lesinskas, Eugenijus; Petrulionis, Mindaugas

    2013-01-01

    The objective of the study was to assess and perceive the vocal and pharyngeal symptoms and acoustic changes of voice after short-term endotracheal intubation and to evaluate the relation between these changes and the endotracheal tube parameters, number of intubation attempts, duration of anaesthesia, experience of anaesthesiologist. A total of 108 patients were evaluated preoperatively, 1-2 and 24 h after extubation. The vocal and pharyngeal symptoms, voice acoustic characteristics and maximum phonation time (MPT) were evaluated to find the relationship with endotracheal tube parameters, number of intubation attempts, duration of anaesthesia, experience of anaesthesiologist. All vocal and pharyngeal symptoms increased significantly at 24 h and remained significantly increased at 24 h after general anaesthesia. The vocal acoustic parameters changed significantly at 1-2 h: decrease of MPT and increase relative average perturbation were recorded. The day after the short-term intubation: only noise to harmony ratio and habitual pitch remains significantly changed. The most important endotracheal tube parameters that affect significantly (P value intubation attempts. In relation to the anaesthesia, the changes of the acoustic parameters did not associate significantly with the anaesthesia-related parameters. No statistically significant relationship between experience of an anaesthesiologist and changes of the voice after anaesthesia was detected. Though being short-term, endotracheal anaesthesia is an invasive procedure, and its temporary influence on vocal function is important.

  17. Effect of varied training techniques on field endotracheal intubation success rates.

    Science.gov (United States)

    Stewart, R D; Paris, P M; Pelton, G H; Garretson, D

    1984-11-01

    A pool of 146 mobile intensive care unit paramedics was divided into four equal groups and trained in the technique of direct laryngoscopic endotracheal intubation of cardiac arrest or deeply comatose patients. Group 1 was selected from supervisors and crew chiefs and trained as preceptors. The remaining paramedics were assigned to three other study groups. Groups 1 and 2 were trained with a didactic presentation followed by manikin practice, an animal laboratory exercise, and operating room experience. Group 3 had no OR experience; Group 4 had only didactic/manikin training. Intubations were observed by preceptors on scene. During the study period of 27 months, 689 of 763 patients (90.3%) were successfully intubated by 122 paramedics. While results suggest variation in skill levels according to training group (Group 1, 92.4%; Group 2, 87.6%, Group 3, 83.3%; Group 4, 76.9%), statistical analysis allowing for the variables of seniority and number of intubations performed by personnel failed to reveal differences in groups attributable to training programs. Complication rates were relatively low for all groups, the most common being prolonged intubation attempts. A significant improvement in the skill was seen as the study progressed when groups are pooled and compared. The findings suggest that endotracheal intubation of deeply comatose or cardiac arrest patients is a field procedure that can be performed safely and skillfully by well-monitored paramedical personnel. Operating room or animal laboratory experience may increase initial success levels, but these factors do not appear to greatly influence eventual performance or incidence of complications of the procedure.

  18. Difficult laryngoscopy and intubation in the Indian population: An assessment of anatomical and clinical risk factors

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    Smita Prakash

    2013-01-01

    Full Text Available Background and Aim: Differences in patient characteristics due to race or ethnicity may influence the incidence of difficult airway. Our purpose was to determine the incidence of difficult laryngoscopy and intubation, as well as the anatomical features and clinical risk factors that influence them, in the Indian population. Methods: In 330 adult patients receiving general anaesthesia with tracheal intubation, airway characteristics and clinical factors were determined and their association with difficult laryngoscopy (Cormack and Lehane grade 3 and 4 was analysed. Intubation Difficulty Scale score was used to identify degree of difficult laryngoscopy. Results: The incidence of difficult laryngoscopy and intubation was 9.7% and 4.5%, respectively. Univariate analysis showed that increasing age and weight, male gender, modified Mallampati class (MMC 3 and 4 in sitting and supine positions, inter-incisor distance (IID ≤3.5 cm, thyromental (TMD and sternomental distance, ratio of height and TMD, short neck, limited mandibular protrusion, decreased range of neck movement, history of snoring, receding mandible and cervical spondylosis were associated with difficult laryngoscopy. Multivariate analysis identified four variables that were independently associated with difficult laryngoscopy: MMC class 3 and 4, range of neck movement <80°, IID ≤ 3.5 cm and snoring. Conclusions: We found an incidence of 9.7% and 4.5% for difficult laryngoscopy and difficult intubation, respectively, in Indian patients with apparently normal airways. MMC class 3 and 4, range of neck movement <80°, IID ≤ 3.5 cm and snoring were independently related to difficult laryngoscopy. There was a high incidence (48.5% of minor difficulty in intubation.

  19. A comparison between the light wand and intubating LMA during blind orotracheal intubation%光棒和插管型喉罩在盲探气管插管中的比较

    Institute of Scientific and Technical Information of China (English)

    管剑峰; 朱俊峰; 盛忠贤

    2011-01-01

    Objective To compare the effect of the Light Wand and Intubating LMA during blind orotracheal intubation. Methods One hundred ASA Ⅰ or Ⅱ patients requiring tracheal intubation were randomly allocated to either the Light Wand group(group A) or the Intubating LMA group(group B). Changes of hemodynamic parameters(SBP, DBP, HR and SpO2 ) were observed before and after anesthesia induction, at the time of intubation, 1 min, 3 min and 5 min after intubation. The success ratio for the first attempt and total intubation, the duration of intubation and the complications were also observed. Results The successful ratas of the first attempt and total intubation were 76% and 96% in group A and 80% and 98% in group B. The duration of intubation in group A and group B was (38. 9±16.1)s and (76. 1±18.0)s respectively (P<0. 05). Conclusion Both Light Wand and Intubating LMA are safe methods in blind orotracheal intubation with high success ratio and few complications.%目的 比较光棒和插管型喉罩在盲探气管插管中的应用效果.方法 拟行气管内插管患者100例,ASA Ⅰ或Ⅱ级,随机均分为光棒组(A组)和插管型喉罩组(B组).记录诱导前、诱导后、插管即刻、插管后1、3、5 min的SBP、DBP、HR、SpO2变化及首次插管成功率和总成功率、插管时间、并发症等.结果 A、B组首次插管成功率分别为76%和80%,插管总成功率分别为96%和98,插管时间分别为(38.9±16.1)s和(76.1±18.0)s(P<0.05).结论 光棒和插管型喉罩在盲探气管插管中成功率高、并发症少,可安全用于盲探气管插管.

  20. Small-dose ketamine improves tracheal intubating conditions during sevoflurane induction in patients undergoing surgery%小剂量氯胺酮复合七氟烷用于无肌松气管插管患者的临床观察

    Institute of Scientific and Technical Information of China (English)

    夏燕飞; 陈瑞海; 卢星; 郑晓铸; 黄浩

    2012-01-01

    目的 探讨小剂量氯胺酮复合七氟烷吸入诱导对手术患者气管插管条件及血流动力学的影响.方法 选择择期行腹部手术的患者56例,随机分为观察组(24例)和对照组(32例).麻醉诱导前,观察组静脉注射氯胺酮负荷量0.3 mg/kg并以14 μg·kg-1·min-1维持,对照组静脉输注等量0.9%氯化钠注射液.两组麻醉诱导均采用8%七氟烷潮气量诱导法,气管插管成功后使呼气末七氟烷浓度达到并维持在1.8%.气管插管条件评估采用哥本哈根评分(Copenhagen Score),所有评分条件达到优秀或良好被界定为插管满意.监测、记录并比较入手术室后(T1)、气管插管前(T2)、气管插管后1min(T3)、5min(T4)、10min(T5)等时点收缩压、舒张压、心率.结果 观察组的插管满意率较对照组高,差异有统计学意义(P<0.05).两组收缩压、舒张压在T2时点较T1下降,差异有统计学意义(P<0.01).两组间收缩压、舒张压在T2、T3时点比较差异有统计学意义(P<0.05).观察组T3、T4、T5时点的心率均较对照组慢,差异有统计学意义(P<0.01).结论 小剂量氯胺酮可改善手术患者七氟烷诱导气管插管的条件,并且使血流动力更稳定.%Objective To investigate intubating conditions and hemodynamic effects of low-dose ketamine combined with sevoflurane induction in patients undergoing surgery. Methods Fifty six patients undergoing abdominal surgery from September 2010 to March 2011 were randomly divided into ketamine group(group K,n= 24) and control group (group C,n= 32). Prior to the induction of anesthesia, patients in group K were intravenously administered with initial loading dose of ketamine 0.3 mg / kg,following by a maintaining dose at 14 ug'kg-1'mirr1; while patients in group C were intravenously injected with normal saline. Anesthesia was induced with 8% sevoflurane tidal volume inhalation technique. After successful endotracheal intubation, the end-tidal concentration of

  1. Teaching intubation skills using newly deceased infants.

    Science.gov (United States)

    Benfield, D G; Flaksman, R J; Lin, T H; Kantak, A D; Kokomoor, F W; Vollman, J H

    1991-05-08

    This prospective study was designed to (1) test the hypothesis that the majority of families of newly dead infants in a tertiary neonatal intensive care unit would consent to their infants' being intubated for teaching purposes, (2) determine factors related to family consent, and (3) determine the effects of participation on resident physicians and respiratory therapists. Family consent for intubation was requested following 44 (80%) of the 55 deaths that occurred during the 10-month study period. Of these requests, 32 (73%) were granted. Proportionately more white than black families consented and consent was positively related to autopsy permission. Fifty-three (75%) of 71 trainees completed a mailed questionnaire after their first intubation experience. Although each respondent found the experience helpful, many reported mixed feelings categorized as doubt about participating, apprehension and discomfort, respect for the body, appreciation for the opportunity, a sense of achievement, and feelings of comfort knowing that consent had been obtained. These findings confirm our initial hypothesis and suggest that (1) newly dead infants can be a valuable resource for teaching intubation skills, and (2) others considering a similar approach need to be aware of and sensitive to trainees' feelings.

  2. EFFECTS OF PREANESTHETIC SINGLE DOSE INTRAVENOUS DEXMEDETOMIDINE VERSUS FENTANYL ON HEMODYNAMIC RESPONSE TO ENDOTRACHEAL INTUBATION-A CLINICAL COMPARATIVE STUDY

    Directory of Open Access Journals (Sweden)

    Chandita

    2015-12-01

    Full Text Available INTRODUCTION Many pharmacological agents have been evaluated in regards to their efficacy of blunting the adverse cardiovascular response to laryngoscopy and tracheal intubation. The aim of this study was to evaluate the efficacy of dexmedetomidine compared to fentanyl in blunting the haemodynamic response to laryngoscopy and intubation. METHOD Sixty patients were randomly allocated into two groups (30 patients in each group. The group D received intravenously 1 µgm/kg dexmedetomidine infusion and group F received 2µgm/kg fentanyl infusion. The study drugs were prepared in an identical looking container and were infused fifteen minutes prior to induction of anaesthesia. The study drugs were infused over a period of ten minutes and all the patients underwent a similar anaesthetics technique. Heart rate (HR and blood pressure (systolic, diastolic and mean blood pressure were noted at baseline, at the end of infusion of the study drugs, after induction of anaesthesia, immediately after laryngoscopy and intubation and at 1, 3, 5, 7 and 10 minutes after laryngoscopy and intubation. RESULTS HR significantly decreased in the group D when compared to group F immediately after study drug infusion and there was statistically significant reduction in heart rate for up to 5 min after intubation in both the groups. Although HR increased after intubation in both the groups, the magnitude was lower in the group D. In both the groups, laryngoscopy and intubation led to an increase in systolic, diastolic and mean arterial pressure; the magnitude was lower in the group D. CONCLUSION Dexmeditomidine (1µ/kg attenuates these untoward responses of laryngoscopy and intubation more effectively than fentanyl (2 µ/kg when administered as bolus dose in the pre-induction period of general anaesthesia.

  3. [A case of subglottic stenosis with bridging granuloma after intubation with double-lumen endotracheal tube].

    Science.gov (United States)

    Ito, Yosuke; Nakata, Yoko; Nakamura, Sakiko; Nagaya, Kei

    2013-08-01

    We present a case of subglottic stenosis with rare bridging granuloma after intubation with double-lumen endotracheal tube. An 81-year-old woman was diagnosed with the lung tumor and scheduled for the thoracoscopic surgery. We induced anesthesia with propofol, remifentanil and rocuronium. A 35 Fr double-lumen intratracheal tube was inserted to the trachea with some resistance, when the tube passed through the glottis. A few days later, she suffered from respiratory discomfort. An otolaryngologist examined her larynx and subglottis. Laryngoscopic examination revealed bridging granuloma leading to tracheal stenosis. Tracheostomy and resection of granuloma were performed, and her symptom improved. If we feel resistance in intubating a double-lumen endotracheal tube in a patient with a history of intubation with a tracheal tube, we should operate gently adjusting the size of the tracheal tube.

  4. COMPARATIVE STUDY OF SUBMENTAL INTUBATION CUFF IN VS CUFF OUT: A CASE SERIES

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    Aprajita

    2016-06-01

    Full Text Available In patients with panfacial trauma where short-term intraoperative control of airway is required, submental intubation is an alternative to tracheostomy as it is associated with lesser morbidity. It is also an interesting alternative to oral and nasal intubation as intraoperatively the tube does not cause any hindrance to the surgeon and occlusion can also be assessed simultaneously. Out of 10 cases of maxillofacial trauma operated in our hospital using submental intubation, the cuff of the pilot tube was brought out in 5 of them through the midline incision, while in remaining 5 it was left inside the nasopharynx. It was observed subsequently that cuff inside the nasopharynx had some advantage, viz. there were lesser chances of accidental extubation, rupture of cuff and the incision size need not be extended to extract the cuff which resulted into a cosmetically better scar.

  5. Rapid tranquilization for agitated patients in emergency psychiatric rooms: a randomized trial of olanzapine, ziprasidone, haloperidol plus promethazine, haloperidol plus midazolam and haloperidol alone Tranquilização rápida para pacientes agitados nos serviços de emergência psiquiátrica: um ensaio clínico randomisado de olanzapina, ziprasidona, haloperidol mais prometazina, haloperidol mais midazolam e haloperidol em monoterapia

    Directory of Open Access Journals (Sweden)

    Leonardo Baldaçara

    2011-03-01

    Full Text Available OBJECTIVE: To compare the effectiveness of intramuscular olanzapine, ziprasidone, haloperidol plus promethazine, haloperidol plus midazolam and haloperidol alone as the first medication(s used to treat patients with agitation and aggressive behavior. METHOD: One hundred fifty patients with agitation caused by psychotic or bipolar disorder were randomly assigned under double-blind conditions to receive olanzapine, ziprasidone, haloperidol plus midazolam, haloperidol plus promethazine or haloperidol alone. The Overt Agitation Severity Scale, Overt Aggression Scale and Ramsay Sedation Scale were applied within 12 hours after the first dosage. RESULTS: All medications produced a calming effect within one hour of administration, but only olanzapine and haloperidol reduced agitation by less than 10 points, and only olanzapine reduced aggression by less than four points in the first hour. After twelve hours, only patients treated with haloperidol plus midazolam had high levels of agitation and aggression and also more side effects. Ziprasidone, olanzapine and haloperidol alone had more stable results for agitation control, while ziprasidone, haloperidol plus promethazine and olanzapine had stable results for aggression control. CONCLUSION: Olanzapine, ziprasidone, haloperidol plus promethazine, haloperidol plus midazolam and haloperidol were effective in controlling agitation and aggression caused by mental illness over 12 hours. Although all the drugs had advantages and disadvantages, haloperidol plus midazolam was associated with the worst results in all the observed parameters.OBJETIVO: Comparar a eficácia da olanzapina, ziprasidona, haloperidol associado ao midazolam, haloperidol associado à prometazina e haloperidol isoladamente por via intramuscular como primeira escolha no tratamento de pacientes em agitação e agressividade. MÉTODO: Cento e cinquenta pacientes com agitação psicomotora por transtorno psicótico ou transtorno bipolar foram

  6. [Awake Nasotracheal Intubation for a 4-Year-old Boy with an Oral Penetrating Toothbrush Injury].

    Science.gov (United States)

    Kobayashi, Naoya; Ando, Kokichi; Saito, Kazutomo; Toyama, Hiroaki; Fudeta, Hiroto; Yamauchi, Masanori

    2015-09-01

    We report a case of an oral penetrating injury caused by a toothbrush in a 4-year-old 17-kg boy. The toothbrush was lodged in the right cervical region through the oral cavity, and emergency surgery for removal was planned under general anesthesia. Although mask ventilation was not possible because of the protruding toothbrush handle, awake nasotracheal intubation was successfully performed with a fiber-scope and intravenous fentanyl 25 μg. We conclude that appropriate analgesics could facilitate awake intubation in pediatric patients.

  7. Edward’s syndrome: A rare cause of difficult intubation-utility of left molar approach

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    Teena Bansal

    2016-04-01

    Full Text Available Edward’s syndrome (trisomy 18 is an autosomal abnormality with dysmorphic face, visceral deformities and delayed mental and motor development including congenital heart disease. Challenges may arise during mask ventilation, laryngoscopy and/or intubation of the trachea due to dysmorphic face. Difficult airway cart should be kept ready. Left molar approach using a standard Macintosh blade improves the laryngoscopic view in patients with difficult midline laryngoscopy. We hereby present a case report of a 2 year old male child with Edward’s syndrome posted for evacuation and drainage of brain abscess, intubated successfully using left molar approach.

  8. Recurred Post-intubation Tracheal Stenosis Treated with Bronchoscopic Cryotherapy.

    Science.gov (United States)

    Jung, Ye-Ryung; Taek Jeong, Joon; Kyu Lee, Myoung; Kim, Sang-Ha; Joong Yong, Suk; Jeong Lee, Seok; Lee, Won-Yeon

    Post-intubation tracheal stenosis accounts for the greatest proportion of whole-cause tracheal stenosis. Treatment of post-intubation tracheal stenosis requires a multidisciplinary approach. Surgery or an endoscopic procedure can be used, depending on the type of stenosis. However, the efficacy of cryotherapy in post-intubation tracheal stenosis has not been validated. Here, we report a case of recurring post-intubation tracheal stenosis successfully treated with bronchoscopic cryotherapy that had previously been treated with surgery. In this case, cryotherapy was effective in treating web-like fibrous stenosis, without requiring more surgery. Cryotherapy can be considered as an alternative or primary treatment for post-intubation tracheal stenosis.

  9. A novel method using Seldinger′s technique for submental intubation in major craniomaxillofacial fractures: A case series

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    Shaik Mastan Saheb

    2014-01-01

    Full Text Available Airway management is a challenge to anesthesiologists particularly in maxillofacial surgeries. The oral tracheal tube is unsuitable because it interferes with the surgical field and prevents dental occlusion. Nasotracheal intubation may not always be possible due to structural deformity or trauma to the nasal bones. Tracheostomy and submental intubation have their drawbacks. To overcome these shortcomings we used Percutaneous Dilatational Tracheostomy Kit (PDTK to modify the technique of submental intubation. Serial dilatations were performed over the guide wire before passing the tracheal tube by submental route, using the PDT kit in four patients. Submental intubation could be achieved in all the four cases with this technique and there were no associated complications. Seldinger′s technique is a simple and easy technique with minimal bleeding, imperceptible scar, and more importantly anesthesiologists feel more comfortable because of their familiarity with the Seldinger technique.

  10. 不同剂量右美托咪啶复合舒芬太尼用于清醒气管插管的比较%Comparison among different dosages of dexmedetomidine combined with sufentanil for tracheal intubation in awake patients

    Institute of Scientific and Technical Information of China (English)

    孙传良; 孙朝辉; 孙玉兰; 李爱荣; 黄强

    2012-01-01

    Objeetive to compare the effect of different dosages of dexmedetomidine (DEX) combined with sufentanil for tracheal intubation in awake patients. Methods Ninety patients with Mallampati test Ⅲ-Ⅳ were randomly assigned into three groups (n=30).Group Ⅰ received intravenously pumping DEX 0.8 μg/kg plus sufentanil 0.1 μg/kg,group Ⅱ with DEX 1.0 μg/kg plus sufentanil 0.1 μg/kg,group Ⅲwith DEX 1.2 μg/kg plus sufentanil 0.1 μg/kg.mean arterial pressure (MAP),heart rate(HR),oxygen saturation (SpO2) of patients were recorded at the time points of entering the operationroom (T0),before intubation (T1) and intubation (T2),respectively.Serial blood samples were obtained for analysis of plasma cortisol concentrations at each time points.The responses at the intubation,and Ramsay scores before intubation were recored.Memory of intubation was inquired after operation. Results HR in patients of group Ⅱ at T1(68±9) beats/min were significantly decreased compared with that at T0(78±10)beats/min (P<0.05),HR inpatients of group Ⅲ at T1 (68±17) beats/min and T2 (64±6) beats/min are significantly decreased compared with that at T0(81±12) beats/min(P<0.05).HR in patients of group Ⅱ (68±9) beats/min and Ⅲ (68±17) beats/min at T1 are significantly decreased compared with that of group Ⅰ (81±12) beats/nin(P~05) and HR in patients of group Ⅲ at T2(64±6) beats/min are significantly decreased compared with that of group Ⅰ (85±15) beats/min(P<0.01).MAP in patients of group Ⅲ at T2(111±-9) mm Hg (1 mm Hg=0.133 kPa) are significantly increased compared with that at T0(98±10) mm Hg(P<0.05 ).MAP in patients of group Ⅱ and Ⅲ at T1 and T2 are significantly increased compared with that of group Ⅰ (P<0.05).Ramsay score in patients of group Ⅱ and Ⅱ at the moment of intubation are significantly higher than that in patients of group Ⅰ (P<0.05). Conclusions These results show that it is optimal for 1.0 μg/kg DEX combined 0.1

  11. ROCURONIUM-INDUCED AND MIVACURIUM-INDUCED NEUROMUSCULAR BLOCK AND INTUBATING CONDITIONS - A COMPARISON WITH VECURONIUM

    NARCIS (Netherlands)

    VANDENBROEK, L; HOMMES, FDM; NAP, HJA; WIERDA, JMKH

    1995-01-01

    The time-course of action after an initial 2 x ED(90) dose and after maintenance doses of 0.5 x ED(90), and intubating conditions at 90 s after a 2 x ED(90) dose following rocuronium, vecuronium and mivacurium were evaluated in anaesthetized adult patients. Neuromuscular measurements were performed

  12. Transparent-cap-fitted colonoscopy shows higher performance with cecal intubation time in difficult cases

    Institute of Scientific and Technical Information of China (English)

    Hyung Hun Kim; Seun Ja Park; Moo In Park; Won Moor; Sung Eun Kim

    2012-01-01

    AIM:To investigate the efficacy of cap-fitted colonoscopy (CFC) with regard to cecal intubation time.METHODS:Two hundred and ninety-five patients undergoing screening colonoscopy at Gospel Hospital,Kosin University College of Medicine were enrolled in this randomized controlled trial between January and December 2010.Colonoscopies were conducted by a single endoscopist.Patient characteristics including age,sex,body mass index,history of abdominal surgery,quality of preparation,and the presence of diverticulosis were recorded.RESULTS:One hundred and fifty patients were allocated into a CFC group and 145 into a non-CFC (NCF)group.Cecal intubations were achieved in all patients.Cecal intubation time in the CFC group was significantly shorter than in the NCF group for specific conditions:age ≥ 60 years,prior abdominal surgery,and poor bowel preparation.The number of detected adenomas was higher in the CFC group than in the NCF group (P =0.040).CONCLUSION:CFC facilitated shortening of the cecal intubation time in difficult cases,and was more sensitive for detecting adenomas than was NCF.

  13. Palliation of left main bronchus compression due to malignant tumor by intubation via a tracheostomy tube.

    Science.gov (United States)

    Terada, Y; Matsunobe, S; Nemoto, T; Tsuda, T; Shimizu, Y

    1991-12-01

    Intubation of the left main bronchus via a tracheostomy tube was performed in a patient with local recurrence of lung cancer associated with invasion and obstruction of the left main bronchus after right sleeve pneumonectomy. The result was satisfactory not only for preventing asphyxia, but also for maintaining the patency of the airway after extubation of the endotracheal tube.

  14. Ketorolac Tromethamine Spray Prevents Postendotracheal-Intubation-Induced Sore Throat after General Anesthesia

    Directory of Open Access Journals (Sweden)

    H. L. Yang

    2016-01-01

    Full Text Available Background. Postoperative sore throat is one of the major complaints of general anesthesia in the postanesthesia care unit. This prospective study investigated the preventive effect of ketorolac tromethamine spray in postendotracheal-intubation-induced sore throat after general anesthesia. Methods. Surgical patients undergoing general anesthesia with endotracheal intubation were recruited from a medical center. Patients were randomly assigned to group K (treated with 5% ketorolac tromethamine spray or group D (treated with distilled water spray. Before intubation, each endotracheal tube was sprayed with the appropriate solution by physicians over the 20 cm length of the cuff. Each group comprised 95 patients fitting the inclusion and exclusion criteria for whom complete data sets were collected. The intensity of the sore throat was measured at 1, 3, 6, and 24 h after surgery, and data were compared. Results. The two groups had similar characteristics. Postoperative sore throat was significantly less frequent in group K than in group D (p<0.001 and the pain intensity was significantly lower in group K than in group D at each time point (all p<0.001. Conclusions. This study demonstrated that preanesthesia 5% ketorolac tromethamine spray could effectively decrease postendotracheal-intubation-induced sore throat in patients undergoing general anesthesia.

  15. TIME-COURSE OF ACTION AND INTUBATING CONDITIONS FOLLOWING VECURONIUM, ROCURONIUM AND MIVACURIUM

    NARCIS (Netherlands)

    WIERDA, JMKH; HOMMES, FDM; NAP, HJA; VANDENBROEK, L

    1995-01-01

    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/O-2 and isoflurane. After a 2 x ED(50) dose the first attempt at tracheal int

  16. INTUBATING CONDITIONS AND ONSET OF NEUROMUSCULAR BLOCK OF ROCURONIUM (ORG-9426) - A COMPARISON WITH SUXAMETHONIUM

    NARCIS (Netherlands)

    HUIZINGA, ACT; VANDENBROM, RHG; WIERDA, JMKH; HOMMES, FDM; HENNIS, PJ

    1992-01-01

    The intubating conditions and neuromuscular blocking profile following 600-mu-g.kg-1 rocuronium (Org 9426) have been investigated in patients under various experimental conditions. They were compared with conditions following 1.5 mg.kg-1 suxamethonium, preceded by a precurarising dose (10 mg) of gal

  17. Non-intubated recovery from refractory cardiogenic shock on percutaneous VA-extracorporeal membrane oxygenation

    NARCIS (Netherlands)

    van Houte, J; Donker, D W; Wagenaar, L J; Slootweg, A P; Kirkels, J H; van Dijk, D

    2015-01-01

    We report on the use of percutaneous femoral veno-arterial extracorporeal membrane oxygenation (VA-ECMO) in a fully awake, non-intubated and spontaneously breathing patient suffering from acute, severe and refractory cardiogenic shock due to a (sub)acute anterior myocardial infarction. Intensified h

  18. DRYING OF GRANULAR MATERIALS IN AGITATED FLUIDIZED BED

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    An experimental study of the drying characteristics of an agitated fluidized bed dryer is presented and discussed. In the study, the citric acid particles were used as bed material with the diameters ranging from 0.2mm to 1.3mm. The variables affecting apparently the drying rate were found to be the mass flow rate, the inlet air temperature, the rotary speed of agitating mechanism and the particles feed rate. Comparing with other variables considered, mass flow rate was found to have the least important influence on the drying rate. The agitated fluidized bed dryer is suitable to drying agglomerating or sticky materials.

  19. Musikterapi til reduktion af agitation hos personer med demens

    DEFF Research Database (Denmark)

    Ridder, Hanne Mette Ochsner; Stige, Brynjulf

    2015-01-01

    Urolig adfærd hos demensramte på plejehjem kan defineres og måles med fagbegrebet agitation. Agitation har alvorlige konsekvenser for de berørte og kan føre til fald i livskvalitet og øget medicinering hos personer med svær demens, og kan ligeledes føre til udbrændthed hos omsorgsgivere. Agitation...... regarding the single individual. A relevant method in an integrated and holistic approach is professional music therapy combined with other staffs’ use of music in daily dementia care....

  20. A CLINICAL ASSESSMENT OF MACINTOSH BLADE, MILLER BLADE AND KING VISIONTM VIDEOLARYNGOSCOPE FOR LARYNGEAL EXPOSURE AND DIFFICULTY IN ENDOTRACHEAL INTUBATION

    Directory of Open Access Journals (Sweden)

    Apoorva Mahendera

    2016-03-01

    Full Text Available CONTEXT Previous studies suggest glottic view is better achieved with straight blades while tracheal intubation is easier with curved blades and videolaryngoscope is better than conventional laryngoscope. AIMS Comparison of conventional laryngoscope (Macintosh blade and Miller blade with channelled videolaryngoscope (King Vision TM with respect to laryngeal visualisation and difficulty in endotracheal intubation. SETTINGS AND DESIGN This prospective randomised comparative study was conducted at a tertiary care hospital (in ASA I and ASA II patients after approval from the Institutional Ethics Committee. METHODS We compared Macintosh, Miller, and the King VisionTM videolaryngoscope for glottic visualisation and ease of tracheal intubation. Patients undergoing elective surgeries under general anaesthesia requiring endotracheal intubation were randomly divided into three groups (N=180. After induction of anaesthesia, laryngoscopy was performed and trachea intubated. We recorded visualisation of glottis (Cormack-Lehane grade-CL, ease of intubation, number of attempts, need to change blade, and need for external laryngeal manipulation. STATISTICAL ANALYSIS Demographic data, Mandibular length, Mallampati classification were compared using ANOVA, Chi-square test, Kruskal-Wallis Test, where P value <0.005 is statically significant. RESULTS CL grade 1 was most often observed in King Vision -TM VL group (90% which is followed by Miller (28.33%, and Macintosh group (15%. We found intubation was to be easier (grade 1 with King Vision -TM VL group (73.33%, followed by Macintosh (38.33%, and Miller group (1.67%. External manipulation (BURP was needed more frequently in patients in Miller group (71.67%, followed by Macintosh (28.33% and in King Vision -TM VL group (6.67%. All (100% patients were intubated in the 1 st attempt with King Vision -TM VL group, followed by Macintosh group (90% and Miller group (58.33%. CONCLUSIONS In patients with normal airway

  1. Prophylactic Use of Oral Acetaminophen or IV Dexamethasone and Combination of them on Prevention Emergence Agitation in Pediatric after Adenotonsillectomy

    Directory of Open Access Journals (Sweden)

    Parvin Sajedi

    2014-01-01

    Full Text Available Background: The present study was aimed to evaluate the efficacy of acetaminophen plus dexamethasone on post-operative emergence agitation in pediatric adenotonsillectomy. Methods: A total of 128 patients were randomized and assigned among four groups as: Intravenous (IV dexamethasone, oral acetaminophen, IV dexamethasone plus oral acetaminophen, placebo. Group 1 received 0.2 mg/kg dexamethasone plus 0.25 mg/kg strawberry syrup 2 h before surgery. Group 2 received 20 mg/kg oral acetaminophen (0.25 ml/kg with 0.05 ml/kg IV normal saline. Group 3 received 20 mg/kg acetaminophen and 0.2 mg/kg dexamethasone intravenously. Group 4 received 0.25 ml/kg strawberry syrup and 0.05 ml/kg normal saline. Agitation was measured according to Richmond agitation sedation score in the post anesthetic care unit (PACU after admission, 10, 20 and 30 min after extubation. Pain score was measured with FACE scale. Nurse satisfaction was measured with verbal analog scale. If agitation scale was 3 ≥ or pain scale was 4 ≥ meperidine was prescribed. If symptoms did not control wit in 15 min midazolam was prescribed. Patients were discharged from PACU according Modified Alderet Score. Data were analyzed with ANOVA, Chi-square, and Kruskal-Wallis among four groups. P < 0.05 was considered statistically significant. Results: A total of 140 patients were recruited in the study, which 12 of them were excluded. Thus, 128 patients were randomized and assigned among four groups. The four treatment groups were generally matched at baseline data. Median of pain score in 0, 10, 20 and 30 min after extubation were different between each study group with the control group (<0.001, 0.003 respectively. Also median of agitation score in 0, 10, 20 and 30 min after extubation were different between each study group with the control group (<0.001. Incidence of pain and incidence of agitation after extubation were not statistically identical among groups (P < 0.001 and P = 0

  2. COMPARATIVE STUDY OF ATTENUATION OF CARDIOVASCULAR RESPONSE TO LARYNGOSCOPY AND INTUBATION WITH IV DEXMEDETOMIDINE VS. IV LIGNOCAINE

    Directory of Open Access Journals (Sweden)

    Shiva

    2016-03-01

    Full Text Available Endotracheal intubation is one of the most commonly performed procedures, where the role of the anaesthesiologists in patient care is noteworthy. Endotracheal intubation is translaryngeal placement of endotracheal tube into the trachea via the nose or mouth. General anaesthesia procedures involve stressful events at various stages. The most stressful situations are seen during the period of induction, intubation and extubation. A 25% to 50% increase in mean arterial pressure and heart rate is seen during induction followed by laryngoscopy and intubation peaking at 1-2 minutes and returning to baseline within 10-15 minutes. AIMS AND OBJECTIVES A comparative study of attenuation of cardiovascular response to laryngoscopy and intubation with IV dexmedetomidine vs IV lignocaine, to compare changes in HR, systolic blood pressure (SBP, diastolic blood pressure (DBP and mean arterial pressure (MAP in patients premedicated with dexmedetomidine and lidocaine and to observe for any significant difference in the anaesthetic requirement and intraoperative complications if any in both the groups. METHODOLOGY A total of 60 patients undergoing elective surgeries were selected. Group D consists of 30 patients, who received IV dexmedetomidine loading dose, 1 mcg/kg diluted in 50 mL NS for 10 minutes prior to laryngoscopy. Group –L consists of 30 patients who received plain preservative-free Lidocaine 2%, 1.5 mg/kg body weight IV bolus ninety seconds prior to laryngoscopy. RESULTS Dexmedetomidine in a bolus dose of 1 ug/kg IV attenuates heart rate response to laryngoscopy and intubation effectively than plain preservative-free lignocaine. The basal values of heart rate were reached within 1 min after intubation in case of dexmedetomidine group. Dexmedetomidine blunts the increase in systolic, diastolic and mean arterial pressure effectively than Plain preservative-free Lignocaine.

  3. EFFECTS OF ALFENTANIL AND ESMOLOL ON HEMODYNAMIC AND CATECHOLAMINE RESPONSE TO TRACHEAL INTUBATION

    Institute of Scientific and Technical Information of China (English)

    龚志毅; 罗爱伦

    1999-01-01

    Objective. To compare the effects of alfentanil and esmolol on hemodynamic and catecholamine responsee to tracheal intubation.Mahods. Thirty-five adult patients were randomly allocated to one of three groups, Group A (control group), Group B (esmolol groap) and Group C (alfentanil group). The patients received either 2 mg/kg esmolol (in Group B) or 30μg/kg alfentanil (in Group C) before intulmtion. Tracheal intubation was performed with 4 mg/kg thiopental and 0. 1 mg/kg vecuronium and 3% isoflurane. Systolic blood pressure(SBP), diastolic blood pressure (DBP), mean blood pressure (MBP), heart rate (HR), norepinephrine(NE),epinephrine(E) and dopamine (DA) were measured before and after intubtttion.Results.The control group had a baseline SBP of 149±23 mmHg while Groups B,C had a baseline SBP of 148±23,and 150±21mmHg,respectively(P>0.05),Three min after tracheal intubation,the control group SBP increased to 160±30mmHg and Group B remained at the baseline level ,147±5mmHg,and Goup C significantly decreased to 91±22mmHg(P<0.01).Two min after intubation HR in Group B increased significantly but 3 min after intubation HR in Groups B and C were significantly lower than that of control group(P<0.05).NE in Groups A and B increased significatly to 5.75±3.51 and 6.75±3.30nmol/L 3 min after intubation(P<0.01).In Group C,3min after intubation NE was not significantly different from the baseline but E becreased significantly(P<0.01).Conclusion.2mg/kg esmolol can moderate the hemodynamic response to tracheal intubation to a certain extent and 30μg/kg alfentanil can completely attenuate the hemodynamic and catecholamine responses.

  4. Incidence and endoscopic characteristics of acute laryngeal lesions in children undergoing endotracheal intubation

    Directory of Open Access Journals (Sweden)

    Eliandra da Silveira de Lima

    Full Text Available ABSTRACT INTRODUCTION: Acute laryngeal lesions after intubation appear to be precursors of chronic lesions. OBJECTIVE: To describe the incidence and type of acute laryngeal lesions after extubation in a pediatric intensive care unit (PICU. METHODS: A cohort study involving children from birth to <5 years, submitted to intubation for more than 24 h in the PICU of an university hospital. In the first eight hours after extubation, a flexible fiberoptic laryngoscopy (FFL was performed at the bedside. Those with moderate to severe abnormalities underwent a second examination seven to ten days later. RESULTS: 177 patients were included, with a median age of 2.46 months. The mean intubation time was 8.19 days. Seventy-three (41.2% patients had moderate or severe alterations at the FFL, with the remaining showing only minor alterations or normal results. During follow-up, 16 children from the group with moderate to severe lesions developed subglottic stenosis. One patient from the normal FFL group had subglottic stenosis, resulting in an incidence of 9.6% of chronic lesions. CONCLUSION: Most children in the study developed mild acute laryngeal lesions caused by endotracheal intubation, which improved in a few days after extubation.

  5. A Dose – Response Study of Magnesium Sulfate in Suppressing Cardiovascular Responses to Laryngoscopy & Endotracheal Intubation

    Directory of Open Access Journals (Sweden)

    K Montazeri

    2005-03-01

    Full Text Available Background: The effects of pretreatment with magnesium on cardiovascular responses associated with intubation have been studied previously. In this study we wanted to find optimal dose of magnesium that causes decreased cardiovascular responses after laryngoscopy & endotracheal intubation. Methods: In a double-blind , randomized, clinical trial ,120 ASA-1 patients with ages between 15-50 years old , who were candidates for elective surgery, were selected and classified in 6 groups (20 patients in each . The pulse rate and arterial blood pressure were measured and recorded at 5 minutes before taking any drug then, according to different groups, patients took magnesium sulfate (10, 20, 30, 40, 50mg/kg and lidocaine (1.5 mg/kg. The induction of anesthesia was same in all groups and the pulse rate and arterial blood pressure were measured and recorded just before intubation and also at 1, 3 , and 5 minutes after intubation (before surgical incision . Statistical analysis was performed by use of ANOVA, Post Hoc test (Duncan, Pearson correlation, and Chi square test. Results: there were no statistically significant differences in blood pressure, pulse rate, Train Of Four (TOF, and complications between groups who received magnesium but the significant differences in these parameters were seen between magnesium and lidocaine groups. Conclusion: We concluded that pretreatment with different doses of magnesium sulfate have a safe decreasing effect on cardiovascular responses that is more effective than pretreatment with lidocaine. Keywords: magnesium sulfate, cardiovascular responses, lidocaine.

  6. Reliabilitas dan Validitas Penilaian Skala Sedasi Richmond Agitation Sedation Scale (RASS) dan Ramsay pada Pasien Kritis dengan Ventilasi Mekanik di Ruang Perawatan Intensif

    OpenAIRE

    2014-01-01

    Routine use of subjective scales for pain, agitation, and sedation promotes more effective patient management in order to reach specific end-points. Each subjective sedation scale method should be evaluated in terms of its reliability and validity. The purpose of this study was to fassess the reliability and validity of Richmond Agitation Sedation Scale (RASS) and Ramsay scale. Subjects were 82 (eighty two) patients assessed using RASS and Ramsay sedation scale after receiving analgesia and s...

  7. Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults†

    Science.gov (United States)

    Frerk, C.; Mitchell, V. S.; McNarry, A. F.; Mendonca, C.; Bhagrath, R.; Patel, A.; O'Sullivan, E. P.; Woodall, N. M.; Ahmad, I.

    2015-01-01

    These guidelines provide a strategy to manage unanticipated difficulty with tracheal intubation. They are founded on published evidence. Where evidence is lacking, they have been directed by feedback from members of the Difficult Airway Society and based on expert opinion. These guidelines have been informed by advances in the understanding of crisis management; they emphasize the recognition and declaration of difficulty during airway management. A simplified, single algorithm now covers unanticipated difficulties in both routine intubation and rapid sequence induction. Planning for failed intubation should form part of the pre-induction briefing, particularly for urgent surgery. Emphasis is placed on assessment, preparation, positioning, preoxygenation, maintenance of oxygenation, and minimizing trauma from airway interventions. It is recommended that the number of airway interventions are limited, and blind techniques using a bougie or through supraglottic airway devices have been superseded by video- or fibre-optically guided intubation. If tracheal intubation fails, supraglottic airway devices are recommended to provide a route for oxygenation while reviewing how to proceed. Second-generation devices have advantages and are recommended. When both tracheal intubation and supraglottic airway device insertion have failed, waking the patient is the default option. If at this stage, face-mask oxygenation is impossible in the presence of muscle relaxation, cricothyroidotomy should follow immediately. Scalpel cricothyroidotomy is recommended as the preferred rescue technique and should be practised by all anaesthetists. The plans outlined are designed to be simple and easy to follow. They should be regularly rehearsed and made familiar to the whole theatre team. PMID:26556848

  8. Etomidate: to use or not to use for endotracheal intubation in the critically ill?

    Science.gov (United States)

    Smischney, Nathan J; Kashyap, Rahul; Gajic, Ognjen

    2015-09-01

    Endotracheal intubation is frequently performed in the intensive care unit (ICU). It can be life-saving for many patients who present with acute respiratory distress. However, it is equally associated with complications that may lead to unwanted effects in this patient population. According to the literature, the rate of complications associated with endotracheal intubation is much higher in an environment such as the ICU as compared to other, more controlled environments (i.e., operating room). Thus, the conduct of performing such a procedure needs to be accomplished with the utmost care. To facilitate establishment of the breathing tube, sedation is routinely administered. Given the tenuous hemodynamic status of the critically ill, etomidate was frequently chosen to blunt further decreases in blood pressure and/or heart rate. Recently however, reports have demonstrated a possible association with the use of etomidate for endotracheal intubation and mortality in the critically ill. In addition, this association seems to be predominantly in patients diagnosed with sepsis. As a result, some have advocated against the use of this medication in septic patients. Due to the negative associations identified with etomidate and mortality, several investigators have evaluated potential alternatives to this solution (e.g., ketamine and ketamine-propofol admixture). These studies have shown promise. However, despite the evidence against using etomidate for endotracheal intubation, other studies have demonstrated no such association. This leaves the critical care clinician with uncertainty regarding the best sedative to administer in this patient population. The following editorial discusses current evidence regarding etomidate use for endotracheal intubation and mortality. In particular, we highlight a recent article with the largest population to date that found no association between etomidate and mortality in the critically ill and illustrate important findings that the

  9. Hydrodynamic effects on cell growth in agitated microcarrier bioreactors

    Science.gov (United States)

    Cherry, Robert S.; Papoutsakis, E. Terry

    1988-01-01

    The net growth rate of bovine embryonic kidney cells in microcarrier bioreactor is the result of a variable death rate imposed on a cell culture trying to grow at a constant intrinsic growth rate. The death rate is a function of the agitation conditions in the system, and increases at higher agitation because of increasingly energetic interactions of the cell covered microcarriers with turbulent eddies in the fluid. At very low agitation rates bead-bead bridging becomes important; the large clumps formed by bridging can interact with larger eddies than single beads, leading to a higher death rate at low agitation. The growth and death rate were correlated with a dimensionless eddy number which compares eddy forces to the buoyant force on the bead.

  10. 关于冲洗法及传统方法护理经口气管插管病人的临床对比研究%Comparison of washing method and traditional method for nursing of oral cavity endotracheal intubation patients

    Institute of Scientific and Technical Information of China (English)

    王艳君; 关华; 袁铭

    2012-01-01

      目的:探讨冲洗法(1%双氧水+0.5%甲硝唑溶液)与传统方法在经口气管插管患者口腔护理的效果.方法:经口气管插管患者60例,随机分为实验组(冲洗法)30例,对照组(传统口腔护理)30例.对两组患者护理后的口腔异味、口腔炎、口腔溃疡及霉菌感染发生率进行对比研究.结果:实验组患者口腔异味、口腔炎、口腔溃疡及霉菌感染率均低于对照组,且P<0.05;并且在护理效率、患者舒适度上冲洗法均优于传统法.结论:对于经口气管插管患者利用冲洗法能彻底清洁口腔,防止口腔感染及相关并发症.%  Aim To compare the effect of oral care for oral cavity endotracheal intubation patients between washing methods (1%hydrogen peroxide + 0.5% metronidazole) and traditional method. Method:60 oral cavity endotracheal intubation patients were randomly devided into experimental group (washing method, 30 patients) and control group (traditional oral care, 30 patients). To compare the mouth odor, stomatitis, oral ulcer and fungal infection between the two groups. Results:the mouth odor, stomatitis, oral ulcer and fungal infection were lower in experimental group, and the P<0.05;and in nursing efficiency and patients comfort, the washing method were better than traditional method. Conclusion:washing method were better for oral cavity endotracheal intubation patients because it could wash the mouth thoroughly and prevent the oral infection and relevant complication.

  11. Effect of angiotensin converting enzyme genetic polymorphism on cardiovascular response to endotracheal intubation in patients with hypertension%血管紧张素转换酶基因多态性对高血压患者气管插管心血管反应的影响

    Institute of Scientific and Technical Information of China (English)

    项玲; 王军; 曾因明; 王晓峰; 金月华; 邓波

    2012-01-01

    Objective To investigate the effect of angiotensin converting enzyme (ACE) genetic polymorphism on the cardiovascular response to endotracheal intubation in patients with hypertension.Methods The patients with primary hypertension,ASA Ⅱ or Ⅲ,aged 54-64 yr,weighing 50-70 kg,scheduled for elective operation under general anesthesia,were enrolled in this study.Polymerase chain reaction-restriction fragment length polymorphism was used to detect the polymorphism of ACE gene.The patients were assigned into 3 groups according to their genotypes:homozygote DD group (group DD),heterozygote ID group (group ID),and homozygote Ⅱ group (group Ⅱ).Systolic blood pressure (SBP),diastolic blood pressure (DBP) and heart rate (HR) were recorded before and after induction of anesthesia,and at 0,1.5 and 5.0 min after intubation (T0-4).The rate-pressure product (RPP) was calculated.The cardiovascular events were recorded.Results In groups DD,ID and Ⅱ,40,39 and 40 cases were included in the analysis respectively.Compared with group ID,there was no significant difference in SBP,DBP,HR and RPP at T0-4 in group DD (P > 0.05).Compared with groups DD and ID,SBP,DBP,HR and RPP were significantly deceased at T2,3,and SBP,HR and RPP were significantly deceased at T4 in group Ⅱ (P < 0.05).The incidences of the myocardial ischemia during intubation and cardiovascular response to intubation were significantly lower in group C than in groups DD and ID (P < 0.05).Conclusion ACE genetic polymorphism exerts an effect on the cardiovascular response to endotracheal intubation in patients with hypertension,and homozygote DD and heterozygote ID have the most influence.%目的 评价血管紧张素转换酶多态性对高血压患者气管插管心血管反应的影响.方法 择期全麻手术的原发性高血压患者,体重50~ 70 kg,ASA分级Ⅱ或Ⅲ级.根据血管紧张素转换酶(ACE)基因型进行分组:DD基因型组(DD组)、ID基因型组(ID组)和Ⅱ基

  12. Period tripling causes rotating spirals in agitated wet granular layers.

    Science.gov (United States)

    Huang, Kai; Rehberg, Ingo

    2011-07-08

    Pattern formation of a thin layer of vertically agitated wet granular matter is investigated experimentally. Rotating spirals with three arms, which correspond to the kinks between regions with different colliding phases, are the dominating pattern. This preferred number of arms corresponds to period tripling of the agitated granular layer, unlike predominantly subharmonic Faraday crispations in dry granular matter. The chirality of the spatiotemporal pattern corresponds to the rotation direction of the spirals.

  13. 无创正压通气减少儿童心内直视术后再次插管%Non-invasive positive pressure ventilation reduces the rate of re-intubation in pediatric patients after cardiac surgery

    Institute of Scientific and Technical Information of China (English)

    高海红; 谈林华; 张彩云; 何小军; 杜立中

    2010-01-01

    目的 探讨鼻(面)罩双水平无创正压通气(bilevel positive airway pressure,BiPAP)应用于儿童心内直视术后呼吸功能不全的呼吸支持,减少再次插管的疗效.方法 将2007年1月至2007年12月在浙江大学医学院附属儿章医院行先天性心脏病(先心病)体外循环心内直视术后在拔除气管插管后表现呼吸费力、呼吸功能不全经常规治疗无效,已符合二次插管机械通气指征的25例患者进行前瞻性研究,记录无创BiPAP通气应用前后临床和动脉血气等指标的变化并进行单因素方差分析,同时分析患者的转1月.结果 (1)25例患者共30例次接受无创鼻(面)罩BiPAP.其中25例次患者(25/30,83.3%)在应用无创BiPAP通气后成功地避免了再次插管.4例患者共5例次接受无创鼻(面)罩BiPAP呼吸衰竭无法改善予气管捕管.(2)该组患者平均在撤离有创通气后9.4 h(0-72)h应用无创BiPAP治疗,BiPAP应用时间1.96 d(0.03-12)d,并发症少而轻微.(3)应用无创BiPAP治疗1 h后患者心率、呼吸频率及心率收缩压乘积显著降低(P2 and PaO2/FiO2 were increased significantly and A-aDO2 was decreased significantly (P < 0.05 all). The PaCO2, was decreased significantly four hours after BiPAP (P < 0.05). Conclusions Non-invasive nasal mask BiPAP can be used safely and effectively in children after cardiac surgery to improve oxygenation/ventilation, decreasing the work of breathing. It may be particularly useful in patients with high risk of re-intubation.

  14. Agitator tank device and drag reduction agent evaluation

    Institute of Scientific and Technical Information of China (English)

    张帆; 肖博元; 汤养浩; 罗旗荣

    2008-01-01

    The device that consists of tank and disk agitator for evaluation drag reduction agents(DRA) was established.The effect of DRA was defined by testing the changes of agitator torque that drives the disk rotation.The HG-DRA for oil pipeline from Linyi to Puyang was studied by agitator tank device.The relationships between the drag reduction rate and Reynolds number,concentration,balance time were studied.The best concentration and the highest Renords number for the best drag reduction rate were confirmed.The results show that the drag reduction rate tested in agitator tank is close to that in pipeline.The maximum error of drag reduction rate between pipeline and agitator tank is 18.3%,which indicates that the agitator tank device is available to evaluate the effect of DRA for pipeline and it also has the advantages of simple,easy to be operated and using small volume of oil.Those are very helpful for operaters to know the properties of DRA and operate pipeline well.

  15. A novel rescue technique for difficult intubation and difficult ventilation.

    Science.gov (United States)

    Zestos, Maria M; Daaboul, Dima; Ahmed, Zulfiqar; Durgham, Nasser; Kaddoum, Roland

    2011-01-17

    We describe a novel non surgical technique to maintain oxygenation and ventilation in a case of difficult intubation and difficult ventilation, which works especially well with poor mask fit. Can not intubate, can not ventilate" (CICV) is a potentially life threatening situation. In this video we present a simulation of the technique we used in a case of CICV where oxygenation and ventilation were maintained by inserting an endotracheal tube (ETT) nasally down to the level of the naso-pharynx while sealing the mouth and nares for successful positive pressure ventilation. A 13 year old patient was taken to the operating room for incision and drainage of a neck abscess and direct laryngobronchoscopy. After preoxygenation, anesthesia was induced intravenously. Mask ventilation was found to be extremely difficult because of the swelling of the soft tissue. The face mask could not fit properly on the face due to significant facial swelling as well. A direct laryngoscopy was attempted with no visualization of the larynx. Oxygen saturation was difficult to maintain, with saturations falling to 80%. In order to oxygenate and ventilate the patient, an endotracheal tube was then inserted nasally after nasal spray with nasal decongestant and lubricant. The tube was pushed gently and blindly into the hypopharynx. The mouth and nose of the patient were sealed by hand and positive pressure ventilation was possible with 100% O2 with good oxygen saturation during that period of time. Once the patient was stable and well sedated, a rigid bronchoscope was introduced by the otolaryngologist showing extensive subglottic and epiglottic edema, and a mass effect from the abscess, contributing to the airway compromise. The airway was secured with an ETT tube by the otolaryngologist.This video will show a simulation of the technique on a patient undergoing general anesthesia for dental restorations.

  16. Post intubation tracheal stenosis in children

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    Marco Caruselli

    2014-12-01

    Full Text Available Many authors have reported that tracheal stenosis is a complication that can follow tracheal intubation in both adults and children. The symptoms, when they do appear, can be confused with asthma, with subsequent treatment providing only mild and inconsistent relief. We report here the case of an 8 year old girl admitted to our hospital for whooping cough that was not responding to therapy.

  17. Curative effect observation of early psychological guidance on alleviation of ICU syndrome in patients with tracheal intubation after resuscitation%气管插管患者复苏后早期心理辅导对缓解ICU综合征疗效观察

    Institute of Scientific and Technical Information of China (English)

    梁武

    2014-01-01

    目的:观察研究气管插管患者复苏后早期心理辅导对缓解ICU综合征的临床疗效。方法:2012年2月-2013年5月收治气管插管/切开复苏后患者66例,将其随机分为观察组和对照组,各33例,对照组采取ICU常规护理,观察组在接受常规护理的基础上复苏时接受心理辅导。对两组ICU综合征各项指标、ICU综合征的发生情况、撤机及撤机后再插管情况和预后进行观察对比。结果:两组在依赖心理方面差异无统计学意义(P>0.05),在绝望、恐惧、郁闷、焦虑、心理否认以及幻觉表现方面差异有统计学意义(P<0.05),观察组ICU综合征发生率36.4%,显著低于对照组84.8%,组间比较差异有统计学意义(P<0.05);观察组撤机率显著高于对照组、撤机后再插管率和死亡率显著低于对照组,两组比较差异有统计学意义(P均<0.05)。结论:在气管插管患者复苏后对其进行早期心理辅导可有效降低ICU综合征的发生率,改善患者预后。%Objective:To explore the curative effect of early psychological guidance on alleviation of ICU syndrome in patients with tracheal intubation after resuscitation.Methods:66 cases with tracheal intubation after resuscitation were selected from February 2012 to May 2013.They were randomly divided into the observation group and the control group with 33 cases in each. The control group were given ICU routine nursing care,and the observation group were given psychological counseling on the basis of conventional care.We compared ICU syndrome indicators,ICU incidence syndrome,re intubation after weaning and prognosis of the two groups.Results:The two groups had no significant difference in the dependent psychology(P>0.05).There was a significant difference in despair,fear,depression,anxiety,psychological denial and illusion(P<0.05).In the observation group,the incidence of ICU syndrome was 36.4%,and the control group was 84.8%.The

  18. Glidescope视频喉镜在头颈外科手术老年患者气管插管中的应用%Application of Glidescope video laryngoscope in gertiatric patients who accepted head-neck surgery during tracheal intubation

    Institute of Scientific and Technical Information of China (English)

    刘若杉; 董彦鹏; 杨萍; 王志强; 陈玉玲; 孙莉

    2012-01-01

    目的 评价Glidescope视频喉镜用于头颈外科手术老年患者气管插管的临床效果.方法 择期行头颈外科手术的老年患者40例,随机分为Glidescope视频喉镜组(G组20例)和直接喉镜组(L组20例).全部患者均于麻醉前进行改良Mallampati分级评估,分析比较两组患者声门暴露情况(Cormrk -Lehane分级)、插管时间,记录麻醉诱导前(T0)、诱导后(T1)、插管后不同时点(T2~T5)的血流动力学变化.结果 与L组比较,G组患者获得较好的声门暴露,且插管时间缩短(P<0.05).两组患者T1时点MAP、HR较T0时点有所降低(P<0.05),T2~T5不同时点MAP、HR较T0时点有不同程度增加(P<0.05),两组比较差异无统计学意义(P>0.05).结论 Glidescope视频喉镜可以为头颈外科手术老年患者创造更好的插管条件,提高插管成功率.%Objective To evaluate the effects of Glidescope video laryngoscope in geriatric patients who accepted head - neck surgery during tracheal intubation. Methods Forty geriatric patients who accepted head - neck Burgery were randomly divided into two groups (n = 20, each) :Croup G (Glidescope video laryngoscope); Group L (direct laryngoscope). Modified Mallampati test was used for airway prediction before anesthesia. The following data were recorded and analyzed: glottic exposure (Cormark - Le-hane) , tracheal intubation, hemodynamic parameters at the point of before induction (T0), after induction (T,), the different time points of intubation (T3 - T5). Results Compared with Group L, Group G a-chieved better glottic exposure and shorter intubation time. Compared with the baseline at T0, MAP and HR were markedly decreased at T1 while MAP and HR were obviously increased at T2 ~T,in two groups. There was no significant difference in MAP and HR between Group G and Group L Conclusions Glidescope video laryngoscope can yield better glottic exposure and higher success rate in geriatric patients who accepted head - neck surgery

  19. Comparison of the Effects of Oral Midazolam, Ketamine and Tramadol on Postoperative Agitation Related to Sevoflurane in Children

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    Rahşan Karayazılı

    2010-12-01

    Full Text Available Aim: The aim of our study was to investigate the effects of oral midazolam, ketamine and tramadol, which have been administered as premedication in pediatric patients, on sedation quality, postoperative agitation and pain. Methods: Sixty pediatric patients (aged 2-12 years with American Society of Anesthesiology (ASA classifications I and II were included in the study. Group M was administered 0.5 mg kg-1 midazolam, Group K 6 mg kg-1 ketamine and Group T 2 mg kg-1 tramadol orally. The mean arterial blood pressure (MAP, heart rates (HR, Ramsey sedation scores (Rss and sedation agitation scores (Sas were recorded before and at 10 and 30 min after drug administration, before induction and 5,10, 15, 30, 45, 60, and 90 minutes after operation in all patients. Anesthesia induction was performed with lidocaine, propofol and rocuronium. Maintenance of anaesthesia was provided with sevoflurane, N2O and O2. Recovery times, Alderete scores and facial pain scores (FPS were recorded. Results: There were no differences between the groups according to demographic data. HR was significantly lower in Group T. Group M was determined to be more agitated 30 and 45 min after the operation. Also, Alderete scores were lower in Goup K. The FPS scores of Group T were lower (p<0.05. There was no statistically significant difference between the groups according to frequency of postoperative agitation and delirium. Conclusion: Although ketamine may reduce the postoperative sedation-agitation scores, it also may reduce the recovery scores in pediatric patients. Tramadol does not provide adequate sedation in premedication, but it reduces postoperative pain scores. However, the frequency of postoperative agitation-delirium is not different among these three agents. (The Medical Bulletin of Haseki 2010; 48: 146-52

  20. Tracheoesophageal fistula--a complication of prolonged tracheal intubation.

    Science.gov (United States)

    Paraschiv, M

    2014-01-01

    Tracheoesophageal fistula most commonly occurs as a complication of prolonged tracheal intubation. The incidence decreased after the use of low pressure and high volume endotracheal cuffs, but the intensive care units continue to provide such cases. The abnormal tracheoesophageal communication causes pulmonary contamination (with severe suppuration) and impossibility to feed the patient. The prognosis is reserved, because most patients are debilitated and ventilator dependent, with severe neurological and cardiovascular diseases. The therapeutic options are elected based on respiratory, neurological and nutritional status. The aim of conservative treatment is to stop the contamination (drainage gastrostomy, feeding jejunostomy) and to treat the pulmonary infection and biological deficits. Endoscopic therapies can be tried in cases with surgical contraindication. Operation is addressed to selected cases and consists in the dissolution of the fistula, esophageal suture with or without segmental tracheal resection associated. Esophageal diversion is rarely required. The correct indication and timing of surgery, proper surgical technique and postoperative care are prerequisites for adequate results.

  1. [Fibre optic-assisted endotracheal intubation through the laryngeal mask in children].

    Science.gov (United States)

    Weiss, M; Mauch, J; Becke, K; Schmidt, J; Jöhr, M

    2009-07-01

    Fibre optic-assisted tracheal intubation through the laryngeal mask airway is a simple and safe procedure for securing the airway in the paediatric patient with unexpected and known difficult tracheal intubation. Therefore, fibre optic-assisted tracheal intubation through the laryngeal mask airway represents a standard airway technique and must be part of clinical education and also regular training. However, the removal of the laryngeal mask airway over the tracheal tube is impaired by the short length of the tracheal tube, easily resulting in tube dislocation from the trachea. Among several techniques to overcome this problem, the Cook airway exchange catheter offers a reliable method not only for safe removal of the laryngeal mask over the tracheal tube but also for insertion of an adequate tracheal tube, particularly in paediatric patients. This is particularly important for cuffed tubes as the pilot balloon of the cuffed tube is too large to pass through laryngeal mask airway tubes size 2.5 and smaller. This presentation demonstrates fibre optic-assisted tracheal intubation through the laryngeal mask airway in children step-by-step and discusses its clinical implications. A list with compatible sizes of laryngeal mask airways, tracheal tubes and airway exchange catheters is also provided.

  2. COMPARISON OF UPPER LIP BITE TEST WITH OTHER FOUR PREDICTORS FOR PREDICTING DIFFICULTY IN INTUBATION

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    Balasubramanyam

    2015-05-01

    Full Text Available Unanticipated difficult tracheal intubation remains a primary concern for anaesth - esiologists, endangering the life of patients at the crucial moment. The aim of the present study is to compare Upper lip bite test (ULBT with other four predictors (Modifi ed Mallampati test MMT, Thyromental distance TMD, Sternomental distance SMD, Inter incisor distance IID for predicting difficulty in intubation. Upper lip Bite test, if proven to be effective, is very helpful to even the junior most Anaesthetist to evalua te the difficulty in tracheal intubation, and thus being ready with all the armamentarium, needed for the difficulty likely to be faced. Hence, leading to better safety of the patient and comfort of the anaesthetist. AIM OF THE STUDY: This prospective stud y was undertaken at Sri Venkatewara Medical College, Tirupati and S.V.R.R.G.G. Hospital, Tirupati, to determine the ability of Upper Lip bite test, to predict difficult/easy visualization of larynx and intubation and comparing upper lip bite test with four different tests i.e., Modified Mallampati test, sternomental distance, thyromental distance and inter incisor distance.

  3. A comparative study of efficacy of intravenous dexmedetomidine and intravenous esmolol for attenuation of stress response during laryngoscopy and endotracheal intubation

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    Hema B. Gupta

    2016-10-01

    Conclusions: Dexmedetomidine 1 and #956;g/kg is more effective than esmolol for attenuating the hemodynamic response to laryngoscopy and intubation in elective surgical patients. [Int J Basic Clin Pharmacol 2016; 5(5.000: 1803-1808

  4. Control of psychomotor agitation and aggressive behavior in patients with autistic disorder: a retrospective chart review Controle da agitação psicomotora e agressividade em pacientes com autismo: estudo retrospectivo de revisão de prontuário

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    Camila Marinho Novaes

    2008-01-01

    Full Text Available OBJECTIVE: To evaluate the efficacy of pharmacotherapy on the symptoms of psychomotor agitation and aggressive behavior in a sample of patients with autistic spectrum disorder. METHOD: The charts of all patients with a diagnosis of autistic spectrum disorder, receiving care for psychomotor agitation and/or aggressive behavior in two psychiatric outpatient departments between 2001 and 2006, were reviewed. The Clinical Global Impression-Severity and -Improvement scales (CGI-S and CGI-I were applied to the data retrieved from the charts. RESULTS: The majority of the 26 patients included were treated with second-generation antipsychotics. A positive, statistically significant correlation was found between the implementation of pharmacotherapy and a reduction in CGI-S scores (pOBJETIVO: Avaliar a eficácia do tratamento farmacológico dos sintomas de agitação psicomotora e agressividade em amostra de pacientes com transtorno do espectro autista. MÉTODO: Foram revisados os prontuários de pacientes com diagnóstico de transtorno do espectro autista que procuraram atendimento por apresentarem agitação psicomotora e/ou heteroagressividade, atendidos entre 2001 e 2006, em dois ambulatórios de psiquiatria. Para avaliação da evolução dos pacientes aplicou-se às informações do prontuário a escala de Impressão Clínica Global Sintomas (ICG-S e a Impressão Clínica Global Melhora (ICG-M. RESULTADOS: A maioria dos 26 pacientes estava em tratamento com antipsicóticos de segunda geração. Houve correlação positiva e estatisticamente significativa entre a introdução do tratamento farmacológico e a redução nos escores da ICG-S (p<0,05. A evolução do tratamento farmacológico foi melhor para os pacientes sem retardo mental do que para aqueles com retardo mental (p<0,05. A maioria dos pacientes que obteve melhora clínica com o tratamento participava de ao menos uma intervenção auxiliar ao tratamento principal (p<0,05. CONCLUSÃO: Os

  5. Evaluation of Truview evo2® Laryngoscope In Anticipated Difficult Intubation-A Comparison To Macintosh Laryngoscope

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    Ishwar Singh

    2009-01-01

    Full Text Available The aim of the study was to assess and compare laryngoscopic view of Truview evo2 laryngoscope with that of Macintosh laryngoscope in patients with one or more predictors of difficult intubation (PDI. Moreover ease of intubation with Truview evo2 in terms of absolute time requirement was also aimed at. Patients for elective surgery requiring endotracheal intubation were initially assessed for three PDI parameters - modified Mallampati test, thyro-mental distance& Atlanto-occipital (AO joint extension. Patients with cumulative PDI scores of 2 to 5 (in a scale of 0 to 8 were evaluated for Cormack& Lehane (CL grading by Macintosh blade after standard induction. Cases with CL grade of two or more were further evaluated by Truview evo2 laryngoscope and corresponding CL grades were assigned. Intubation attempted under Truview evo2 vision and time required for each successful tracheal intubation (i.e. tracheal intubation completed within one minute was noted. Total fifty cases were studied. The CL grades assigned by Macintosh blade correlated well with the cumulative PDI scores assigned preoperatively, confirming there predictability. Truview evo2 improved laryngeal view in 92 % cases by one or more CL grade. Intubation with Truview evo2 was possible in 88% cases within stipulated time of one minute and mean time of 28.6 seconds with SD of 11.23 was reasonably quick. No significant complication like oro- pharyngeal trauma or extreme pressor response to laryngoscopy was noticed. To conclude, Truview evo2 proved to be a better tool than conventional laryngoscope in anticipated difficult situations.

  6. Difficult airway and difficult intubation in postintubation tracheal stenosis: a case report and literature review

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    Zarogoulidis P

    2012-06-01

    Full Text Available Paul Zarogoulidis,1 Theodoros Kontakiotis,1 Kosmas Tsakiridis,2 Michael Karanikas,3 Christos Simoglou,4 Konstantinos Porpodis,1 Alexandros Mitrakas,3 Agisilaos Esebidis, 3 Maria Konoglou,5 Nikolaos Katsikogiannis,6 Vasilis Zervas,1 Christina Aggelopoulou,7 Dimitrios Mikroulis,4 Konstantinos Zarogoulidis11Pulmonary Department, "G Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece; 2Cardiothoracic Department, Saint Luke Private Hospital, Thessaloniki, Greece; 31st University Surgery Department, 4Cardiothoracic Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece; 51st Pulmonary Department, "G Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece; 6Surgery Department (NHS, 7Neurology Department (NHS, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, GreeceAbstract: Management of a "difficult airway" remains one of the most relevant and challenging tasks for anesthesiologists and pulmonary physicians. Several conditions, such as inflammation, trauma, tumor, and immunologic and metabolic diseases, are considered responsible for the difficult intubation of a critically ill patient. In this case report we present the case of a 46-year-old male with postintubation tracheal stenosis. We will focus on the method of intubation used, since the patient had a "difficult airway" and had to be intubated immediately because he was in a life-threatening situation. Although technology is of utter importance, clinical examination and history-taking remain invaluable for the appropriate evaluation of the critically ill patient in everyday medical life. Every physician who will be required to perform intubation has to be familiar with the evaluation of the difficult airway and, in the event of the unanticipated difficult airway, to be able to use a wide variety of tools and

  7. Research Progress of Capnography and Its Application in Non-intubated Patients%呼出气二氧化碳监测仪的研究进展及其在非气管插管患者中的应用

    Institute of Scientific and Technical Information of China (English)

    张小青(综述); 李民(审校)

    2016-01-01

    [Summary] Alveolar hypoventilation and respiratory depression occur frequently in a variety of clinical settings where patients receive sedatives or opioids .Current clinical guidelines recommend capnography as one of the best non -invasive methods , which should be routinely used for non-intubated patients with high respiratory depression risk .This article reviewed the current evidences for the application of capnography in non-intubated patients and summarized the outcomes in recent clinical trials .The clinical studies support the use of this non-invasive technique .Clinicians should not solely rely on pulse oximetry in assessing patients with high risk of respiratory depression .%肺泡通气不足和呼吸抑制常见于接受镇静药物或阿片类药物的患者。目前的临床指南均推荐将无创的呼出气二氧化碳监测仪作为有呼吸抑制风险的非插管患者的常规监测方法。本文对呼出气二氧化碳监测仪对非插管患者进行监测的临床研究进行文献综述,其在保障患者安全、及时发现呼吸抑制方面发挥重要作用,对存在呼吸抑制风险的患者,不应单纯依赖脉搏氧饱和度。

  8. Learning curve for paramedic endotracheal intubation and complications

    OpenAIRE

    Toda, J; Toda, AA; Arakawa, J

    2013-01-01

    Background Pre-hospital laryngoscopic endotracheal intubation (ETI) is potentially a life-saving procedure but is a technique difficult to acquire. This study aimed to obtain a recommendation for the number of times ETI should be practiced by constructing the learning curve for endotracheal intubation by paramedics, as well as to report the change in the frequency of complications possibly associated with intubation over the training period. Methods Under training c...

  9. AIRWAY ASSESSMENT FOR ANTICIPATION OF DIFFICULT INTUBATION: A DOUBLE BLIND COMPARATIVE STUDY

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    Ushakumary

    2016-05-01

    Full Text Available BACKGROUND AND AIMS In this era of high technology, we still face an ageless problem in anaesthesia – the difficult airway. In 1997, Smarajith Sur Roy of India introduced a new airway index to predict difficult intubation. Aim of the study is to compare the new airway index with modified Mallampati classification and also with Cormack and Lehane grading for predicting intubation difficulty. MATERIALS AND METHODS The study was conducted on 200 patients undergoing various surgeries at a Government Medical College Hospital. Patients between the age group of 15 to 50 years and belonging to American Society of Anaesthesiologist Grade 1 or 2 were selected. Patients were graded using Modified Mallampati classification. Then in hyperextended neck, the distance between the angle of mandible and the midpoint of Symphysis menti (Variable A and the distance between the symphysis menti and the thyroid notch (Variable B were taken in centimetres and A/B ratio calculated. This ratio is the New Airway Index. After premedication and induction of anaesthesia, laryngoscopy was done, Cormack and Lehane grade noted and intubation difficulty assessed. The predictive value of the new airway index was compared against modified Mallampati classification as well as Cormack and Lehane grading and statistical significance assessed. RESULTS The observations made on the calculation of the new airway index were, 1. When the airway index was 1, the intubation was very easy, irrespective of the findings of Mallampati classification and Cormack and Lehane Grade was 1; 2. When the index was 1 to 1.399, the intubation was easier and the laryngoscopic findings were of Cormack and Lehane Grade II; 3. When the index was 1.4 or more, the intubation was difficult and they belonged to Cormack and Lehane Grade III. The predictability was also statistically very significant when compared with modified Mallampati classification (p<0.001 – Chi square test - test for single proportion

  10. 急诊重型颅脑损伤患者咪达唑仑诱导气管插管的效果分析%Efficacy Analysis of Tracheal Intubation Induced by Midazolam in Patients with Acute Severe Brain Injury

    Institute of Scientific and Technical Information of China (English)

    洪海斌; 黄之抗; 庄炯宇; 李海忠; 蔡家骥

    2016-01-01

    目的:总结急诊重型颅脑损伤患者咪达唑仑诱导气管插管的效果。方法:回顾性分析2013年1月-2015年12月我院急诊救治的96例重型颅脑损伤患者的临床资料,按麻醉方案不同分为对照组(n=40)和研究组(n=56),对照组行地西泮麻醉,研究组行咪达唑仑麻醉,比较两组插管即刻生命体征及插管后连接呼吸机前血气分析情况。结果:研究组平均动脉压(MAP)、呼吸频率(RR)、心率(HR)、血氧分压(PaO2)及二氧化碳分压(PaCO2)均显著优于对照组(P<0.05)。结论:急诊重型颅脑损伤患者使用咪达唑仑镇静行气管插管术较地西泮能更有效减轻气管插管时的心血管反应,而对呼吸功能几乎无影响。%Objective: To summarize effect of tracheal intubation induced by midazolam in patients with acute severe brain injury. Methods:The clinical data of 96 patients with acute severe brain injury were retrospectively analyzed from Jan 2013 to Dec 2015,and the cases were divided into control group (n=40) and research group (n=56) anesthetized by diazepam and midazolam respectively,the vital signs after intubation and before connecting the ventilator gas analysis situation were compared between the two groups. Results:The mean arterial pressure (MAP), respiratory rate (RR), heart rate (HR), blood oxygen pressure (PaO2) and carbon dioxide partial pressure (PaCO2) in research group were significantly better than those in the control group (all P<0.05). Conclusion:Compared with diazepam,it is more effective in reducing cardiovascular response and almost no impact on the respiratory function in patients with acute severe brain injury tracheal intubation induced by midazolam.

  11. History of neonatal resuscitation - part 3: endotracheal intubation.

    Science.gov (United States)

    Obladen, Michael

    2009-01-01

    Endotracheal intubation to resuscitate neonates was used by Scheel in 1798. A century before endotracheal anesthesia was developed, inventive obstetricians constructed devices for endotracheal intubation of infants and mastered their insertion, localization, and airtight sealing. Fell's laryngoscope, Magill's intubation forceps and tissue-friendly materials were significant contributions of the 20th century to endotracheal intubation of the newborn. The striking absence of scientific studies on the most efficient resuscitation techniques for neonates can be explained by the difficulty to adjust for the personal skills of the resuscitator.

  12. COMPARATIVE STUDY ON THREE DOSES OF ESMOLOL TO ATTENUATE THE HAEMODYNAMIC STRESS RESPONSE DURING LARYNGOSCOPY AND ENDOTRACHEAL INTUBATION

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    Raghavan

    2016-06-01

    Full Text Available BACKGROUND The advantage of IV Esmolol due to its ultra-short action seem to be ideal to control intense but brief sympathetic stimulation following endotracheal intubation, inspired us to conduct a study in which we compared the three doses of Esmolol to attenuate the haemodynamic stress response during Laryngoscopy and Endotracheal intubation. AIM This study was done to compare the varying doses of IV Esmolol in attenuating the haemodynamic stress response to laryngoscopy and endotracheal intubation. METHODS AND MATERIALS Sixty ASA I and II patients undergoing elective surgical procedure under general anaesthesia with endotracheal intubation were included in this study. Patients belonging to age group 20-50 years of both the sexes were included. It is prospective double blind randomized study. The study was approved by the Ethical Committee and was randomly grouped into three groups. Group A (Esmolol 5 mg/kg 20 patients were given Esmolol 0.5 mg/kg IV 2 minutes before intubation. Group B (Esmolol 1.0 mg/kg–20 Patients were given Esmolol 1 mg/kg IV 2 minutes before intubation. Group C (Esmolol 1.5 mg/kg 20 patients were given Esmolol 1.5 mg/kg IV 2 minutes before intubation. STATISTICAL ANALYSIS Heart rate, systolic Blood pressure, Diastolic pressure and mean arterial pressure were recorded using MS Excel software and analysed using STATA software for determining the statistical significance. ANOVA test was used to determine the significance among three groups. Student’s ‘t’ test was used to compare the three groups in mean values of various parameters. The P value taken for signification is <0.05. RESULTS The dose of Esmolol 1.5 mg/kg (Group C to be effective in attenuating the haemodynamic responses during laryngoscopy and ET intubation with no major adverse effects when compared to 0.5 and 1.0 mg/kg. CONCLUSION We found that the dose of Esmolol 1.5 mg/kg (Group C to be effective in attenuating the haemodynamic responses during

  13. A CASE REPORT OF RETROPHARYNGEAL PASSAGE OF ENDOTRACHEAL TUBE WHILE ATTEMPTING BLIND NASAL INTUBATION - A RARE COMPLICATION

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    Harinath

    2015-06-01

    Full Text Available Nasal route of intubation is commonly used for surgical procedures involving Head and Neck, Patients with intra - oral pathology, structural abnormalities, trismus, cervical spine instability, cervical spine disease and OSA. The intubation may be aided by direct laryngoscopy, flexible fibreoptic laryngoscopy or by blind technique. The classical tec hnique of blind nasal intubation requires a spontaneously breathing patient and uses breath sounds to guide placement. Most common complication associated with this technique is epistaxis. Other rare complications include - Inferior turbinate avulsion, mid dle turbinate/nasal polyp/tumour avulsion, Bacteraemia, Retropharyngeal mucosa dissection/laceration. Here we present to you a case of fracture mandible posted for ORIF for which blind nasal intubation was planned. While attempting the intubation the endot racheal tube coursed behind the retropharyngeal mucosa for a short distance before entering the trachea. Post - operatively the patient was put on Ryle’s tube feeding for 3 days followed by orals. The track healed spontaneously and the recovery was uneventfu l.

  14. Comparative Evaluation of the Sniffing Position with Simple Head Extension for Laryngoscopic View and Intubation Difficulty in Adults Undergoing Elective Surgery

    Science.gov (United States)

    Prakash, Smita; Rapsang, Amy G.; Mahajan, Saurabh; Bhattacharjee, Shameek; Singh, Rajvir; Gogia, Anoop R.

    2011-01-01

    The effect of patient position on mask ventilation, laryngoscopic view, intubation difficulty, and the stance adopted by the anesthesiologist during laryngoscopy and tracheal intubation was investigated in 546 anesthetized adults in this prospective, randomized study. Patients were randomly assigned to either the sniffing position group or the simple extension group. The distribution of Cormack grades was comparable between the two groups (P = 0.144). The IDS score [median (IQR)] was 0 (0–2) in the sniffing group and 1 (0–2) in the simple extension group; P = 0.002. There were significant differences between groups with regard to intensity of lifting force, external laryngeal manipulation, alternate techniques used, number of attempts, and the stance adopted by anesthesiologist. We conclude that the sniffing position is superior to simple head extension with regard to ease of intubation as assessed by IDS. An upright stance is adopted by more anesthesiologists performing intubation with patients in the sniffing position. PMID:22110497

  15. Comparative Evaluation of the Sniffing Position with Simple Head Extension for Laryngoscopic View and Intubation Difficulty in Adults Undergoing Elective Surgery

    Directory of Open Access Journals (Sweden)

    Smita Prakash

    2011-01-01

    Full Text Available The effect of patient position on mask ventilation, laryngoscopic view, intubation difficulty, and the stance adopted by the anesthesiologist during laryngoscopy and tracheal intubation was investigated in 546 anesthetized adults in this prospective, randomized study. Patients were randomly assigned to either the sniffing position group or the simple extension group. The distribution of Cormack grades was comparable between the two groups (P=0.144. The IDS score [median (IQR] was 0 (0–2 in the sniffing group and 1 (0–2 in the simple extension group; P=0.002. There were significant differences between groups with regard to intensity of lifting force, external laryngeal manipulation, alternate techniques used, number of attempts, and the stance adopted by anesthesiologist. We conclude that the sniffing position is superior to simple head extension with regard to ease of intubation as assessed by IDS. An upright stance is adopted by more anesthesiologists performing intubation with patients in the sniffing position.

  16. Prior esophagogastroduodenoscopy does not affect the cecal intubation time at bidirectional endoscopies

    OpenAIRE

    Öner, Osman Zekai; Demirci, Rojbin Karakoyun; Gündüz, Umut Rıza; Aslaner, Arif; KOÇ, Ümit; Bülbüller, Nurullah

    2013-01-01

    Bidirectional endoscopy (BE) is often used to assess patients for the reason of anemia or to screen asymptomatic population for malignancy. Limited clinical data favors to perform first the upper gastrointestinal system endoscopy, but its effect to the duration of colonoscopy is yet to be determined. The aim of this retrospective study is to evaluate the effect of upper gastrointestinal system endoscopy on the time to achieve cecal intubation during colonoscopy in patients undergoing BE. Pati...

  17. Changes in intraocular pressure following administration of suxamethonium and endotracheal intubation: Influence of dexmedetomidine premedication

    OpenAIRE

    Chandan Kumar Pal; Manjushree Ray; Anjana Sen; Bimal Hajra; Dipankar Mukherjee; Anil Kumar Ghanta

    2011-01-01

    Background: Use of suxamethonium is associated with an increase in intraocular pressure (IOP) and may be harmful for patients with penetrating eye injuries. The purpose of our study was to observe the efficacy of dexmedetomidine for prevention of rise in IOP associated with the administration of suxamethonium and endotracheal intubation. Methods: Sixty-six American Society of Anaesthesiologists I or II patients undergoing general anaesthesia for non-ophthalmic surgery were included in this ra...

  18. Transmylohyoid Submental Intubation in complex maxillofacial trauma: The easiest method is also the safest method

    Directory of Open Access Journals (Sweden)

    Ashutosh Kumar Singh

    2016-08-01

    Full Text Available Background & Objectives: Complex maxillofacial trauma is a common occurrence with high velocity road traffic accidents. Multiple facial bone fracture with loss of reference point for bony reduction requires use of intra-operative intermaxillary fixation to obtain good occlusion which precludes oral intubation. Fractures of nasal bones and ethmoid bones with complex distorted anatomy lead to inability to perform a nasal intubation. In such cases sub-mental intubation can be a safe and easy method of securing the intra-operative airway thus avoiding  tracheotomy and its complications.Materials & Methods: Retrospective clinical analytical study was planned in which 25 patients were included. Patient’s age, sex, type of trauma, time taken for procedure and complications were taken as study variables. Results: Average time taken for the procedure was nine minutes and only four out of 25 cases had complications. Conclusion: Sub-mental intubation requires simple skills, less time and is relatively complication free compared to tracheotomy in securing intra-operative airway during surgeries for complex maxillofacial trauma.JCMS Nepal. 2016;12(2:55-9

  19. Optimization of agitation and aeration conditions for maximum virginiamycin production.

    Science.gov (United States)

    Shioya, S; Morikawa, M; Kajihara, Y; Shimizu, H

    1999-02-01

    To maximize the productivity of virginiamycin, which is a commercially important antibiotic as an animal feed additive, an empirical approach was employed in the batch culture of Streptomyces virginiae. Here, the effects of dissolved oxygen (DO) concentration and agitation speed on the maximum cell concentration at the production phase, as well as on the productivity of virginiamycin, were investigated. To maintain the DO concentration in the fermentor at a certain level, either the agitation speed or the inlet oxygen concentration of the supply gas was manipulated. It was found that increasing the agitation speed had a positive effect on the antibiotic productivity independent of the DO concentration. The optimum DO concentration, agitation speed and addition of an autoregulator, virginiae butanolide C (VB-C), were determined to maximize virginiamycin productivity. The optimal strategy was to start the cultivation at 450 rpm and to continue until the DO concentration reached 80%. After reaching 80%, the DO concentration was maintained at this level by changing the agitation speed, up to a maximum of 800 rpm. The addition of an optimal amount of the autoregulator VB-C in an experiment resulted in the maximal production of virginiamycin M (399 mg/l), which was about 1.8-fold those obtained previously.

  20. Comparison of Mallampati test with lower jaw protrusion maneuver in predicting difficult laryngoscopy and intubation

    Directory of Open Access Journals (Sweden)

    Muhammad Irfan Ul Haq

    2013-01-01

    Full Text Available Background: Failure to maintain a patent airway is one of the commonest causes of anesthesia-related morbidity and mortality. Many protocols, algorithms, and different combinations of tested methods for airway assessment have been developed to predict difficult laryngoscopy and intubation. The reported incidence of a difficult intubation varies from 1.5% to 13%. The objective of this study was to compare Mallampati test (MT with lower jaw protrusion (LJP maneuver in predicting difficult laryngoscopy and intubation. Materials and Methods: Seven hundred and sixty patients were included in the study. All the patients underwent MT and LJP maneuver for their airway assessment. After a standardized technique of induction of anesthesia, primary anesthetist performed laryngoscopy and graded it according to the grades described by Cormack and Lehane. Sensitivity, specificity, accuracy, and positive predictive value (PPV and negative predictive value (NPV were calculated for both these tests with 95% confidence interval (CI using conventional laryngoscopy as gold standard. Area under curve was also calculated for both, MT and LJP maneuver. A P < 0.05 was taken as significant. Results: LJP maneuver had higher sensitivity (95.9% vs. 27.1%, NPV (98.7% vs. 82.0%, and accuracy (90.1% vs. 80.3% when compared to MT in predicting difficult laryngoscopy and intubation. Both tests, however, had similar specificity and PPV. There was marked difference in the positive and negative likelihood ratio between LJP and MT. Similarly, the area under the curve favored LJP maneuver over MT. Conclusion: The results of this study show that LJP maneuver is a better test to predict difficult laryngoscopy and tracheal intubation. We recommend the addition of this maneuver to the routine preoperative evaluation of airway.

  1. COMPARISON OF ONSET TIME, DURATION OF ACTION AND INTUBATING CONDITION SACHIEVED WITH SUXAMETHONIUM AND ROCURONIUM BROMIDE

    Directory of Open Access Journals (Sweden)

    Ajit P

    2013-12-01

    Full Text Available Adverse event profile ofSuxamethonium which is still the relaxant of choice to facilitate tracheal intubation inspired us to conduct a study in which we compared Onset time, Duration of Action and Intubating Conditions Achieved with Suxametho nium and Rocuronium Bromide with the Help of TOF Guard. AIMS : W e compared the onset of relaxation time, intubating condition, and duration of action, the cardiovascular effect, side effects between Suxamethonium and Rocuronium to ascertain the place of Rocu ronium as a relaxant for rapid sequence intubation as compared to the Suxamethonium. METHODS AND MATERIAL : The present study was carried out with the association of Department of Anesthesiology, S.S. Medical College and Associated S.G.M. and G.M. Hospitals, Rewa (M.P., and Departmen t of Pharmacology NSCB Medical C ollege Jabalpur (M.P. in 100 patients of either sex of ASA grade I and II between the ages of 16 to 70 years. The patients were randomly divided in two groups of 50 each. Group I & II received Sux amethonium 1.5 mg/kg B.W. or Rocuronium 1.0 mg/kg B.W. RESULTS : Onset time of maximum relaxation is < 60 seconds in each relaxants under study i.e. Rocuronium 1 mg/kg and Suxamethonium 1.5 mg/kg. Intubating conditions after Rocuronium 1 mg/kg are clinically acceptable in 100% of cases and are equivalent to that after Suxamethonium 1.5 mg/kg. Rocuronium upto dose of 1 mg/kg does not have any clinically significant cardiovascular effect. Rocuronium does not have any side effects including the sign of histamine release and anaphylactic or anaphylactoid reactions. Duration of action after Rocuronium 1 mg/kg is about 2346.4 seconds (39.14 minutes so it is not suitable for surgeries of short duration. CONCLUSIONS : Rocuronium can replace Suxamethonium for rapid sequ ence intubation in conditions where use of Suxamethonium is eithe r hazardous or contraindicated p rovided there is no anticipated difficulty in intubation.

  2. Comparaison de l'Ambu® aScope 2 versus fibroscope conventionnel pour l'intubation trachéale des patients avec colonne cervicale immobilisée par une minerve

    OpenAIRE

    Krugel V.

    2013-01-01

    La prise en charge des voies aériennes est un aspect majeur de l'anesthésie dont le défaut de gestion reste la première cause de mortalité per-anesthésique. La fibroscopie reste à l'heure actuelle une technique clé pour la gestion des situations d'intubation difficiles, mais les fibroscopes standards réutilisables sont couteux, fragiles et doivent être nettoyés et désinfectés entre chaque utilisation. L'apparition sur le marché de l'Ambu ®aScope?2, vidéoscope souple à usage unique pourrait se...

  3. Management of avulsed permanent maxillary central incisors during endotracheal intubation

    Directory of Open Access Journals (Sweden)

    Ritesh R Kalaskar

    2016-01-01

    Full Text Available Avulsion is serious injury that may encounter during endotracheal intubation and its management often presents a challenge. Replantation of the avulsed tooth can restore esthetic appearance and occlusal function shortly after the injury. The present article describes the management of air-dried maxillary permanent incisors that have been avulsed due to direct laryngoscopy during the induction of general anesthesia for tonsillectomy procedure. The replanted maxillary central incisors had maintained its function and esthetic for 1 year after replantation. Children in a mixed dentition phase are high-risk group children for traumatic dental injury during laryngoscopy; therefore, Anesthetic Departments should have local protocols to refer patients for dental treatment postoperatively in the event of trauma.

  4. Comparison of sedation strategies for critically ill patients

    DEFF Research Database (Denmark)

    Hutton, Brian; Burry, Lisa D; Kanji, Salmaan

    2016-01-01

    BACKGROUND: Sedatives and analgesics are administered to provide sedation and manage agitation and pain in most critically ill mechanically ventilated patients. Various sedation administration strategies including protocolized sedation and daily sedation interruption are used to mitigate drug...... of interest include duration of mechanical ventilation, time to first extubation, ICU and hospital length of stay, re-intubation, tracheostomy, mortality, total sedative and opioid exposure, health-related quality of life, and adverse events. To inform our NMA, we will first conduct conventional pair......-wise meta-analyses using random-effects models. Where appropriate, we will perform Bayesian NMA using WinBUGS software. DISCUSSION: There are multiple strategies to optimize sedation for mechanically ventilated patients. Current ICU guidelines recommend protocolized sedation or daily sedation interruption...

  5. Musikterapi til reduktion af agitation hos personer med demens

    DEFF Research Database (Denmark)

    Ridder, Hanne Mette Ochsner; Stige, Brynjulf

    2015-01-01

    Urolig adfærd hos demensramte på plejehjem kan defineres og måles med fagbegrebet agitation. Agitation har alvorlige konsekvenser for de berørte og kan føre til fald i livskvalitet og øget medicinering hos personer med svær demens, og kan ligeledes føre til udbrændthed hos omsorgsgivere. Agitatio...... regarding the single individual. A relevant method in an integrated and holistic approach is professional music therapy combined with other staffs’ use of music in daily dementia care........ The concept agitation is used professionally to define and measure disturbing behaviours in people with severe dementia. The causes are multiple and include factors in the psychosocial environment, which suggests that treatment should be holistic and interdisciplinary and not limited to symptom management...

  6. Activated depression: mixed bipolar disorder or agitated unipolar depression?

    Science.gov (United States)

    Swann, Alan C

    2013-08-01

    The combination of depression and activation presents clinical and diagnostic challenges. It can occur, in either bipolar disorder or major depressive disorder, as increased agitation as a dimension of depression. What is called agitation can consist of expressions of painful inner tension or as disinhibited goal-directed behavior and thought. In bipolar disorder, elements of depression can be combined with those of mania. In this case, the agitation, in addition to increased motor activity and painful inner tension, must include symptoms of mania that are related to goal-directed behavior or manic cognition. These diagnostic considerations are important, as activated depression potentially carries increased behavioral risk, especially for suicidal behavior, and optimal treatments for depressive episodes differ between bipolar disorder and major depressive disorder.

  7. Effect of dexmedetomidine on mechanical pain threshold and emergence agitation after laparoscopic myomectomy

    Institute of Scientific and Technical Information of China (English)

    Tao Qin; Xiao-Mei Liu

    2016-01-01

    Objective:To study the effect of dexmedetomidine on mechanical pain threshold and emergence agitation after laparoscopic myomectomy.Methods:Random number table was used to divide 82 cases of patients who received laparoscopic myomectomy in our hospital from May 2012 to October 2014 into dexmedetomidine group (Dex group) and control group (Con group), and postoperative mechanical pain threshold and emergence agitation extent were assessed.Results: 4 h, 8 h, 12 h and 24 h after operation, mechanical pain threshold of both Dex group and Con group were significantly lower than those before operation (P<0.05) and mechanical pain threshold of Dex group 4 h, 8 h, 12 h and 24 h after operation were significantly higher than those of Con group (P<0.05); both incidence and average grade of emergence agitation of Dex group were significantly lower than those of Con group (P<0.05); serum melatonin content of Dex group in recovery period were not significantly different from those in anesthesia induction period, serum melatonin content of Con group in recovery period were significantly lower than those in anesthesia induction period, and serum melatonin content of Dex group in recovery period were significantly higher than those of Con group (P<0.05); serum cortisol content of both Dex group and Con group in recovery period were significantly higher than those before anesthesia induction and cortisol content of Dex group in recovery period was significantly lower than that of Con group (P<0.05).Conclusions:Dexmedetomidine for laparoscopic myomectomy can reduce postoperative hyperalgesia and prevent emergence agitation, and it has positive clinical value.

  8. Effects of Doxofyline on Intraoperative Pulmonary Function in Patients Undergoing Double Lumen Endotracheal Intubation for One-lung Ventilation%多索茶碱对双腔气管插管单肺通气患者术中肺功能的影响

    Institute of Scientific and Technical Information of China (English)

    王武; 吴绍芳; 潘晓霞; 雷李培

    2016-01-01

    Objective To evaluate the effects of doxofyline on intraoperative pulmonary function in patients receiving double lumen endotracheal intubation for one-lung ventilation. Methods Fifty patients who underwent elective pulmonary lo-bectomy under general anesthesia using double lumen endotracheal intubation were randomly divided into two groups ( n=25 each):control group (group C) and doxofyline group (group D).Doxofyline (4 mg•kg-1) was injected intravenously after double lumen endotracheal intubation in group D,while equal volume of 0.9% sodium chloride was intravenously given in group C.Total intravenous anesthesia with target controlled infusion was performed during the operation.Two milliliter blood samples were taken from the radial artery for blood gas analysis immediately before administration ( t0 ) ,at 30 min ( t1 ) ,60 min ( t2 ) after one-lung ventilation and at the moment of two-lung ventilation after chest closing ( t3 ) . The PaCO2 , PaO2 , peak airway pressure (Ppeak),airway plateau pressure (Pplat),airway resistance (Raw) and lung compliance (Compl) were recorded at t0-3. Results The Ppeak,Pplat and Raw were significantly decreased and the Compl and PaO2 significantly increased at t1-t3 in group D when com-pared with those in group C (P<0.05).The Ppeak,Pplat and Raw were significantly increased and Compl and PaO2 significantly de-creased at t3 as compared with those at t0 in group C ( P<0.05) . Conclusion Doxofyline can improve intraoperative pulmonary function in patients who undergo double lumen endotracheal intubation for one-lung ventilation.%目的:评价多索茶碱对双腔气管插管单肺通气患者术中肺功能的影响。方法择期双腔气管插管全身麻醉下行开胸肺叶切除术患者50例,采用随机数字表法分为对照组( C组)和多索茶碱组( D组)( n=25)。 D组于双腔气管插管后静脉输注多索茶碱4 mg•kg-1;C组静脉输注等量0.9%氯化钠注射液。麻醉维持采用靶控输注全

  9. Sinusitis associated with nasogastric intubation in 3 horses.

    Science.gov (United States)

    Nieto, Jorge E; Yamout, Sawsan; Dechant, Julie E

    2014-06-01

    Sinusitis has not been reported as a complication of long-term nasogastric intubation in horses. We describe 3 horses that developed nosocomial sinusitis following abdominal surgery with associated perioperative nasogastric intubation. Sinusitis was suspected by the presence of malodorous discharge and confirmed by percussion, upper airway endoscopy, radiographs (n = 3), and bacterial culture (n = 1).

  10. Prehospital endotracheal intubation; need for routine cuff pressure measurement?

    NARCIS (Netherlands)

    Peters, J.H.; Hoogerwerf, N.

    2013-01-01

    In endotracheal intubation, a secured airway includes an insufflated cuff distal to the vocal cords. High cuff pressures may lead to major complications occurring after a short period of time. Cuff pressures are not routinely checked after intubation in the prehospital setting, dealing with a vulner

  11. Effect of Budesonide and Parecoxib Sodium Treatment on Relieving Postoperative Sore Throat after Tracheal Intubation of Thoracic Surgery Patients%布地奈德联合帕瑞昔布钠对胸科手术患者术后咽痛的影响∗

    Institute of Scientific and Technical Information of China (English)

    陈丽红; 董良; 黄一丹; 曹健斌; 曾金

    2016-01-01

    Obj ective]To evaluate the effects of inhaling budesonide after extubation and parecoxib inj ection on the prevention and treatment of postoperative sore throat (POST)after tracheal intubation with a double-lumen endobronchial tube in thoracic surgery patients.[Methods]One hundred and sixty patients aged 18~64 scheduled for elective thoracic surgery under general anesthesia were randomly divided into four groups equally with 40 pa-tients each group.Patients in group C received no inhalation treatment.Patients in group B inhaled 1 mg budesonide 30 minutes after extubation,patients in group P received a 40 mg parecoxib injection of sodium 30 minutes before postoperation,and patients in group BP inhaled 1mg budesonide and received a 40 mg parecoxib injection of sodi-um with a double_lumen endobronchial tube.The incidence and VAS score of POST at 1h,6h and 24h in the post-operative period after tracheal extubation were assessed.[Results]There was no statistical significance of patients 'age,sex ratio,height,weight,time of operation,or intubation (P >0.05).The incidence and VAS scores of POST were significantly lower in group B,group P,and group BP than those of group C (P 0.05)。B组、P 组和 BP 组拔管后各时间点咽痛发生率及咽痛 VAS评分明显低于C组(P <0.05),且BP组明显低于 B组和 P 组(P <0.05),各组未见与药物应用相关的明显不良反应。【结论】布地奈德早期雾化吸入联合帕瑞昔布钠静脉注射能够有效降低双腔支气管插管患者POST的发生率并减轻其严重程度,同时提高患者对麻醉复苏期的护理满意度。

  12. INTUBATIONS CONDITIONS AND HOMODYNAMIC RESPONSES UNDER ANESTHESIA INDUCTION WITH THREE COMBINATION DRUGS: ALFENTANIL- MIDAZOLAM, ALFENTANIL- THIOPENTAL AND ALFENTANIL- KETAMINE

    Directory of Open Access Journals (Sweden)

    H SOLTANI NEZHAD

    2000-03-01

    Full Text Available Background. Administration of alfentanil followed by propofol intravenously (IV without neuromuscular blockage for induction of anesthesia provides adaquate conditions for tracheal intubation. Other hypnotic drugs have not been thoroughly investigated in this regard. The aim of the present study was comparison of intubation conditions and hemodynamic responses of anesthesia induction with alfentanil/midazolam, alfentanil/Na thiopental and alfentanil/ ketamine. Methods. In a clinical trial study one hundred and twenty children were randomly allocated to four groups. Medication in these groups were alfentanil 40 µg/kg+ midazolam 200 µg/kg,alfentanil 40 µg/kg+Na thiopental 6 µg/kg, alfentanil 40 µg/kg+ketamin 2 mg/kg & Na thipental 6 mg/kg+suxamethonium 2 mg/kg (as control group. In all patients the ease of ventilation via face mask, jaw mobility, degree of exposure and position of vocal cords, patient's response to tracheal intubation, duration of time was needed for intubation and hemodynamic changes after intubation were assessed and recorded. Findings. There are significant differences between first three groups (interventional groups for jaw mebility, ventilation, vocal cord visuality, vocal cord position, patient movement during laryngoscopy and mean laryngoscopy time, (P < 0.05. There is significant difference between all groups of nesdonal+alfentanil except for patient movement. There is significant difference between mean SBP and PR before and after intubation in first and third group. Conclusion. Results represent that the group of Alfentanil plus Nesdonal had a better quality of ventilation rather than two other groups. It is recommended that administration of alfentanil plus thiopental combination is preferred in cases that using muscle relaxant is contraindicated.

  13. Recurred Post-intubation Tracheal Stenosis Treated with Bronchoscopic Cryotherapy

    Science.gov (United States)

    Jung, Ye-Ryung; Taek Jeong, Joon; Kyu Lee, Myoung; Kim, Sang-Ha; Joong Yong, Suk; Jeong Lee, Seok; Lee, Won-Yeon

    2016-01-01

    Post-intubation tracheal stenosis accounts for the greatest proportion of whole-cause tracheal stenosis. Treatment of post-intubation tracheal stenosis requires a multidisciplinary approach. Surgery or an endoscopic procedure can be used, depending on the type of stenosis. However, the efficacy of cryotherapy in post-intubation tracheal stenosis has not been validated. Here, we report a case of recurring post-intubation tracheal stenosis successfully treated with bronchoscopic cryotherapy that had previously been treated with surgery. In this case, cryotherapy was effective in treating web-like fibrous stenosis, without requiring more surgery. Cryotherapy can be considered as an alternative or primary treatment for post-intubation tracheal stenosis. PMID:27853078

  14. Observation of tracheal intubation teaching%全麻气管插管的教学观察

    Institute of Scientific and Technical Information of China (English)

    陆慧红; 李桂凤; 陈洪飞; 白浪; 姜桢

    2014-01-01

    目的:观察气管插管教学中伴随的问题及术后喉痛及声音嘶哑的发生情况,以期提高气管插管教学的质量。方法:100例全麻手术患者随机分为教学组和医师组,每组50例。记录2组的插管时间、脱氧合发生率和尝试插管次数,并在患者离开麻醉后恢复室时和术后24 h评估患者喉痛和声音嘶哑情况。结果:插管时间、脱氧合发生率和插管次数在教学组均显著高于医师组(P0.05)。结论:气管插管教学会延长插管时间并增加插管次数,同时增加气道损伤的概率。%Objective:To observe the problems in endotracheal intubation teaching and the incidence of postoperative sore throat and hoarseness so as to improve the teaching quality of intubation. Methods:One hundred patients undergoing general anesthesia were randomized into teaching group(n=50) and anesthetist group(n=50). The time length of intubation,incidence of deoxygenation and number of intubating attempts were recorded in both groups. The postoperative sore throat and hoarseness were also assessed when the patients departed from the Postanesthesia care unif and 24 hours after the operation. Results:The time length of intubation,incidence of deoxygenation and number of intubating attempts in the teaching group were significantly higher than those in the anesthetist group( P0. 05). Conclusions:Endotracheal intubation teaching will extend the time length of intubation,increase the number of intubating attempts and increase the risk of airway injuries.

  15. QuantiFERON–TB Gold In-Tube test performance in Denmark

    DEFF Research Database (Denmark)

    Hermansen, Thomas; Lillebaek, Troels; Hansen, Ann-Brit E;

    2014-01-01

    BACKGROUND: Little is known about the QuantiFERON-TB Gold In-Tube Test (QFT) in extreme age groups. The test performance has been reported to be impaired in children and elderly, but reports are diverging. The aim of this study was to evaluate QFT performance in patients with and without Tubercul...... in children ≥ 1 years in low endemic regions but that the test should be used with care among the elderly.......BACKGROUND: Little is known about the QuantiFERON-TB Gold In-Tube Test (QFT) in extreme age groups. The test performance has been reported to be impaired in children and elderly, but reports are diverging. The aim of this study was to evaluate QFT performance in patients with and without...

  16. Application of Bi-level Positive Airway Pressure Ventilation in Elderly Do-not-intubate Patients with Acute Exacerbation Chronic Obstructive Pulmonary Disease and Respiratory Failure%双水平正压通气在拒绝插管的老年慢性阻塞性肺病急性加重呼吸衰竭病人的应用

    Institute of Scientific and Technical Information of China (English)

    王长捷

    2012-01-01

    Objective To determine the effect of bi- level positive airway pressure ventilation (Bi- PAP) in elderly do- not- intubate patients with acute exacerbation chronic obstructive pulmonary disease (AECOPD) and respiratory failure. Methods 65 elderly patients who were admitted to intensive care unit from September 2006 to December 2010 with acute exacerbation chronic obstructive pulmonary disease (AECOPD) and respiratory failure were randomly divided into 2 groups standard group (re =32) and Bi-PAP group (re =33) . The changes of consciousness, physiological parameters, hospital mortality and adverse events in patients were compared between the two groups. Results The baseline characters of patients were similar in both the Bi- PAP and standard therapy groups. After 2 hour of treatment, GCS scores of patients in Bi-PAP group (P<0.01) and median (5th-95th percentile) PaO2/FIO2 ratios were significantly higher [182 (77-384) vs 165 (70-358), P<0.0l] , and PaCO2 was lower than standard group [55 (31~86) mmHg vs 82 (47 - 107) mmHg, P<0.0l]. Treatment with Bi-PAP successfully reduced the hospital mortality [11 (33%) vs 24 (75%), P< 0.01]. It looked similar with adverse events occurred both Bi-PAP and standard treatment. Conclusion For elderly do-not-intubate patients with AECOPD and respiratory failure, treatment with Bi- PAP not only can improve the patient's physiological parameters, but also improve the patient's outcomes.%目的 观察双水平正压通气(Bi-PAP)在拒绝插管(Do-not-intubate)的老年慢件阻塞性肺病急性加重(AECOPD)呼吸衰竭病人的疗效.方法 2006年9月至2010年12月65名入住重症监护病房的老年慢性阻塞性肺病急性加重呼吸衰竭病人纳入研究.将病人随机分为普通治疗组(n=32)和Bi-PAP(n=33)组.比较2组病人研究期间的意识变化、生理学参数的变化、院内死亡率及不良事件发生率.结果 老年慢性阻塞性肺病急性加重呼吸衰竭无创通气组与普通治疗

  17. 三种护理方法对经口气管插管患者口腔护理效果的对比研究%Comparative study on efficacy of the three methods of nursing for oral cavities of patients with orotracheal intubation

    Institute of Scientific and Technical Information of China (English)

    刘春香; 祝立阳; 黎冬梅; 莫伟梅; 林琦; 韦涌初; 能靖

    2013-01-01

    Objective To study the most effective method for oral care for patients with orotracheal intubation. Method 90 patients with orotracheal intubation and hospitalized in department of cardiac and chest surgery form March 2008 to May 2011 were randomly divided into group A,group B and group C,30 patients in each group. The patients' oral cavities in group A were washed with cotton balls soaked by 3% hydrogen peroxide solution and rinsed with normal saline;Patients in group B were rinsed with normal saline; and patients in group C were washed with cotton balls soaked by normal saline. The oral care was conducted twice daily. The bacterial number in pharyngo oral cavities, the pH values and clean degree of oral cavities and the incidence of stomatitis were observed and compared among the three methods. Result After oral care with the three methods,The bacterial number in all the three groups decreased. The decrease in the bacterial number in group A was more significant than that of in group B and that in group C. There was no significant difference in incidence of oral filth and stomatitis, there was significant difference in incidence of halitosis (P<0. 05). The incidence of halitosis in group A was lowest. The endotracheal tubes shift, fall off or mistake suction was not found among the three groups. Conclusion Patients' oral cavities washing with cotton balls soaked by 3 % hydrogen peroxide solution and rinsing with normal saline can more effectively clear away the oral filth and decrease the bacterial adhesion and growth in the pharyngo-oral cavities . This method can more effectively prevent the infectious complication for patients with orotracheal intubation. It's the best and effective methods out of the three reported method.%目的 探讨经口气管插管患者最佳的口腔护理方法.方法 将2008年3月~2011年5月在我院心胸外科住院、符合入组条件的90例患者随机分为A、B、C三组,每组各30例.A组患者口腔用3%过氧化

  18. What underlies waves of agitation in starling flocks

    NARCIS (Netherlands)

    Hemelrijk, Charlotte K.; van Zuidam, Lars; Hildenbrandt, Hanno

    2015-01-01

    Fast transfer of information in groups can have survival value. An example is the so-called wave of agitation observed in groups of animals of several taxa under attack. It has been shown to reduce predator success. It usually involves the repetition of a manoeuvre throughout the group, transmitting

  19. A COMPARATIVE CLINICAL STUDY BETWEEN IV ESMOLOL AND IV FENTANYL ON ATTENUATION OF HAEMODYNAMIC RESPONSES TO LARYNGOSCOPY AND INTUBATION

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    Abu Lais Mustaque

    2016-04-01

    Full Text Available INTRODUCTION Laryngoscopy and intubation is an integral part for providing general anaesthesia to patients undergoing various types of surgery. It also plays an important role in critical care units viz. for providing mechanical ventilation. It is a very essential tool in the hands of anaesthesiologist in maintaining airway. The present study is undertaken to determine and compare the efficacy of single bolus dose of IV esmolol 1 mg/kg and IV fentanyl 2 mcg/kg in attenuating the haemodynamic responses to laryngoscopy and tracheal intubation and to ascertain the effectiveness of esmolol hydrochloride and fentanyl citrate in suppressing sympathetic responses. MATERIAL & METHODS The study was conducted under the Department of Anaesthesiology and Critical Care, Assam Medical College and Hospital, Dibrugarh, during the period July 2013 to June 2014. For this purpose, 150 patients of either sex between 20-50 years of ASA I & II physical status were selected after obtaining informed and written consent and were divided into two groups namely, Group E receiving IV esmolol (1 mg/kg and Group F receiving IV fentanyl (2 mcg/kg. RESULTS Inj. fentanyl 2 mcg/kg IV administered 5 minutes before laryngoscopy and intubation was able to prevent adverse haemodynamic changes better than Inj. esmolol 1 mg/kg IV administered 3 minutes prior to laryngoscopy and intubation during elective surgeries under general anaesthesia. CONCLUSION Hence, from the findings of this study we can conclude that IV bolus dose of fentanyl 2 mcg/kg administered 5 minutes before laryngoscopy and intubation can attenuate the sympathetic response to laryngoscopy and intubation without any side effects of the drug in healthy patients undergoing elective surgeries under general anaesthesia.

  20. Use of Adult Fibreoptic Bronchoscope for Difficult Paediatric Intubation: A Case Report

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    Kundan Sandugir Gosavi

    2015-06-01

    Full Text Available Difficult airway management in paediatric patients may require a technique different from the standard one. We report the use of an adult fibreoptic bronchoscope and J tipped guidewire to intubate a child having temporo-mandibular joint ankylosis. Spontaneous respiration was maintained and local anaesthesia was provided to the upper airway during the procedure and the successful use of this technique avoided the requirement of surgical airway.

  1. Tunge- og stemmebåndsparese efter endotrakeal intubation for Legionella-pneumoni

    DEFF Research Database (Denmark)

    Sønnichsen, Rikke; Lauritsen, Anne Oberg

    2013-01-01

    Extracranial involvement of the hypoglossal nerve and recurrent laryngeal branch of the vagal nerve can be a complication of anaesthetic airway management (Tapia's syndrome) or focal involvement due to Legionella infection. We present a patient with bilateral hypoglossal and unilateral recurrent...... laryngeal nerves palsy after a complicated intubation and a Legionella infection. Clarithromycin therapy was started. Within months, tongue mobility and swallowing gradually improved. Two months after discharge persisting unilateral recurrent nerve palsy was observed....

  2. Aberrant right subclavian artery-esophageal fistula: massive upper gastrointestinal hemorrhage secondary to prolonged intubation

    OpenAIRE

    Elsa Oliveira; Margarida Anastácio; Anabela Marques

    2016-01-01

    ABSTRACT Aberrant right subclavian artery-esophageal fistula is a rare but potentially fatal complication. It may be associated with procedures, such as tracheostomy and tracheal or esophageal intubation, and yields massive upper gastrointestinal bleeding difficult to identify and to control. A high index of suspicion is essential for early diagnosis and better prognosis. We report a rare case of a patient who survived after emergent surgical procedure for massive upper gastrointestinal bleed...

  3. Jaw lift causes less laryngeal interference during lightwand-guided intubation than combined jaw and tongue traction applied by single operator

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    Umesh Goneppanavar

    2011-01-01

    Full Text Available Lightwand-guided intubation is a semi-blind technique that takes advantage of the anterior location of the trachea in relation to the oesophagus. Fibreoptic evaluation of lightwand-guided intubation has revealed a possibility of laryngeal interference and epiglottic distortion. Jaw lift, tongue traction or a combination of both have been used to assist in lightwand-guided intubation. This study fibreoptically evaluates lightwand-guided intubation using jaw lift and combined jaw and tongue traction. Eighty four patients with normal airway undergoing general anaesthesia were studied. This randomised, double blinded, cross over study was done in two phases. First phase - after achieving adequate depth of anaesthesia, a fibrescope was advanced nasally, and lightwand-guided intubation was carried out under direct fibreoptic visualisation with the aid of either jaw lift or combined jaw and tongue traction. Second phase - Extubation followed by reintubation using the other manoeuvre. Interference with laryngeal structures during intubation and position of the epiglottis at the end of intubation were noted. Epiglottic distortion (deviated to one side/infolded into trachea was observed in 6 patients with jaw lift and 17 patients with combined jaw and tongue traction (P=0.003. Laryngeal interference was significantly higher (P=0.012 with combined manoeuvre (30/78 than with jaw lift alone (9/81. Although lightwand-guided intubation can be performed quickly and easily, interference with laryngeal structures and distortion of the epiglottis can occur. Jaw lift manoeuvre causes less laryngeal interference than combined jaw and tongue traction applied by a single operator.

  4. Submandibular intubation as an alternative for intra-operative airway management in maxillofacial fractures - our institutional experience

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    Praveer K Banerjee

    2016-01-01

    Full Text Available Background and Aims: Airway management in anaesthesia for maxillofacial surgical procedures is tricky at times when the nasal/oral routes are contraindicated or are impossible. Tracheostomy as an alternative inherits its own complications. We present a case series of the submandibular route for tracheal intubation as an alternative. Methods: The procedure was performed in ten selected adult patients with maxillofacial/mandibular fractures associated with a fracture of skull base or nasal bone. All of them were medically stable with no need of intensive care or mechanical ventilation in post-operative period. Results: Submandibular intubation in all ten patients of panfacial fractures allowed uninterrupted surgical techniques with a secured airway. All patients were reverted to oro-tracheal tube at the end of surgery as immediate maxillomandibular fixation was not necessary. The patients were extubated after recovery from anaesthesia before they left the operating theatre. One patient in the post-operative period had a superficial infection of incision site that responded well to local treatment. No other complications were encountered in the intra-operative or post-operative period. Conclusion: In complex maxillofacial injuries, when oral or nasal intubation hampers surgeon′s field of view, submandibular intubation offers an effective alternative to short-term tracheostomy along with small risk potential. There is a need to emphasise its regular application in such cases so that technique can be mastered by both surgeons and anaesthesiologist.

  5. Submandibular intubation as an alternative for intra-operative airway management in maxillofacial fractures - our institutional experience

    Science.gov (United States)

    Banerjee, Praveer K; Jain, Abhineet; Behera, Bikram

    2016-01-01

    Background and Aims: Airway management in anaesthesia for maxillofacial surgical procedures is tricky at times when the nasal/oral routes are contraindicated or are impossible. Tracheostomy as an alternative inherits its own complications. We present a case series of the submandibular route for tracheal intubation as an alternative. Methods: The procedure was performed in ten selected adult patients with maxillofacial/mandibular fractures associated with a fracture of skull base or nasal bone. All of them were medically stable with no need of intensive care or mechanical ventilation in post-operative period. Results: Submandibular intubation in all ten patients of panfacial fractures allowed uninterrupted surgical techniques with a secured airway. All patients were reverted to oro-tracheal tube at the end of surgery as immediate maxillomandibular fixation was not necessary. The patients were extubated after recovery from anaesthesia before they left the operating theatre. One patient in the post-operative period had a superficial infection of incision site that responded well to local treatment. No other complications were encountered in the intra-operative or post-operative period. Conclusion: In complex maxillofacial injuries, when oral or nasal intubation hampers surgeon's field of view, submandibular intubation offers an effective alternative to short-term tracheostomy along with small risk potential. There is a need to emphasise its regular application in such cases so that technique can be mastered by both surgeons and anaesthesiologist. PMID:27601740

  6. Validation of modified Mallampati test with addition of thyromental distance and sternomental distance to predict difficult endotracheal intubation in adults

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    Bhavdip Patel

    2014-01-01

    Full Text Available Background and Aims: Intubation is often a challenge for anaesthesiologists. Many parameters assist to predict difficult intubation. The present study was undertaken to assess the validity of different parameters in predicting difficult intubation for general anaesthesia (GA in adults and effect of combining the parameters on the validity. Methods: The anaesthesiologist assessed oropharynx of 135 adult patients. Modified Mallampati test (MMT was used and the thyromental distance (TMD and sternomental distances (SMD for each of the patients were also measured. The Cormack and Lehane laryngoscopic grading was assessed following laryngoscopy. The validity parameters such as sensitivity, specificity, false positive and negatives values, positive and negative predictive values were calculated. The effect of combining different measurements on the validity was also studied. Univariate analysis was performed using the parametric method. Results: The study group comprised of 135 patients. The sensitivity and specificity of MMT were 28.6% and 93%, respectively. The TMD (<6.5 CM had sensitivity and specificity of 100% and 75.8%, respectively. The SMD (<12.5 CM had sensitivity and specificity of 91% and 92.7%, respectively. Combination of MMT grading and TMD and SMD measurements increased the validity (sensitivity of 100% and specificity of 92.7%. Conclusion: MMT had high specificity. The validity of combination of MMT, SMD and TMD as compared to MMT alone was very high in predicting difficult intubation in adult patients. All parameters should be used in assessing an adult patient for surgery under GA.

  7. Wire-guided (Seldinger technique) intubation through a face mask in urgent, difficult and grossly distorted airways.

    Science.gov (United States)

    Heier, Jake M; Schroeder, Kristopher M; Galgon, Richard E; Arndt, George A

    2012-07-01

    We report two cases of successful urgent intubation using a Seldinger technique for airway management through an anesthesia facemask, while maintaining ventilation in patients with difficult airways and grossly distorted airway anatomy. In both cases, conventional airway management techniques were predicted to be difficult or impossible, and a high likelihood for a surgical airway was present. This technique was chosen as it allows tracheal tube placement through the nares during spontaneous ventilation with the airway stented open and oxygen delivery with either continuous positive airway pressure and/or pressure support ventilation. This unhurried technique may allow intubation when other techniques are unsuitable, while maintaining control of the airway.

  8. Direct Laryngoscopy and Endotracheal Intubation Complicated by Anterior Tracheal Laceration Secondary to Protrusion of Preloaded Endotracheal Tube Stylet.

    Science.gov (United States)

    Warner, Matthew A; Fox, Jonathan F

    2016-02-15

    Tracheal wall disruption is a rare complication of endotracheal intubation, typically occurring in the posterior (membranous) trachea lacking cartilaginous support. We present the case of a 68-year-old man who developed an anterior tracheal tear after routine endotracheal intubation, most likely occurring secondary to protrusion of a factory-preloaded stylet beyond the distal orifice of the endotracheal tube. Tracheal disruption should be considered in any patient with subcutaneous emphysema and respiratory distress after tracheal extubation and confirmed with bronchoscopy. Conservative management may be appropriate for those with small tears, hemodynamic stability, and the ability to isolate the tear from positive pressure ventilation.

  9. Wire-guided (Seldinger technique intubation through a face mask in urgent, difficult and grossly distorted airways

    Directory of Open Access Journals (Sweden)

    Jake M Heier

    2012-01-01

    Full Text Available We report two cases of successful urgent intubation using a Seldinger technique for airway management through an anesthesia facemask, while maintaining ventilation in patients with difficult airways and grossly distorted airway anatomy. In both cases, conventional airway management techniques were predicted to be difficult or impossible, and a high likelihood for a surgical airway was present. This technique was chosen as it allows tracheal tube placement through the nares during spontaneous ventilation with the airway stented open and oxygen delivery with either continuous positive airway pressure and/or pressure support ventilation. This unhurried technique may allow intubation when other techniques are unsuitable, while maintaining control of the airway.