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Sample records for agitated intubated patients

  1. 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 H...

  2. Monoamine oxidase and agitation in psychiatric patients.

    Science.gov (United States)

    Nikolac Perkovic, Matea; Svob Strac, Dubravka; Nedic Erjavec, Gordana; Uzun, Suzana; Podobnik, Josip; Kozumplik, Oliver; Vlatkovic, Suzana; Pivac, Nela

    2016-08-01

    Subjects with schizophrenia or conduct disorder display a lifelong pattern of antisocial, aggressive and violent behavior and agitation. Monoamine oxidase (MAO) is an enzyme involved in the degradation of various monoamine neurotransmitters and neuromodulators and therefore has a role in various psychiatric and neurodegenerative disorders and pathological behaviors. Platelet MAO-B activity has been associated with psychopathy- and aggression-related personality traits, while variants of the MAOA and MAOB genes have been associated with diverse clinical phenotypes, including aggressiveness, antisocial problems and violent delinquency. The aim of the study was to evaluate the association of platelet MAO-B activity, MAOB rs1799836 polymorphism and MAOA uVNTR polymorphism with severe agitation in 363 subjects with schizophrenia and conduct disorder. The results demonstrated significant association of severe agitation and smoking, but not diagnosis or age, with platelet MAO-B activity. Higher platelet MAO-B activity was found in subjects with severe agitation compared to non-agitated subjects. Platelet MAO-B activity was not associated with MAOB rs1799836 polymorphism. These results suggested the association between increased platelet MAO-B activity and severe agitation. No significant association was found between severe agitation and MAOA uVNTR or MAOB rs1799836 polymorphism, revealing that these individual polymorphisms in MAO genes are not related to severe agitation in subjects with schizophrenia and conduct disorder. As our study included 363 homogenous Caucasian male subjects, our data showing this negative genetic association will be a useful addition to future meta-analyses. PMID:26851573

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

    OpenAIRE

    Pratik Tantia; Sunny Malik; Shahin Jamil; Rajiv Samal

    2011-01-01

    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 attempte...

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

    OpenAIRE

    Payal Kajekar; Cyprian Mendonca; Rati Danha; Carl Hillermann

    2014-01-01

    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), to...

  5. Pain and Agitation Management in Critically Ill Patients.

    Science.gov (United States)

    Stephens, Julie; Wright, Michael

    2016-03-01

    Pain and agitation may be difficult to assess in a critically ill patient. Pain is best assessed by self-reporting pain scales; but in patients who are unable to communicate, behavioral pain scales seem to have benefit. Patients' sedation level should be assessed each shift and preferably by a validated ICU tool, such as the RASS or SAS scale. Pain is most appropriately treated with the use of opiates, and careful consideration should be given to the pharmacokinetic and pharmacodynamic properties of various analgesics to determine the optimal agent for each individual patient. Sedation levels should preferably remain light or with the use of a daily awakening trial. Preferred treatment of agitation is analgosedation with the addition of nonbenzodiazepine sedatives if necessary. There are risks associated with each agent used in the treatment of pain and agitation, and it is important to monitor patients for effectiveness, signs of toxicity, and adverse drug reactions. PMID:26897427

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

    Directory of Open Access Journals (Sweden)

    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.

  7. 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

  8. Efficacy and complications of submental tracheal intubation compared with tracheostomy in maxillofacial trauma patients.

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    Kita, Ryosuke; Kikuta, Toshihiro; Takahashi, Masahiro; Ootani, Taishi; Takaoka, Masao; Matsuda, Michitaka; Tsurushima, Hiroki; Yoshioka, Izumi

    2016-01-01

    Submental tracheal intubation is a technique for use in patients with maxillofacial trauma. The purpose of this retrospective study was to evaluate the efficacy and complications of this technique compared with tracheostomy. Twenty-five patients underwent submental tracheal intubation since 2001. Submental tracheal intubation was performed in cases needing intermaxillary fixation complicated by a nasal pyramid or anterior skull base fracture. No severe perioperative or long-term complications were noted. Intra- and postoperative complications were observed in three patients. In one case, the tube was accidentally dislodged into the right main bronchus during submental tracheal intubation. Two patients developed skin infections. Submental scarring was undetectable, except for one patient with slight scarring. Submental tracheal intubation avoids the complications associated with tracheostomy and the difficulty of nasal intubation during intubation and surgery. Therefore, submental tracheal intubation is useful in the intraoperative management of patients with complex maxillofacial trauma. (J Oral Sci 58, 23-28, 2016). PMID:27021536

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

    LENUS (Irish Health Repository)

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

  12. 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 patients...

  13. 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.

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

    Science.gov (United States)

    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.

  15. 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.

  16. Assesment of Macintosh Laryngoscope and Truview EVO2 Video-laryngoscope With Respect to Hemodynamic and Intubation Quality in Patients With Presumptive Difficult Intubation

    OpenAIRE

    ÇAĞLAR TORUN, Aysun; TÜR, Ayla; Özkan, Fatih; KELSAKA, Ebru; Karakaya, Deniz; Sarihasan, Binnur; TORTOP, Emişe

    2011-01-01

    ABSTRACT This study aims to compare Macintosh laryngoscope and Truview EVO2 video- laryngoscope with respect to the quality of glottic image, the success rate of intubation and their impact on the duration of intubation, hemodynamic responses and also related complications in patients with expected difficult intubation according to the Mallampati scoring system. Sixty patients in ASA I-II group ranging from 18-65 years of age were included in the study. Patients were randomly divided into ...

  17. 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

  18. TotalTrack video intubating laryngeal mask in super-obese patients – series of cases

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    Gaszynski T

    2016-03-01

    Full Text Available Tomasz Gaszynski Department of Emergency and Disaster Medicine, Medical University of Lodz, Lodz, Poland Background: Super-obese patients are at increased risk of difficult mask ventilation and difficult intubation. Therefore, devices that allow for simultaneous ventilation/oxygenation during attempts to visualize the entrance to the larynx, increase patient safety. TotalTrack video intubating laryngeal mask is a new device that allows for ventilation during intubation efforts. Patients and methods: Twenty-four super-obese patients (body mass index >50 kg/m2 were divided into two subgroups: intubation efforts using 1 TotalTrack and 2 Macintosh blade standard laryngoscope in induction of general anesthesia. Visualization and successful intubation was evaluated for both groups with ventilation and post-mask complications additionally evaluated for TotalTrack. Results: In all cases in the TotalTrack group, the Cormack-Lehane score was 1, ventilation and intubation was successful in 11/12 patients. No hypoxia during intubation efforts was recorded. No serious complications of use of TotalTrack were observed. In the Macintosh blade laryngoscope group, all patients were intubated, but the Cormack-Lehane score was 2 in four cases, and 3 in three cases. Conclusion: TotalTrack video intubating laryngeal mask is a device that allows for better visualization of the larynx compared to the standard Macintosh blade laryngoscope, it provides effective ventilation/oxygenation and intubation in super-obese patients. Keywords: super-obese, intubation, ventilation, laryngeal mask, standard laryngoscope, video laryngoscope 

  19. [Prostaglandin E1 (PGE1) prevents the pressure responses to tracheal intubation in hypertensive patients].

    Science.gov (United States)

    Kito, T; Otagiri, T; Ina, H; Harashima, N; Sakaki, J

    1991-11-01

    Forty-five hypertensive patients for elective abdominal surgery were investigated regarding the effects of PGE1 on the cardiovascular responses to tracheal intubation. Administration of PGE1 at the dose of 0.10 or 0.20 micrograms.kg-1.min-1 for 10 minutes before tracheal intubation significantly reduced the blood pressure responses immediately after the intubation and 2 minutes later. The increases in heart rate were not altered with and without the administration of PGE1. So the increases in rate pressure products were markedly reduced with PGE1 compared with the control values. Plasma concentration of catecholamines was measured before and after tracheal intubation. Norepinephrine was elevated markedly immediately after the intubation and this change was not affected by the infusion of PGE1. These results demonstrate that PGE1 ameliorates the pressure responses by the release of norepinephrine and thus reduces the increases in rate pressure products immediately after tracheal intubation. PMID:1766115

  20. 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.

  1. 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

  2. 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 ...... laryngoscope (DL) in a group of morbidly obese patients....

  3. 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

  4. 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.

  5. Expired CO2 Measurement in Intubated or Spontaneously Breathing Patients from the Emergency Department

    OpenAIRE

    Verschuren, Franck; Kabayadondo, Maidei Gugu; Thys, Frédéric

    2011-01-01

    Carbon dioxide (CO2) along with oxygen (O2) share the role of being the most important gases in the human body. The measuring of expired CO2 at the mouth has solicited growing clinical interest among physicians in the emergency department for various indications: (1) surveillance et monitoring of the intubated patient; (2) verification of the correct positioning of an endotracheal tube; (3) monitoring of a patient in cardiac arrest; (4) achieving normocapnia in intubated head trauma patients;...

  6. 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.

  7. Influence of GlideScope assisted endotracheal intubation on intraocular pressure in ophthalmic patients

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    Nauman Ahmad

    2015-01-01

    Full Text Available Background: Traditional Macintoch laryngoscopy is known to cause a rise in intraocular pressure (IOP, tachycardia and hypertension. These changes are not desirable in patients with glaucoma and open globe injury. GlideScope is a video laryngoscope that functions independent of the line of sight, reduces upward lifting forces for glottic exposure and requires less cervical neck movement for intubation, making it less stimulating than Macintosh laryngoscopy. Aim: The aim was to assess the variations in IOP and hemodynamic changes after GlideScope assisted intubation. Materials and Methods: After approval of the local Institutional Research and Ethical Board and informed patient consent, 50 adult American Society of Anesthesiologist I and II patients with normal IOP were enrolled in a prospective, randomized study for ophthalmic surgery requiring tracheal intubation. In all patients, trachea was intubated using either GlideScope or Macintoch laryngoscope. IOP of nonoperated eye, heart rate and blood pressure were measured as baseline, 1 min after induction, 1 min and 5 min after tracheal intubation. Results: IOP was not significantly different between groups before and after anesthetic induction and 5 min after tracheal intubation (P = 0.217, 0.726, and 0.110 respectively. The only significant difference in IOP was at 1 min after intubation (P = 0.041. No significant difference noted between groups in mean arterial pressure (P = 0.899, 0.62, 0.47, 0.82 respectively and heart rate (P = 0.21, 0.72, 0.07, 0.29, respectively at all measurements. Conclusion: GlideScope assisted tracheal intubation shown lesser rise in IOP at 1 min after intubation in comparison to Macintoch laryngoscope, suggesting that GlideScope may be preferable to Macintosh laryngoscope.

  8. 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.

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

    Directory of Open Access Journals (Sweden)

    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

  10. 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.

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

    OpenAIRE

    Lakshmanappa, Suresh; Suryanarayana, Venkatesh G; Alore, Ashley; Sathees B. Chandra

    2012-01-01

    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 fe...

  12. 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

  13. 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

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

    Science.gov (United States)

    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…

  15. Risk factors for endotracheal intubation and mechanical ventilation in patients with opioids intoxication

    International Nuclear Information System (INIS)

    Objectives: Patients poisoned with opioids sometimes need endotracheal intubation with or without the use of mechanical ventilation. This study was done to determine the prognostic risk factors for of the need for endotracheal intubation and mechanical ventilation. Methodology: In this cross-sectional study which was performed in Isfahan (Iran), one hundred (n=100) opioid poisoned patients whom their overdoses were diagnosed by their full and reliable history, physical examination and positive response to naloxone; vital signs at the hospital admission, blood biochemistry, ABG details and also the type and estimated dosage of opioid, route of consumption, and their need to mechanical ventilation were evaluated. Results: Patients were mostly aged between 20-40 years old. Seventy nine patients were male and 26 cases (21 men) required endotracheal intubation and 15 cases (14 men) needed both intubation and mechanical ventilation. The most consumed opiates among the poisoned patients were opium (35%), heroin (16%), Tramadol (15%), Methadone (9%), crack (6%), Diphenoxylate (4%) and others (15%). There was a significant difference between the mean heart rates and respiratory rate of the patients who were connected to the ventilator and others (99.8 +- 21.8 and 87.3 +- 16.3; p=0.01). The lower level of consciousness [OR: 2.2 95% Confidence Interval (CI): 1.2-4.2], and lower admission level of hemoglobin (OR: 3.6; CI:1.2-10.8) were among the factors for predicting the need for intubation and ventilation. Conclusion: Determining the risk factors with prognostic value for the need to intubation or ventilation seems to be necessary for improving the standard of therapy in opioids poisoned patients. (author)

  16. 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 capno...

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

    Directory of Open Access Journals (Sweden)

    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.

  18. 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

  19. Airway Management in a Patient with Severe Ankylosing Spondylitis Causing Bamboo Spine: Use of Aintree Intubation Catheter.

    Science.gov (United States)

    Ul Haq, Muhammad Irfan; Shamim, Faisal; Lal, Shankar; Shafiq, Faraz

    2015-12-01

    Management of a case of ankylosing spondylitis can be very challenging as the airway and the central neuraxial blockade are extremely difficult to handle. Fiberoptic intubation may lead to predictable success in the face of difficult airway. We are presenting a new technique of fiberoptic intubation in a young patient, suffering from severe ankylosing spondylitis, came for total hip replacement surgery. There was anticipated difficult airway due to severe limitation in neck movement and it was successfully managed by using Aintree Intubation Catheter (AIC) with intubating fiberoptic bronchoscope. PMID:26691367

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

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    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.

  1. Capnography for monitoring non-intubated spontaneously breathing patients in an emergency room setting.

    OpenAIRE

    Egleston, C. V.; Ben Aslam, H; Lambert, M A

    1997-01-01

    OBJECTIVE: To examine the feasibility of using expiratory capnography as an indicator of airway obstruction in non-intubated resuscitation room patients. METHODS: Patients with potential respiratory compromise admitted to the resuscitation room were assessed for widespread expiratory wheeze. This was taken as clinical evidence of airways obstruction. Expiratory capnograms of these patients and patients who had no wheeze were obtained. The traces were analysed for basic morphology and where ap...

  2. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

  4. 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

  5. "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.

  6. Intravenous lidocaine as a suppressant of coughing during tracheal intubation in elderly patients.

    Science.gov (United States)

    Yukioka, H; Hayashi, M; Terai, T; Fujimori, M

    1993-08-01

    The effects of intravenously administered lidocaine on cough suppression in elderly patients over the age of 60 yr during tracheal intubation under general anesthesia were evaluated in two studies. In the first study, 100 patients received a placebo of either 0.5, 1.0, 1.5, or 2.0 mg/kg lidocaine intravenously 1 min before tracheal intubation. All visible coughs were classified as coughing. The incidence of coughing decreased as the dose of lidocaine increased. A dose of 1.5 mg/kg or more of intravenous lidocaine suppressed the cough reflex significantly (P cough during tracheal intubation were used as in Study 1. The incidence of coughing decreased significantly (P cough reflex was almost entirely suppressed by plasma concentrations of lidocaine in excess of 4 micrograms/mL. The results suggest that intravenous administration of lidocaine is effective in suppressing the cough reflex during tracheal intubation in elderly patients under general anesthesia, but that relatively high plasma concentrations of lidocaine may be required for suppression of coughing. PMID:8346830

  7. A naturalistic comparison of the efficacy and safety of intramuscular olanzapine and intramuscular levomepromazine in agitated elderly patients with schizophrenia

    OpenAIRE

    Suzuki H; Gen K

    2013-01-01

    Hidenobu Suzuki,1 Keishi Gen2 1Department of Psychiatry, Suzuki Clinic, Tokyo, Japan; 2Department of Psychiatry, Seimo Hospital, Gunma, Japan Background: There have not been any reports in Japan clarifying the efficacy and safety of intramuscular (IM) olanzapine and IM levomepromazine in agitated elderly patients with schizophrenia. This study was a comparative investigation of the clinical efficacy and safety of IM olanzapine and IM levomepromazine in agitated elderly patients with schizoph...

  8. 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...

  9. A novel approach to manage patients with compromised airway. Videoscopic assisted retromolar intubation.

    Science.gov (United States)

    Boker, Abdulaziz M

    2013-03-01

    Aids to difficult airway management are essential for safe practice of anesthesia particularly for high-risk patients. This case series described a novel approach of combined use of complementing tools (videolaryngeoscopic assisted retromolar intubation) to enhance airway management of a subset of various high-risk patients with extremely difficult airway. It also addressed the rational for the combination of such approaches as well as the advantages and disadvantages of this technique. In all of the 4 patients, the use of the combined approach resulted in a successful intubation without the need for surgical airway. This technique showed many advantages making it possible to use in cases with life threatening airway obstruction. PMID:23475097

  10. 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.

  11. 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.

  12. Identification of Legionella Pneumophila in Intubated Patients With TaqMan Real Time PCR

    Science.gov (United States)

    Divan Khosroshahi, Nader; Naserpour Farivar, Taghi; Johari, Pouran

    2015-01-01

    Background: Legionellaceae contains Legionella genus with over 52 species and 64 serogroups. It is one of the most important causes of respiratory disease in human. More than 30% of hospital-acquired pneumonia is caused by Legionella. Ventilator-associated pneumonia (VAP) is an infection acquired in hospital wards, particularly in intensive care unit (ICU). This disease approximately affects 9% to 20% of intubated patients. Mortality in these patients varies between 8% and 76%. Legionella is one of the important factors for infection in intubated patients. Objectives: The present study was aimed to investigate the use of molecular methods in diagnosis of infection caused by Legionella pneumophila. Materials and Methods: In this study, 109 samples of lung secretions collected from intubated patients admitted to ICU wards of four university hospitals in a three-month period were examined. Cultivation and Real time Polymerase Chain Reaction (PCR) methods were used to assess L. pneumophila colonization in these samples. Results: Eleven samples had positive results using real time PCR analysis of 16s rRNA gene fragments specific for L. pneumophila, but according to culture method on specific buffered charcoal-yeast extract medium (BCYE), no positive cases were detected. Of the total positive cases, six were males, one female and four infants. The seven adults aged 40-65 years. Conclusions: Using molecular methods in diagnosis of infection caused by L. pneumophila has a great value because of its high specificity and rapid diagnosis potency. PMID:25834717

  13. [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.

  14. [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.

  15. 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...

  16. Awake nasotracheal fiberoptic intubation and self-positioning followed by anesthesia induction in prone patients: A pilot observational study.

    Science.gov (United States)

    Heng, Lei; Wang, Ming-Yu; Sun, Hou-Liang; Zhu, Shan-Shan

    2016-08-01

    Anesthesia followed by placement in the prone position takes time and may result in complications. This study aimed to evaluate the feasibility of awake nasotracheal fiberoptic intubation and self-positioning followed by anesthesia induction in prone-positioned patients under general anesthesia.Sixty-two patients (ASA physical status I-II) scheduled for awake nasotracheal fiberoptic intubation and prone self-positioning before surgery under general anesthesia were selected. Patient preparation began with detailed preoperative counseling regarding the procedure. Premedication with sedative and antisialagogue was followed by airway anesthesia with topical lidocaine; then, awake nasotracheal fiberoptic intubation was carried out. The patients then positioned themselves comfortably before induction of general anesthesia. The changes in systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), incidence of coughing or gagging, and rate pressure product (RPP) were assessed. Statistical analysis was performed with repeated-measures one-way analysis of variance.Fifty-eight of the 62 patients completed prone self-positioning smoothly. Compared with values before intubation, SBP, DBP, HR, and RPP were slightly increased after intubation, although the difference was not statistically significant (P > 0.05). One patient had moderate coughing and 1 patient had gagging during prone self-positioning, which were tolerable.These findings indicated that awake nasotracheal fiberoptic intubation and self-positioning followed by induction of anesthesia is safe and feasible alternative to routine prone positioning after induction of general anesthesia. PMID:27512858

  17. 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.

  18. Failed endotracheal intubation

    Directory of Open Access Journals (Sweden)

    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.

  19. [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.

  20. Post intubation tracheal stenosis

    OpenAIRE

    De, Sajal; De, Sarmishtha

    2008-01-01

    Tracheal stenosis following prolonged intubation is a relatively rare but a serious problem. However, some degree of airway injury is common following intubation, no matter whether it is prolonged or of short duration. Here, we are reporting a fifty six year old male patient who developed multiple web like tracheal stenosis following intubation with high volume low pressure cuff endotracheal tube. Subsequently, the stenosis was successfully dilated by balloon bronchoplasty.

  1. [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.

  2. Associations Between Prolonged Intubation and Developing Post-extubation Dysphagia and Aspiration Pneumonia in Non-neurologic Critically Ill Patients

    OpenAIRE

    Kim, Min Jung; Park, Yun Hee; Park, Young Sook; Song, You Hong

    2015-01-01

    Objective To identify the associations between the duration of endotracheal intubation and developing post-extubational supraglottic and infraglottic aspiration (PEA) and subsequent aspiration pneumonia. Methods This was a retrospective observational study from January 2009 to November 2014 of all adult patients who had non-neurologic critical illness, required endotracheal intubation and were referred for videofluoroscopic swallowing study. Demographic information, intensive care unit (ICU) ...

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

    Directory of Open Access Journals (Sweden)

    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

  4. 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.

  5. [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.

  6. Characteristics of an ideal nebulized antibiotic for the treatment of pneumonia in the intubated patient.

    Science.gov (United States)

    Bassetti, Matteo; Luyt, Charles-Edouard; Nicolau, David P; Pugin, Jérôme

    2016-12-01

    Gram-negative pneumonia in patients who are intubated and mechanically ventilated is associated with increased morbidity and mortality as well as higher healthcare costs compared with those who do not have the disease. Intravenous antibiotics are currently the standard of care for pneumonia; however, increasing rates of multidrug resistance and limited penetration of some classes of antimicrobials into the lungs reduce the effectiveness of this treatment option, and current clinical cure rates are variable, while recurrence rates remain high. Inhaled antibiotics may have the potential to improve outcomes in this patient population, but their use is currently restricted by a lack of specifically formulated solutions for inhalation and a limited number of devices designed for the nebulization of antibiotics. In this article, we review the challenges clinicians face in the treatment of pneumonia and discuss the characteristics that would constitute an ideal inhaled drug/device combination. We also review inhaled antibiotic options currently in development for the treatment of pneumonia in patients who are intubated and mechanically ventilated. PMID:27090532

  7. 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.

  8. [Management of agitated, violent or psychotic patients in the emergency department: an overdue protocol for an increasing problem].

    Science.gov (United States)

    Jiménez Busselo, M T; Aragó Domingo, J; Nuño Ballesteros, A; Loño Capote, J; Ochando Perales, G

    2005-12-01

    Patients with extreme agitation, delirium, violent behavior or acute psychosis are frequently evaluated in the emergency departments of general hospitals. However, the traditional infrequency of this type of situation in pediatric emergency services can lead to a certain lack of foresight and efficiency in the initial management of these patients. Because of the current known increase of psychosocial disorders in pediatric emergencies, new pharmacological treatments for juvenile psychotic processes, and particularly the lack of compliance with these treatments, as well as the earlier consumption of ever more varied illicit drugs among young people, the frequency and diversity of this kind of disorder is on the increase. The treatment of agitation, aggression and violence begins with successful management of the acute episode, followed by strategies designed to reduce the intensity and frequency of subsequent episodes. The key to safety is early intervention to prevent progression from agitation to aggression and violence. Consequently, urgent measures designed to inhibit agitation should be adopted without delay by the staff initially dealing with the patient, usually in the emergency unit. Patients with psychomotor agitation disorder (PMAD) may require emergency physical and/or chemical restraints for their own safety and that of the healthcare provider in order to prevent harmful clinical sequelae and to expedite medical evaluation to determine the cause. However, the risks of restraint measures must be weighed against the benefits in each case. This review aims to present the emergency measures to be taken in children with PMAD. The distinct etiological situations and criteria for the choice of drugs for chemical restraint in each situation, as well as the complications associated with certain drugs, are discussed. It is advisable, therefore, that health professionals become familiar with the distinct pharmacological options. PMID:16324619

  9. 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

    aortic surgery, arterial to internal jugular venous (a-v) concentration differences for oxygen versus lactate and glucose were determined from before anaesthesia to when the patient left the recovery room. Intravenous anaesthesia was supplemented with thoracic epidural anaesthesia for open aortic surgery......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...... (n = 5) and infiltration with bupivacaine for endovascular procedures (n = 14). The a-v difference for O2 decreased throughout anaesthesia and in the recovery room (1.6 ± 1.9 versus 3.2 ± 0.8 mmol l(-1), mean ± SD), and while a-v glucose decreased during surgery and into the recovery (0.4 ± 0...

  10. A population pharmacokinetic model for R- and S-citalopram and desmethylcitalopram in Alzheimer’s disease patients with agitation

    OpenAIRE

    Akil, Ayman; Bies, Robert R.; Bruce G Pollock; Avramopoulos, Dimitrios; Devanand, D. P.; Mintzer, Jacobo E.; Porsteinsson, Anton P.; Schneider, Lon S; Weintraub, Daniel; Yesavage, Jerome; Shade, David M.; Lyketsos, Constantine G.

    2015-01-01

    The citalopram for Alzheimer’s disease trial evaluated citalopram for the management for agitation in Alzheimer’s disease patients. Sparse data was available from this elderly patient population. A nonlinear mixed effects population pharmacokinetic modeling approach was used to describe the pharmacokinetics of R- and S-citalopram and their primary metabolite (desmethylcitalopram). A structural model with 4 compartments (one compartment/compound) with linear oral absorption and elimination des...

  11. 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

  12. 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.

  13. A rare complication of tracheal intubation

    OpenAIRE

    Wan Fadzlina Wan Muhd Shukeri; Wan Mohd Nazaruddin Wan Hassan; Chandran Nadarajan

    2016-01-01

    Accidental endobronchial intubation is a frequent complication in critically ill patients requiring tracheal intubation (TI). If such complication occurs, it is more often the right main bronchus that is intubated due to anatomical reasons. Left main bronchus (LMB) intubation is rare. Here, we report a case with auscultatory, bronchoscopic, and radiographic evidence of accidental LMB intubation in a pregnant woman with dengue shock syndrome. We highlight this case to increase awareness about ...

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

    OpenAIRE

    Annapurna Sarma; Subbalakshmi; Srinivasa Rao

    2015-01-01

    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) ...

  15. Akathisia—rare cause of psychomotor agitation in patients with traumatic brain injury: Case report and review of literature

    OpenAIRE

    Janet E. Wielenga-Boiten, MD; Gerard M. Ribbers, MD, PhD

    2012-01-01

    Akathisia is reported to be one of the most common and disabling side effects of antipsychotics and other drugs. Akathisia is also a rare cause of psychomotor agitation in patients with traumatic brain injury (TBI). In this clinical note, we describe a case report of akathisia in a 34-year-old woman with TBI; review earlier case studies on akathisia in TBI; and discuss the differential diagnosis and its pathophysiology, treatment, and prognosis.

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

    OpenAIRE

    Dante Ranieri Jr.; Fabio Riefel Zinelli; Adecir Geraldo Neubauer; Andre P. Schneider; Paulo do Nascimento Jr.

    2014-01-01

    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) lar...

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

    OpenAIRE

    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 imm...

  19. Effects of Esmolol on Hemodynamic Responses to Laryngoscopy and Tracheal Intubation in Diabetic Versus Non-Diabetic Patients

    OpenAIRE

    TAŞYÜZ, Taner

    2007-01-01

    Aim: We aimed to investigate the efficiency of esmolol, a short-acting ß-blocker, in preventing the hemodynamic response to laryngoscopy and endotracheal intubation in diabetic patients. Materials and Methods: Eighty diabetic or non-diabetic patients with ASA physical status I-II scheduled for noncardiac surgery were included in this study. They were divided randomly into 4 groups (Non-diabetic control: NDC, Non-diabetic esmolol: NDE, Diabetic control: DC, Diabetic esmolol: DE). Blood gluco...

  20. 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.

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

    OpenAIRE

    Neeharika

    2014-01-01

    : 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...

  2. 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

    Directory of Open Access Journals (Sweden)

    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.

  3. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

  5. 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."

  6. 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.

  7. 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.

  8. Pre-hospital intubation by anaesthesiologists in patients with severe trauma: an audit of a Norwegian helicopter emergency medical service

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    Lossius Hans

    2010-06-01

    Full Text Available Abstract Background Anaesthesiologists are airway management experts, which is one of the reasons why they serve as pre-hospital emergency physicians in many countries. However, limited data are available on the actual quality and safety of anaesthesiologist-managed pre-hospital endotracheal intubation (ETI. To explore whether the general indications for ETI are followed and what complications are recorded, we analysed the use of pre-hospital ETI in severely traumatised patients treated by anaesthesiologists in a Norwegian helicopter emergency medical service (HEMS. Methods A retrospective audit of prospectively registered data concerning patients with trauma as the primary diagnosis and a National Committee on Aeronautics score of 4 - 7 during the period of 1994-2005 from a mixed rural/urban Norwegian HEMS was performed. Results Among the 1255 cases identified, 238 successful pre-hospital ETIs out of 240 attempts were recorded (99.2% success rate. Furthermore, we identified 47 patients for whom ETI was performed immediately upon arrival to the emergency department (ED. This group represented 16% of all intubated patients. Of the ETIs performed in the ED, 43 patients had an initial Glasgow Coma Score (GCS Conclusions We found a very high success rate of pre-hospital ETI and few recorded complications in the studied anaesthesiologist-manned HEMS. However, a substantial number of trauma patients were intubated first on arrival in the ED. This delay may represent a quality problem. Therefore, we believe that more studies are needed to clarify the reasons for and possible clinical consequences of the delayed ETIs.

  9. 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

    conditions of standard doses of rocuronium 0.6 mg kg[-1] and succinylcholine 1.0 mg kg[-1] during a strict rapid-sequence induction regimen including propofol and alfentanil. Methods: Male and female patients (ASA I-III) older than 17 yr scheduled for emergency abdominal or gynaecological surgery and with...... fulfil the inclusion criteria. Clinically acceptable intubation conditions were present in 93.5% and 96.1% of patients in the succinylcholine group (n=107) and the rocuronium group (n=102), respectively (P=0.59). Conclusions: During a rapid-sequence induction with alfentanil and propofol, both rocuronium...

  10. Airtraq® optical laryngoscope for tracheal intubation in patients with severe ankylosing spondylitis: A report of two cases

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    Qazi Ehsan Ali

    2012-01-01

    Full Text Available Airway management in patients of ankylosing spondylitis remains a challenge for anaesthesiologists. Many new airway devices have been used for securing airway in these patients. The Airtraq® optical laryngoscope is one of the new rigid laryngoscopes with a proximal view finder that reflects an image transferred from the distal tip of the blade through a series of lenses, prisms and mirrors. We report two cases of ankylosing spondylitis who were scheduled for total hip replacement and subtotal thyroidectomy and were successfully intubated using the Airtraq® laryngoscope.

  11. 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.

  12. 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

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

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    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.

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

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    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.

  15. 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)

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

    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

  16. 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

  17. 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

  18. 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

  19. 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

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

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    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.

  1. 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

  2. Elderly Patients with Dementia-Related Symptoms of Severe Agitation and Aggression: Consensus Statement on Treatment Options, Clinical Trials Methodology, and Policy

    OpenAIRE

    Salzman, C; Jeste, D.; Meyer, RE; Cohen-Mansfield, J; Cummings, J; Grossberg, G; Jarvik, L; Kraemer, H; Lebowitz, B; Maslow, K; Pollock, B.; Raskind, M; Schultz, S; Wang, P.; Zito, JM

    2008-01-01

    Atypical antipsychotic drugs have been used off-label in clinical practice for treatment of serious dementia-associated agitation and aggression. Following reports of cerebrovascular adverse events associated with the use of atypical antipsychotic in elderly patients with dementia, the FDA issued black box warnings for several atypical antipsychotics, titled “Cerebrovascular Adverse Events, including Stroke, in Elderly Patients with Dementia.” Subsequently, the FDA initiated a meta-analysis o...

  3. [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.

  4. 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.

  5. Tracheal rupture post-emergency intubation

    OpenAIRE

    Andrea Billè; Luca Errico; Francesco Ardissone; Luciano Cardinale

    2009-01-01

    Tracheal rupture is an uncommon and potentially lifethreatening complication of endotracheal intubation. We present a case of intrathoracic tracheal rupture in a female patient who required emergent endotracheal intubation for acute respiratory distress related to chronic obstructive pulmonary disease exacerbation. Possible contributing factors to tracheal injury included overinflation of the tube cuff, chronic obstructive pulmonary disease, and chronic steroid use. The patient underwent surg...

  6. 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...

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

    Directory of Open Access Journals (Sweden)

    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.

  8. Monitoring Agitated Behavior After acquired Brain Injury

    DEFF Research Database (Denmark)

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

    2015-01-01

    behavior was registered with the Agitated Behavior Scale (ABS). The nurse or therapist allocated the individual patient assessed ABS during each shift. Intensity of agitated behavior was tested using exact test. A within-subject shift effect was analyzed with repeated-measure ANOVA. Findings: The onset...

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

    Directory of Open Access Journals (Sweden)

    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.

  10. 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...

  11. The use of capnometry to predict arterial partial pressure of CO2 in non-intubated breathless patients in the emergency department

    OpenAIRE

    NIK AB RAHMAN, Nik Hisamuddin; Mamat, Amiruddin Fairuz

    2010-01-01

    Background Capnometry measures carbon dioxide in expired air and provides the clinician with a noninvasive measure of the systemic metabolism, circulation and ventilation. This study was carried out on patients with acute breathlessness to define the utility and role of capnometry in the emergency department. Aim The objectives of the study were: To determine the correlation between end tidal CO2 and PaCO2 in non-intubated acutely breathless patients. To determine factors that influence the e...

  12. Implementation of the Pain, Agitation, and Delirium Clinical Practice Guidelines and promoting patient mobility to prevent post-intensive care syndrome.

    Science.gov (United States)

    Davidson, Judy E; Harvey, Maurene A; Bemis-Dougherty, Anita; Smith, James M; Hopkins, Ramona O

    2013-09-01

    Surviving critical illness is associated with persistent and severe physical, cognitive, and psychological morbidities. The Society of Critical Care Medicine has developed pain, agitation, and delirium guidelines and promoted mobility to improve care of critically ill patients. A task force has developed tools to facilitate and rapidly implement the translation of guideline care recommendations into practice. The Society of Critical Care Medicine has also assembled a task force to assess the long-term consequences of critical illness. This article will explore relationships between the pain, agitation, and delirium guidelines, mobility recommendations, and post-intensive care syndrome initiative. Implementation of the pain, agitation, and delirium guidelines taking into account current data regarding post-intensive care syndrome outcomes and potential interventions are an important first step toward improving outcomes for patients and their families. Research is needed to reduce the impact of long-term negative consequences of critical illness and to fully understand the best within- and post-ICU interventions, along with the optimal timing and dose of such interventions to produce the best long-term outcomes.

  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. 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...

  15. 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.

  16. Individual Music Therapy for Agitation in Dementia

    DEFF Research Database (Denmark)

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

    2013-01-01

    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......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...... 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. Tracheal intubation without neuromuscular block in children

    Directory of Open Access Journals (Sweden)

    Safiya I Shaikh

    2010-01-01

    Full Text Available Endotracheal intubation has been performed during the administration of Propofol anaesthesia without neuromuscular blockade. In the study, we have assessed tracheal intubating conditions and haemodynamic responses in children aged 4 to12 years by using combination of either Fentanyl and Propofol; or Propofol and a neuromuscular blocker, suxamethonium. Intubating conditions were assessed on a 1-4 scale based on ease of laryngoscopy, position of vocal cords, degree of coughing and jaw relaxation. Tracheal intubation was successful in 95% of patients receiving Fentanyl-Propofol and 100% of patients receiving Propofol-suxamethonium. Fentanyl-Propofol provided better haemodynamic stability than Propofol-suxamethonium. We conclude that Propofol-Fentanyl combination could be a useful alternative technique for tracheal intubation when neuromuscular blocking drugs are contraindicated or need to be avoided.

  18. Impact of tracheal cuff shape on microaspiration of gastric contents in intubated critically ill patients: study protocol for a randomized controlled trial

    OpenAIRE

    Jaillette, Emmanuelle; Brunin, Guillaume; Girault, Christophe; Zerimech, Farid; Chiche, Arnaud; Broucqsault-Dedrie, Céline; Fayolle, Cyril; Minacori, Franck; Alves, Isabelle; Barrailler, Stephanie; Robriquet, Laurent; Tamion, Fabienne; Delaporte, Emmanuel; Thellier, Damien; Delcourte, Claire

    2015-01-01

    Background Ventilator-associated pneumonia (VAP) is the most common infection in intubated critically ill patients. Microaspiration of the contaminated gastric and oropharyngeal secretions is the main mechanism involved in the pathophysiology of VAP. Tracheal cuff plays an important role in stopping the progression of contaminated secretions into the lower respiratory tract. Previous in vitro studies suggested that conical cuff shape might be helpful in improving tracheal sealing. However, cl...

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

    OpenAIRE

    Ruchi Bhola; Swaran Bhalla; Radha Gupta; Ishwar Singh; Sunil Kumar

    2014-01-01

    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 ...

  20. Combined use of a McGrath® MAC video laryngoscope and Frova Intubating Introducer in a patient with Pierre Robin syndrome: a case report

    OpenAIRE

    Kim, Yongsuk; Kim, Jeong Eun; Jeong, Da Hye; Lee, Jaemin

    2014-01-01

    Patients with Pierre Robin syndrome are characterized by micrognathia, retrognathia, glossoptosis, and respiratory obstruction and are prone to have a difficult-to-intubate airway. The McGrath® MAC video laryngoscope provides a better view of the glottis than a Macintosh laryngoscope, but it is not easy to insert an endotracheal tube through the vocal cords because a video laryngoscope has a much greater curvature than that of a conventional direct laryngoscope and an endotracheal tube has a ...

  1. 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.

  2. 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.

  3. Time to Intubation Is Associated with Outcome in Patients with Community-Acquired Pneumonia

    OpenAIRE

    Hraiech, Sami; Alingrin, Julie; Dizier, Stéphanie; Brunet, Julie; Forel, Jean-Marie; La Scola, Bernard; Roch, Antoine; Papazian, Laurent; Pauly, Vanessa

    2013-01-01

    Introduction It has been suggested that delayed intensive care unit (ICU) transfer is associated with increased mortality for patients with community-acquired pneumonia (CAP). However, ICU admission policies and patient epidemiology vary widely across the world depending on local hospital practices and organizational constraints. We hypothesized that the time from the onset of CAP symptoms to invasive mechanical ventilation could be a relevant prognostic factor. Methods One hundred patients w...

  4. 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.

  5. 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。

  6. [Esophageal intubation for palliative treatment in advanced carcinoma of the esophagus and cardia].

    Science.gov (United States)

    Domene, C E; Cecconello, I; Volpe, P; Zilberstein, B; Sakai, P; Ishioka, S; Pinotti, H W

    1998-01-01

    This is a report of 121 cases of advanced esophageal and cardia cancer managed by endoscopic and surgical esophageal intubation. They were submitted to surgical intubation 69 (53%) patients, and 52 (47%) to endoscopic intubation. There were 32.5% of technical complications in endoscopic intubation and 26.5% in surgical intubation. Perfuration was more frequent (11.5%) in endoscopic intubation than surgical group. Mortality rate was 17.3% for endoscopic and 5.8% for surgical intubation. Perfuration was the main cause of death in endoscopic intubation. Survival rate was 3.5 months for endoscopic and 4.7 months for surgical intubation. The majority of patients died of cancer evolution--caquexia (55.5%), carcinomatosis (4.5%) and brain methastasis (1.1%). The results of endoscopic and surgical intubation in this group of patients recommend its use in patients with advanced esophageal and cardic cancer. PMID:9699358

  7. Postoperative intubation time is associated with acute kidney injury in cardiac surgical patients

    OpenAIRE

    Heringlake, Matthias; Nowak, Yvonne; Schön, Julika; Trautmann, Jens; Berggreen, Astrid Ellen; Charitos, Efstratios I.; Paarmann, Hauke

    2014-01-01

    Introduction Acute kidney injury (AKI) is a frequent complication after cardiac surgery and is associated with a poor prognosis. Mechanical ventilation is an important risk factor for developing AKI in critically ill patients. Ventilation with high tidal volumes has been associated with postoperative organ dysfunction in cardiac surgical patients. No data are available about the effects of the duration of postoperative respiratory support in the immediate postoperative period on the incidence...

  8. Accuracy of Alpha Amylase in Diagnosing Microaspiration in Intubated Critically-Ill Patients

    OpenAIRE

    Florent Dewavrin; Farid Zerimech; Alexandre Boyer; Patrice Maboudou; Malika Balduyck; Alain Duhamel; Saad Nseir

    2014-01-01

    OBJECTIVES: Amylase concentration in respiratory secretions was reported to be a potentially useful marker for aspiration and pneumonia. The aim of this study was to determine accuracy of α-amylase in diagnosing microaspiration in critically ill patients. METHODS: Retrospective analysis of prospectively collected data collected in a medical ICU. All patients requiring mechanical ventilation for at least 48 h, and included in a previous randomized controlled trial were eligible for this study,...

  9. The pathophysiology of agitation.

    Science.gov (United States)

    Lindenmayer, J P

    2000-01-01

    Agitation is a nonspecific constellation of relatively unrelated behaviors that can be seen in a number of different clinical conditions, usually presenting a fluctuating course. Multiple underlying pathophysiologic abnormalities are mediated by dysregulations of dopaminergic, serotonergic, noradrenergic, and GABAergic systems. Pathophysiologic mechanisms of agitation that operate in the different clinical disorders where agitation occurs are discussed. These pathophysiologic abnormalities are not associated with distinct clinical features. Although there may be a final common pathway, there is no unifying etiologic pathophysiology. The author suggests that the clinician address the underlying pathophysiology through a treatment intervention that addresses the overarching psychiatric disorder. Generally, agents that reduce dopaminergic or noradrenergic tone or increase serotonergic or GABAergic tone will attenuate agitation, often irrespective of etiology. PMID:11154018

  10. 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.

  11. Application of different methods of tracheal intubation in patients undergoing cervical vertebra surgery%不同气管插管方法在颈椎手术中的应用

    Institute of Scientific and Technical Information of China (English)

    谢言虎; 柴小青; 音樱; 章蔚; 耿擎天

    2012-01-01

    Objective To compare the outcomes of tracheal intubation with different tecniques of maintain axis stability ( MILS), fiberoptic bronchoscope ( FOB) and blind tracheal intubation instrument (BT1I) in the patients undergoing cervical spine surgery. Methods Ninety patients undergoing selective cervical spine surgery were equally randomized into 3 groups of A (intubation with MILS) ,B (intubation with FOB) and CCintubation with BTII). The events related to intubation were compared among three groups. Results The time spent for intubation in group A was the least among three groups. The success rates of intubation in groups of B and C were 100% and 96. 7%, respectively, which were higher than 80% in group A(P<0. 05). There were no severe complications related to intubation in three groups. Conclusion To reduce the risk for cervical spine injury and increase the success rate of intubation, tracheal intubation in the patients undergoing cervical spine surgery is better to be guided by FOR BTII can provide a new intubation technique for the patients with cervical vertebrae injury.%目的 比较不同气管插管方法在颈椎手术中的应用效果.方法 90例颈椎择期手术患者按插管方法随机均分为三组:A组采用手法保持轴线稳定性(MILS);B组采用纤维支气管镜(FOB);C组采用盲探气管插管装置(BTⅡ).比较三组患者的气管插管相关资料.结果 A组插管费时最少.B、C组插管成功率分别为100%和96.7%,均明显高于A组的80%(P<0.05).三组患者均无严重并发症发生.结论 颈椎手术麻醉宜在FOB引导等技术下实施气管插管,以减少颈椎损伤机率,提高插管成功率.BTⅡ技术可为颈椎损伤患者插管提供了一种新的方法.

  12. 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

  13. Effect of noninvasive mechanical ventilation in elderly patients with hypercapnic acute-on-chronic respiratory failure and a do-not-intubate order

    Directory of Open Access Journals (Sweden)

    Paolo Scarpazza

    2008-10-01

    Full Text Available Paolo Scarpazza1, Cristoforo Incorvaia2, Giuseppe di Franco1, Stefania Raschi1, Pierfranco Usai1, Monica Bernareggi1, Cristiano Bonacina1, Chiara Melacini1, Silvia Vanni1, Serena Bencini1, Chiara Pravettoni2, Giuseppe Di Cara3, Mona-Rita Yacoub4, Gian Galeazzo Riario-Sforza2, Enrico Guffanti5, Walter Casali11Divisione di Broncopneumotisiologia, Ospedale Civile, Vimercate, Italy; 2Pulmonary rehabilitation, Istituti Clinici di Perfezionamento, Milan, Italy; 3University Department of Medical and Surgical Specialties and Public Health, Perugia, Italy; 4Allergy and Immunology Unit, IRCCS San Raffaele Hospital, Milan, Italy; 5Pulmonary rehabilitation, INRCA, Casatenovo, ItalyAbstract: Noninvasive mechanical ventilation (NIMV is effective in the treatment of patients with acute respiratory failure (ARF. It proved to reduce the need of endotracheal intubation (ETI, the incidence of ETI-associated pneumonia, and mortality compared to nonventilated patients. A particular aspect concerns the outcome of NIMV in patients referring to an emergency room (ER for ARF, and with a do-not-intubate (DNI status due to advanced age or critical conditions. The aim of our study is to assess the outcome of NIMV in a group of elderly patients with acute hypercapnic ARF who had a DNI status. An overall number of 62 subjects (30 males, 32 females, mean age 81 ± 4.8 years, range 79–91 years referred to our semi-intensive respiratory department were enrolled in the study. The underlying diseases were severe chronic obstructive pulmonary disease (COPD in 50/62 subjects, restrictive thoracic disorders in 7/62 subjects, and multiorgan failure in 5/62 subjects. Fifty-four/62 patients were successfully treated with NIMV while 2/62 did not respond to NIMV and were therefore submitted to ETI (one survived. Among NIMV-treated patients, death occurred in 6 patients after a mean of 9.9 days; the overall rate of NIMV failure was 12.9%. Negative prognostic factors for NIMV response

  14. 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 .

  15. 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.

  16. 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.

  17. Comparison of Dexmedetomidine and Esmolol for Attenuation of Hemodynamic Responses to Laryngoscopy and Tracheal Intubation in Hypertensive Patients

    OpenAIRE

    Özkan, Ahmet Selim; Bombacı, Elif

    2013-01-01

    Aim: During general anesthesia, control of the airway is often provided with endotracheal intubation, as a result, larynx and trachea are stimulated and plasma concentrations of noradrenaline and adrenaline are increased. This increase in blood pressure and heart rate causing arrhythmias and has a negative impact on myocardial oxygen delivery and consumption. Many drugs used for the prevention response to increased sympathic activity in blood pressure and heart rate. It was aimed to evaluate ...

  18. Evaluation of the Truview™ EVO2 laryngoscope for nasotracheal intubation

    OpenAIRE

    Raveendra, U. S.; Mehandale, Sripada G.; Shetty, Sumalatha R; Kamath, Manjunath R

    2012-01-01

    Background: The Truview™ EVO2 laryngoscope, with its unique optical lens system and blade tip angulation, has proved its usefulness in providing adequate laryngeal exposure and intubation via the oral route. However, the same has not been evaluated for nasotracheal intubation. Aim: We evaluated the suitability of the Truview™ EVO2 laryngoscope for nasotracheal intubation. Methods: Fifty ASA grade I and II elective surgical patients were studied. Patients aged below 15 years or having difficul...

  19. Submandibular Approach for Tracheal Intubation-A Case Report

    OpenAIRE

    Uma, G.; Viswanathan, P N; Nagaraja, P. S.

    2009-01-01

    Summary Intubating a patient with panfacial fractures is always a challenge to the anaesthesiologist. In a 40-yr-old male patient with left Le Fort's III fracture with nasal bone and symphysis menti fracture, we successfully carried out oral endotracheal intubation which was then modified to submandibular approach to provide adequate surgical field. Initially oral endotracheal intubation was performed, then an incision was made in the submandibular region through which the endotracheal tube w...

  20. Bonfils Fiberscope: Intubating Conditions and Hemodynamic Changes without Neuromuscular Blockade

    Directory of Open Access Journals (Sweden)

    Atabak Najafi

    2011-04-01

    Full Text Available To compare intubating conditions and hemodynamic changes between Bonfils Intubation Fiberscope and Macintosh laryngoscopy without administering neuromuscular blocking drugs (NMBDs. METHODS: In this randomized controlled trial,80 male and female patients, scheduled for elective surgery, aged 15 to 60 years, ASA class II or I, non-obese, non smokers, without anticipated difficult intubation; were randomly allocated into two groups of 40: Bonfils and Macintosh. Following adequate hydration and preoxygenation, midazolam 0.03 mg.kg-1 was administered, followed by intravenous alfentanil 20 µg.kg-1, lidocaine 1.0 mg.kg-1, and propofol 2 mg.kg-1 sequentially. Trachea was then intubated using Bonfils Intubation Fiberscope in the Bonfils group and conventional Macintosh laryngoscopy in the Macintosh group. Intubating condition, mean arterial blood pressure, heart rate, pulse oximetry, and success rate were measured. RESULTS: Clinically acceptable intubating condition scores did not differ significantly between the groups (P=0.465. Compared to the baseline values, heart rate rose significantly after intubation only in the Macintosh group (P<0.001. Although mean arterial blood pressure increased immediately after intubation in the Macintosh group (P=0.022, its post-intubation values were significantly less than baseline in both groups (P<0.001. Intubation time took much longer in the Bonfils group (40 s than the Macintosh group (11 s, P<0.001. In the absence of NMBDs, Bonfils Intubation Fiberscope compares well with Macintosh laryngoscopy in terms of success rate and intubating conditions, but with less mechanical stress and hemodynamic compromise and longer intubation time.

  1. Myocardial ischaemia during tracheal intubation and extubation.

    Science.gov (United States)

    Edwards, N D; Alford, A M; Dobson, P M; Peacock, J E; Reilly, C S

    1994-10-01

    The incidence of myocardial ischaemia during tracheal intubation and extubation was compared using ambulatory ECG monitoring in 60 patients undergoing a variety of different surgical operations. Seven patients had myocardial ischaemia after tracheal intubation and seven patients during tracheal extubation. The patients who developed myocardial ischaemia during tracheal extubation had significantly greater rate-pressure products immediately before tracheal extubation (P < 0.05) and 1 min after tracheal extubation (P < 0.01) compared with those patients who did not develop myocardial ischaemia during extubation. PMID:7999498

  2. Effect of esmolol on bispectral index in patients undergoing orotracheal intubation during induction of anesthesia%艾司洛尔对患者麻醉诱导气管插管时脑电双频谱指数的影响

    Institute of Scientific and Technical Information of China (English)

    曹德权; 陈艳平; 张燕玲

    2010-01-01

    Objective To evaluate the effect of esmolol on bispectral index (BIS) in patients undergoing orotracheal intubation during induction of anesthesia and to investigate the mechanism of inhibiting the cardiovascular responses to tracheal intubation.Methode Forty patients in physical status of ASA Ⅰ or Ⅱ and aged 20-60 years were randomly divided into 2 groups ( n = 20 each): esmolol group (group E) and control group (group C). Anesthesia was induced with midazolam 0.1 mg/kg, fentanyl 5 μg/kg and vecuronium 0.1 mg/kg. In group E, esmolol 1 mg/kg was given intravenously before anesthesia induction and followed by an infusion of esmolol 250 μg· kg- 1·min-1, while a comparable volume of saline was given for group C. Mean arterial pressure (MAP), heart rate (HR) and BIS were recorded before esmolol administration, before induction of anesthesia, before orotracheal intubation, and at 1, 2 and 5 min after intubation, respectively.Results There were no significant differences in HR, MAP and BIS between the two groups before tracheal intubation. HR and MAP significantly increased after tracheal intubation in both groups, but BIS only in group C significantly increased after intubation.HR, MAP and BIS were significantly lower after intubation in group E than in group C ( P< 0.05).Conclusion Esmolol can decrease BIS during tracheal intubation and its antinociceptive property is related to the mechanism of inhibiting cardiovascular responses to tracheal intubation.

  3. 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.

  4. Inadvertent endobronchial intubation: A sentinel event

    Directory of Open Access Journals (Sweden)

    Ali S Al-Qahtani

    2012-01-01

    Full Text Available Background: Unintentional bronchial intubation may result in serious complications such as lung collapse or pneumothorax. These complications amount to sentinel events should be reported, and a hospital sentinel event policy should be implemented, including corrective actions to prevent recurrence. Methods: A 12-month prospective observational study in a multidisciplinary adult intensive care unit (ICU to estimate the frequency of inadvertent bronchial intubation and its major sequels in intubated patients admitted to the unit. Complications will be reported as sentinel events attracting investigation by root cause analysis method, action plan, and follow-up. Results: There were 36 (12.9% cases of inadvertent bronchial intubations in 279 orally-intubated patients admitted to the ICU during the study period (1.5.2010 - 30.4.2011, 2 (0.7% of them already developed total left lung collapse. The hospital sentinel event policy was activated followed by action plan, which included raising the awareness of the problem, presentations, and regular checking on the position of the tube following tracheal intubation at different location in the hospital. Conclusion: Early detection and correction of endobronchial intubation will prevent complications developing. Applying sentinel event policy on complications of inadvertent bronchial intubation will encourage finding permanent solution to an old and preventable problem. Anesthetic and resuscitative regulatory bodies should incorporate methods of checking on correct position of tracheal tubes in their training programs. Knowing that the tube may advance into a bronchus, they should insist on regular checking of the tube in a manner similar to monitoring patient′s vital signs.

  5. Haemodynamic response to endotracheal intubation in coronary artery disease: Direct versus video laryngoscopy

    OpenAIRE

    Muralidhar Kanchi; Nair, Hema C; Sanjay Banakal; Keshava Murthy; C Murugesan

    2011-01-01

    Endotracheal intubation involving conventional laryngoscopy elicits a haemodynamic response associated with increased heart and blood pressure. The study was aimed to see if video laryngoscopy and endotracheal intubation has any advantages over conventional laryngoscopy and endotracheal intubation in patients with coronary artery disease. Thirty patients suffering from coronary artery disease scheduled for elective coronary artery bypass grafting (CABG) were studied. The patients were randoml...

  6. 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.

  7. 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

  8. Effect of Preferred Music on Agitation After Traumatic Brain Injury.

    Science.gov (United States)

    Park, Soohyun; Williams, Reg Arthur; Lee, Donghyun

    2016-04-01

    Agitation is a common behavioral problem after traumatic brain injury (TBI), which threatens the safety of patients and caregivers and disrupts the rehabilitation process. This study aimed to evaluate the effects of a preferred music intervention on the reduction of agitation in TBI patients and to compare the effects of preferred music with those of classical "relaxation" music. A single group, within-subjects, randomized crossover trial design was formed, consisting of 14 agitated patients with cognitive impairment after severe TBI. Patients listened to preferred music and classical "relaxation" music, with a wash-out period in between. Patients listening to the preferred music reported a significantly greater reduction in agitation compared with the effect seen during the classical "relaxation" music intervention (p = .046). These findings provide preliminary evidence that the preferred music intervention may be effective as an environmental therapeutic approach for reducing agitation after TBI. PMID:26129873

  9. 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.

  10. Validation of the Excited Component of the Positive and Negative Syndrome Scale (PANSS-EC in a naturalistic sample of 278 patients with acute psychosis and agitation in a psychiatric emergency room

    Directory of Open Access Journals (Sweden)

    San Luis

    2011-03-01

    Full Text Available Abstract Background Despite the wide use of the Excited Component of the Positive and Negative Syndrome Scale (PANSS-EC in a clinical setting to assess agitated patients, a validation study to evaluate its psychometric properties was missing. Methods Data from the observational NATURA study were used. This research describes trends in the use of treatments in patients with acute psychotic episodes and agitation seen in emergency departments. Exploratory principal component factor analysis was performed. Spearman's correlation and regression analyses (linear regression model as well as equipercentile linking of Clinical Global Impression of Severity (CGI-S, Agitation and Calmness Evaluation Scale (ACES and PANSS-EC items were conducted to examine the scale's diagnostic validity. Furthermore, reliability (Cronbach's alpha and responsiveness were evaluated. Results Factor analysis resulted in one factor being retained according to eigenvalue ≥1. At admission, the PANSS-EC and CGI-S were found to be linearly related, with an average increase of 3.4 points (p Conclusions The factorial analyses confirm the unifactorial structure of the PANSS-EC subscale. The PANSS-EC showed a strong linear correlation with rating scales such as CGI-S and ACES. PANSS-EC has also shown an excellent capacity to detect real changes in agitated patients.

  11. 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

    -depolarizing NMBA to be more at risk for DTI than those anaesthetized with depolarizing NMBA alone. CONCLUSIONS: Avoiding NMBA may increase the risk of DTI. However, confounding by indication may be a problem in this observational study and systematic reviews with meta-analysis or more randomized clinical trials......BACKGROUND: Previous studies indicate that avoiding neuromuscular blocking agents (NMBAs) may be a risk factor for difficult tracheal intubation (DTI). We investigated whether avoiding NMBA was associated with DTI. METHODS: A cohort of 103,812 consecutive patients planned for tracheal intubation by...

  12. Opioid sparing during endotracheal intubation using mccoy laryngoscope in neurosurgical patients: The comparison of haemodynamic changes with macintosh blade in a randomized trial

    Directory of Open Access Journals (Sweden)

    Tewari Prabhat

    2005-01-01

    Full Text Available Background: There is conflicting data in literature to show that the McCoy laryngoscope is less stressful and opioids can actually be avoided during laryngoscopy and intubation with the use of this laryngoscope. Aim: A comparison of hemodynamic changes with McCoy vs Macintosh laryngoscope.. Settings and Design: 180 ASA I and II neurosurgical patients undergoing elective surgery for space occupying lesions were recruited. The study was was prospective, randomized and blinded in the setting of neurosurgical perioperative services. Methods and Materials: The patients were divided into four groups (Gr.1 McCoy and fentanyl; Gr. 2 McCoy and no fentanyl; Gr. 3 Macintosh and fentanyl; Gr. 4 Macintosh and no fentanyl. In Gr. 2 and 4 equivalent volume of saline was given in place of fentanyl as placebo. Heart rate, systolic and diastolic blood pressure were measured after laryngoscopy, after intubation and subsequently every minute for the next five minutes. The incidence of cough due to fentanyl treatment was observed. Statistical Analysis: Haemodynamic changes were compared between and within groups using oneway ANOVA and repeated measures ANOVA. All analysis included 95% CI at 5% significance. The Mann Whitney U test was used for comparing incidence of cough. Results: No difference was found between McCoy laryngoscopy when done with or without fentanyl pretreatment (HR p =0.848, sys BP p =0.229 and diastolic blood pressure p =0.981. Significant changes in haemodynamic parameters were seen between Macintosh and McCoy laryngoscopy without fentanyl pretreatment ( p p Conclusions: McCoy laryngoscope blade is less stressful and fentanyl pretreatment is not necessary to attenuate haemodynamic responses with its use in ASA I and II patients.

  13. Clinical application effect of nasal blind tracheal intubation in emergency trauma patients%经鼻盲探气管插管术在急诊创伤患者中的临床应用效果分析

    Institute of Scientific and Technical Information of China (English)

    王彪; 曾良; 李晶

    2016-01-01

    目的:探讨在急诊创伤患者抢救中应用经鼻盲探气管插管术( BNTI )的临床效果及价值。方法回顾性分析2013年12月至2015年12月我院收治的48例急诊创伤患者的临床资料,抢救过程中均行BNTI术,观察患者的插管即刻反应、插管成功率、插管辅助法。结果48例患者的意识状态包括GCS<8分、GCS8~10分、无意识障碍;1次插管成功率为52.1%,插管失败率16.7%。24例患者出现插管即刻反应,包括轻度呛咳、剧烈呛咳与屏气、有吞咽反射,插管成功率分别为100.0%、0.0%、0.0%。首次插管不成功16例,使用套囊充气法9例,插管成功率88.9%;使用非套囊充气法7例,插管成功率85.7%。结论在急诊创伤患者抢救中应用BNTI 术,效果良好,适用性、有效性高,但需注意患者的意识状态、咽喉反射,积极选用插管辅助法,为手术顺利进行奠定基础。%Objective To investigate the clinical effect and value of the application of nasal blind tracheal intubation ( BNTI) in the emergency treatment of trauma patients .Methods A retrospective analysis of the clinical data of December 2015 2013 to December 2004 in our hospital were of 48 cases of emergency trauma patients, rescued process were performed BNTI and observation of patients with immediate responses to tracheal intubation, intubation success rate of intubation and assisted method .Results 48 cases of patients with state of consciousness including GCS <8 points, GCS8 ~10, disturbance of consciousness , the first intubation success rate of 52.1%and failed intubation rate was 16.7%.24 cases of immediate responses to tracheal intubation in patients, including mild cough, acuteness choke to cough and breath , swallowing reflex, the success rate of catheterization was 100%, 0.0%, 0.0%respectively.First intubation was unsuccessful in 16 cases, using the cuff method in 9 cases, success rate of

  14. 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

  15. Molar Intubation for Intra Oral Swellings:Our Experience

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    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.

  16. Comparison of hemodynamic responses to laryngoscopy and intubation with Truview PCD TM , McGrath ® and Macintosh laryngoscope in patients undergoing coronary artery bypass grafting: A randomized prospective study

    Directory of Open Access Journals (Sweden)

    Deepak K Tempe

    2016-01-01

    Full Text Available Context: We hypothesized that reduced oropharyngolaryngeal stimulation with video laryngoscopes would attenuate hemodynamic response to laryngoscopy and intubation. Aim: Comparison of hemodynamic response to laryngoscopy and intubation with video laryngoscopes and Macintosh (MC laryngoscope. Setting and Design: Superspecialty tertiary care public hospital; prospective, randomized control study. Methods: Sixty adult patients undergoing elective coronary artery bypass grafting (CABG were randomly allocated to three groups of 20 each: MC, McGrath (MG, and Truview (TV. Hemodynamic parameters were serially recorded before and after intubation. Laryngoscopic grade, laryngoscopy, and tracheal intubation time, ST segment changes, and intra-/post-operative complications were also recorded and compared between groups. Statistical Analysis: SPSS version 17 was used, and appropriate tests applied. P < 0.05 was considered significant. Results: Heart rate and diastolic arterial pressure increased at 0 and 1 min of intubation in all the three groups (P < 0.05 while mean arterial pressure increased at 0 min in the MG and TV groups and at 1 min in all three groups (P < 0.05. A significant increase in systolic arterial pressure was only observed in TV group at 1 min (P < 0.05. These hemodynamic parameters returned to baseline by 3 min of intubation in all the groups. The intergroup comparisons of all hemodynamic parameters were not significant at any time of observation. Highest intubation difficulty score was observed with MC (2.16 ± 1.86 as compared with MG (0.55 ± 0.88 and TV (0.42 ± 0.83 groups (P = 0.003 and P = 0.001, respectively. However, duration of laryngoscopy and intubation was significantly less in MC (36.68 ± 16.15 s as compared with MG (75.25 ± 30.94 s and TV (60.47 ± 27.45 s groups (P = 0.000 and 0.003, respectively. Conclusions: Video laryngoscopes did not demonstrate any advantage in terms of hemodynamic response in patients with normal

  17. 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.

  18. 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

  19. 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

  20. 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...

  1. 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

  2. [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.

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

    Directory of Open Access Journals (Sweden)

    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

  4. The King Vision™ video laryngoscope for awake intubation: series of cases and literature review

    Directory of Open Access Journals (Sweden)

    Gaszynska E

    2014-06-01

    Full Text Available Ewelina Gaszynska, Tomasz GaszynskiDepartment of Emergency Medicine and Disaster Medicine, Medical University of Lodz, Lodz, PolandAbstract: Intubation of patients with a supraglottic mass causing obstruction of the glottis remains a difficult problem for the experienced anesthesiologist. Awake fiberscopic endotracheal intubation is the recommended approach in such cases; however, use of a video laryngoscope for awake intubation can be an alternative to a fiberscope. Here we present two cases of awake intubation using a King Vision™ video laryngoscope in patients with a supraglottic mass, and a literature review on use of video laryngoscopes for awake intubation. After topical anesthesia and sedation with opioids, the patients were successfully intubated.Keywords: airway management, difficult airway, awake intubation, video laryngoscope

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

    Directory of Open Access Journals (Sweden)

    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

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

    Science.gov (United States)

    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

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

    Directory of Open Access Journals (Sweden)

    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

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

    Directory of Open Access Journals (Sweden)

    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.

  9. 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

  10. EFFECT OF DEXMEDETOMIDINE ON STRESS RESPONSE TO ENDOTRACHEAL INTUBATION

    Directory of Open Access Journals (Sweden)

    Sathee Devi

    2015-03-01

    Full Text Available Laryngoscopy as well as tracheal intubation cause changes in the hemodynamics of the patients. A similar set of hemodynamic events have been noticed by various studies during tracheal extubation also. These responses may produce myocardial ischemia or infarction in susceptible patients. Various agents like lignocaine, e smolol, sodium nitropruside, nitroglycerine etc . have been proved to be effective in attenuating these response. Dexmedetomidine, an alpha 2 agonist have been successfully used for attenuating the sympathetic response during endotracheal extubation. We conducted an observational study to examine the rol e of dexmedetomidine on hemodynamic response during endotracheal intubation. A bolus dose of Dexmedetomidine 0.7 - 1 mcg /kg over 10mts prior to endotracheal intubation provided hemodynamic stability than inj. lignocaine hydrochloride ( G old standard .This c an prove beneficial for patients where the stress response to intubation is highly undesirable.

  11. 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

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

    Directory of Open Access Journals (Sweden)

    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.

  13. Endotracheal intubation with thiopental/succinylcholine or sevoflurane-nitrous oxide anesthesia in adults: a comparative study.

    Science.gov (United States)

    Iamaroon, A; Pitimana-aree, S; Prechawai, C; Anusit, J; Somcharoen, K; Chaiyaroj, O

    2001-02-01

    We performed a double-blinded, prospective, randomized controlled trial to compare intubating conditions facilitated by succinylcholine or sevoflurane. One hundred twenty patients were randomized to receive either succinylcholine or sevoflurane for tracheal intubation. For the Succinylcholine group, patients were induced with thiopental 5 mg. kg(-1) and tracheally intubated after administration of succinylcholine 1.5 mg. kg(-1) IV. Patients receiving sevoflurane took three vital capacity breaths of 8% sevoflurane and 66% N(2)O in O(2). At the loss of eyelash reflex, ventilation was assisted to establish end-tidal CO(2) between 25-30 mm Hg, and intubation was performed when end-tidal sevoflurane was approximately 6%. Criteria of jaw relaxation, vocal cords position, and intubating response were used to assess intubation condition. If the intubation score was 0.05). Therefore, the three vital capacity breaths inhalation technique with sevoflurane may be an alternative for endotracheal intubation in adults. PMID:11159262

  14. A comparison of Mallampati scoring, upper lip bite test and sternomental distance in predicting difficult intubation

    OpenAIRE

    Arun Varghese; Taznim Mohamed

    2016-01-01

    Background: Difficult or failed tracheal intubation has been identified as one of the most important causes of death or permanent brain damage during anaesthesia. The present study has aimed to compare modified Mallampati score, Upper lip bite test and sternomental distance for predicting difficult intubation in adult patients. Methods: In this study 199 patients aged 18-60 years were recruited who were undergoing elective surgeries requiring endotracheal intubation. All patients were eva...

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

    OpenAIRE

    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...

  16. 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

    Energy Technology Data Exchange (ETDEWEB)

    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.

  17. Airtraq® optical laryngoscope for tracheal intubation in patients with severe ankylosing spondylitis: A report of two cases

    OpenAIRE

    Qazi Ehsan Ali; Syed Hussain Amir; Obaid Ahmed Siddiqui; Abu Nadeem; Abdulla Zoheb Azhar

    2012-01-01

    Airway management in patients of ankylosing spondylitis remains a challenge for anaesthesiologists. Many new airway devices have been used for securing airway in these patients. The Airtraq® optical laryngoscope is one of the new rigid laryngoscopes with a proximal view finder that reflects an image transferred from the distal tip of the blade through a series of lenses, prisms and mirrors. We report two cases of ankylosing spondylitis who were scheduled for total hip replacement and subtotal...

  18. Discopo optical laryngoscope for tracheal intubation in patients with neoplasm of larynx%Discopo气管插管内镜在喉部新生物患者全身麻醉插管中的应用

    Institute of Scientific and Technical Information of China (English)

    李卫星; 蔡一榕; 李文献

    2012-01-01

    目的 评估一种新型的可视管芯(Discopo气管插管内镜)在喉部新生物患者全身麻醉气管插管中的作用.方法 选择2011年1-12月间因喉部新生物择期行支撑喉镜手术的患者200例,随机分成普通喉镜组和内镜组,每组100例.全身麻醉诱导后两组患者分别应用Macintosh喉镜或Discopo气管插管内镜插入气管导管.观察并记录两种气管插管方法所需时间和插管次数,插管前和插管时的收缩压( SBP)、舒张压(DBP)、心率(HR),以及与气管插管相关的损伤发生率.结果 内镜组的气管插管时间显著短于普通喉镜组(P<0.05),一次气管插管成功率显著高于普通喉镜组(P<0.05).两组间气管插管前的SBP、DBP和HR的差异均无统计学意义(P值均>0.05).普通喉镜组在气管插管时的SBP、DBP和HR均显著高于内镜组(P值均<0.05),普通喉镜组在气管插管时的SBP、DBP和HR均显著高于气管插管前(P值均<0.05),而内镜组在气管插管时的SBP、DBP和HR均与气管插管前的差异无统计学意义(P值均>0.05).内镜组的气管插管相关并发症新生物出血和黏膜损伤的发生率显著低于普通喉镜组(P值均<0.05).结论 与Macintosh喉镜相比,使用Discopo气管插管内镜进行气管插管的耗时较少,一次插管成功率较高,气管插管过程中血流动力学更稳定,气管插管相关损伤较少.%Objective To investigate the application of a new visual stylet (Discopo optical laryngoscope) for tracheal intubation in patients with neoplasm of larynx under general anesthesia. Methods From January to December 2011, 200 larynx neoplasm patients scheduled for suspension laryngoscopic surgery were randomly divided into Macintosh direct laryngoscope group and Discopo optical laryngoscope group (n — 100). After intravenous induction, the patients were orally intubated with Macintosh direct laryngoscope or Discopo optical laryngoscope in each group. Parameters, including

  19. Airtraq可视喉镜和Macintosh喉镜在困难气管插管中的对比应用%Comparison of the Airtraq laryngoscopes and Macintosh laryngoscopes in patients with difficult tracheal intubation

    Institute of Scientific and Technical Information of China (English)

    杨改生; 薛晓东; 夏舒萌; 黄俊梅; 张晋东

    2012-01-01

    目的 探讨Airtraq可视喉镜和Macintosh喉镜在困难气管插管中的临床应用和对血流动力学的影响.方法 选择ASA Ⅰ~Ⅱ级,年龄20~62岁的Mallampatis Ⅲ~Ⅳ级的困难气道患者68例,随机均分为M组和A组.M组使用Macintosh喉镜传统方法直视下插管,A组使用Airtraq可视喉镜,全部患者采用相同的快速诱导方法进行气管插管,显露声门后在明视下气管插管;连续2次插管失败后采用Macintosh喉镜联合纤维支气管镜完成气管插管.从开口置入喉镜到气管插管成功并监测呼气末二氧化碳(ETCO2)确认插管正确无误为止进行秒表计时,记录完成气管插管的全部时间、插管次数、插管前后血流动力学变化、牙齿和口咽部有无损伤.结果 M组34例患者中16例一次插管成功,12例2次插管成功,另外6例经过两次插管失败后在Macintosh喉镜配合纤维支气管镜下插管成功;A组34患者中29例不需要导丝一次插管成功,另外5例声门显露清楚,但导管远端接近声门后联合而偏离声门中央,在特制的导丝引导下顺利完成插管.M组插管时间(82±38) s较A组(35±16) s显著延长(P<0.01);M组较A组插管开始0.5、1、3和5 min多个时点心率明显增快、血压显著升高(P<0.05或P<0.01);M组插管后10例出现咽喉部少量渗血、2例门齿松动,A组1例咽喉部出血,无门齿损伤情况发生.结论 使用Airtraq可视喉镜在困难气管插管时具有快速、成功率高、应激反应小等优点,为困难气道处理提供了一种非常好的方法.%Objective To compare the use of the Airtraq laryngoscope versus Macintosh laryngoscope for difficult tracheal intubation. Methods Sixty -eight (ASA I - II , aged 20-62 years) patients with difficult tracheal intubation scheduled for elective operation were randomly divided into two groups. 34 patients with the traditional Macintosh laryngoscope ( M group) and 34 patients were intubated with the Airtraq

  20. Comparison of Macintosh laryngoscope and C-MAC video laryngoscope for intubation in lateral position

    OpenAIRE

    Bhat, Ravi; Sanickop, Channabasavaraj S.; Patil, Manjunath C.; Umrani, Vijay S.; Dhorigol, Mallikarjun G.

    2015-01-01

    Background and Aims: Endotracheal intubation is conventionally performed when the patient is in supine position. It may be required to secure airway in laterally positioned patient. Tracheal intubation in lateral position seems to be difficult because the laryngeal view is compromised. Hence, C-MAC video laryngoscope (Karl Storz, Germany), a newer device using a modified macintosh blade may be useful for intubation in lateral position. Material and Methods: A total of 100 American Society of ...

  1. A comparison of hemodynamic changes after endotracheal intubation by the Optiscope™ and the conventional laryngoscope

    OpenAIRE

    Ko, Duk-Dong; Kang, Hyun; Yang, So-Young; Shin, Hwa-Yong; Baek, Chong Wha; Jung, Yong Hun; Woo, Young-Cheol; Kim, Jin-Yun; Koo, Gill Hoi; Kim, Seong-Deok

    2012-01-01

    Background Optiscope™ is a newly developed video stylet device. This study evaluated and compared the hemodynamic changes observed after endotracheal intubation with video stylet and after conventional laryngoscopic endotracheal intubation. Methods Fifty-eight adult patients with American Society of Anesthesiologists (ASA) physical status class 1 or 2, undergoing general anesthesia, were randomized into two groups: one group of patients were intubated using video stylet (n = 29) and the other...

  2. McGrath Video Laryngoscope May Take a Longer Intubation Time Than Macintosh Laryngoscope

    Directory of Open Access Journals (Sweden)

    Prerana N. Shah

    2015-01-01

    Full Text Available Background. Video laryngoscopes provide better view and can improve ease of intubation compared with standard laryngoscopes. Methods. A prospective randomized study was done on 60 patients, 18 to 65 years old, comparing McGrath video laryngoscope and Macintosh laryngoscope. The aim was to compare the ease, efficacy, and usability of them during routine airway management. The primary endpoint was duration of intubation and the secondary endpoints were Cormack and Lehane grade of laryngoscopic view, number of intubation attempts, and incidence of complications. Results. There was an increase in total duration of intubation with McGrath video laryngoscope with 42.9 ± 19.5 seconds compared to Macintosh laryngoscope with 17.9 ± 4.6 seconds. In Macintosh group, 73.3% had grade I, 20% had grade II, and 6.7% had grade III Cormack Lehane view, while in McGrath group, 83.3% had grade I, 13.3% had grade II, and 3.3% had grade III. In McGrath group, 6 patients (20% required more than 120 seconds to get intubated and only 73.3% were intubated in 1 attempt, while patients in Macintosh group had 100% successful intubation in 1 attempt. Pharyngeal trauma was seen with McGrath videolaryngoscopy. Conclusion. Duration of laryngoscopy, intubation, and total duration of intubation were significantly higher in McGrath group than in Macintosh group. McGrath group required a higher number of intubation attempts.

  3. 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. PMID:27024905

  4. 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.

  5. 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...

  6. Factors Influencing Continuous Breath Signal in Intubated and Mechanically-Ventilated Intensive Care Unit Patients Measured by an Electronic Nose

    Science.gov (United States)

    Leopold, Jan Hendrik; Abu-Hanna, Ameen; Colombo, Camilla; Sterk, Peter J.; Schultz, Marcus J.; Bos, Lieuwe D. J.

    2016-01-01

    Introduction: Continuous breath analysis by electronic nose (eNose) technology in the intensive care unit (ICU) may be useful in monitoring (patho) physiological changes. However, the application of breath monitoring in a non-controlled clinical setting introduces noise into the data. We hypothesized that the sensor signal is influenced by: (1) humidity in the side-stream; (2) patient-ventilator disconnections and the nebulization of medication; and (3) changes in ventilator settings and the amount of exhaled CO2. We aimed to explore whether the aforementioned factors introduce noise into the signal, and discuss several approaches to reduce this noise. Methods: Study in mechanically-ventilated ICU patients. Exhaled breath was monitored using a continuous eNose with metal oxide sensors. Linear (mixed) models were used to study hypothesized associations. Results: In total, 1251 h of eNose data were collected. First, the initial 15 min of the signal was discarded. There was a negative association between humidity and Sensor 1 (Fixed-effect β: −0.05 ± 0.002) and a positive association with Sensors 2–4 (Fixed-effect β: 0.12 ± 0.001); the signal was corrected for this noise. Outliers were most likely due to noise and therefore removed. Sensor values were positively associated with end-tidal CO2, tidal volume and the pressure variables. The signal was corrected for changes in these ventilator variables after which the associations disappeared. Conclusion: Variations in humidity, ventilator disconnections, nebulization of medication and changes of ventilator settings indeed influenced exhaled breath signals measured in ventilated patients by continuous eNose analysis. We discussed several approaches to reduce the effects of these noise inducing variables. PMID:27556467

  7. Factors Influencing Continuous Breath Signal in Intubated and Mechanically-Ventilated Intensive Care Unit Patients Measured by an Electronic Nose

    Directory of Open Access Journals (Sweden)

    Jan Hendrik Leopold

    2016-08-01

    Full Text Available Introduction: Continuous breath analysis by electronic nose (eNose technology in the intensive care unit (ICU may be useful in monitoring (patho physiological changes. However, the application of breath monitoring in a non-controlled clinical setting introduces noise into the data. We hypothesized that the sensor signal is influenced by: (1 humidity in the side-stream; (2 patient-ventilator disconnections and the nebulization of medication; and (3 changes in ventilator settings and the amount of exhaled CO2. We aimed to explore whether the aforementioned factors introduce noise into the signal, and discuss several approaches to reduce this noise. Methods: Study in mechanically-ventilated ICU patients. Exhaled breath was monitored using a continuous eNose with metal oxide sensors. Linear (mixed models were used to study hypothesized associations. Results: In total, 1251 h of eNose data were collected. First, the initial 15 min of the signal was discarded. There was a negative association between humidity and Sensor 1 (Fixed-effect β: −0.05 ± 0.002 and a positive association with Sensors 2–4 (Fixed-effect β: 0.12 ± 0.001; the signal was corrected for this noise. Outliers were most likely due to noise and therefore removed. Sensor values were positively associated with end-tidal CO2, tidal volume and the pressure variables. The signal was corrected for changes in these ventilator variables after which the associations disappeared. Conclusion: Variations in humidity, ventilator disconnections, nebulization of medication and changes of ventilator settings indeed influenced exhaled breath signals measured in ventilated patients by continuous eNose analysis. We discussed several approaches to reduce the effects of these noise inducing variables.

  8. 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.

  9. 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.

  10. EVALUATION OF INTUBATING CONDITIONS USING SEVOFLURANE WITHOUT USING MUSCLE RELAXANTS

    Directory of Open Access Journals (Sweden)

    Vankineni Kuchela

    2016-03-01

    Full Text Available BACKGROUND In healthy paediatric patients undergoing mask induction of general anaesthesia with sevoflurane, the induction time can be significantly shortened without an increase in the frequency of airway or vital sign complications using a high concentration, primed circuit technique compared with a conventional, incremental induction method. The vital capacity-rapid inhalation group primed with sevoflurane 8% was the fastest with no relevant side effects.(1 Sevoflurane using this technique was very well tolerated, indicated by high haemodynamic stability and a reduced rate of postoperative restlessness, shivering, nausea and vomiting.(2 It has a definite role in predicted difficult airway patients. MATERIALS AND METHODS A prospective randomized controlled study to evaluate intubating conditions using 8% sevoflurane without any use of muscle relaxants through vital capacity inhalational technique was undertaken in our institute, Seven Hills Hospital, Vishakhapatnam, during the period 2012-2013 on 51 patients aged between 18 to 65 years, belonging to ASA Grade I and II. Time taken for smooth intubation was noted and other induction parameters were observed. During laryngoscopy, evaluation of intubating conditions was done and haemodynamic parameters were noted at different point of time. The time of exposure to the inhaled gas was varied for consecutive participants. It was either increased or decreased by 30 sec increments based on the failure or success of preceding patient’s response to laryngoscopy and intubation after a preselected exposure time. RESULTS On assessment of intubating condition during laryngoscopy, it was found that 76.47% of patients fell into excellent category, 17.64% of patients fell into good category, rest 5.88% fell into moderate category. Two patients could not be intubated because of failure of jaw relaxation as it was very tight, so laryngoscopy was impossible. Excellent intubating condition in 76.47% patients

  11. ICU气管插管患者基本需求及影响因素分析%Basic Needs of Intubated Patients in ICU and Its Influencing Factors

    Institute of Scientific and Technical Information of China (English)

    侯春怡; 王梅; 刘丽琴

    2012-01-01

    Objective To understand the hasio needs and communication difficulties of intuhated patients and to discuss influencing factors of patients' basic needs. Methods The data were collected by structured questionnaires and reviewing charts. A total of 80 intubated patients completed the interviews. Basic needs and communication difficulties of them and the influencing factors of their basic needs were described. Results Moderate basic needs and communication difficulties existed among intubated patients, with the standardized scores of 53.38 and 45.98. The sense of being loved and belonging was what intubated patients involved needed most. The basic needs of intubated patients could be significantly predicted by communication difficulties, physical restraints, intubation history and educational background (P<0.05). Conclusion The intubated patients in ICU are with moderate basic needs and communication difficulties. ICU nurses are suggested improving their communication skills to satisfy patients ' basic needs.%目的 了解重症监护室气管插管患者的基本需求和交流障碍情况,并探讨影响患者基本需求的相关因素.方法 选取ICU气管插管患者80例,在患者拔管3 d后对其气管插管期间的基本需求、交流障碍程度进行评估,对基本需求的影响因素进行多重线性逐步回归分析.结果 本组气管插管患者基本需求标准分为53.38分,表示有中度基本需求,被关爱感和归属感是最主要的需求;交流障碍标准分为45.98分,有中度交流障碍.多重线性逐步回归分析结果显示,交流障碍、身体约束、气管插管史和文化程度4个因素是患者基本需求的独立影响因素(P<0.05).结论 ICU气管插管患者有中度的基本需求和交流障碍,患者的基本需求受交流障碍、身体约束及文化程度等因素影响.提示ICU护士需要提高其沟通技巧并减少对患者采用身体约束措施,尤其是对文化程度较低者,以满足患者的基本需求.

  12. 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.

  13. 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. PMID:26917188

  14. Airtraq™ versus Macintoch laryngoscope in intubation performance in the pediatric population

    Directory of Open Access Journals (Sweden)

    Waleed Riad

    2012-01-01

    Full Text Available Purpose: Airtraq™ is an optical laryngoscope that allows viewing of the vocal cords without a direct line of sight. The main objective of this prospective, randomized, controlled trial was to evaluate Airtraq intubation characteristics, mainly intubation time and cardiovascular changes in the pediatric patients. Methods: Fifty children of American Society of Anesthesiologists class I, 2-10 years of age were divided into 2 groups using sealed envelope technique. Children were premedicated with midazolam. Anesthesia was induced with sevoflurane, fentanyl, and atracurium. Patients were randomly allocated to be intubated with either Airtraq (Airtraq group or Macintosh laryngoscope (Macintosh group. Intubation time, number of intubation attempts, optimization maneuvers, and ease of intubation were recorded. Hemodynamic variables were recorded before and after anesthetic induction, 1, 3, and 5 min after tracheal intubation. Results: The mean age of children was 6.1 years. Compared with Macintosh group, the use of Airtraq was associated with shorter intubation time (51.6±26.7 s vs 22.8±6.1 s, respectively, P=0.001, less median number of intubation attempts 2 (1-2 versus 1 (1-1, P=0.001, more ease of intubation [2 (1-3 versus 1 (1-1, P=0.001] and less increase in the heart rate 5 min after intubation (P=0.007. No optimization maneuvers required for Airtraq laryngoscope (P=0.001. Conclusion: Airtraq decreases intubation time, number of attempts, and optimization maneuvers, less heart rate changes during intubation compared with Macintosh laryngoscope.

  15. The King Vision™ video laryngoscope for awake intubation: series of cases and literature review

    OpenAIRE

    Gaszynska E; Gaszynski T

    2014-01-01

    Ewelina Gaszynska, Tomasz GaszynskiDepartment of Emergency Medicine and Disaster Medicine, Medical University of Lodz, Lodz, PolandAbstract: Intubation of patients with a supraglottic mass causing obstruction of the glottis remains a difficult problem for the experienced anesthesiologist. Awake fiberscopic endotracheal intubation is the recommended approach in such cases; however, use of a video laryngoscope for awake intubation can be an alternative to a fiberscope. Here we present two cases...

  16. The King Vision™ video laryngoscope for awake intubation: series of cases and literature review

    OpenAIRE

    Gaszynski, Tomasz

    2014-01-01

    Ewelina Gaszynska, Tomasz GaszynskiDepartment of Emergency Medicine and Disaster Medicine, Medical University of Lodz, Lodz, PolandAbstract: Intubation of patients with a supraglottic mass causing obstruction of the glottis remains a difficult problem for the experienced anesthesiologist. Awake fiberscopic endotracheal intubation is the recommended approach in such cases; however, use of a video laryngoscope for awake intubation can be an alternative to a fiberscope. Here we present two cases...

  17. The effect of ketamine versus fentanyl on the incidence of emergence agitation after sevoflurane anesthesia in pediatric patients undergoing tonsillectomy with or without adenoidectomy

    Directory of Open Access Journals (Sweden)

    Ashraf Arafat Abdelhalim

    2013-01-01

    Full Text Available Background: Emergence agitation (EA has been documented as a common side-effect of sevoflurane anesthesia. This prospective, randomized, double-blind, placebo-controlled study was designed to compare the effects of ketamine versus fentanyl, administered 10 min before the end of surgery on the development of EA. Methods: A total of 120 children aged 3-7 years of American Society of Anesthesiologists I-II physical status were randomly assigned to one of three equal groups receiving either ketamine 0.5 mg/kg (Group K, fentanyl 1 μg/kg (Group F or saline (Group C at 10 min before the end of surgery. Post-operative EA was assessed with Aono′′s four point scale. Recovery times, the post-operative pain and adverse reactions were assessed. Results: There was no significant difference between the three groups regarding recovery and discharge times from post-anesthesia care unit. The incidence of EA was significantly low in Group K and Group F (15% and 17.5%, respectively compared to the control group (42.5%, with no significant difference between Group K and Group F. There were no significant differences in Children′s Hospital of Eastern Ontario Pain Scale between the three groups. The incidence of nausea or vomiting was significantly more in Group F compared to that in other two groups. However, no complications such as somnolence, oxygen desaturation or respiratory depression occurred during the study period and there were no episodes of hallucinations or bad dreams in the ketamine group. Conclusion: The intravenous administration of either ketamine 0.5 mg/kg or fentanyl 1 μg/kg before the end of surgery in sevoflurane-anesthetized children undergoing tonsillectomy with or without adenoidectomy reduces the incidence of post-operative agitation without delaying emergence.

  18. Inoperable oesophageal and cardia cancer. Benefits from Celestin intubation

    DEFF Research Database (Denmark)

    Qvist, N; Ryttov, N; Larsen, K E

    1987-01-01

    in five. One-third of the patients benefited from the operation, i.e. experienced good palliation and no serious complications. The mortality rate was 27%. The authors conclude that all patients with difficulty in swallowing saliva should be intubated, as good palliation was achieved in all such patients...

  19. Comparison of Esmolol and Lignocaine for Atttenuation of Cardiovascular Stress response to Laryngoscopy and Endotracheal Intubation

    Directory of Open Access Journals (Sweden)

    Ajay Gupta, Renu Wakhloo, Vishal Gupta, Anjali Mehta, BB Kapoor

    2009-04-01

    Full Text Available Direct laryngoscopy and endotracheal intubation frequently induces a cardiovascular stress response dueto reflex symbathetic stimulation. This response may be hazardous in patients with Hypertension, Coronaryartery disease, Myocardial disease, cerebrovascular disease. Numerous agents have therefore been utilizedto blunt this response. The present study was undertaken in view of above mentioned facts, to compareeffectiveness of intravenous esmolol and lignocaine in suppressing the cardiovascular stress response.Patients were divided in to three groups of 20 patients each. Group-C did not receive any drug understudy. Group-L received lignocaine and Group-E received esmolol three minutes before intubation. All thegroups were observed for changes in haemodynamic parameters i.e. heart rate (HR systolic and diastolicblood pressure every minute after intubation till 5 minutes post intubation. It was found that patients givenesmolol had better attenuation of stress response to laryngoscopy and intubation than patients givenlignocaine.

  20. 老年无牙患者气管插管改良固定方法的研究%Analysis on the effect in no teeth elderly patients of modified tracheal intubation

    Institute of Scientific and Technical Information of China (English)

    郑兰华

    2015-01-01

    Objective:To analyze the edentulous elderly patients with self-locking tracheal intubation fixer and effective improvement of fixed.Methods: From December 2013 to November 2014 in our hospital treated by oral tracheal intubation in elderly patients with a total of 74 cases, all patients according to the fixed mode of tracheal intubation were divided into control group and observation group, compared the two groups of patients with tracheal shift and satisfaction degree, degree of comfort and unexpected accidents.Results: The observation group patients with intubation without shifting the proportion was significantly higher than the control group, while the proportion of moderate displacement was significantly less than the control group, the differences were statistically significant; the observation group patients feel comfortable proportion was significantly greater than the control group, the proportion of discomfort was significantly higher than the control group, the differences were statistically significant; patients in observation group were fixed number was significantly less than the control group, patients satisfaction rate were significantly higher than those in control group, the differences were statistically significant (x2=5.845,P<0.05). Conclusion: The self-locking fixer for tracheal intubation can maximize the comfort degree of patients, improve the operation convenience, reduce the tracheal shift, it is worthy of clinical application.%目的:分析无牙的老年患者以自锁式固定器气管插管改良固定的有效性。方法:选取74例收治的经口腔插管的老年患者,根据插管的固定方式不同将其分为对照组(36例)与观察组(38例),比较插管后两组气管位移、舒适程度、意外事件发生以及患者满意率。结果:观察组无位移患者明显多于对照组,中度位移数量明显小于对照组;患者舒适程度方面观察组显著大于对照组;观察组患者的固定次数

  1. Research progress on oral care for critically ill patients with endotracheal intubation%气管插管危重病人口腔护理的研究进展

    Institute of Scientific and Technical Information of China (English)

    唐慧婷; 卢惠娟; 曹艳佩; 李铮

    2013-01-01

    It analyzed the oral care method and effect for patients receiving endotracheal intubation in China. And it put forward the evidence -based oral care guideline and unified national oral care standards should be established for critically ill patients with endotracheal intubation,so as to make the oral care in ICU regulations viable and evidence - based and play the most positive role for oral care of critically ill patients%对目前国内气管插管病人口腔护理方法及效果进行分析,提出建立以循证为基础的气管插管危重病人口腔护理指南及统一的全国性口腔护理规范,使重症监护室的口腔护理有规可行、有据可依,发挥口腔护理对危重病人的最大正性作用.

  2. Changes in three-dimensional computer tomography images of upper airway in patients with difficult tracheal intubation%困难气道患者上气道三维CT图像的改变

    Institute of Scientific and Technical Information of China (English)

    范莉琼; 姜虹; 朱也森

    2009-01-01

    Objective To evaluate the changes in three-dimensional computer tomography (3DCT) images of upper airway in patients with difficult tracheal intubation and provide theoretical evidence for predicting the difficult tracheal intubation. Methods Seventeen ASA Ⅰ or Ⅱ male patients, 25-60 yr old, height 165-185 era, weight 55-110 kg, body mass index 19-33 kg/m2, scheduled for elective surgery under general anesthesia, were studied. The airway condition was evaluated with Mallampati classification and Willsan score system in all patients before the operation. The patients underwent 3DCT scanning under 2 different statuses: with or without tongue protruding while opening his mouth maximally. The volume of the oropharyngeal cavity (Va1, Va2) andtongue body (Vt1, Vt2), and area of the oropharyngeal cavity (Aa1, Aa2) and tongue body (At1, At2) in the coronal position were measured before and during tongue protruding. The midline sagittal images of the upper airway were made on computer to measure the direct laryngoscope angle and vertical distance between the mandible and hyoid (MHD). Awake blind tracheal intubation was performed in all patients. The exposure of the glottis was performed after anesthesia induction and evaluated with Cormack-Lehane classification. The patients were divided into non-difficult intubation group (group NDI, Cormack-Lehane grade Ⅰ or Ⅱ) and difficult intubation group (group DI, Cormack-Lehane grade Ⅲ or Ⅳ) according to Cormack-Lehane classification. Results There were 8 patients in group NDI, and 9 patients in group DI. There was no significant difference in the indices before tongue protruding between group DI and NDI (P>0.05). Va2, Va1 - Va1, Aa2, Aa1 - Aa2, and At1- At2 weresignificanfly smaller, MHD was significantly longer and Va1,/Vt1- Va2/Vt2was significantly larger in group DI than in group NDI (P 0.05),Va2、Va1-Va2、Aa2、Aa1一Aa2、At1-At1减小,MHD延长,Va1/Vt1-Va2/Vt2增大(P<0.05或0.01);与Va1或Aa1比较,DI组Va2

  3. 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。

  4. Comparison of successful intubation with two different blades of laryngoscope: single-use and reusable.

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    Ali Shahriari

    2007-05-01

    Full Text Available BACKGROUND: Many types of single-use blades are manufactured with different designs and materials. There have been several reports of difficulties in obtaining a view of the glottis with single-use laryngoscopes. The purpose of this prospective study was to compare the quickness and the success rate of endotracheal intubations with two different laryngoscope blades: disposable laryngoscope blades and reusable laryngoscope blades. METHODS: The study included 200 patients aged 18 to 70 who were admitted to the operating room of the Ali Ebne Abitaleb Hospital in Zahedan. The patients were randomly divided in two groups. Disposable laryngoscope blades were used for the first group and reusable laryngoscope blades were used for the second group. The endotracheal intubation duration and the failure rate of the intubation were assessed in the two groups. RESULTS: No failures and prolongations of intubations were found in the reusable laryngoscope blades group compared with 21% incidence of prolonged intubations and 14% incidence of failed intubations in the prolonged intubations group which led to change of the laryngoscope by the anesthetists (P<0.05. CONCLUSIONS: The single-use laryngoscope blades appear to be efficient devices because they do not modify the ease of endotracheal intubation in most cases. Nonetheless, for difficult intubations it is advised to maintain conventional laryngoscopes in reserve.

  5. 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

  6. Intravenous lidocaine as a suppressant of coughing during tracheal intubation.

    Science.gov (United States)

    Yukioka, H; Yoshimoto, N; Nishimura, K; Fujimori, M

    1985-12-01

    Effects of intravenously administered lidocaine on cough suppression during tracheal intubation under general anesthesia were evaluated in two studies. In study 1, 100 patients received either a placebo or 0.5, 1.0, 1.5, or 2.0 mg/kg lidocaine intravenously 1 min before tracheal intubation. All visible coughs were classified as coughing. The incidence of coughing decreased as the dose of lidocaine increased. A dose of 1 mg/kg or more of intravenous lidocaine suppressed the cough reflex significantly (P less than 0.01). Coughing was suppressed completely by 2 mg/kg of intravenous lidocaine. In study 2, 108 patients received 2 mg/kg lidocaine intravenously or a placebo 1, 3, 5, 7, 10, or 15 min before intubation. The same criteria for determining whether a patient did or did not cough during tracheal intubation were used as in study 1. The incidence of coughing decreased significantly (P less than 0.01) when 2 mg/kg of lidocaine was injected intravenously between 1 and 5 min before our attempting intubation. Cough reflex was suppressed completely by plasma concentrations of lidocaine in excess of 3 micrograms/ml. PMID:4061901

  7. Agitation

    Science.gov (United States)

    ... withdrawal Allergic reaction Caffeine intoxication Certain forms of heart, lung, liver, or kidney disease Intoxication or withdrawal from drugs of abuse (such as cocaine, marijuana, hallucinogens, PCP, or opiates) Hospitalization (older adults often ...

  8. Guillain-Barré syndrome in child with prolong intubation

    Directory of Open Access Journals (Sweden)

    Ashwin Borade

    2010-01-01

    Full Text Available Guillain-Barré syndrome (GBS is an acute demyelinating disorder of the peripheral nervous system that results from an aberrant immune response directed at peripheral nerves. A typical GBS patient presents with rapidly ascending symmetrical weakness, which may progress to respiratory failure in 30% of patients. There are no definite criteria exists in GBS in children regarding prolonged ventilation. Here we report a child of GBS requiring prolonged intubation and ventilation for 60 days who afterward had a complete recovery. We present this case to highlight the importance that even in children prolonged intubation and ventilation of GBS case prognosis can be good.

  9. Evaluation of intra ocular pressure and hemodynamic change following intubation with Maccoy, Macintosh and Video laryngoscope

    OpenAIRE

    Hamid Khosro Zamiri; Mehrdad Noroozi; Siavash Moradi; Mohammad Shabani; Ali Sharifi; Mohammad Ali Haghbin

    2013-01-01

    Background & Objective: The induction of anesthesia, laryngoscopy and endotracheal intubation can be associated with adverse hemodynamic response and increased intraocular pressure. The aim of this study was to evaluate intraocular pressure and hemodynamic changes after laryngoscopy and endotracheal intubation with three methods of laryngoscopy (Macintosh, Maccoy and Video laryngoscope).Materials & Methods: One hundred and eighty patients with American Society of Anesthesiology (ASA) classifi...

  10. COMPARISON OF ROCURONIUM BROMIDE AND SUCCINYLCHOLINE CHLORIDE FOR USE DURING RAPID SEQUENCE INTUBATION IN ADULTS

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    Ch. Penchalaiah

    2015-08-01

    Full Text Available BACKGROUND AND OBJECTIVE : The goal of rapid sequence intubation is to secure the patients airway smoothly and quickly, minimizing the chances of regurgitation and aspiration of gastric contents. Traditionally succinylcholine chloride has been the neuromuscular blocking drug of choi ce for use in rapid sequence intubation because of its rapid onset of action and profound relaxation. Succinylcholine chloride remains unsurpassed in providing ideal intubating conditions. However the use of succinylcholine chloride is associated with many side effects like muscle pain, bradycardia, hyperkalaemia and rise in intragastric and intraocular pressure. Rocuronium bromide is the only drug currently available which has the rapidity of onset of action like succinylcholine chloride. Hence the present study was undertaken to compare rocuronium bromide with succinylcholine chloride for use during rapid sequence intubation in adult patients. METHODOLOGY : The study population consisted of 90 patients aged between 18 - 60 years posted for various elective su rgeries requiring general anaesthesia . S tudy population was randomly divided into 3 groups with 30 patients in each sub group. 1. Group I : Intubated with 1 mg kg - 1 of succinylcholine chloride (n=30 . 2. Grou p II : Intubated with rocuronium bromide 0.6 mg kg - 1 (n=30 . 3. Group III : Intubated with rocuronium bromide 0.9 mg kg - 1 (n=30 . Intubating conditions were assessed at 60 seconds based on the scale adopted by Toni Magorian et al. 1993. The haemodynamic para meters in the present study were compared using p - value obtained from student t - test . RESULTS : It was noted that succinylcholine chloride 1 mg kg - 1 body weight produced excellent intubating conditions in all patients. Rocuronium bromide 0.6 mg kg - 1 body we ight produced excellent intubating conditions in 53.33% of patients but produced good to excellent intubating conditions in 96.67% of patients. Rocuronium bromide 0.9 mg kg - 1

  11. The effect of esmolol on the QTc interval during tracheal intubation in elderly patients with coronary%艾司洛尔对老年冠心病患者气管插管QTc间期的影响

    Institute of Scientific and Technical Information of China (English)

    张兆平; 顾美蓉; 房宁宁; 孙国华

    2011-01-01

    Objective To evaluate the effect of esmolol on the QTc interval during tracheal intubation after anesthesia induction in elderly patients with coronary artery disease. Methods Fifty patients aged 60-75y with ASA Ⅱ were randomly allocated either to esmolol (E) or to control (C)group. A bolus of 0. 3 mg/kg esmolol was administered to the group E and followed by a continuous infusion at a rate of 100 μg·kg-1 ·min-1; group C received same volume of saline. The changes in QTc, MAP and HR were recorded at following time points: prior to anesthesia induction (T0), 2 min after esmolol or saline injection (T1), 1 min following fentanyl and propofol delivery (T2), 3 min after vecuronium given (T3), 30 s (T4), 2 min (T5) and 4 min (T6) after intubation. Results QTc interval was enlarged significantly after intubation at T4, T5 and T6 than that of at T0 (P<0.05), and this effect was far greater in the group C than the group E (P<0. 01), and the number of patients with QTc intervals > 440 ms were more in the control group than the esmolol one (P < 0.05).Conclusion QTc interval enlarged following tracheal intubation during induction of anesthesia in elderly patients with coronary artery disease, but esmolol can attenuate such change in the QTc interval associated with tracheal intubation.%目的 评价艾司洛尔在麻醉诱导气管插管时对老年冠心病患者QTc间期的影响.方法 50例ASA Ⅱ级,年龄60~75岁择期全麻手术患者随机分为艾司洛尔组(E组)与对照组(C组).E组麻醉诱导前单次静脉缓慢注射艾司洛尔0.3 mg/kg后100 μg·kg-1·min-1持续输注至气管插管后4 mim;C组给予等容量生理盐水.记录给予艾司洛尔前(T0)、单次给予艾司洛尔或生理盐水后2 min(T1)、芬太尼与丙泊酚诱导后1 min(T2)、维库溴铵后3 min(插管前,T3)及插管后30 s(T4)、2 min(T5)与4 min(T6)QTc、MAP及HR变化.结果 T4~T6时QTc间期C组均长于T0时(P<0.05),且C组明显长于E组(P<0.01),

  12. Fluroscopic assisted airway intubation in temporomandibular joint ankylosis: A novel technique

    Directory of Open Access Journals (Sweden)

    Ibin Varughese

    2011-01-01

    Full Text Available Airway management is considered one of the most difficult and challenging procedures among the various anesthetic procedures. It becomes tougher when there is a diseased temporomandibular joint (TMJ due to inadequate mouth opening. In the current scenario there are only a few methods that ensure a safe, uneventful intubation in a TMJ ankylosis patient with a difficult airway. These include techniques ranging from minimally invasive techniques like blind nasal intubation, retrograde intubation using a guide wire, the latest technique of intubating with the help of a fiberoptic laryngoscope and the time tested tracheostomy. All these techniques have got their own disadvantages. So we report a case series of five patients with TMJ ankylosis who underwent fluoroscopic-assisted intubation for airway management. We found that this technique is 100% successful in managing the airway in these patients. To the best of our knowledge, this is the first case series detailing this novel technique in the entire English medical literature.

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

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    Basak Ceyda Meco

    2015-06-01

    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.

  14. A Controlled Agitation Process for Improving Quality of Canned Green Beans during Agitation Thermal Processing.

    Science.gov (United States)

    Singh, Anika; Pratap Singh, Anubhav; Ramaswamy, Hosahalli S

    2016-06-01

    This work introduces the concept of a controlled agitation thermal process to reduce quality damage in liquid-particulate products during agitation thermal processing. Reciprocating agitation thermal processing (RA-TP) was used as the agitation thermal process. In order to reduce the impact of agitation, a new concept of "stopping agitations after sufficient development of cold-spot temperature" was proposed. Green beans were processed in No. 2 (307×409) cans filled with liquids of various consistency (0% to 2% CMC) at various frequencies (1 to 3 Hz) of RA-TP using a full-factorial design and heat penetration results were collected. Corresponding operator's process time to impart a 10-min process lethality (Fo ) and agitation time (AT) were calculated using heat penetration results. Accordingly, products were processed again by stopping agitations as per 3 agitation regimes, namely; full time agitation, equilibration time agitation, and partial time agitation. Processed products were photographed and tested for visual quality, color, texture, breakage of green beans, turbidity, and percentage of insoluble solids in can liquid. Results showed that stopping agitations after sufficient development of cold-spot temperatures is an effective way of reducing product damages caused by agitation (for example, breakage of beans and its leaching into liquid). Agitations till one-log temperature difference gave best color, texture and visual product quality for low-viscosity liquid-particulate mixture and extended agitations till equilibration time was best for high-viscosity products. Thus, it was shown that a controlled agitation thermal process is more effective in obtaining high product quality as compared to a regular agitation thermal process. PMID:27096606

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

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    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.

  16. 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.

  17. 有机磷农药中毒气管插管患者非计划性拔管的原因分析%Reason analysis of unplanned extubation in organophosphorus pesticide poisoning patients with endotracheal intubation

    Institute of Scientific and Technical Information of China (English)

    杨德淑; 张惠

    2011-01-01

    Objective To analyze the incidence and risk factors of unplanned extubation(UE) in organophosphorus pesticide poisoning patients with endotracheal intubation. Methods The prevalence and risk factors of UE in 43 organophosphorus pesticide poisoning patients with endotracheal intubation were retrospectively analyzed. Results The incidence of UE in organophosphorus pesticide poisoning patients with endotracheal intubation was 30.23 percent. Logistic regression analysis showed that Ramsay sedation score (OR=0.079) and sputum scab score (OR =7.029) were the risk factors of UE. Conclusions The incidence of UE in organophosphorus pesticide poisoning patients is relatively high. Ramsay sedation score and sputum scab score are the independent risk factors of UE. Effective sedation measures and airway management may reduce the incidence of UE and increase the successful rescue rate of organophosphorus pesticide poisoning patients.%目的 总结有机磷农药中毒气管插管患者非计划性拔管(Unplanned extubation,UE)的发生率,分析UE发生的相关原因.方法 回顾性分析2009年1月至2010年12月我科收治的43例有机磷农药中毒气管插管患者年龄、性别、Ramsay评分、阿托品日平均用量、气道痰痴评分、使用气管导管型号等临床资料,评估UE发生率并筛查UE的临床危险因素.结果 本组有机磷农药中毒气管插患者UE发生率为30.23%,单因素分析显示,UE组与非UE组Ramsay评分、阿托品日平均用量及气道痰痴评分差异有统计学意义,Logistics逐步回归分析显示Ramsay评分(OR=0.079)和气道痰痴评分(OR=7.029)与UE的发生独立相关.结论 有机磷农药中毒气管插患者UE发生率较高,Ramsay评分低和气道痰痂评分高是发生UE的独立危险因素.有效镇静和强化气道管理可能有助于减少UE的发生,提高有机磷农药中毒患者的救治成功率.

  18. Distributions of ethanol and intubation-related lidocaine in the brain of a trauma patient who was brain dead for about 5 days.

    Science.gov (United States)

    Moriya, Fumio; Hashimoto, Yoshiaki; Nakanishi, Akinori

    2003-03-01

    A 48-year-old intoxicated man was admitted to a hospital with an acute subarachnoid hemorrhage from a blow to the head following a drinking session. Lidocaine jelly was used to facilitate intubation during cardiopulmonary resuscitation. While his heart resumed beating, he was classified as brain dead and his heart stopped 114 h after admission. His brain was soft and weighed 1.7 kg at autopsy. A small rupture (0.5 by 0.3 cm) of the left vertebral artery and diffuse subarachnoid hemorrhage were observed. Ethanol was detected only in the cerebrum, cerebellum and clotted blood in the superior sagittal sinus at 0.29, 0.15 and 0.12 mg/g, respectively. Lidocaine was also found in these areas at levels of 28, 24 and 7 ng/g, respectively. Significant amounts of ethanol were present in his brain because blood flow stopped after the injury. Smaller amounts of intubation-related lidocaine were probably distributed to the brain by limited cerebral circulation and remained there after circulation ceased. Toxicological analysis of the brain after death was useful for evaluating his state during treatment. PMID:12935567

  19. 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.

  20. Evaluation of Truview evo2® Laryngoscope In Anticipated Difficult Intubation-A Comparison To Macintosh Laryngoscope

    OpenAIRE

    Ishwar Singh; Abhijit Khaund; Abhishek Gupta

    2009-01-01

    Summary 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 (...

  1. Efficacy of esmolol administration at different time intervals in attenuating hemodynamic response to tracheal intubation

    Directory of Open Access Journals (Sweden)

    S K Singhal

    2010-01-01

    Full Text Available Background: Laryngoscopy and endotracheal intubation are known to cause increase in both arterial blood pressure and heart rate. Several strategies have been evolved to blunt the haemodynamic response to tracheal intubation but each method has its own advantages and disadvantages. Esmolol, a cardio selective Beta -1 blocking drug, can alleviate some of these problems. Esmolol, when administered parenterally, exhibits rapid onset and a short duration of action due to its rapid clearance by red blood cell esterases. Hence we conducted the present study to evaluate the efficacy and optimum time of single bolus esmolol administration in attenuating hypertensive- tachycardiac response to laryngoscopy and tracheal intubation. Materials and Methods: The randomized double blind prospective study was conducted in 60 patients, in the age group of 20-40 years, of both sexes, belonging to American Society of Anaesthesiologists (ASA physical status class I or II and scheduled for elective surgery requiring endotracheal intubation and general anaesthesia. The efficacy and optimum time of single bolus esmolol administration in attenuating hypertensive - tachycardiac response to laryngoscopy and tracheal intubation was evaluated. Patients in group I (n=20 received bolus administration of injection esmolol 1.5 mg/kg intravenously (iv 90 seconds before intubation; in group II (n=20 three minutes before intubation and in group III (n=20 six minutes before intubation. Results: There was no clinical and statistically significant variation in heart rate in group I and II at different time intervals of the study period but in group III heart rate increased significantly one minute after tracheal intubation. (P0.05 Conclusion: To conclude, single intravenous bolus dose of esmolol (1.5 mg/kg is safe and more effective in attenuating haemodynamic response to laryngoscopy and tracheal intubation when administered three minutes prior to intubation.

  2. 经鼻盲探插管术在张口受限患者的应用%Application of Blind Nasal Intubation in Patients with Limitation of Mouth Opening

    Institute of Scientific and Technical Information of China (English)

    苏云锋

    2014-01-01

    目的:研究经鼻盲探插管术在张口受限患者中的应用。方法选择2013年7月—2014年5月收治的口腔科手术患者52例,ASA评分Ⅰ~Ⅱ级。其中32例张口度﹤2 cm,完全张口受限患者20例。导管选择ID 4.0~7.0 mm。麻醉前给予足量抗胆碱药物,必要时给予小剂量咪唑安定和芬太尼静脉注射,在充分表面麻醉下行经鼻盲探插管术,观察在操作过程中血压、心率、脉搏血氧饱和度的变化。结果该组52例患者在充足的麻醉前准备和完善的表面麻醉下经鼻盲探插管全部成功。在插管前与插管后即刻SBP分别为(123.0依9.3)mmHg、(129.0依9.7)mmHg,DBP分别为(72.0依6.2)mmHg、(74.0依6.5)mmHg, HR分别为(82.0依2.4)次/min、(85.3依2.6)次/min,SPO2分别为(99.7依0.5)%、(99.6依0.6)%,盲探插管操作过程的血压、心率、脉搏血氧饱和度无明显变化。术后随访患者无喉痛、声嘶、喉头水肿等并发症。结论经鼻盲探插管在张口受限患者的应用是切实安全、有效地。%Objective To study the application of blind nasal intubation in patients with limitation of mouth opening. Methods 52 cases with ASA score grade Ⅰ~Ⅱ underwent stomatological operation were selected. Of them, 32 cases had degree of mouth opening < 2cm, and 20 cases had complete limitation of mouth opening. The ID 4.0~7.0mm catheter was selected. Before anesthe-sia, adequate anticholinergic drugs, and when necessary, intravenous injection of small doses of midazolam and fentanyl, were giv-en to the patients, then the patients underwent blind nasotracheal intubation with full surface anesthesia. And the change of blood pressure, heart rate and pulse oxygen saturation during the operation were observed. Results All the 52 patients in this group un-derwent the blind nasal intubation successfully with adequate preanesthetic preparation and perfect surface anesthesia. The SBP of the patients before

  3. Application of Non-intubated Anesthesia in VATS

    Directory of Open Access Journals (Sweden)

    Xiaotan DAI

    2016-05-01

    Full Text Available 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.

  4. 氧瞬得可视喉镜用于意外困难气管插管20例临床分析%The use of airtraq oPtical laryngoscoPe in unanticiPated difficult tracheal intubation of 20 Patients

    Institute of Scientific and Technical Information of China (English)

    李光元; 李明强

    2014-01-01

    Objective To summarize the experiences usinG the Airtraq optical larynGoscope( AL)in the manaGement of unanticipated difficult endotracheal intubation. Methods Twenty surGical patients with General anesthesia usinG tracheal intubation were induced with propofol-remifentanyl and injected with atracuriun (0. 5 mG/kG). And then,larynGoscope with Macintosh directly throuGh oral tracheal intubation,and located the tracheal intubation by end tidal carbon dioxide detection method. AttemptinG oral tracheal intubation with Macintosh larynGoscope were failed for twice time,the AL was used to accomplish tracheal intubation. Results In all the patients,tracheal intubations with AL as a rescue intubation device Got clear GradeⅠCormack-Lehane Glottis exposure,with once-time successful intubation attemptinG in l8 patients. But in other 2 patients,tracheal intubations were accomplished by combined use of a fibreoptic bronchoscope which GuidinG tracheal tube into the Glottis throuGh AL after tracheal tube slidinG backward into the esophaGus repeatedly. DurinG the intubation attempts,interval mask ventilation were Given maintaininG SaO2≥90% in all patients. Conclusion AL offers an new effective technique as a rescue airway device in deal with unanticipated difficult tracheal intubation.%目的:总结应用氧瞬得可视喉镜处理意外困难气管插管的临床经验。方法20例拟在气管插管全身麻醉下手术的患者,以丙泊酚-瑞芬太尼静脉诱导,阿曲库铵0.5 mG/kG 静脉注射后以Macintosh 直接喉镜行经口明视下气管插管术,以呼气末二氧化碳检测法确定气管导管位置。直接喉镜试插2次未能成功,改用氧瞬得可视喉镜引导插管。结果20例患者改用氧瞬得喉镜气管插管后,声门显露完整清楚,C-L分级均为l级,l8例气管插管l 次成功,2例通过喉镜观察到导管向后反复滑入食道,经联合使用纤维支气管镜引导,气管导管插入成功;插管过程

  5. 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...

  6. [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. PMID:17004208

  7. 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...... in the shimmer values in that group implies that the Endoflex may be associated with less laryngeal morbidity....

  8. Avoidance of Laryngeal Injuries during Gastric Intubation

    Directory of Open Access Journals (Sweden)

    Jyoti Burad

    2014-08-01

    Full Text Available Gastric intubation is a common and simple procedure that is often performed on patients who are sedated or anaesthetised. If the gastric tube (GT is inserted blindly while the patient is unconscious, this procedure may result in easily preventable complications such as laryngeal trauma. We present an interesting case where the blind placement of a orogastric tube (OGT in an anesthetised 52-year-old female patient at Sultan Qaboos University Hospital in Oman resulted in significant arytenoid trauma. This led to delayed tracheal extubation. The movement of the GT from the oropharyngeal area to the upper oesophageal sphincter can be visualised and controlled with the use of Magill forceps and a laryngoscope. Therefore, this report highlights the need for GT insertion procedures to be performed under direct vision in patients who are unconscious (due to sedation, anaesthesia or an inherent condition in order to prevent trauma to the laryngeal structures.

  9. 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.

  10. 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. PMID:26401748

  11. 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.

  12. 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

  13. 刷牙冲洗法对ICU经口气管插管患者口腔护理的效果研究%Brushing-teeth irrigation for patients' oral care after trachea intubation in ICU

    Institute of Scientific and Technical Information of China (English)

    吴秀玲; 汪海芹; 罗玉珍; 李润华; 陈雨婵

    2014-01-01

    目的 探讨刷牙冲洗法对ICU经口气管插管患者口腔护理的临床效果.方法 将150例ICU经口气管插管患者随机分为实验组(n=75)和对照组(n=75),实验组采用儿童软毛牙刷蘸牙膏刷牙,然后用生理盐水冲洗的方法进行口腔护理,对照组采用传统口腔护理方法进行口腔护理,对两组患者口腔护理的效果进行比较.结果 实验组患者口腔护理效果明显优于对照组患者,与对照组比较,实验组患者口臭发生率为6.67%、口腔溃疡发生率为1.33%、疱疹发生率为4.00%及呼吸机相关性肺炎发生率均明显降低,经统计学分析,差异均有统计学意义(P<0.05).结论 刷牙冲洗法应用于ICU经口气管插管患者口腔护理,能促进患者舒适,降低气管插管后并发症的发生.%Objective To explore the clinical effect of brushing-teeth irrigation for patients' oral care after trachea intubation in ICU.Methods 150 patients taking oral trachea intubation were randomly divided into an experimental group and a control group,75 cases for each group.The experimental group used child fur toothbrush ditpping toothpaste to brush teeth,then flushed their mouths with normal saline.The control group received traditional oral care.The efficacies of the 2 groups were compared.Results The oral care effect was better in the experimental group than in the control group.6.67% patients got ozostomia,1.33% oral ulcer,and 4.00% herpes,and the incidence of ventilator associated pneumonia were significantly low in the experimental group,comparing with the control group,there were statistical differences(P<0.05).Conclusions Brushing-teeth irrigation for patients' oral care after trachea intubation in ICU can make the patients comfortable and lower the incidence of the complications after intubation.

  14. Comparison of the Clinical Use of Macintosh and Miller Laryngoscopes for Orotracheal Intubation by Second-Month Nurse Students in Anesthesiology

    Directory of Open Access Journals (Sweden)

    Somchai Amornyotin

    2010-01-01

    Full Text Available Aim. The aim of this study is to compare the clinical feasibility of Macintosh and Miller laryngoscopes for tracheal intubation in non-experienced users in anesthetized patients. Patients and Methods. 119 patients were randomized into the Macintosh group (59 and the Miller group (60. The primary outcome variable was successful tracheal intubation. The secondary outcome variables were number of insertion attempt, intubation time needed, total time to intubation, hemodynamic change and complications. Results. All patients were successfully intubated using the Macintosh, whereas 13 patients (21.6% were failed with the Miller (<.001. The Macintosh significantly reduced the mean total time to intubation (<.001. There were significant differences in the mean blood pressure at 2 minutes after laryngoscope insertion, immediately, and 2 minutes after tracheal intubation and in the mean heart rate at the laryngoscope insertion, immediately, and at 2 minutes after tracheal intubation between the two groups. Overall complications in both were not significantly different. Conclusion. Orotracheal intubation using the Macintosh is an effective and safe technique in non-experienced hands with significantly increased success rate as well as decreased mean total time to intubation as compare to the Miller. However, these intubations only apply to selected patients deemed to have normal airways.

  15. Haemodynamic response to endotracheal intubation in coronary artery disease: Direct versus video laryngoscopy

    Directory of Open Access Journals (Sweden)

    Muralidhar Kanchi

    2011-01-01

    Full Text Available Endotracheal intubation involving conventional laryngoscopy elicits a haemodynamic response associated with increased heart and blood pressure. The study was aimed to see if video laryngoscopy and endotracheal intubation has any advantages over conventional laryngoscopy and endotracheal intubation in patients with coronary artery disease. Thirty patients suffering from coronary artery disease scheduled for elective coronary artery bypass grafting (CABG were studied. The patients were randomly allocated to undergo either conventional laryngoscopy (group A or video laryngoscopy (group B. The time taken to perform endotracheal intubation and haemodynamic changes associated with intubation were noted in both the groups at different time points. The duration of laryngoscopy and intubation was significantly longer in group B (video laryngoscopy when compared to group A patients. However, haemodynamic changes were no different between the groups. There were no events of myocardial ischaemia as monitored by surface electrocardiography during the study period in either of the groups. In conclusion, video laryngoscopy did not provide any benefit in terms of haemodynamic response to laryngoscopy and intubation in patients undergoing primary CABG with a Mallampatti grade of <2.

  16. Haemodynamic response to endotracheal intubation in coronary artery disease: Direct versus video laryngoscopy

    Science.gov (United States)

    Kanchi, Muralidhar; Nair, Hema C; Banakal, Sanjay; Murthy, Keshava; Murugesan, C

    2011-01-01

    Endotracheal intubation involving conventional laryngoscopy elicits a haemodynamic response associated with increased heart and blood pressure. The study was aimed to see if video laryngoscopy and endotracheal intubation has any advantages over conventional laryngoscopy and endotracheal intubation in patients with coronary artery disease. Thirty patients suffering from coronary artery disease scheduled for elective coronary artery bypass grafting (CABG) were studied. The patients were randomly allocated to undergo either conventional laryngoscopy (group A) or video laryngoscopy (group B). The time taken to perform endotracheal intubation and haemodynamic changes associated with intubation were noted in both the groups at different time points. The duration of laryngoscopy and intubation was significantly longer in group B (video laryngoscopy) when compared to group A patients. However, haemodynamic changes were no different between the groups. There were no events of myocardial ischaemia as monitored by surface electrocardiography during the study period in either of the groups. In conclusion, video laryngoscopy did not provide any benefit in terms of haemodynamic response to laryngoscopy and intubation in patients undergoing primary CABG with a Mallampatti grade of <2. PMID:21808398

  17. 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

  18. 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.

  19. Attenuation of pressor response following intubation: Efficacy of nitro-glycerine lingual spray

    Science.gov (United States)

    Kumari, Indira; Naithani, Udita; Dadheech, Vinod Kumar; Pradeep, D. S.; Meena, Khemraj; Verma, Devendra

    2016-01-01

    Background and Aims: The role of nitro-glycerine (NTG) lingual spray for attenuation of the hemodynamic response associated with intubation is not much investigated. We conducted this study to evaluate the efficacy of NTG lingual pump or pen spray in attenuation of intubation induced hemodynamic responses and to elucidate the optimum dose. Material and Methods: In a prospective randomized controlled trial, 90 adult patients of ASA I, II, 18-60 year posted for elective general surgery under general anesthesia with intubation were randomly allocated to three groups as Group C (control) - receiving no NTG spray, Group N1 – receiving 1 NTG spray and Group N2 – receiving 2 NTG spray one minute before intubation. Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate were recorded at baseline, just before intubation (i.e., 60 s just after induction and NTG spray), immediately after intubation, at 1, 2, 5 and 10 min after intubation. Results: Incidence of hypertension was significantly higher in Group C (60%, n = 18) as compared to Group N1 and N2 (10%, n = 3 each), P N1> N2), P 0.05). Conclusions: We concluded that the NTG lingual spray in dose of 0.4 mg (1 spray) or 0.8 mg (2 sprays) was effective in attenuation of intubation induced hemodynamic response, in terms of preventing significant rise in SBP, DBP and MAP compared to control group. PMID:27006545

  20. Non-intubated video-assisted thoracoscopic lung resections: the future of thoracic surgery?

    Science.gov (United States)

    Gonzalez-Rivas, Diego; Bonome, Cesar; Fieira, Eva; Aymerich, Humberto; Fernandez, Ricardo; Delgado, Maria; Mendez, Lucia; de la Torre, Mercedes

    2016-03-01

    Thanks to the experience gained through the improvement of video-assisted thoracoscopic surgery (VATS) technique, and the enhancement of surgical instruments and high-definition cameras, most pulmonary resections can now be performed by minimally invasive surgery. The future of the thoracic surgery should be associated with a combination of surgical and anaesthetic evolution and improvements to reduce the trauma to the patient. Traditionally, intubated general anaesthesia with one-lung ventilation was considered necessary for thoracoscopic major pulmonary resections. However, thanks to the advances in minimally invasive techniques, the non-intubated thoracoscopic approach has been adapted even for use with major lung resections. An adequate analgesia obtained from regional anaesthesia techniques allows VATS to be performed in sedated patients and the potential adverse effects related to general anaesthesia and selective ventilation can be avoided. The non-intubated procedures try to minimize the adverse effects of tracheal intubation and general anaesthesia, such as intubation-related airway trauma, ventilation-induced lung injury, residual neuromuscular blockade, and postoperative nausea and vomiting. Anaesthesiologists should be acquainted with the procedure to be performed. Furthermore, patients may also benefit from the efficient contraction of the dependent hemidiaphragm and preserved hypoxic pulmonary vasoconstriction during surgically induced pneumothorax in spontaneous ventilation. However, the surgical team must be aware of the potential problems and have the judgement to convert regional anaesthesia to intubated general anaesthesia in enforced circumstances. The non-intubated anaesthesia combined with the uniportal approach represents another step forward in the minimally invasive strategies of treatment, and can be reliably offered in the near future to an increasing number of patients. Therefore, educating and training programmes in VATS with non-intubated

  1. Tracheal intubation in the ICU: Life saving or life threatening?

    Directory of Open Access Journals (Sweden)

    Jigeeshu V Divatia

    2011-01-01

    Full Text Available Tracheal intubation (TI is a routine procedure in the intensive care unit (ICU, and is often life saving. However, life-threatening complications occur in a significant proportion of procedures, making TI perhaps one the most common but underappreciated airway emergencies in the ICU. In contrast to the controlled conditions in the operating room (OR, the unstable physiologic state of critically ill patients along with underevaluation of the airways and suboptimal response to pre-oxygenation are the major factors for the high incidence of life-threatening complications like severe hypoxaemia and cardiovascular collapse in the ICU. Studies have shown that strategies planned for TI in the OR can be adapted and extrapolated for use in the ICU. Non-invasive positive-pressure ventilation for pre-oxygenation provides adequate oxygen stores during TI for patients with precarious respiratory pathology. The intubation procedure should include not only airway management but also haemodynamic, gas exchange and neurologic care, which are often crucial in critically ill patients. Hence, there is a necessity for the implementation of an Intubation Bundle during routine airway management in the ICU. Adherence to a plan for difficult airway management incorporating the use of intubation aids and airway rescue devices and strategies is useful.

  2. Developing competency in interns for endotracheal intubation: An educational article

    Science.gov (United States)

    Makwana, Harsha Dhirubhai; Suthar, Nilay N; Gajjar, Mehul P; Thakor, Advait V

    2016-01-01

    Background: Our existing undergraduate curriculum lacks developing competency for endotracheal intubation. Even though it is a lifesaving procedure, interns are exposed only during their posting in anesthesia or emergency medicine and so, when need arises, they fail to perform endotracheal intubation and it leads to catastrophes. Aims and Objectives: The aim of this study was to develop competency in interns for endotracheal intubation. Materials and Methods: A study was conducted on fifty interns of medical college. Lecture and demonstration were used for cognitive domain and one-to-one training and practice on manikin for affective and psychomotor domains, respectively. Live demonstration on patients was done whenever possible. Gain in knowledge was evaluated by pre- and post-test using standardized validated questionnaire. Skills were assessed by direct observation of procedural skill on manikin, split in steps: Laryngoscopy, intubation, and ventilation. Session was evaluated using feedback questionnaire and Likert scale. Results: Interns showed mean marks of 8.12 ± 1.63 in pretest compared to 13.86 ± 1.06 of posttest with a gain of 34.8% (P = 0.0001), which is highly significant. Twenty-two percent interns completed all steps correctly in the first attempt, 62% in the second attempt, while 16% required third attempt to correctly complete all steps. Conclusion: This training developed competency for basic knowledge and practice of endotracheal intubation in interns adequately on manikin. Training for endotracheal intubation should be carried out at the beginning of internship before they go for clinical practice and repeated during their rotation of Anesthesia and Emergency Medicine Department, so they can retain their competency for it and can do later on whenever required. PMID:27563588

  3. Factors Affecting the Intubation Conditions Created by Mivacurium. A Meta-analysis and Meta-regression analysis.

    OpenAIRE

    Hadush Mesfin, Samson

    2012-01-01

    Intubation is the process of inserting a flexible tube anywhere in the human body. It is used in emergency medecine to help when a patient have difficulty in breathing, and to keep the airway open for delivery of anesthetic drugs and oxygen during surgery. Mivacurium is a non-depolarizing neuromuscular blocker used to facilitate intubation. The objective of the paper is to identify the factors that affect the probability of excellent intubation condition of Mivacurium (EIC). A total of 1029 p...

  4. Comparison evaluation of tracheal intubation with and without succinylcholine administration in emergency department

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    R. Salehi, M.D.

    2007-01-01

    Full Text Available AbstractBackground and Purpose: Succinylcholine isn’t used in Emergency Department intubations routinely, that, this study was performed to compare success and complications of tracheal intubation with and without succinylcholine administration.Materials and Methods: This interventional study was done on 150 patients admitted in Emergency Department of Hazrat Rasoul Akram Hospital who underwent intratracheal intubation. Demographic data were evaluated. The Cases were entered in protocol A (rapid sequence intubation with succinylcholine or B (modified RSI without succinylcholine randomly and then intubated. During and after intubations, results and complications were recorded in checklists and analyzed via SPSS11 software.Results: The mean age in group A was 34.1±5.1 yrs while in group B was 35.1±5.3 yrs. In group A, 35 cases (46.6% were female and 40 cases (53.4% were male and in group B 37 cases (49.3% were female and 38 cases (50.7% were male. The differences between groups were not significant. In group A, 74 cases (98% were intubated in first attempt and 1 case (2% in second attempt. Bradicardia was seen in 3 cases (4%, hypotension in 8 cases (10.6 %, vomiting in 8 cases (2.6 %, hypertension in 2 cases (2.6 % and hypoxia (O2 sat<90% in 9 cases (12%. In group B, 64 cases (88% were intubated in first attempt and 9 cases (12% in second attempt. Bradicardia occurred in 2 cases (2.6%, hypotension in 9 cases (12%, vomiting in 3 cases (4%, hypoxia in 11 cases (14% and hypertension in no case. In this study, the success rate of intubation in RSI with succynilcholine was higher significantly. There are no significant differences regarding in complications between two groups.Conclusion: Our study showed that in emergency patients intubation the which there is no contraindication for succynilcholine, it is better to try RSI.

  5. 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

  6. COMPARISON OF EFFICACY AND SAFETY OF DEXMEDETOMIDINE AND PROPOFOL INFUSION FOR SEDATION DURING FIBREOPTIC NASOTRACHEAL INTUBATION

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    Nidhi

    2014-02-01

    Full Text Available efficacy and safety of dexmedetomidine and propofol infusion for sedation during fibreoptic nasotracheal intubation. Twenty patients of either sex aged between 18 to 60 years belonging to ASA I or ASA II grade were enrolled and randomly allocated into the dexmedetomidine group (1.0 μg/kg infusion over 10 min followed by 0.5 μg/kg/hr. during fibreoptic nasotracheal intubation (n = 10 and the propofol group (100μg/kg/min body weight over 10 min followed by 50μg/kg/min during fibreoptic nasotracheal intubation (n = 10. Intubating conditions and patient tolerance as graded by a scoring system were evaluated as primary outcomes. Intubation was successful in all patients. Satisfactory intubating conditions were found in both groups (10/10 in each group. In the evaluation of efficacy it was found that dexmedetomidine group had better patient tolerability according to 5 point fibreoptic intubation comfort score (3.0±1.05 and 1.8±1.03 in propofol and dexmedetomidine group respectively [p<0.05]. In the evaluation of safety it was found that in dexmedetomidine group better Spo2 is maintained during intubation (p<0.05, there was significant decrease in diastolic blood pressure in propofol group at the end of infusion (p<0.05 and there was significant decrease in pulse rate in dexmedetomidine group than propofol group at the end of infusion (p<0.05. Both drugs infusion are effective and safe to be used as sedative agent during fibreoptic nasotracheal intubation with same incidence of amnesia but better patient tolerance and Spo2 maintenance with dexmedetomidine.

  7. 国产UE可视喉镜在全麻甲状腺手术患者气管插管中的临床观察%Clinical observation of domestic UE visual laryngoscope used in tracheal intubation for patients with general anesthe-sia in the thyroid surgical

    Institute of Scientific and Technical Information of China (English)

    陈伟; 胡北

    2015-01-01

    目的:比较 UE 可视喉镜和 Macintosh 直接喉镜在全麻甲状腺手术患者气管插管中的临床应用效果。方法:收治甲状腺手术全麻患者60例,随机分为可视喉镜组(A 组)和直接喉镜组(B 组),每组30例。比较两组麻醉插管前(T0)、插管即刻(T1)、插管完成后5 min(T2)时的平均动脉压和心率,比较两组声门暴露程度、插管所用时间、一次插管成功率及并发症发生情况。结果:B组插管即刻(T1)MAP、HR明显高于A组,差异有统计学意义(P<0.05)。A组插管时间缩短,声门暴露程度优,一次性插管成功率高,插管相关并发症少,两组比较,差异均有统计学意义(P<0.05)。结论:国产UE可视喉镜在全麻甲状腺手术患者气管插管中对血流动力学影响更小,且快捷、安全。%Objective:To compare the clinical application effect of UE visual laryngoscope and Macintosh direct laryngoscope used in tracheal intubation for patients with general anesthesia in the thyroid surgical.Methods:60 cases of patients with general anesthesia in the thyroid surgical were randomly divided into the visual laryngoscope group(group A) and the direct laryngoscope group(group B),with 30 cases in each group.The mean arterial pressure and heart rate of the two groups before anesthesia intubation(T0),immediate intubation(T1),5 min after intubation(T2) were compared.The glottis exposure,intubation time,once successful intubation rate and complications of the two groups were compared.Results:The MAP and HR of the Group B immediate intubation(T1) were significantly higher than those of group A,and the differences were statistically significant(P<0.05). Group A had shorter intubation time,better glottis exposure,higher once successful intubation rate and less complications caused by intubation,and the differences between the two groups had statistical significance(P<0.05).Conclusion:Domestic UE visual laryngoscope used in tracheal

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

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    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

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

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    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. 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

  11. Effect of intravenous lidocaine on bispectral index and stress reaction in patients undergo tracheal intubation%静脉注射利多卡因对气管插管病人BIS值及应激反应的影响

    Institute of Scientific and Technical Information of China (English)

    王红珠; 陈冯琳; 王明仓

    2011-01-01

    AIM:To observe the relationship between the level of catecholamine with bispec-tral index during endotracheal intubation with propofol anesthesia in order to investigate the mechanism of the preventing of endotracheal intubation response with lidocaine. METHODS: Sixty patients were randomly allocated into two groups:control group (Group C) and lidocaine group (Group L). The patients received lidocaine 1. 5 mg/kg in Group L and saline in Group C before induction of anesthesia. Anesthesia was induced with propofol (2 mg/kg) and fentanyl (4 jug/kg) and tracheal intubation was facilitated with rocuronium (0.6 mg/kg) in all patients. Bispectral index (BIS), systolic pressure ( SP) , diastolic pressure(DP) and heart rate(HR)were continuously monitored and recorded before induced of anesthesia(T0) , preintubation(T!) , immediately and 1,3 min after intubation (T2-4). Arterial blood samples were obtained at To? Tj and T3 for determination of plasma concentration of adrenaline (Ad) and noradrenaline(NA). RE-SULTS :SP, DP,HR were significantly increased after intubation in Group C compared with baseline values at T0 ( P 0. 05). Compared with Group C, BIS value at Ti to T4 decreased significantly in Group L(P<0. 05). Plasma Ad and NA were lower at T3 in Group L than those in Group C and T0(P<0. 05). CONCLUSION: Lidocaine can further reduce BIS value and the plasma concentration of catecholamines during propofol anesthesia, indicating the sedative and anti-nociep-tive effect of intravenous lidocaine. Lidocaine (1. 5 mg/kg) can restrain the changes of BIS and reduce stress reaction caused by tracheal intubation.%目的:观察利多卡因对丙泊酚麻醉诱导气管插管时血浆儿茶酚胺与脑电双频指数(BIS)变化的影响,探讨利多卡因抑制气管插管反应的机制.方法:60例患者随机分为对照组(C组)和利多卡因组(L组).L组先静脉注射利多卡因1.5 mg/kg,C组注入等量生理盐水,然后两组均静脉注射丙泊酚2 mg/kg、芬太尼4

  12. 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

  13. 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

  14. Unexpected difficulty in ventilating the lungs after tracheal intubation -A case report-

    OpenAIRE

    Lee, Jong-Yeon; Lee, Su-Yeon; Shin, Inho; Chung, Kum-Hee; Chun, Duk-hee

    2011-01-01

    We experienced difficulty in ventilating the lungs of a patient after tracheal intubation. After intubation, an insufficient amount of tidal volume (VT) was delivered to the patient and the fiberoptic bronchoscopic examination identified partial abutment of the endotracheal tube (ETT) orifice against the tracheal wall. After various attempts to correctly place the ETT, a double-lumen endotracheal tube was placed to achieve a sufficient VT. It is important to notice that even an appropriately ...

  15. Attenuation of hemodynamic responses to laryngoscopy and endotracheal intubation by intravenous esmolol

    OpenAIRE

    Gurudatta KN; Kiran Mallappa; Ravindra GL

    2014-01-01

    Background: Sympathetic response associated with laryngoscopy and endotracheal intubation is a potential cause for a number of complications especially in patients with cardio-vascular compromise. The aim of our study was to evaluate and study the efficiency of intravenous esmolol in the attenuation of hemodynamic response to laryngoscopy and intubation in normotensive individuals. Methods: 100 surgical patients of either sex of physical status ASA I/II were randomly divided into 2 groups....

  16. Tracheal intubation without neuromuscular block in children

    OpenAIRE

    Shaikh, Safiya I; Bellagali, Vijayalaxmi P

    2010-01-01

    Endotracheal intubation has been performed during the administration of Propofol anaesthesia without neuromuscular blockade. In the study, we have assessed tracheal intubating conditions and haemodynamic responses in children aged 4 to12 years by using combination of either Fentanyl and Propofol; or Propofol and a neuromuscular blocker, suxamethonium. Intubating conditions were assessed on a 1-4 scale based on ease of laryngoscopy, position of vocal cords, degree of coughing and jaw relaxatio...

  17. Sonographically guided superior laryngeal nerve block during awake fiberoptic intubation.

    Science.gov (United States)

    Sawka, Andrew; Tang, Raymond; Vaghadia, Himat

    2015-04-15

    We report 5 patients who underwent ultrasound-guided superior laryngeal nerve block before awake intubation and general anesthesia. We used a 8- to 15-MHz hockey stick-shaped ultrasound transducer (HST15-8/20 linear probe, Ultrasonix) to visualize the superior laryngeal nerve. A 3.8-cm 25-G needle was inserted in real time and directed toward the superior laryngeal nerve followed by circumferential placement of local anesthetic. All 5 patients tolerated subsequent awake fiberoptic intubation with either minimal or no sedation. Sonographically guided superior laryngeal nerve block may be useful in patients where identification of landmarks in the neck is difficult as a result of patient anatomy. PMID:25867195

  18. 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.

  19. 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

    .8% to 62.5% in HIV-negative/TB; 70.3% to 33.3% in HIV-positive/TB patients) down to a level comparable to a control group of blood donors (51.2%). The agreement between TST and QFN was poor in TB patients compared to healthy controls. A negative TST correlated to more advanced TB in contrast to a......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....... Smear-positive TB patients (n = 71) were recruited at Gondar University Hospital, Ethiopia. The TST, QFN, CD4+ cell count and clinical symptoms (TB score) were assessed and followed up during treatment. From baseline to 7 months after treatment, there was a significant decrease in QFN reactivity (93...

  20. 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.

  1. 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),

  2. Attenuation of Hemodynamic Responses to Laryngoscopy and Tracheal Intubation: Propacetamol versus Lidocaine—A Randomized Clinical Trial

    Directory of Open Access Journals (Sweden)

    Ali Kord Valeshabad

    2014-01-01

    Full Text Available The purpose of this study is to assess the effects of propacetamol on attenuating hemodynamic responses subsequent laryngoscopy and tracheal intubation compared to lidocaine. In this randomized clinical trial, 62 patients with the American Anesthesiologists Society (ASA class I/II who required laryngoscopy and tracheal intubation for elective surgery were assigned to receive propacetamol 2 g/I.V./infusion (group P or lidocaine 1.5 mg/kg (group L prior to laryngoscopy. Systolic and diastolic blood pressures (SBP, DBP, mean arterial pressure (MAP, and heart rate (HR were recorded at baseline, before laryngoscopy and within nine minutes after intubation. In both groups P and L, MAP increased after laryngoscopy and the changes were statistically significant (P<0.001. There were significant changes of HR in both groups after intubation (P<0.02, but the trend of changes was different between two groups (P<0.001. In group L, HR increased after intubation and its change was statistically significant within 9 minutes after intubation (P<0.001, while in group P, HR remained stable after intubation (P=0.8. Propacetamol 2 gr one hour prior intubation attenuates heart rate responses after laryngoscopy but is not effective to prevent acute alterations in blood pressure after intubation.

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

    OpenAIRE

    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...

  4. Amlodipine and the Successful Management of Post-Electroconvulsive Therapy Agitation

    OpenAIRE

    Ali Shahriari; Maryam Khooshideh; Mahdi Sheikh

    2016-01-01

    Electroconvulsive therapy (ECT) is a highly effective nonpharmacologic treatment for the management of depression and some other psychiatric disorders. Post-ECT agitation occurs in up to 12% of ECT treatments and is characterized by motor restlessness, irritability, disorientation, and panic-like behaviors. The severity of post-ECT agitation ranges from mild and self-limited to serious and severe forms requiring prompt medical intervention to protect the patient and the medical staff. In seve...

  5. McGrath Video Laryngoscope May Take a Longer Intubation Time Than Macintosh Laryngoscope

    OpenAIRE

    Prerana N Shah; Kaveri Das

    2015-01-01

    Background. Video laryngoscopes provide better view and can improve ease of intubation compared with standard laryngoscopes. Methods. A prospective randomized study was done on 60 patients, 18 to 65 years old, comparing McGrath video laryngoscope and Macintosh laryngoscope. The aim was to compare the ease, efficacy, and usability of them during routine airway management. The primary endpoint was duration of intubation and the secondary endpoints were Cormack and Lehane grade of laryngoscopic ...

  6. Airtraq™ versus Macintoch laryngoscope in intubation performance in the pediatric population

    OpenAIRE

    Waleed Riad; Ashraf Moussa; David T Wong

    2012-01-01

    Purpose: Airtraq™ is an optical laryngoscope that allows viewing of the vocal cords without a direct line of sight. The main objective of this prospective, randomized, controlled trial was to evaluate Airtraq intubation characteristics, mainly intubation time and cardiovascular changes in the pediatric patients. Methods: Fifty children of American Society of Anesthesiologists class I, 2-10 years of age were divided into 2 groups using sealed envelope technique. Children were premedicated with...

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

    Directory of Open Access Journals (Sweden)

    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.

  8. 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

  9. The SensaScope® - A new hybrid video intubation stylet

    Directory of Open Access Journals (Sweden)

    Peter Biro

    2011-01-01

    Full Text Available The recently developed SensaScope ® is a hybrid intubation endoscope that has been designed and developed according to our clinical requirements for a safe, easy-to-handle, and effective video-assisted intubation. The attribute "hybrid" derives from the fact that the shaft of the instrument is combined by both, rigid and flexible parts. Its S-shaped rigid segment enables a very intuitive handling by one hand only, thus leaving the left hand free to operate a conventional laryngoscope. The tip of the device can be controlled via a steering handle in a similar fashion as fiberoptic endoscopes. Due to these attributes, the SensaScope® became a very versatile and effective tool to master the unanticipated difficult intubation in anesthetized and paralyzed patients. For this reason, in our institution it has been included as the first-line technique into our local failed intubation algorithm. The first clinical experience with the device and its standardized technique of use produced encouraging results; the success rate for novices was found to be at 97% (in 194 of 200 patients of all intubation attempts in both patients categories: those who were rated as having normal (84.5% and in those showing difficult intubation conditions (15.5%. The technical development, the way of using the device, the suitable indications, and limitations are discussed here.

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

    Directory of Open Access Journals (Sweden)

    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

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

    Directory of Open Access Journals (Sweden)

    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

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Directory of Open Access Journals (Sweden)

    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

  14. In patients with head injuries who undergo rapid sequence intubation using succinylcholine, does pretreatment with a competitive neuromuscular blocking agent improve outcome? A literature review

    Science.gov (United States)

    Clancy, M; Halford, S; Walls, R; Murphy, M

    2001-01-01

    A literature search was undertaken for evidence of the effect of succinylcholine (SCH) on the intracranial pressure (ICP) of patients with acute brain injury and whether pretreatment with a defasciculating dose of competitive neuromuscular blocker is beneficial in this patient group. The authors could find no definitive evidence that SCH caused a rise in ICP in patients with brain injury. However, these studies were often weak and small. For those patients suffering acute traumatic brain injury the authors could find no studies that investigated the issue of pretreatment with defasciculating doses of competitive neuromuscular blockers and their effect on ICP in patients given SCH. There is level 2 evidence that SCH caused an increase in ICP for patients undergoing neurosurgery for brain tumours with elective anaesthesia and that pretreatment with defasciculating doses of neuromuscular blockers reduced such increases. It is unknown if this affects neurological outcome for this patient group. PMID:11559609

  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. Endoscopic dacryocystorhinostomy with and without silicone intubation: 4 years retrospective study.

    Science.gov (United States)

    Longari, F; Dehgani Mobaraki, P; Ricci, A L; Lapenna, R; Cagini, C; Ricci, G

    2016-08-01

    The objective of this study is to assess different outcomes between endoscopic dacryocystorhinostomy (En-DCR) with and without silicone intubation. We retrospectively analyzed 84 patients (89 procedures), suffering from chronic epiphora for primary acquired nasolacrimal duct obstruction, treated with En-DCR and divided into two groups depending on silicone stent intubation. The surgical outcomes were evaluated at 7 post-operative controls using Munk's score criteria. Functional success was defined as absence of epiphora, no further episodes of dacryocystitis, and a patent ostium after fluorescein irrigation. 45 En-DCR with stent and 44 En-DCR without stent were performed. Success rate after 18 months follow-up were, respectively, 82.2 % in the stent group and 88.6 % in the non-stent group (OR 0.59) with no statistical differences. The ostial size reduction has been reported in higher percentage in the stent group, mainly due to peristomal granuloma (OR 3.64), scar tissue formation (OR 2.25), and turbinoseptal synaechia (OR 1.76). The benefits of non-intubation are less patient discomfort, reduced surgical time and costs, simpler follow-up regimen and less intubation-associated complications. En-DCR without silicone stent intubation should be the first choice of procedure, stent intubation should be reserved in selected cases with poor local conditions pre and intra-operatively assessed. PMID:26732693

  18. The Value and Prognostic Role of the CT Scan versus Chest Radiography in the Follow-up of Intubated Burn Patients with Possible Inhalation Injury

    OpenAIRE

    Spyropoulou, G.A.; Iconomou, T.; Tsagarakis, M.; Tsoutsos, D.

    2005-01-01

    The admission and follow-up chest radiographs as well as the follow-up CT scans of 13 burn patients admitted to our clinic requiring ventilatory support were analysed for signs of inhalation injury and pulmonary complications. The findings were compared with the results of the clinical examination, the blood gas tests, and bronchoscopy. Eleven out of the 13 patients underwent bronchoscopy revealing inhalation injury. The CT scan detected pleural effusion in two patients with a normal chest ra...

  19. 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

  20. A COMPARATIVE STUDY OF INTRAVENOUS MAGNESIUM SULFATE AND ESMOLOL IN ATTENUATING HEMODYNAMIC RESPONSE TO LARYNGOSCOPY AND INTUBATION

    Directory of Open Access Journals (Sweden)

    Aasim

    2014-08-01

    Full Text Available : AIMS AND OBJECTIVES: To compare the effect of intravenous Magnesium sulfate and Esmolol in attenuating the hemodynamic response to laryngoscopy and endo-tracheal intubation. METHODS: A prospective study was conducted with sixty ASA (American society of Anesthesiologists grade I and II patients undergoing elective surgery under general anesthesia who were selected to receive Esmolol hydrochloride 1.5 mg/kg or Magnesium sulfate 50 mg/kg randomly. Heart rate and blood pressure recording were done pre-intubation, immediately after intubation and at 2 minutes and 5 minutes after intubation. RESULTS: There was a significant rise in heart rate in Group M as compared to Group E (P<0.05. No significant difference in mean arterial pressure was seen in both groups. CONCLUSION: Esmolol is a better agent to attenuate hemodynamic response to laryngoscopy and intubation than magnesium sulfate as it attenuates the rise in both heart rate and blood pressure.

  1. Attenuation of Hemodynamic Responses to Laryngoscopy and Tracheal Intubation: Propacetamol versus Lidocaine—A Randomized Clinical Trial

    Science.gov (United States)

    Kord Valeshabad, Ali; Nabavian, Omid; Nourijelyani, Keramat; Kord, Hadi; Vafainejad, Hossein; Kord Valeshabad, Reza; Reza Feili, Ali; Rezaei, Mehdi; Darabi, Hamed; Koohkan, Mohammad; Golbinimofrad, Poorya; Jafari, Samira

    2014-01-01

    The purpose of this study is to assess the effects of propacetamol on attenuating hemodynamic responses subsequent laryngoscopy and tracheal intubation compared to lidocaine. In this randomized clinical trial, 62 patients with the American Anesthesiologists Society (ASA) class I/II who required laryngoscopy and tracheal intubation for elective surgery were assigned to receive propacetamol 2 g/I.V./infusion (group P) or lidocaine 1.5 mg/kg (group L) prior to laryngoscopy. Systolic and diastolic blood pressures (SBP, DBP), mean arterial pressure (MAP), and heart rate (HR) were recorded at baseline, before laryngoscopy and within nine minutes after intubation. In both groups P and L, MAP increased after laryngoscopy and the changes were statistically significant (P Propacetamol 2 gr one hour prior intubation attenuates heart rate responses after laryngoscopy but is not effective to prevent acute alterations in blood pressure after intubation. PMID:24822063

  2. Attenuation of Hemodynamic Responses to Laryngoscopy and Tracheal Intubation: Propacetamol versus Lidocaine-A Randomized Clinical Trial.

    Science.gov (United States)

    Kord Valeshabad, Ali; Nabavian, Omid; Nourijelyani, Keramat; Kord, Hadi; Vafainejad, Hossein; Kord Valeshabad, Reza; Reza Feili, Ali; Rezaei, Mehdi; Darabi, Hamed; Koohkan, Mohammad; Golbinimofrad, Poorya; Jafari, Samira

    2014-01-01

    The purpose of this study is to assess the effects of propacetamol on attenuating hemodynamic responses subsequent laryngoscopy and tracheal intubation compared to lidocaine. In this randomized clinical trial, 62 patients with the American Anesthesiologists Society (ASA) class I/II who required laryngoscopy and tracheal intubation for elective surgery were assigned to receive propacetamol 2 g/I.V./infusion (group P) or lidocaine 1.5 mg/kg (group L) prior to laryngoscopy. Systolic and diastolic blood pressures (SBP, DBP), mean arterial pressure (MAP), and heart rate (HR) were recorded at baseline, before laryngoscopy and within nine minutes after intubation. In both groups P and L, MAP increased after laryngoscopy and the changes were statistically significant (P Propacetamol 2 gr one hour prior intubation attenuates heart rate responses after laryngoscopy but is not effective to prevent acute alterations in blood pressure after intubation. PMID:24822063

  3. Comparison of esmolol and labetalol, in low doses, for attenuation of sympathomimetic response to laryngoscopy and intubation

    OpenAIRE

    Singh Sarvesh; Quadir Abdul; Malhotra Poonam

    2010-01-01

    Objective: The present study compared the efficacy of esmolol and labetalol, in low doses, for attenuation of sympathomimetic response to laryngoscopy and intubation. Design: Prospective, randomized, placebo controlled, double-blinded study. Setting: Operation room. Patients and Methods: 75 ASA physical status I and II adult patients, aged 18-45 years undergoing elective surgical procedures, requiring general anesthesia and orotracheal intubation. Interventions: Patients were allocated to any...

  4. Elimination of Quench Cracking by Controlling Agitation Uniformity

    Institute of Scientific and Technical Information of China (English)

    CANALE, Lauralice C.F; TOTTEN, George E

    2004-01-01

    Uniform agitation of the quenchant is a critically important control parameter in optimizing distortion control and reducing steel cracking. Quenching with ultrasonic agitation or in the presence of electrical and magnetic fields provide uniform agitation leading to improved uniformity of the stress fields within the metal not readily achievable with more traditional agitation methods such as propeller pumps and sprays. These methods provide the additional potential advantage of varying agitation throughout the cooling cycle to achieve a wide range of cooling profiles not readily achievable with quenchants and more traditional agitation systems currently in use.

  5. 光棒和直接喉镜引导下气管插管麻醉对老年择期手术患者血液动力学的影响%Inlfuence of Intratracheal Intubation Anesthesia Guided with Light Wand and Direct Laryngoscope on the Hemodynamics in Selective Operations of Elderly Patients

    Institute of Scientific and Technical Information of China (English)

    先小纲

    2014-01-01

    Objective To evaluate the inlfuence of intratracheal intubation anesthesia guided with light wand and direct laryngoscope on the hemodynamics in selective operations of elderly patients.Methods 170 elderly patients who would undergo selective operations from October 2011 to October 2013 in our hospital were randomly divided into light wand group (n=85) and direct laryngoscope group (n=85). Hemorheology indexs and stress hormone levels of the patients in two groups were recorded at T0 (before anesthesia induction), T1 (after anesthesia induction), T2 (immediately after intubation) and T3 (1 min after intubation). The incidence rates of various complications in two groups were also analyzed and compared.Results The fluctuation of hemorheology indexes and stress hormone levels of light wand group were signiifcantly lower than that of laryngoscope group (P<0.05). The once intubation success rate in light wand group was signiifcantly higher than that of laryngoscope group (P<0.05). The intubation time of light wand group was signiifcantly shorter than that of laryngoscope group (P<0.05). The incidence rates of various complications of light wand group were signiifcantly lower than those of laryngoscope group (P<0.05).Conclusion Compared with intratracheal intubation anesthesia guided by direct laryngoscope, intratracheal intubation anesthesia guided by light wand with higher once intubation success rate, more stable hemodynamics, weaker stress response and fewer complications was worth to be promoted in clinic.%目的:评估光棒和直接喉镜引导下气管插管麻醉对老年择期手术患者血液动力学的影响。方法将170例于2011年10月~2013年10月在我院进行手术的老年患者随机分为光棒组和直接喉镜组。分别对两组患者麻醉各时间点(T0、T1、T2、T3)血液动力学指标、应激激素水平以及并发症进行比较。结果光棒组患者在麻醉过程中血液动力学指标和应激激素水平波

  6. Comparative analysis of the cardiovascular circulation effects and the amount of oral secretions volume of surgery patients after laryngeal mask and tracheal intubation combined with epidural anesthesia%喉罩与气管插管复合硬膜外麻醉对手术患者心血管循环及口腔分泌物量的影响

    Institute of Scientific and Technical Information of China (English)

    周庆九

    2011-01-01

    目的 探讨全麻合并连硬外手术中置喉罩和气管内插管对患者心血管反应及口腔分泌物量的影响.方法 选择无心血管疾病、无重要脏器疾患、ASA Ⅰ~Ⅱ级、择期全麻合并连硬外手术患者40例,随机分成两组:喉罩组和插管组,每组20例.记录各组患者置喉罩或气管插管前(T1)、诱导后(T2)、1 min(T3)、3 min(T4)、术中(T5)、拔罩(管)时(T6)、拔罩(管)后1 min( T7)、拔罩(管)后3 min(T8)的SBP、DBP、HR、SpO2.结果 喉罩或气管插管前的SBP、DBP、HR差别不大;拔管T6、T7、T8的SBP、DBP、HR组间比较差异有统计学意义(P<0.05),插管组T6 SBP( 138±35) mm Hg,DBP(92±16)mm Hg,HR(96±19)次/min高于喉罩组T6(P<0.05).结论 喉罩对患者心血管系统影响小,可以达到与气管插管一样满意的通气效果,具有血流动力学平稳、操作方便、简单、咽部不适、声嘶发生低而且口腔分泌物量少等优点.%Objective To compare the effects of cardiovascular reaction after laryngeal mask and endotracheal intubation in patients of epidural anesthesia combined with surgery and a comparative analysis of the oral secretions volume.Methods Choose elevcitce general anesthesia associated with epidurdl opuo cases.Randomly divided into 2 groups:laryngeal mask airway group and endotracheal intubation set,each group 20 coses.Records before each group of patients with laryngeal mask airway or endotracheal intubation( T1 ),after induction( T2 ),1 minute( T3 ),3minute ( T4 ),intraoperative ( T5 ),remove cover(pipes) ( T6 ),to pull over and over 1 minute ( T7 ) and remove cover ( pipes )after 3minute(T8) SBP,DBP,HR,SpO2.Results Laryngeal mask or tracheal intubation prior to SBP,DBP,HR was not very different.Prior to extubation T6,T7,T8 of the SBP,DBP,HR between the two groups had significant differences The tracheal intubation group showed that the group with more than the larYngeal mask group.Particularly T6 endotracheal intubation group

  7. Selective bronchial intubation for pulmonary emphysema.

    OpenAIRE

    Campbell, A N; Zarfin, Y; Perlman, M

    1984-01-01

    Two neonates with respiratory distress syndrome developed unilateral pulmonary interstitial emphysema causing mediastinal shift and compressive atelectasis. Treatment with contralateral bronchial intubation for five days proved to be life saving.

  8. 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.

  9. 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

  10. A COMPARATIVE STUDY OF EFFICACY OF ESMOLOL AND FENTANYL FOR ATTENUATION OF INTUBATION RESPONSE DURING LARYNGOSCOPY

    Directory of Open Access Journals (Sweden)

    Varma

    2015-05-01

    Full Text Available AIM: To compare the attenuation of haemodynamic changes to laryngoscopy and intubation with IV bolus Esmolol 2mg/kg and IV Fentanyl 2μg/kg. METHODS: 90 adult patients of both sex between age 18 and 55 years with ASA grade I and II normotensive with normal rhythm in ECG are divided randomly into three groups. Group - C was control group. In these patients no drug was given. Group - E was Esmolol group. In this group patients were given Inj. Esmolol - 2mg/kg IV 3 min . before intubation over 30 seconds Group - F was Fentanyl group. In this group patients were given Inj. Fentanyl - 2μg/kg IV 3 min . before intubation over 30 seconds. Heart rate, systolic blood pressure, diastolic blood pressure and mean arterial pressu re were recorded as baseline and after administration of study drug. RESULTS: Heart rate, systolic, diastolic blood pressures and mean arterial blood pressures were compared at pre op, 1 minute after induction and 1, 3, 5 and 10 minute intervals from the o nset of laryngoscopy and intubation. Esmolol showed better attenuation of sympathetic response which is statistically highly significant. It remains significant till the end of 5 minutes. CONCLUSION : Esmolol is more effective than Fentanyl in attenuation o f sympathetic response to laryngoscopy and intubation. IV. bolus dose of Esmolol 2mg/kg administered 3 minutes before laryngoscopy and intubation can be recommended to attenuate the sympathetic response to laryngoscopy and intubation without any side effec ts of the drug.

  11. Effect of the McGRATH MAC® Video Laryngoscope on Hemodynamic Response during Tracheal Intubation: A Retrospective Study.

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    Masashi Yokose

    Full Text Available Hypertension often occurs after tracheal intubation using a Macintosh laryngoscope and may lead to rare but serious complications. The Macintosh laryngoscope may increase the incidence of hypertension because it requires forced alignment of the oral and pharyngeal axes in order to view the glottis. In contrast, the McGRATH MAC video laryngoscope does not require this manipulation. The objective of this study was to evaluate the incidence of hypertension after tracheal intubation using a McGRATH laryngoscope compared with a Macintosh laryngoscope.Data of 360 consecutive patients who underwent general anesthesia with tracheal intubation by Macintosh laryngoscope or McGRATH video laryngoscope were obtained retrospectively. A total of 16 variables including patient characteristics, anesthetic drug used, and intubation techniques were extracted as potential factors affecting the incidence of hypertension after intubation. The incidence of hypertension after tracheal intubation was defined as an increase in systolic blood pressure (SBP >20% of values immediately before intubation. Propensity scoring with inverse probability weighting was used to calculate the odds ratio for the incidence of hypertension after intubation with a McGRATH video laryngoscope as the primary outcome. The mean difference in SBP change between the two laryngoscopes was also calculated.A McGRATH laryngoscope was used in 68 of 360 patients (18%. The numbers of patients who increase in systolic blood pressure of more than 20% was 189 patients (53%. The odds ratio for the use of a McGRATH laryngoscope was 0.43 (95% confidence interval (CI, 0.19-0.96; P = 0.04. The mean difference in SBP change between the two laryngoscopes was -8.6 mmHg (95% CI, -17.4 to 0.2; P = 0.06.The use of a McGRATH laryngoscope may reduce the incidence of hypertension after tracheal intubation compared to the Macintosh laryngoscope.

  12. 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

  13. Slow induction and intubation in emergency intubation difficulty in application%慢诱导插管在急诊困难插管中的应用

    Institute of Scientific and Technical Information of China (English)

    许柳; 颜麒麟; 李解

    2013-01-01

    Objective To observe the application effect of surface anaesthesia slow induction in emergency intubation difficulty with endotracheal intubation. Methods 20 cases of severe dyspnea patients were included. The age ranged from 22 to 82 years old. In the use of sedative drugs after conventional after failed intubation using analgesia induction and tracheal intubation through mouth. Observation records of patients with the base value (TO). The cricothyroid membrane puncture (Tl). Intubation (T2) and lmin after intubation (T3) at different time points in mean arterial pressure (MAP), heart rate (HR), systolic pressure (SDP), arterial partial pressure of oxygen (SPO2). And forget the effect and adverse reaction. Results In 20 patients, a successful intubation for 18 cases. In 1 case during operation by the assistant to the cricoid pressure after the two insert. In 1 patient with facial trauma, trismus, blind nasal intubation success. Until the patient conscious, postoperative follow-up in 20 cases without any complications of intubation, 2 cases of V. sore throat, 1 case of coma. Fully awake patients to accept the process without memory. MAP, HR, SDP before intubation, little change. Comparing with baseline differences were not statistically significant (P>0. 05) SPO2 has significantly improved (P<0. 05). Conclusion Analgesia induction and tracheal intubation in the emergency intubation are safe, effective and feasible.%目的 观察咽喉表面麻醉慢诱导气管内插管在急诊困难插管中的应用效果.方法 选择20例严重呼吸困难病人,在使用镇静药物常规插管失败后采用健忘镇痛慢诱导经口气管插管,观察记录患者的基础值(T0),环甲膜穿刺时(T1)、插管时(T2)和插管后1min(T3)各时间点的平均动脉压(MAP)、心率(HR)、收缩压(SDP)、动脉氧分压(SPO2),以及健忘作用与不良反应.结果 20例患者中一次插管成功18例,1例在操作过程中经助手对环状软

  14. ProSeal laryngeal mask airway improves oxygenation when used as a conduit prior to laryngoscope guided intubation in bariatric patients

    Directory of Open Access Journals (Sweden)

    Aparna Sinha

    2013-01-01

    Full Text Available Background: The primary objective of this study was to compare the effect of ventilation using the ProSeal TM laryngeal mask airway (PLMA with facemask and oropharyngeal airway (FM, prior to laryngoscopy, on arterial oxygenation in morbidly obese patients undergoing bariatric surgery. Methods: Forty morbidly obese patients were randomly recruited to either PLMA or FM. After pre-oxygenation (FiO 2 1.0 in the ramp position with continuous positive airway pressure of 10 cm H 2 O for 5 min, anaesthesia was induced. Following loss of jaw thrust oropharyngeal airway, the FM and PLMA were inserted. On achieving paralysis, volume control ventilation with PEEP (5 cm H 2 O was initiated. The difficulty in mask ventilation (DMV in FM, number of attempts at PLMA and laryngoscopy were graded (Cormack and Lehane in all patients. Time from onset of laryngoscopy to endotracheal tube confirmation was recorded. Hypoxia was defined as mild (SpO 2 ≤95%, moderate (SpO 2 ≤90% and severe (SpO 2 ≤85%. Results: Significant rise in pO 2 was observed within both groups ( P=0.001, and this was significantly higher in the PLMA ( P=0.0001 when compared between the groups. SpO 2 ≥ 90% ( P=0.018 was seen in 19/20 (95% patients in PLMA and 13/20 (65% in FM at confirmation of tracheal tube. A strong association was found between DMV and Cormack Lehane in the FM group and with number of attempts in the PLMA group. No adverse events were observed. Conclusion: ProSeal TM laryngeal mask airway as conduit prior to laryngoscopy in morbidly obese patients seems effective in increasing oxygen reserves, and can be suggested as a routine airway management technique when managing the airway in the morbidly obese.

  15. 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

  16. Application of topical anesthesia with lidocaine through the laryngotracheal topical anesthesia kit and thyrocricoid puncture in emergency treatment on patients with acute craniocerebral injury during blind nasotracheal intubation%喉麻管联合环甲膜穿刺表麻在颅脑损伤患者经鼻盲探气管插管病区急救中的应用

    Institute of Scientific and Technical Information of China (English)

    蒋卓汛

    2014-01-01

    目的:采用2%利多卡因经喉麻管喷雾行鼻腔、咽喉部表麻并联合环甲膜穿刺气管内表麻,探讨在颅脑损伤患者经鼻盲探气管内插管病区急救中的应用效果。方法将60例需经鼻盲探气管插管的急性颅脑损伤患者随机均分为2组:环甲膜穿刺注药组(Ⅰ组)和喉麻管联合环甲膜穿刺注药组(Ⅱ组),行经鼻盲探气管内插管。观察两组患者气管插管过程中平均动脉压(MAP)和心率(HR)的最大值,记录 MAP变化率>30%、HR 变化率>30%发生的例数;气管插管操作反应评分;并记录成功气管插管所需的插管次数。结果与Ⅰ组比较,Ⅱ组患者气管插管过程中MAP和HR的最大值及MAP变化率>30%、HR变化率>30%发生的例数均低于Ⅰ组(P<0.05);气管插管操作反应评分及成功气管插管所需的插管次数比较,Ⅱ组低于Ⅰ组(P<0.05);差异有统计学意义。结论2%利多卡因经喉麻管喷雾行鼻腔、咽喉部表麻并联合环甲膜穿刺气管内表麻,能降低颅脑损伤患者经鼻盲探气管内插管的心血管反应,降低气管插管的呛咳反射,提高经鼻盲探插管的成功率,在颅脑损伤患者经鼻盲探气管内插管病区急救中应用,是一种比较完善、有效、安全的表面麻醉方法,具有一定的临床应用价值。%Objective To investigate the application effect of topical anesthesia with 2%lidocaine through the laryngotracheal topical anesthesia kit and thyrocricoid puncture in emergency treatment on patients with acute craniocerebral injury during blind nasotracheal intubation .Methods Sixty patients with acute craniocerebral injury by blind nasotracheal intubation were randomly divided into 2 groups:thyrocricoid puncture group(Ⅰgroup)and laryngotracheal topical anesthesia kit and thyrocricoid puncture group(Ⅱgroup) .All patients were underwent blind nasotracheal intubation

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

    Directory of Open Access Journals (Sweden)

    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.

  18. 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.

  19. Evaluation of intra ocular pressure and hemodynamic change following intubation with Maccoy, Macintosh and Video laryngoscope

    Directory of Open Access Journals (Sweden)

    Hamid Khosro Zamiri

    2013-09-01

    Full Text Available Background & Objective: The induction of anesthesia, laryngoscopy and endotracheal intubation can be associated with adverse hemodynamic response and increased intraocular pressure. The aim of this study was to evaluate intraocular pressure and hemodynamic changes after laryngoscopy and endotracheal intubation with three methods of laryngoscopy (Macintosh, Maccoy and Video laryngoscope.Materials & Methods: One hundred and eighty patients with American Society of Anesthesiology (ASA classification of I and II, aged 20-70 year, were enrolled in a randomized clinical trial (RCT. Anesthesia was induced by administration of Propofol 2 mg/kg, Fentanyl 1µg/kg and Cisatracurium 0.1mg/kg. the Hemodynamic information of the patients and intraocular pressures were documented and assessed in three stages (after induction of anesthesia and endotracheal intubation, and 5 minutes after endotracheal intubation using Maccoy, Macintosh and Video laryngoscope.Results: Hemodynamic parameters' of patients increased in these three groups compared with those of pre anesthesia measures, but this increase was not significant. Evaluation of intraocular pressure (IOP in Video laryngoscope group showed that there is a significant drop in intraocular pressure (IOP compared with other groups. There weren’t any significant differences of IOP after intubation in Maccoy compared to the Macintosh group. Nevertheless there was not any significant difference in IOP, before and five minutes after intubation in these groups.Conclusion: According to a low degree of augment of IOP in Video laryngoscope group and no changes in the Hemodynamic parameters, it seems that the use of Video laryngoscope in eye surgeries might be more suitable for endotracheal intubation.

  20. The Fast and Easy Way for Double-Lumen Tube Intubation: Individual Angle-Modification

    Science.gov (United States)

    Min, Jeong Jin; Lee, Jong-Hwan; Kang, Se Hee; Kim, Eunhee; Lee, Sangmin M.; Cho, Jong Ho; Kim, Hong Kwan

    2016-01-01

    To find the faster and easier way than the existing intubating technique for double-lumen tube, we modified the angle of double-lumen tube according to an individual’s upper airway anatomy and compared the time needed and the number of attempts for successful intubation between individually angle-modified and non-modified double-lumen tubes. Adult patients undergoing elective thoracic surgery were randomly allocated in either non-angle-modified (Group N, n = 54) or angle-modified (Group M, n = 54) groups. During mask ventilation in the sniffing position, angle-modification was performed in Group M as follows: the distal tip of the tube was placed at the level of the cricoid cartilage and the shaft was bent at the intersection of the oral and pharyngeal axes estimated from the patient’s surface anatomy. The time needed and the number of attempts for successful intubation and Cormack and Lehane (C-L) grade were recorded. Overall median intubation time (sec) was significantly shorter in Group M than in Group N [10.2 vs. 15.1, P<0.001]. In addition, Group M showed the shorter median intubation time (sec) in C-L grades I-III [8.2 vs. 11.1 in C-L grade I, (P = 0.003), 10.3 vs. 15.3 in II, (P = 0.001), and 11.8 vs. 27.9 in III, (P<0.001), respectively]. Moreover, all intubation was successfully performed at the first attempt in patients with C-L grades I-III in Group M (P = 0.027). Our study showed an individual angle-modification would be useful for the fast and easy intubation of double-lumen tube in patients with C-L grades I-III. Trial Registration: ClinicalTrials.gov NCT02190032 PMID:27537372

  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. Comparison of the efficacy of aroma-acupressure and aromatherapy for the treatment of dementia-associated agitation

    OpenAIRE

    Yang, Man-Hua; Lin, Li-Chan; Wu, Shiao-Chi; Chiu, Jen-Hwey; Wang, Pei-Ning; Lin, Jaung-Geng

    2015-01-01

    Background One of the most common symptoms observed in patients with dementia is agitation, and several non-pharmacological treatments have been used to control this symptom. However, because of limitations in research design, the benefit of non-pharmacological treatments has only been demonstrated in certain cases. The purpose of this study was to compare aroma-acupressure and aromatherapy with respect to their effects on agitation in patients with dementia. Methods In this experimental stud...

  3. The Comparison of Priming with Pancrunium and Atracurium in the Speed of Providing Adequate Neuromuscular Blockade for Tracheal Intubating

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    S. Sanaie, M.D

    Full Text Available Abstract Background and purpose: Neuromuscular relaxants are one group of the important drugs in providing good condition for tracheal intubation and operation. Rapid intubation is needed in most situations. Also, most of non- depolarizing relaxants almost have long onset time. We compared the priming with pancrunium and atracurium in providing good and rapid relaxation for tracheal intubation.Materials and Methods: In this prospective study, 65 patients with ASA class I, II were randomized into two groups. Group A received pancrunium and group B received atracurium. Primimg dose was injected as 20% of total dose of relaxant. Twitching response was measured with peripheral nerve stimulator. Intubation was done when % 80 of the twitching response disappeared. The time of total disappearance of twitching response was also recorded.Results: The mean time for the injection of the first dose of relaxant until the time of intubation was 94.47 seconds in group A and 142.9 seconds in group B, which were significantly different (P<0/01. If intubation until the time of twitch response is detained, the time gap of group A will again be less than group B (P<0/01.Conclusion: In priming technique, the time of tracheal intubation with pancrunium is significantly less than atracurium. So, considering the patient's condition and the need for rapid relaxation, pancrunium could be is a better relaxant than atracurium.

  4. 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

  5. Effects of fentanyl-lidocaine-propofol and dexmedetomidine-lidocaine-propofol on tracheal intubation without use of muscle relaxants.

    Science.gov (United States)

    Hanci, Volkan; Erdoğan, Gülay; Okyay, Rahşan Dilek; Yurtlu, Bülent Serhan; Ayoğlu, Hilal; Baydilek, Yunus; Turan, Işil Ozkoçak

    2010-05-01

    The aim of this study was to compare the effects of fentanyl or dexmedetomidine when used in combination with propofol and lidocaine for tracheal intubation without using muscle relaxants. Sixty patients with American Society of Anesthesiologists stage I risk were randomized to receive 1 mg/kg dexmedetomidine (Group D, n = 30) or 2 mg/kg fentanyl (Group F, n = 30), both in combination with 1.5 mg/kg lidocaine and 3 mg/kg propofol. The requirement for intubation was determined based on mask ventilation capability, jaw motility, position of the vocal cords and the patient's response to intubation and inflation of the endotracheal tube cuff. Systolic arterial pressure, mean arterial pressure, heart rate and peripheral oxygen saturation values were also recorded. Rate pressure products were calculated. Jaw relaxation, position of the vocal cords and patient's response to intubation and inflation of the endotracheal tube cuff were significantly better in Group D than in Group F (p < 0.05). The intubation conditions were significantly more satisfactory in Group D than in Group F (p = 0.01). Heart rate was significantly lower in Group D than in Group F after the administration of the study drugs and intubation (p < 0.05). Mean arterial pressure was significantly lower in Group F than in Group D after propofol injection and at 3 and 5 minutes after intubation (p < 0.05). After intubation, the rate pressure product values were significantly lower in Group D than in Group F (p < 0.05). We conclude that endotracheal intubation was better with the dexmedetomidine-lidocaine-propofol combination than with the fentanyl-lidocaine-propofol combination. However, side effects such as bradycardia should be considered when using dexmedetomidine. PMID:20466334

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

    Directory of Open Access Journals (Sweden)

    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.

  7. 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.

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

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    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.

  9. COMPARISON OF LABETOLOL AND ESMOLOL IN ATTENUATING THE SYMPATHETIC RESPONSE TO LARYNGOSCOPY AND INTUBATION

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    Gilakala Varaha

    2015-03-01

    Full Text Available BACKGROUND: To Compare the attenuation of the sympathomimetic response to laryngoscopy and Intubation of the two drugs Labetolol (0 . 25mg/kg and Esmolol (0 . 5mg/kg in low doses . METHODS: In a prospective randomized study , 75 patients were selected for different types of elective surgeries under general anesthesia and divided into 3 groups of 25 each . Group C , Group E and Group L They were given 10ml of 0 . 9% normal saline , 0 . 25mg of labetolol and 0 . 5mg of Esmolol respecti vely . We compared the degree of attenuation of the sympathomimetic response to laryngoscopy and intubation in these three groups . RESULTS: The Group L patients who received low doses of 0 . 25mg/kg of labetolol showed greater attenuation to the sympathomimetic response to laryngoscopy and Intubation in terms of heart rate and systolic blood pressure than the Group E who recieved esmolol 0 . 5mg /kg . But there was no change in both the groups regarding the Diastolic blood pressure and Mean arterial pressure in response to laryngoscopy and Intubation . CONCLUSION: We concluded that Labetolol in low doses of 0 . 25mg/kg showed better attenuation of sympathomimetic response to laryngoscopy and intubation compared to Esmolol of 0 . 5mg/kg

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

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    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.

  11. Non-intubated combined with video-assisted thoracoscopic in carinal reconstruction.

    Science.gov (United States)

    Peng, Guilin; Cui, Fei; Ang, Keng Leong; Zhang, Xin; Yin, Weiqiang; Shao, Wenlong; Dong, Qinglong; Liang, Lixia; He, Jianxing

    2016-03-01

    Carinal reconstruction is a difficult technique combined with video-assisted thoracoscopic surgery (VATS). It has a high requirement on the operator's skills in operating thoracoscope and meanwhile requires the close cooperation from anesthesiologists. Tracheal intubation and ventilator-assisted ventilation are key steps to ensure the success of surgery. However, tracheal intubation itself may influence the exposure of surgical field and increase the difficulty of anastomosis. In close cooperation of anesthesiologists, we did not perform tracheal intubation; rather, we carried out non-intubated complete VATS carinal reconstruction in a patient with adenoid cystic carcinoma (ACC) of the lower trachea. The awake complete VATS carinal reconstruction was successfully performed. The anastomosis lasted about 36 hours, and the whole surgical procedure lasted 230 min. The intraoperative blood loss was about 80 mL. The patient recovered well 100 min after surgery. A semi-solid diet began 6 hours following the surgery. This non-intubated anesthesia method makes the surgery easier, especially during the anastomosis of stumps. It is feasible and safe to apply this anesthesia technique in carinal reconstruction. PMID:27076956

  12. 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.

  13. ATTENUATION OF HAEMODYNAMIC RESPONSES TO LARYNGOSCOPY AND ENDOTRACHEAL INTUBATION: ROLE OF I.V. BOLUS DOSE OF ESMOLOL HYDROCHLORIDE AND LIGNOCAINE HYDROCHLORIDE : A COMPARATIVE STUDY

    OpenAIRE

    Padma; Mydhili

    2015-01-01

    AIM: The aim of the study is to compare the efficacy of intravenous Bolus dose of Esmolol Hydrochloride and Lignocaine Hydrochloride to attenuate the Haemodynamic responses to Laryngoscopy and Endotracheal intubation. MATERIALS & METHODS : A study of Esmolol hydrochloride and Lignocaine hydrochloride in attenuation of the cardiovascular respons e during Laryngoscopy and intubation was compared in 50 adult patient, undergoing s...

  14. The effect of alfentanil on maternal haemodynamic changes due to tracheal intubation in elective caesarean sections under general anaesthesia

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    Seyedeh Masoumeh Hosseini Valami

    2015-01-01

    Full Text Available Background and Aims: Endotracheal intubation can produce severe maternal haemodynamic changes during caesarean sections under general anaesthesia. However, administration of narcotics before endotracheal intubation to prevent these changes may affect the Apgar score in neonates. This study was designed to evaluate the effect of intravenous alfentanil on haemodynamic changes due to endotracheal intubation in elective caesarean sections performed under general anaesthesia. Methods: Fifty parturients were randomly divided into two equal groups. Patients in the first group received alfentanil 10 μg/kg and in the second group received placebo intravenously 1 min before induction of anaesthesia for elective caesarean section. Haemodynamic parameters and bispectral index system (BIS in mothers, peripheral capillary oxygen saturation (SpO 2 and Apgar score in the newborn were assessed. Results: Changes in systolic blood pressure were significant at 1, 5 and 10 min after intubation between two groups. Changes in diastolic blood pressure were significantly less in alfentanil group, 1 min after induction of anaesthesia and 1 min after endotracheal intubation. Mean heart rate at 1 min after induction and at 1 and 5 min after intubation also reduced significantly in this group. Conclusion: Alfentanil use was associated with decreases or minimal increases in maternal systolic and diastolic blood pressures and heart rate after endotracheal intubation.

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

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    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.

  16. 右旋美托咪定与瑞芬太尼对全麻患者气管插管血流动力学的影响%Influence of dexmedetomidine and remifentanil on the hemodynamics of patients with tracheal intubation undergoing general anesthesia

    Institute of Scientific and Technical Information of China (English)

    杨文胜

    2014-01-01

    Objective To investigate the influence of dexmedetomidine and remifentanil on the hemodynamics of patients with tracheal intubation undergoing general anesthesia. Methods A total of 90 patients (ASAⅠ~Ⅱ) scheduled for general anesthesia were randomly divided into three groups (n=30), dexmedetomidine group (group D), remifentanil group (group R) and saline group (group S). Anesthesia induction was performed by total intravenous anesthesia, and maintaince was conducted by sevoflurane inhalation anesthesia. Patients in group D and group R were intravenously injected with 1μg/kg of dexmedetomidine or remifentanil 10 min before tracheal intubation respectively, while patients in group S were injected the same volume of saline. The systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) were recorded. Results Compared with group S, the rise ratio of blood pressure in group D and R were significantly lower, and the increase of HR after 1 min of intubation was also obviously lower (P<0.05). Conclusion Dexmedetomidine and remifentanil can stabilize the hemodynamic fluctuations caused by tracheal intubation.%目的:探讨右旋美托咪定与瑞芬太尼对全身麻醉(全麻)患者气管插管血流动力学的影响。方法择期全麻手术患者90例, ASAⅠ~Ⅱ级,随机分为三组,每组30例:右旋美托咪定组(D组)、瑞芬太尼组(R组)及生理盐水组(S组)。麻醉诱导采用全凭静脉麻醉,维持采用七氟醚吸入麻醉。D组及R组患者于插管前10 min分别静脉输注1μg/kg右旋美托咪定及瑞芬太尼, S组则静脉输注等容积生理盐水。记录患者收缩压(SBP)、舒张压(DBP)及心率(HR)。结果与S组相比, D组及R组患者插管后血压上升比率显著减少,且插管后1 min心率上升幅度也显著降低(P<0.05)。结论右旋美托咪定与瑞芬太尼可用于稳定气管插管引起的血流动力学波动。

  17. 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

  18. The Pentax airway scope versus the Macintosh laryngoscope: Comparison of hemodynamic responses and concentrations of plasma norepinephrine to tracheal intubation

    OpenAIRE

    Lee, Heeseung

    2013-01-01

    Background The Pentax Airway Scope (AWS) is a video laryngoscope designed to facilitate tracheal intubation with a high-resolution image. The Pentax AWS has been reported to cause less hemodynamic stress than the Macintosh laryngoscope. The aims of this study are to investigate the differences in hemodynamic responses and norepinephrine concentrations to tracheal intubation between procedures using he Pentax AWS and the Macintosh laryngoscope. Methods Forty patients (American Society of Anest...

  19. Attenuation of Hemodynamic Responses to Laryngoscopy and Tracheal Intubation: Propacetamol versus Lidocaine—A Randomized Clinical Trial

    OpenAIRE

    Ali Kord Valeshabad; Omid Nabavian; Keramat Nourijelyani; Hadi Kord; Hossein Vafainejad; Reza Kord Valeshabad; Ali Reza Feili; Mehdi Rezaei; Hamed Darabi; Mohammad Koohkan; Poorya Golbinimofrad; Samira Jafari

    2014-01-01

    The purpose of this study is to assess the effects of propacetamol on attenuating hemodynamic responses subsequent laryngoscopy and tracheal intubation compared to lidocaine. In this randomized clinical trial, 62 patients with the American Anesthesiologists Society (ASA) class I/II who required laryngoscopy and tracheal intubation for elective surgery were assigned to receive propacetamol 2 g/I.V./infusion (group P) or lidocaine 1.5 mg/kg (group L) prior to laryngoscopy. Systolic and diastoli...

  20. Prospective randomized study to compare between intravenous dexmedetomidine and esmolol for attenuation of hemodynamic response to endotracheal intubation

    OpenAIRE

    Selvaraj, Venkatesh; Manoharan, Karthik Raj

    2016-01-01

    Background: Esmolol has an established role in attenuation of hemodynamic response to laryngoscopy and endotracheal intubation. We studied the effect of dexmedetomidine compared to that of esmolol in this study. Aim: To study the role of dexmedetomidine in attenuation of hemodynamic response to laryngoscopy and oral endotracheal intubation compared to that of esmolol hydrochloride in patients posted for elective surgery under general anesthesia. Study Design: Prospective randomized study doub...

  1. The comparison of the effects of dexmedetomidine, fentanyl and esmolol on prevention of hemodynamic response to intubation

    OpenAIRE

    Nermin Gogus; Belgin Akan; Nurten Serger; Mustafa Baydar

    2014-01-01

    Background and objectives: Laryngoscopy and intubation can cause hemodynamic response. Various medications may be employed to control that response. In this study, we aimed to compare the effects of dexmedetomidine, fentanyl and esmolol on hemodynamic response. Methods: Ninety elective surgery patients who needed endotracheal intubation who were in American Society of Anesthesiology I–II group and ages between 21 and 65 years were included in that prospective, randomized, double-blind study...

  2. Pharyngeal oxygen administration increases the time to serious desaturation at intubation in acute lung injury: an experimental study

    OpenAIRE

    Engström, Joakim; Hedenstierna, Göran; Larsson, Anders

    2010-01-01

    Introduction Endotracheal intubation in critically ill patients is associated with severe life-threatening complications in about 20%, mainly due to hypoxemia. We hypothesized that apneic oxygenation via a pharyngeal catheter during the endotracheal intubation procedure would prevent or increase the time to life-threatening hypoxemia and tested this hypothesis in an acute lung injury animal model. Methods Eight anesthetized piglets with collapse-prone lungs induced by lung lavage were ventila...

  3. 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

    with an odds ratio of 1.34 (95% CI 1.19-1.51, P < 0.0001). As a stand alone test, BMI of 35 or more predicted DTI with a sensitivity of 7.5% (95% CI 7.3-7.7%) and with a predictive value of a positive test of 6.4% (95% CI 6.3-6.6%). BMI as a continuous covariate was a risk for failed intubation with an...

  4. Emergence agitation in children: risk factors, prevention, and treatment.

    Science.gov (United States)

    Kanaya, Akihiro

    2016-04-01

    Emergence agitation (EA) in children is a major postoperative issue that increases the risk of patient self-harm, places a burden on nursing staff, and reduces parent satisfaction with treatment. Risk factors for EA include age, preoperative anxiety, patient personality, pain, anesthesia method, and surgical procedure. Sevoflurane and desflurane are widely used anesthetics due to their low blood/gas partition coefficients, but they have recently been posited as a cause of EA in children. The perioperative administration of opioids, midazolam, ketamine, alpha-2 agonist sedatives, and nonsteroidal anti-inflammatory drugs has demonstrated efficacy in the prevention and treatment of EA. Maintenance of anesthesia using propofol has also been shown to prevent EA. In children, anesthesia methods that are unlikely to cause EA should be selected, with the prompt adminstration of appropriate treatment in cases of EA. PMID:26601849

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

    Directory of Open Access Journals (Sweden)

    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.

  6. 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.

  7. Agitation-associated behavioral symptoms in mild cognitive impairment and Alzheimer's dementia

    NARCIS (Netherlands)

    Van der Mussele, Stefan; Le Bastard, Nathalie; Saerens, Jos; Somers, Nore; Marien, Peter; Goeman, Johan; De Deyn, Peter P.; Engelborghs, Sebastiaan

    2015-01-01

    Objectives: The aim of this study is to determine the prevalence of agitation in mild cognitive impairment (MCI, Petersen's criteria) and patients with Alzheimer's dementia (AD), and to characterize the associated behavioral symptoms. Method: A cross-sectional analysis of baseline data from a prospe

  8. Effects of Tracheal Cuff Pressure on Tracheal Mucosal Damage in Patients with Intubation%气管导管套囊压力与患者气道黏膜损伤程度的关系

    Institute of Scientific and Technical Information of China (English)

    孙霞; 陈家伟; 尹华; 谭志明

    2011-01-01

    Objective:To investigate the effects of tracheal cuff pressure on traeheal mucosal damage in patients with intubation. Methods: We obtained informed consent from 80 American Society of Anesthesiologists (ASA) class I or II. Body mass index CBMI) 18-23 kg/m2,18-65 year-old patients, who were scheduled for radical treatment of gynaecological cancer. They were randomly allocated to either Group A or Group B. Patients in both groups were placed an epidural catheter at vertebral interspace between T11 and T12. General anesthesia was induced with propofol 1. 5-2.0 mg/kg, fentanyl 3-4μg/kg and rocuronium 0. 6-0. 8 mg/kg. Anaesthesia was maintained with porpofol and intermittent epidually administration of 0.375% ropovacaine. In Group A, the intracuff pressure was kept at 25 mmHg during the operation. In Group B, the intracuff pressure was kept at 25 mmHg, with intermittent lowered to 10 mmHg for 10 minutes every 60 minutes. Patients were questioned postoperatively about sore throat, dysphonia, and about whether they were satisfied with their anesthetic. Complications after tracheal tube removal, including coughing, bronchospasm, laryngospasm and the presence of blood on the tracheal tube, were recorded. Results: There was no difference in the incidence of complications of tracheal tube removal between two groups (P>0. 05). Conclusions: The method of maintaining the intracuff pressure for 1 h with intermitted deflation can not reduce the mucosal damage.%目的:探讨气管导管套囊压力的变化对患者气道黏膜损伤程度的影响.方法:择期行妇科肿瘤手术患者共80例,年龄18~65岁,身高155~165 cm,体质量指数(BMI)18~23 kg/m,美国麻醉医师协会(ASA)分级为Ⅰ~H级,随机分为2组:持续压力组(A组)和压力变化组(B组),每组40例.A组气管插管后维持气管导管套囊压力于25 mmHg直至手术结束.B组气管插管后维持气管导管套囊压力于25 mmHg,每隔1h套囊放气至10 mmHg压力,维持10 min

  9. 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.

  10. Edward’s syndrome: A rare cause of difficult intubation-utility of left molar approach

    Directory of Open Access Journals (Sweden)

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

  12. [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.

  13. 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

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

    Directory of Open Access Journals (Sweden)

    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.

  15. Pulmonary delivery of vancomycin dry powder aerosol to intubated rabbits

    Science.gov (United States)

    Sullivan, Bradley P.; El-Gendy, Nashwa; Kuehl, Christopher; Berkland, Cory

    2016-01-01

    Antibiotic multi-resistant pneumonia is a risk associated with long term mechanical ventilation. Vancomycin is commonly prescribed for methicillin-resistant staphylococcus aureus infections; however, current formulations of vancomycin are only given intravenously. High doses of vancomycin have been associated with severe renal toxicity. In this study we characterized dry powder vancomyin as a potential inhaled therapeutic aerosol and compared pharmacokinetic profiles of i.v. and pulmonary administered vancomycin in intubated rabbits using a novel endotracheal tube catheter system. Cascade Impaction studies indicated that using an endotracheal tube, which bypasses deposition the mouth and throat, increased the amount of drug entering the lung. Drug deposition in the lung was further enhanced by using an endotracheal tube catheter, which did not alter the aerosol fine particle fraction. Interestingly, intubated rabbits administered 1 mg/kg vancomycin via inhalation had similar AUC to rabbits that were administered 1 mg/kg vancomycin via a single bolus i.v. infusion; however, inhalation of vancomycin reduced Cmax and increased Tmax, suggesting that inhaled vancomycin resulted in more sustained pulmonary levels of vancomycin. Collectively, these results suggested that dry powder vancomycin can successfully be delivered by pulmonary inhalation in intubated patients. Furthermore, as inhaled vancomycin is delivered locally to the site of pulmonary infection, this delivery route could reduce the total dose required for therapeutic efficacy and simultaneously reduce the risk of renal toxicity by eliminating the high levels of systemic drug exposure required to push the pulmonary dose to therapeutic thresholds during i.v. administration. PMID:25915095

  16. Comparison of efficacy of labetalol and fentanyl for attenuating reflex responses to laryngoscopy and intubation.

    Science.gov (United States)

    Meftahuzzaman, S M; Islam, M M; Ireen, S T; Islam, M R; Kabir, H; Rashid, H; Uddin, M Z

    2014-04-01

    Stress response due to laryngoscopy and intubation has been universally recognized phenomenon resulting in increase in heart rate, arterial, intracranial, and intraocular pressure. Various pharmacological approaches have been used to blunt or attenuate such pressure responses. This prospective, randomized, placebo controlled, double blinded study was designed to compare the efficacy of bolus dose of Labetalol and Fentanyl for attenuating reflex responses to laryngoscopy and intubation. Ninety patients with physical status of ASA I and II were scheduled for elective surgery under standard protocol of general anaesthesia, randomly allocated into three groups, consisting of 30 patients in each group, assigned as C (Control), L (Labetalol), and F (Fentanyl). In control group 10ml of 0.9% saline, in Labetalol group 0.25 mg/kg Labetalol and in Fentanyl group 2μgm/kg of Fentanyl were given intravenously at 3 minutes prior to laryngoscopy and intubation. Pulse rate, systolic, diastolic, mean arterial pressure and rate pressure products (RPP) were recorded before and after premedication, after administration of study drugs and at 1, 3, 5, 10 and 15 minutes after intubation. For statistical analysis of data, ANOVA tests were performed for comparison between groups. There were an increase in heart rate, systolic, diastolic, mean arterial pressures and rate pressure product in all the three groups after intubation in comparison to base line value. But the rise was minimum in L and F group as compared to C group which is statistically significant and also minimum in L group as compared to F group. So Labetalol is better agent for attenuation of laryngoscopic and intubation reflex. PMID:24858149

  17. 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.

  18. Survey of Accepted Practice following Failed Intubation for Emergency Caesarean Delivery

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    Daniel Soltanifar

    2015-01-01

    Full Text Available Background. There is no consensus on the optimum management of failed tracheal intubation in emergency cesarean delivery performed for fetal compromise. The decision making process on whether to wake the patient or continue anesthesia with a supraglottic airway device is an underexplored area. This survey explores perceptions and experiences of obstetric anesthetists managing failed intubation. Methods. Anesthetists attending the Group of Obstetric Anaesthetists London (GOAL Meeting in April 2014 were surveyed. Results. Ninety-three percent of anesthetists surveyed would not always wake the patient in the event of failed intubation for emergency cesarean delivery performed for fetal compromise. The median (interquartile range of perceived acceptability of continuing anesthesia with a well-fitting supraglottic airway device, assessed using a visual analogue scale (0–100; 0 completely unacceptable; 100 completely acceptable, was 90 [22.5]. Preoperative patient consent regarding the use of a supraglottic airway device for surgery in the event of failed intubation would affect the decision making of 40% of anaesthetists surveyed. Conclusion. These results demonstrate that a significant body of anesthetists with a subspecialty interest in obstetric anesthesia in the UK would not always wake up the patient and would continue with anesthesia and surgery with a supraglottic airway device in this setting.

  19. Comparison of Esmolol and Lignocaine for Atttenuation of Cardiovascular Stress response to Laryngoscopy and Endotracheal Intubation

    OpenAIRE

    Ajay Gupta, Renu Wakhloo, Vishal Gupta, Anjali Mehta, BB Kapoor

    2009-01-01

    Direct laryngoscopy and endotracheal intubation frequently induces a cardiovascular stress response dueto reflex symbathetic stimulation. This response may be hazardous in patients with Hypertension, Coronaryartery disease, Myocardial disease, cerebrovascular disease. Numerous agents have therefore been utilizedto blunt this response. The present study was undertaken in view of above mentioned facts, to compareeffectiveness of intravenous esmolol and lignocaine in suppressing the cardiovascul...

  20. COMPARISON OF LABETOLOL AND ESMOLOL IN ATTENUATING THE SYMPATHETIC RESPONSE TO LARYNGOSCOPY AND INTUBATION

    OpenAIRE

    Gilakala Varaha; Saroj; P. N. V.

    2015-01-01

    BACKGROUND: To Compare the attenuation of the sympathomimetic response to laryngoscopy and Intubation of the two drugs Labetolol (0 . 25mg/kg) and Esmolol (0 . 5mg/kg) in low doses . METHODS: In a prospective randomized study , 75 patients were selected for different types of elective surgeries under general anesthesia and divided into 3 groups of 25 each ...

  1. 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

  2. Musikterapi til reduktion af agitation hos personer med demens

    DEFF Research Database (Denmark)

    Ridder, Hanne Mette Ochsner; Stige, Brynjulf

    2015-01-01

    . 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......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...

  3. AGITATION LACQUER MINIATURE IN THE HISTORY OF AGRONOMY

    Directory of Open Access Journals (Sweden)

    Tsatsenko L. V.

    2015-09-01

    Full Text Available The article considers issues related to the history of the popularization of agricultural knowledge by agitation lacquer miniatures. The agitation lacquer miniature in its content and meaning has similarities with such kinds of art as agitation posters, agitation porcelain and agitation textiles. We have discussed issues the emergence of this kind of art. The agitation lacquer miniature or agitlak appeared in Soviet Russia in the 1920s. In the work, we have attempted to analyze one of the most interesting directions of art - propaganda or lacquer miniature agitlak and its role in promoting agricultural knowledge. Agitlak - a term invented by the collector Alexander Andreyevich Dobrovskij, by association with the established terms such as agitporcelain and agit-textile. To achieve this goal the database was created visual images of agitation lacquer miniatures taken from exhibition catalogs, brochures and books. As a tool of the analysis method we have used sketches or visual notes. To use lacquer miniatures as resource information for popularization agricultural knowledge in Russia in the period from 1920 to 1970 there are several topics: change of manual labor by mechanized, types of agricultural works, harvesting, growing of different cultures, experience exchange, attracting the pioneers in the agricultural sector - opytnichestvo. In the work we have shown the history of the development of agitation lacquer miniature, goals and objectives, an illustrative number of samples as well as analyzed lacquer miniatures with scenes of agricultural production

  4. A CLINICAL ASSESSMENT OF MACINTOSH BLADE, MILLER BLADE AND KING VISIONTM VIDEOLARYNGOSCOPE FOR LARYNGEAL EXPOSURE AND DIFFICULTY IN ENDOTRACHEAL INTUBATION

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    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

  5. COMPARATIVE STUDY OF ATTENUATION OF CARDIOVASCULAR RESPONSE TO LARYNGOSCOPY AND INTUBATION WITH IV DEXMEDETOMIDINE VS. IV LIGNOCAINE

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    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.

  6. Comparison Between Truview EVO2 and Macintosh Laryngoscopes in Endotreacheal Intubation for Patients with Restricted Neck Movement%Truview EVO 2喉镜与 Macintosh 喉镜用于颈椎活动受限患者气管插管的对比研究

    Institute of Scientific and Technical Information of China (English)

    张耕; 韩永正; 李民; 王军; 郭向阳

    2014-01-01

    目的:评价Truview EVO2喉镜与Macintosh喉镜用于颈椎活动受限患者气管插管的临床应用情况。方法择期颈椎活动受限经口气管插管全麻手术49例,静脉麻醉诱导后,随机先后使用Truview EVO2喉镜与Macintosh喉镜显露喉部,并采用喉部暴露条件好的喉镜行气管插管。比较2种喉镜Cormack-Lehane(C-L)分级,喉部结构显露时间和声门显露时血流动力学改变。结果 Truview EVO2喉镜组C-L分级显著优于Macintosh喉镜组(Z=-5.488,P=0.000),喉部结构显露时间明显长于Macintosh喉镜组[(15.9±6.7)s vs.(12.3±4.5)s,t=4.304,P=0.000]。2种喉镜声门显露时HR、SBP、MAP变化无统计学差异(P>0.05)。结论 Truview EVO2喉镜用于颈椎活动受限患者气管插管效果明显优于Macintosh喉镜,可提高气管插管成功率,对于部分困难气道患者具有较好的应用价值。%Objective To compare the clinical application between Truview EVO 2 and Macintosh laryngoscopes in endotreachal intubation for patients with restricted neck movement. Methods Forty-nine patients scheduled for elective surgery under general anesthesia requiring orotracheal intubation were enrolled. After intravenous anesthetic induction, orotracheal intubation was randomly performed by an experienced anesthesiologist with both Truview EVO 2 and Macintosh laryngoscopes. Then the patient was intubated with the laryngoscope with better view. Parameters were recorded, including Cormack-Lehane ( C-L) grade of laryngeal view, the laryngeal exposuring time, and hemodynamic changes during intubation. Results Better C-L grade of laryngeal view was achieved in the Truview EVO2 laryngoscope as compared with the Macintosh laryngoscope (Z=-5.488, P=0.000).The laryngeal exposuring time of Truview EVO2 laryngoscopy was longer than that of Macintosh laryngoscope [(15.9 ±6.7) s vs.(12.3 ±4.5) s, t=4.304, P =0.000].There was no

  7. 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

  8. 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.

  9. 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.

  10. Efficacy and safety of risperidone oral solution in agitation associated with dementia in the elderly

    Directory of Open Access Journals (Sweden)

    Laks Jerson

    2001-01-01

    Full Text Available BACKGROUND: Behavioral and psychological symptoms in dementia (BPSD contribute to caregiver burden and institutionalization of elderly. Neuroleptics are prescribed to control agitation. Side effects of typical neuroleptics are harmful, making atypical neuroleptics an indication. OBJECTIVES: To evaluate efficacy and tolerability of risperidone oral solution (ROS given once daily to demented elderly outpatients with BPSD (agitation. METHOD: Patients (n=26, 76.35±8.63 years, Diagnostic and Statistical Manual of Mental Disorders 4th ed. (DSM-IV criteria for dementia. RSO was given, starting dose of 0.25 mg and increments of 0.25 mg every week. Mini-Mental State Examination (MMSE assessed cognitive status, Behavioral and Emotional Activities Manifested in Dementia (BEAM-D and Clinical Global Impression (CGI measured BPSD, Extrapiramidal Symptom Rating Scale (ESRS evaluated extrapyramidal symptoms. Cardiovascular side effects were evaluated clinically. RESULTS: There was a 26% reduction in agitation and no cardiovascular side effects in the range from 1.0 to 1.25 mg. Side effects were more prevalent above 2.5 mg. CONCLUSION: Risperidone oral solution improved agitation with good tolerability from 0.5 to 1.25 mg. A single dose with increments of 0.25 mg may be more acceptable to patients and caregivers.

  11. 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.

  12. A STUDY ON COMPARISON OF INTRAVENOUS DEXMEDETOMIDINE WITH INTRAVENOUS FENTANYL FOR SUPPRESSION OF HEMODYNAMIC RESPONSES TO LARYNGOSCOPY AND ENDOTRACHEAL INTUBATION DURING GENERAL ANAESTHESIA

    Directory of Open Access Journals (Sweden)

    Nidhi D Patel

    2015-06-01

    Full Text Available Background: Laryngoscopy and intubation is the Gold standard for airway management but this evokes a stress response which is exhibited in the form of changes in heart rate, blood pressure and arrhythmias. This study was prospective, randomized, double blind study to determine whether the fentanyl 2 and micro;g/Kg or dexmedetomidine 1 and micro;g/Kg would decrease the attenuation of hemodynamic response during laryngoscopy and tracheal intubation during general anaesthesia. Methodology: The patients were randomly allocated into two groups. In Group D cases (n=30 received injection Dexmedetomidine 1 and micro;g/kg diluted to 10ml NS IV over 10min using syringe pump prior to intubation and 5ml of NS 5 min. prior to intubation. In Group F cases (n=30 received 2 and micro;g/kg diluted to 5ml NS 5min. prior to intubation and 20ml NS in infusion pump over 10 min., prior to intubation. Results: The age and weight of the cases in both the groups are comparable. It was observed that mean HR increased in both groups D and F immediately after endotracheal intubation. The systolic blood pressure was highly significant in group F as compared to group D during laryngoscopy and intubation, 1, 3, 5 and 10 min after intubation (p<0.000. Ramsay sedation score was and #8805; 4 in all patients in group D and was and #8804; 3 in group F. Dexmedetomidine has higher sedation score but no respiratory depression. Conclusion: We concluded that dexmedetomidine in dose 1 and micro;gm/kg i.v. is more effective in attenuating the hemodynamic pressor responses to laryngoscopy and intubation than Inj. Fentanyl 2 and micro;gm/kg i.v. when given as pre-medicant without significant side effects. [Natl J Med Res 2015; 5(2.000: 127-131

  13. Effect of red suction type of oral care suction tube used in oral care of critically ill patients undergoing intubation%冲吸式吸痰管应用于气管插管危重病人口腔护理的效果

    Institute of Scientific and Technical Information of China (English)

    黄苑玲; 邓少军; 马爱平; 徐丽娟

    2014-01-01

    Obj ective:To probe into the effect of red suction type of oral care suction tube used in oral care of critically ill patients undergoing intubation. Methods:A total of 160 cases of patients receiving orotracheal intubation were randomly divided into observation group and control group,80 cases in each.Patients in observation group received oral care with saline 100 mL+red suction oral care suction tube,patients in control group received oral care by using traditional cotton ball to wiping mouth,then to compare the inci-dence of ventilator associated pneumonia (VAP ),oral unclean,bad breath and oral cavity inflammation.Results:The incidence of Ventilator associated pneumonia (VAP),oral unclean,bad breath and oral cavity inflammation in observation group was lower than that in control group(P<0.05).Conclu-sion:Red suction type of oral care suction tube used in oral care of critically ill patients undergoing intubation can thoroughly clean the mouth,reduce bad breath and oral cavity inflammation,prevent and reduce the occurrence of VAP.%[目的]探讨冲吸式吸痰管应用于气管插管危重病人口腔护理的效果。[方法]将160例经口气管插管病人随机分为观察组、对照组各80例,观察组采用生理盐水100 mL+冲吸式吸痰管进行口腔护理,对照组采用传统棉球擦拭口腔护理方法,比较两组病人呼吸机相关性肺炎(VAP)、口腔不洁、口臭、口腔炎症的发生率。[结果]观察组VAP、口腔不洁、口臭、口腔炎症发生率均低于对照组(P<0.05)。[结论]冲吸式吸痰管应用于气管插管危重病人口腔护理,能够彻底清洁口腔、减少口臭及口腔炎症的发生、预防和减少 VAP的发生。

  14. A comparison of the BURP and conventional and modified jaw thrust manoeuvres for orotracheal intubation using the Clarus Video System.

    Science.gov (United States)

    Lee, A R; Yang, S; Shin, Y H; Kim, J A; Chung, I S; Cho, H S; Lee, J J

    2013-09-01

    We evaluated the effects of three airway manipulation manoeuvres: (a) conventional (single-handed chin lift); (b) backward, upward and right-sided pressure (BURP) manoeuvre; and (c) modified jaw thrust manoeuvre (two-handed aided by an assistant) on laryngeal view and intubation time using the Clarus Video System in 215 patients undergoing general anaesthesia with orotracheal intubation. In the first part of this study, the laryngeal view was recorded as a modified Cormack-Lehane grade with each manoeuvre. In the second part, intubation was performed using the assigned airway manipulation. The primary outcome was the time to intubation, and the secondary outcomes were the modified Cormack-Lehane grade, the number of attempts and the overall success rate. There were significant differences in modified Cormack-Lehane grade between the three airway manipulations (p BURP manoeuvres (p BURP worsened the laryngeal view compared with the conventional manoeuvre (p = 0.0132). The time to intubation in the modified jaw thrust group was shorter than with the conventional manoeuvre (p = 0.0004) and the BURP group (p < 0.0001). We conclude that the modified jaw thrust is the most effective manoeuvre at improving the laryngeal view and shortening intubation time with the Clarus Video System. PMID:23841798

  15. Post intubation tracheal stenosis in children

    Directory of Open Access Journals (Sweden)

    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.

  16. Ketofol-Dexmedetomidine combination in ECT: A punch for depression and agitation

    OpenAIRE

    Tarek Shams; Ragaa El-Masry

    2014-01-01

    Background and Aims : The choice of anaesthetic agent for electroconvulsive therapy (ECT) depends on seizure duration, haemodynamic, and recovery parameters. The aim of the study was to assess the effects of ketamine-propofol induction with dexmedetomidine preadministration (ketofol-dex group) and without its preadministration (ketofol group) on haemodynamics, depression, seizure duration, recovery characteristics, and agitation following ECT in patients with depression. Methods : 40 patients...

  17. 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.

  18. 不同剂量右美托咪定预防腹腔镜患者全身麻醉苏醒期躁动及寒战临床评价%Different Doses of Dexmedetomidine for Preventing Agitation and Shivering of Patients during Recovery Period of General Anesthesia in Gynecological Laparoscopy

    Institute of Scientific and Technical Information of China (English)

    吴静; 杨帆

    2016-01-01

    Objective To analyze clinical efficacy of different doses of dexmedetomidine on shivering and agitation of laparoscopic patients with given anesthesia. Methods 60 cases of laparoscopic patients from March 2015 to February 2016 were divided into into group A, B, C, D according to random number table method, 15 cases in each group. Before induction of anesthesia, groups A, B, C were given dexmedetomidine infusion of 0. 5 μg/kg, 0. 75 μg/kg, 1. 0 μg/kg, group D received isovolumetric saline infusion. The occurrence rates of agitation and shivering were compared between the 4 groups. Results The incidence rates of agitation after general anesthesia in groups A, B, C were 26. 67%, 6. 67%, 20. 00%, which were all significantly lower than 53. 33% in group D, and group B ( 6. 67%) was significantly lower than group A ( 26. 67%) ( P < 0. 05 ) . The incidence rates of shivering after general anesthesia in groups A, B, C were 40. 00%, 73. 33%, 46. 67%, which were all significantly higher than 26. 67% in group D, and group B had the most significant preventive efficacy on shivering with statistically significant difference ( P < 0. 05 ) . Conclusion Dexmedetomidine has good good clinical efficacy on preventing agitation and shivering in laparoscopic patients with general anesthesia, and the dose of 0. 75 μg/kg of dexmedetomidine has the best preventive effect with good recovery.%目的:探讨腹腔镜患者采用不同剂量右美托咪定预防全身麻醉(简称全麻)苏醒期躁动及寒战的临床疗效。方法将2015年3月至2016年2月收治的60例腹腔镜患者采用随机数字表法分成A,B,C,D 4组,各15例;A,B,C组在麻醉诱导前均给予右美托咪定泵注,给予剂量分别为0.5,0.75,1.0μg/kg,D组给予等容生理盐水泵注。比较4组患者术后全麻苏醒期躁动及寒颤的发生情况。结果 A,B,C 3组患者全麻苏醒期躁动发生率(26.67%,6.67%,20.00%)均明显低于D组(53.33%)

  19. 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.

  20. The comparison of the effects of dexmedetomidine, fentanyl and esmolol on prevention of hemodynamic response to intubation

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    Nermin Gogus

    2014-09-01

    Full Text Available Background and objectives: Laryngoscopy and intubation can cause hemodynamic response. Various medications may be employed to control that response. In this study, we aimed to compare the effects of dexmedetomidine, fentanyl and esmolol on hemodynamic response. Methods: Ninety elective surgery patients who needed endotracheal intubation who were in American Society of Anesthesiology I–II group and ages between 21 and 65 years were included in that prospective, randomized, double-blind study. Systolic, diastolic, mean arterial pressures, heart rates at the time of admittance at operation room were recorded as basal measurements. The patients were randomized into three groups: Group I (n = 30 received 1 μg/kg dexmedetomidine with infusion in 10 min, Group II (n = 30 received 2 μg/kg fentanyl, Group III received 2 mg/kg esmolol 2 min before induction. The patients were intubated in 3 min. Systolic, diastolic, mean arterial pressures and heart rates were measured before induction, before intubation and 1, 3, 5, 10 min after intubation. Results: When basal levels were compared with the measurements of the groups, it was found that 5 and 10 min after intubation heart rate in Group I and systolic, diastolic, mean arterial pressures in Group III were lower than other measurements (p < 0.05. Conclusions: Dexmedetomidine was superior in the prevention of tachycardia. Esmolol prevented sytolic, diastolic, mean arterial pressure increases following intubation. We concluded that further studies are needed in order to find a strategy that prevents the increase in systemic blood pressure and heart rate both.

  1. A RANDOMIZED CLINICAL TRIAL OF ENDOTRACHEAL INTUBATION FOLLOWING THIOPENTAL - SUCCINYLCHOLINE OR SEVOFLURANE - NITROUS OXIDE ANESTHESIA FOR GENERAL ANESTHESIA IN ELECTIVE SURGERIES IN ADULTS

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    A.S. Kameswara

    2013-12-01

    Full Text Available We performed a double - blinded , prospective , randomized controlledtrial to compare intubating conditions facilitated by succinylcholineor sevoflurane. One hundred twenty patients were randomizedto receive either succinylcholine or sevoflurane for trachealintubation. For the Succinylcholine group , patients were inducedwith thiopental 5 mg · kg - 1 and tracheally intubatedafter administration of succinylcholine 1.5 mg · kg - 1 IV. Patients receiving sevoflurane took three vital capacitybreaths of 8% sevoflurane and 66% N 2 O in O 2 . At the loss ofeyelash reflex , ventilation was assisted to establi sh end - tidalCO 2 between 25 – 30 mm Hg , and intubation was performed. Criteria ofjaw relaxation , vocal cords positionand intubating responsewere used to assess intubation condition. If the intubationscore was 6 of 12 , it was described as acceptable; otherwis eit was described as an unacceptable intubation condition. Trachealintubation was successful in all patients. The study was i ntubator and observer blinded with reference to patient group and they judged that four patients (6.7%in the Sevoflurane group and only one patient (1.7% in theSuccinylcholine group had an unacceptable intubation condition.However , there was no significant difference between groups(P > 0.05. Therefore , the three vital capacity breaths inhalationtechnique with sevoflurane may be an a lternative for endotrachealintubation in adults. Implications: The three vital capacity inhaled anesthetic techniqueswith 8% sevoflurane and 66% N 2 O in O 2 may be an alternative for endotracheal intubationin adults who are at high risk from succinylcholine

  2. Air-Q laryngeal airway for rescue and tracheal intubation.

    Science.gov (United States)

    Ads, Ayman; Auerbach, Frederic; Ryan, Kelly; El-Ganzouri, Abdel R

    2016-08-01

    We report the successful use of the Air-Q laryngeal airway (Air-Q LA) as a ventilatory device and a conduit for tracheal intubation to rescue the airway in a patient with difficult airway and tracheal stenosis. This is the first case report of the device to secure the airway after two episodes of hypoxemia in the operating room and intensive care unit. Consent for submission of this case report was obtained from our institution's human studies institutional review board given that the patient died a few months after his discharge from the hospital before his personal consent could be obtained and before preparation of this report. All personal identifiers that could lead to his identification have been removed from this report. A 59-year-old man was scheduled for a flexible and rigid bronchoscopy with possible laser excision of tracheal stenosis. He had a history of hypertension, atrial fibrillation, and diabetes. Assessment of airway revealed a thyromental distance of 6.5 cm, Mallampati class II, and body weight of 110 kg. He had hoarseness and audible inspiratory/expiratory stridor with Spo2 90% breathing room air. After induction and muscle relaxation, tracheal intubation and flexible bronchoscopy were achieved without incident. The patient was then extubated and a rigid bronchoscopy was attempted but failed with Spo2 dropping to 92%; rocuronium 60 mg was given, and reintubation was accomplished with a 7.5-mm endotracheal tube. A second rigid bronchoscopy attempt failed, with Spo2 dropping to 63%. Subsequent direct laryngoscopy revealed a bloody hypopharynx. A size 4.5 Air-Q LA was placed successfully and confirmed with capnography, and Spo2 returned to 100%. The airway was suctioned through the Air-Q LA device, and the airway was secured using a fiberoptic bronchoscope to place an endotracheal tube of 7.5-mm internal diameter. The case was canceled because of edema of the upper airway from multiple attempts with rigid bronchoscopy. The patient was transported

  3. Comparison of bolus and continuous infusion of esmolol on hemodynamic response to laryngoscopy, endotracheal intubation and sternotomy in coronary artery bypass graft

    OpenAIRE

    Esra Mercanooglu Efe; Basak Atabey Bilgin; Zekeriyya Alanoglu; Murat Akbaba; Cigdem Denker

    2014-01-01

    BACKGROUND AND OBJECTIVE: The aim of this randomized, prospective and double blinded study is to investigate effects of different esmolol use on hemodynamic response of laryngoscopy, endotracheal intubation and sternotomy in coronary artery bypass graft surgery. METHODS: After approval of local ethics committee and patients' written informed consent, 45 patients were randomized into three groups equally. In Infusion Group; from 10 min before intubation up to 5th minute after sternotomy, ...

  4. 右美托咪定对高血压患者麻醉诱导期循环功能的影响%Effects of dexmedetomidine premedication on the circulation in patient with hypertension during anesthetic induction and tracheal intubation

    Institute of Scientific and Technical Information of China (English)

    于明帅; 张科; 余学英; 齐磊; 胥晓倩

    2014-01-01

    Objective: To investigate the effects of demedetomidine premedication on the circulation in patients with hypertension during anesthetic induction and tracheal intubation. Methods: Forty patients with hypertension scheduled for spinal surgery were enrol ed in this study. Patients were randomized into two group (n=20 each):group C=control; group D=dexmedetomidine. Dexmedetomidine (0.5ug/kg) were administered to patients in group D by a infusion pump 10min prior to anesthetic induction. While patients in group C received the same volume normal saline. The infusion lasted 10 min. BP( Blood pressure)HR(heart rate)were respectively recorded at the fol owing time points, before infusion of dexmedetomidine (T0), immediately before tracheal intubation(Tl),1, 3, 5 min after tracheal intubation(T2-5).Results: Compared with T0,In group N,BP were significantly decreased at T1 then increased at T3 and T4(P<0.05) .These variables had no significant change in group D. Statistical y significant differences were found between the two groups(P<0.05).The level of HR was significantly lower at Tl-5 than that at T0 in group D, Statistical y significant differences were found between the two groups(P<0.05). Conclusion: Dexmedetomidine premedication can safely and effectively al eviate the cardiovascular response and keep the stability of circulation in patients with hypertension during anesthetic induction and tracheal intubation.%目的:研究右美托咪定(dexmedtomidine,DEX)对高血压患者手术麻醉诱导过程中循环功能的影响。方法选择40例行脊柱手术麻醉的高血压患者, ASAⅡ-Ⅲ级,随机分为两组(n=40):右美托咪定组(D组,n=20)和生理盐水对照组(N组,n=20),对照组按常规诱导麻醉,右美托咪定组在麻醉诱导前,使用右美托咪定0.5μg/kg在10分钟内泵入,接着持续用0.5μg/kg/h,记录基础值(T0)、生理盐水对照和右美托咪啶注射后(T1)、插管前(T2)及气管内插管后1min(T3

  5. [Sedated non-intubated bilateral thoracoscopic sympathectomy R3-R4].

    Science.gov (United States)

    Mier-Odriozola, José Manuel

    2016-01-01

    Non-intubated thoracic surgery entails procedures performed through regional anesthesia method in awake or mildly sedated, spontaneously ventilating patients. This method represents advantages for the cardiovascular system, and reduces the orotracheal trauma, postoperative atelectasis, and pneumonia. It also possibly reduces costs. Other theoretical advantages are: easier acceptance of surgery, attenuated stress hormone and immune response, and possibly a better survival in oncological surgery. We show a 34-year-old woman with sever palmar-axillary hyperhidrosis. We performed the procedure with local anesthesia (ropivacaine 2 mg/ml) 5 ml in each wound trocar; 20 ml inside the thoracic cavity. The patient was mildly sedated with fentanyl and dexmedetomidine. The procedure was very simple, the patient was included in an outpatient program 90 minutes after the surgery. We conclude that sympathectomy with a non-intubated patient is safe and could be the beginning of other kinds of more complex procedures. PMID:27160623

  6. 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

  7. Study of effects of oral care by irrigation and cotton scrubbing in patients with orotracheal intubation%经口气管插管患者冲洗+棉球擦洗进行口腔护理的效果观察

    Institute of Scientific and Technical Information of China (English)

    郭风; 冯向英; 李彩茹; 张艳; 胡荣; 季芳英; 官静

    2011-01-01

    Objective To explore the effect of oral care by irrigation and cotton scrubbing in patients with orotracheal intubation. Methods A total of 60 patients with orotracheal intubation were assigned to the control group and the experimental group ,30 cases in each group. The control group received oral care by the routine method of cotton scrubbing, while the experimental group received oral care by cotton scrubbing combined with irrigation. The condition of bad breath,oral infection and lung infection were collected and compared between the two groups. Results The rates of bad breath was lower than the control group ( P < 0.01 ). Conclusion The method of cotton scrubbing combined with irrigation can clean oral cavities thoroughly and the patients feel comfortble.%目的 探讨冲洗+棉球擦洗在经口气管插管患者口腔护理中的应用效果.方法 经口气管插管患者60例,分为对照组和实验组各30例.对照组采取传统的棉球擦洗法;观察组同时实施冲洗与棉球擦洗进行口腔护理.对两组患者在口腔护理后的口腔异味、口腔感染率、肺部感染进行比较.结果 实验组患者的口腔异味率低于对照组(P<0.01).结论 冲洗+棉球擦洗能彻底清洗经口气管插管患者的口腔,提高患者舒适感.

  8. 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.

  9. Observation on the Efficacy of Small Dose of Esmolol Intravenous Pre-injection Alleviating the Reac-tion of Tracheal Intubation for Patients with Hypertension and Coronary Heart Disease%小剂量艾司洛尔预先静脉注射减轻高血压冠心病患者气管插管反应的疗效观察

    Institute of Scientific and Technical Information of China (English)

    王光福; 徐小波; 李河志; 赵辉; 刘绍靖

    2016-01-01

    目的 观察小剂量艾司洛尔预先静脉注射在减轻高血压冠心病患者气管插管反应的作用. 方法 选取2009年2月至2012年10月在武装警察部队四川总队成都医院行全身麻醉手术的高血压冠心病患者60例,根据随机数字表法分为艾司洛尔组和对照组,各30 例. 艾司洛尔组在麻醉插管前5 min给予小剂量艾司洛尔(0.7 mg/kg);对照组仅给予0.9%NaCl注射液,两组麻醉诱导和维持方法相同,分别监测并记录麻醉诱导前、诱导后、插管即刻、插管后1、3、5 min时心率和平均动脉压变化. 结果 对照组插管即刻、插管1、3、5 min 的平均动脉压较诱导前有明显升高[ ( 120 ± 15)mmHg(1 mmHg=0.133 kPa)、(118 ±23) mmHg、(115 ±10) mmHg、(112 ±14) mmHg 比(98 ± 14) mmHg],心率明显增快[(88 ±8)次/min、(94 ±15)次/min、(91 ±10)次/min、(93 ±10)次/min比(76 ±4)次/min],艾司洛尔组的平均动脉压[(101 ±11) mmHg、(104 ±18) mmHg、(101 ± 10) mmHg、(98 ±10) mmHg比(98 ±14) mmHg],心率[(78 ±4)次/min、(81 ±12)次/min、(80 ± 7)次/min、(78 ±5)次/min比(75 ±7)次/min]分别较诱导前有轻度升高,但变化幅度不大. 两组比较差异有统计学意义( P<0.05 ). 结论 小剂量艾司洛尔预先注射能够有效减轻高血压冠心病患者气管插管时的心血管反应.%Objective To observe the effect of intravenous pre-injection of small dose of esmolol on alle-viating the impact of tracheal intubation on patients with hypertension and coronary heart disease .Methods Total of 60 patients with hypertension and coronary heart disease undergoing general anesthesia operations at Chengdu Armed Police Corps Hospital from Feb.2009 to Oct.2012 were selected, and were divide into esmolol group and control group according to random number table method,with 30 patients in each group. The esmolol group was injected with small dose of esmolol(0.7 mg/kg) 5 minutes prior to the anesthetic intubation;the control

  10. The effect of lidocaine on reducing the tracheal mucosal damage following tracheal intubation

    OpenAIRE

    Saeed Abbasi; Hosein Mahjobipoor; Parviz Kashefi; Gholamreza Massumi; Omid Aghadavoudi; Ziba Farajzadegan; Parvin Sajedi

    2013-01-01

    Background: The aim of this study was to investigate the efficacy of lidocaine solution in the cuff of the endotracheal tube in reducing mucosal damage following tracheal intubation. Materials and Methods: This was a randomized controlled trial study undertaken in the intensive care unit patients. Participants, who met all eligibility criteria, were randomly assigned to one of two groups of patients, according to whether lidocaine or air was used to fill the tracheal tube cuff. The tracheal m...

  11. 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...

  12. 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.

  13. 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

  14. 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...

  15. Nanocellulose Composite Materials Synthesizes with Ultrasonic Agitation

    Science.gov (United States)

    Kidd, Timothy; Folken, Andrew; Fritch, Byron; Bradley, Derek

    We have extended current techniques in forming nanocellulose composite solids, suspensions and aerogels to enhance the breakdown of cellulose into its molecular components. Using only mechanical processing which includes ball milling, using a simple mortar and pestle, and ultrasonic agitation, we are able to create very low concentration uniform nanocellulose suspensions in water, as well as incorporate other materials such as graphite, carbon nanotubes, and magnetic materials. Of interest is that no chemical processing is necessary, nor is the use of nanoparticles, necessary for composite formation. Using both graphite and carbon nanotubes, we are able to achieve conducting nanocellulose solids and aerogels. Standard magnetic powder can also be incorporated to create magnetic solids. The technique also allows for the creation of an extremely fine nanocellulose suspension in water. Using extremely low concentrations, less than 1% cellulose by mass, along with careful control over processing parameters, we are able to achieve highly dilute, yet homogenous nanocellulose suspensions. When air dried, these suspensions have similar hardness and strength properties to those created with more typical starting cellulose concentrations (2-10%). However, when freeze-dried, these dilute suspensions form aerogels with a new morphology with much higher surface area than those with higher starting concentrations. We are currently examining the effect of this higher surface area on the properties of nanocellulose aerogel composites and how it influences the impact of incorporating nanocellulose into other polymer materials.

  16. 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

  17. 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.

  18. Comparison of Mallampati test with lower jaw protrusion maneuver in predicting difficult laryngoscopy and intubation

    Science.gov (United States)

    Ul Haq, Muhammad Irfan; Ullah, Hameed

    2013-01-01

    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. PMID:24106353

  19. Reliabilitas dan Validitas Penilaian Skala Sedasi Richmond Agitation Sedation Scale (RASS) dan Ramsay pada Pasien Kritis dengan Ventilasi Mekanik di Ruang Perawatan Intensif

    OpenAIRE

    Suhandoko; Erwin Pradian; Tinni T. Maskoen

    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...

  20. 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.

  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. Comparison of esmolol and labetalol, in low doses, for attenuation of sympathomimetic response to laryngoscopy and intubation

    Directory of Open Access Journals (Sweden)

    Singh Sarvesh

    2010-01-01

    Full Text Available Objective: The present study compared the efficacy of esmolol and labetalol, in low doses, for attenuation of sympathomimetic response to laryngoscopy and intubation. Design: Prospective, randomized, placebo controlled, double-blinded study. Setting: Operation room. Patients and Methods: 75 ASA physical status I and II adult patients, aged 18-45 years undergoing elective surgical procedures, requiring general anesthesia and orotracheal intubation. Interventions: Patients were allocated to any of the three groups (25 each-Group C (control10 ml 0.9% saline i.v. Group E (esmolol 0.5 mg/kg diluted with 0.9% saline to 10 ml i.v. Group L (labetalol 0.25 mg/kg diluted with 0.9% saline to 10 ml i.v. In the control group 10 ml of 0.9% saline was given both at 2 and 5 min prior to intubation. In the esmolol group 0.5 mg/kg of esmolol (diluted with 0.9% saline to 10 ml was given 2 min prior and 10 ml of 0.9% saline 5 min prior to intubation. In the labetalol group 10 ml of 0.9% saline was administered 2 min prior and 0.25 mg/kg of labetalol (diluted with 0.9% saline to 10 ml 5 min prior to intubation. All the patients were subjected to the same standard anesthetic technique. Measurements: Heart rate (HR, systolic blood pressure (SBP and diastolic blood pressure (DBP were recorded prior to induction, at time of intubation and 1, 3, 5, and 10 min after intubation. Mean arterial pressure (MAP and rate pressure product (RPP were calculated. Abnormal ECG changes were also recorded. Results: Compared to placebo and esmolol (0.5 mg/kg, labetalol (0.25 mg/kg significantly attenuated the rise in heart rate, systolic blood pressure, and RPP during laryngoscopy and intubation. However, the difference was not statistically significant among the values for DBP and MAP. Conclusion: In lower doses, labetalol (0.25 mg/kg is a better agent than esmolol (0.5 mg/kg in attenuating the sympathomimetic response to laryngoscopy and intubation.

  3. 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.

  4. 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....

  5. Hands-Off Time for Endotracheal Intubation during CPR Is Not Altered by the Use of the C-MAC Video-Laryngoscope Compared to Conventional Direct Laryngoscopy. A Randomized Crossover Manikin Study.

    Directory of Open Access Journals (Sweden)

    Philipp Schuerner

    Full Text Available Sufficient ventilation and oxygenation through proper airway management is essential in patients undergoing cardio-pulmonary resuscitation (CPR. Although widely discussed, securing the airway using an endotracheal tube is considered the standard of care. Endotracheal intubation may be challenging and causes prolonged interruption of chest compressions. Videolaryngoscopes have been introduced to better visualize the vocal cords and accelerate intubation, which makes endotracheal intubation much safer and may contribute to intubation success. Therefore, we aimed to compare hands-off time and intubation success of direct laryngoscopy with videolaryngoscopy (C-MAC, Karl Storz, Tuttlingen, Germany in a randomized, cross-over manikin study.Twenty-six anesthesia residents and twelve anesthesia consultants of the University Hospital Zurich were recruited through a voluntary enrolment. All participants performed endotracheal intubation using direct laryngoscopy and C-MAC in a random order during ongoing chest compressions. Participants were strictly advised to stop chest compression only if necessary.The median hands-off time was 1.9 seconds in direct laryngoscopy, compared to 3 seconds in the C-MAC group. In direct laryngoscopy 39 intubation attempts were recorded, resulting in an overall first intubation attempt success rate of 97%, compared to 38 intubation attempts and 100% overall first intubation attempt success rate in the C-MAC group.As a conclusion, the results of our manikin-study demonstrate that video laryngoscopes might not be beneficial compared to conventional, direct laryngoscopy in easily accessible airways under CPR conditions and in experienced hands. The benefits of video laryngoscopes are of course more distinct in overcoming difficult airways, as it converts a potential "blind intubation" into an intubation under visual control.

  6. Comparative assessment of efficacy of lignocaine (1.5 mg/kg, esmolol (300 and micro;g/kg, and dexmedetomidine (0.5 and micro;g/kg in minimizing the pressor response to laryngoscopy and intubation

    Directory of Open Access Journals (Sweden)

    Prashant Dass

    2015-04-01

    Conclusion: Dexmedetomidine 0.5 and micro;g/kg has manifested to maintain hemodynamic stability associated with intubation and hence may prove beneficial for cardiac patients where the stress response to laryngoscopy and intubation is highly undesirable. [Int J Basic Clin Pharmacol 2015; 4(2.000: 306-311

  7. Effects of dexmedetomidine premedication on the hemodynamics in patient with hypertension and coronary heart disease during anesthetic induction and tracheal intubation%右美托咪定预先给药对高血压冠心病病人诱导插管时血流动力学的影响

    Institute of Scientific and Technical Information of China (English)

    严六狮; 袁伟; 周荣胜

    2012-01-01

    Objective:To investigate the effects of dexmedetomidine premedication on the hemodynamics in patients with hypertension and coronary heart disease during anesthetic induction and tracheal intubation. Meth-ods:Sixty patients(30 males and 30 females) with hypertension and coronary heart disease scheduled for upper abdominal surgery were enrolled in this study. Patients were randomized into two groups(n=30 each) ;group C= control; group D= dexmedetomidine. 15ml of titrated dexmedetomidine(1. Ojig/kg) were administered to patients in group D by a infusion pump 15 min prior to anesthetic induction . While patients in group C received the same volume normal saline. The infusion lasted 15 min. After anesthetic induction , tracheal intubation was achieved and then ventilated. BP(Blood pressure) , HR(heart rate) , RPP (rate pressure product) were respectively recorded at the following time points: before infusion of dexmedetomidine ( T0 ), immediately before tracheal intubation ( T1 ), the moment of tracheal intubation(T2) ,1,3,5 and 10 min after tracheal intubation(T3~ 6). Venous blood samples were obtained for analysis of norepinephrine(NK) and epinephrine(K) levels at T0 ,T3~6. Results:Compared with T0 ,BP and HR were significantly decreased then increased from T1 to T5 (P < 0.05) and RPP were significantly higher at T3 ~ 5 than those in group C(P<0. 01). These above-mentioned variables had no significant change in group D. Statistically significant differences were found between the two groups(P<0. 05). The levels of NE and E were significantly higher at T3 ~ 5 than those at T0 in group C(P<0. 05) but had no significant differences at these time points in group D. Statistically significant differences were found between the two groups(P<0. 05). Conclusion; Dexmedetomidine premedication can safely and effectively alleviate the cardiovascular response in patients with hypertension and coronary heart disease during anesthetic induction and tracheal intubation.%目的:探

  8. 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。

  9. Effects of different doses of dexmedetomidine on agitation and extubation reactions in emergence period after general anesthesia in elderly patients%不同剂量右旋美托咪啶对老年患者全麻苏醒期躁动及气管拔管反应的影响

    Institute of Scientific and Technical Information of China (English)

    刘焕仪; 张欢欢; 许学兵; 许立新

    2011-01-01

    Objective To observe the effects of different doses of dexmedetomidine on agitation and extubation reactions in emergence period after general anesthesia in elderly patients. Methods Eighty patients aged 65 - 95 years undergoing elective abdominal operation under general anesthesia were studied and divided into 4 groups, with 20 patients in each group. The control group received intravenous injection of 20 ml saline, and the other 3 groups were given intravenous injection of different doses of dexmedetomidine 0. 2, 0. 3, 0. 4 μg/kg respectively. Results Compared with the dexmedetomidine-treating groups, the fluctuations of arterial blood pressure (MAP) and heart rate (HR) in the saline-treating group were more significant; the incidence rates of agitation and endo-tracheal-tube-associated cough showed significant differences among the 4 groups (P<0. 05 for all). The group treated with dexmedetomidine of 0. 4 fig/kg had longer emergence period than the other groups (P<0. 05). Conclusion The incidence of agitation and extubation reactions can be reduced by injecting 0. 3 fig/kg dexmedetomidine in emergence period after general anesthesia in elderly patients without prolonging extubation time.%目的 观察不同剂量右旋美托咪啶对老年患者苏醒期躁动及气管拔管反应的影响。方法选择择期上腹部手术老年患者80例,随机分为对照组,右旋美托咪啶干预D1、D2和D3组各20例。手术结束前5 min对照组静脉注射0.9%氯化钠注射液20 ml;D1、D2和D3组分别单次缓慢静脉注射右旋美托咪啶0.2 μg/kg、0.3μg/kg、0.4 μg/kg。结果对照组苏醒拔管期间平均动脉压、心率波动显著,D1、D2、D3组较平稳;四组躁动、呛咳发生率比较,差异有统计学意义(均P<0. 05);D3组苏醒时间显著长于其他三组(均P<0. 05)。结论单次静脉注射右旋美托咪啶0.3 μg/kg可有效降低腹部手术老年患者麻醉苏醒期躁动发生率,减少气管拔

  10. Horizontal dimensions of ionosphere agitation provoked by underground nuclear explosions

    International Nuclear Information System (INIS)

    The horizontal dimensions of ionosphere agitation provoked by underground nuclear explosions have been experimentally determined for 13 explosions conducted at the Balapan test site of the Semipalatinsk test site. (author)

  11. Aeroelasticity-based fluid agitation for lab-on-chips.

    Science.gov (United States)

    Xia, H M; Wang, Z P; Wang, W; Fan, W; Wijaya, A; Wang, Z F

    2013-04-21

    In this study, we report a robust agitation method for small-volume liquids. It utilizes an elastic diaphragm as the bottom of a liquid chamber, upon which an initial tension is also applied to enhance the aeroelasticity effects at small/micro scales. As a result, spontaneous vibration of the diaphragm can be induced by an external air flow, which further provides fluid agitations. The device structure is simple and can be easily fabricated at low cost. More importantly, the vibration amplitude is controllable and varies widely from several tens to several hundred micrometers depending on the applied air pressure. The resulting agitation is effective and applicable at high viscosities of up to 900 cSt. The influences of air pressure and liquid viscosity on the vibration frequency are discussed. Potential applications of this technique for solid particle agitation, focusing and fluid mixing are also demonstrated. PMID:23455690

  12. 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.

  13. Comparison of the Effects of Oral Midazolam, Ketamine and Tramadol on Postoperative Agitation Related to Sevoflurane in Children

    Directory of Open Access Journals (Sweden)

    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

  14. 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

    Directory of Open Access Journals (Sweden)

    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

  15. 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

  16. Periodic-peristole agitation for process enhancement of butanol fermentation

    OpenAIRE

    Xia, Meng-lei; Wang, Lan; Yang, Zhi-Xia; Chen, Hong-Zhang

    2015-01-01

    Background Mass transfer plays an important role in determining the efficiency of the biofuel conversion. However, adverse effect of shear stress from traditional agitation inhibits the cell growth and production of biofuels. How to enhance the mass transfer with less adverse effect is considered as one of the important bioengineering issues. Results In this study, a novel agitation type, named periodic-peristole was applied to butanol fermentation with Clostridium acetobutylicum ATCC 824. Me...

  17. 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.

  18. Compared haemodynamics effects of laryngeal mask airway and tracheal intubation in patients undergoing laparoscopic cholecystectomy%喉罩与气管插管在腹腔镜胆囊切除术中对血流动力学的影响

    Institute of Scientific and Technical Information of China (English)

    赵占志; 吴慧; 胡松; 许大伟

    2012-01-01

    Objective To compare the haemodynamics effects of laryngeal mask airway (LMA) and tracheal intubation in patients undergoing laparoscopic cholecystectomy (LC).Methods Sixty patients with cholecystolithiasis were divided into two groups:Laryngeal mask airway group (group A) and tracheal intubation group (group B).Anesthesia induction was performed by intravenous injection with midazolam(0.1 mg/kg),sulfentanyl(0.2 μg/kg),propofol(2 mg/kg),atracurium(0.15 mg/kg).The parameter of ventilation to be as follow,tidal volume 6-8 ml/kg,respiratory frequency 12-14 times/min intermittent positive pressure ventilation (IPPV),CO2 pneumoperitoneum pressure < 12 mm Hg (1 mm Hg =0.133 kPa).SBP,DBP,HR and postoperative complications were recorded before anesthesia induction(T0),three minutes after LMA or endotracheal tube insertion(T1),after pneumoperitoneum (T2),three minutes before departed LMA or endotracheal tube(T3) and three minutes after departed LMA or endotracheal tube (T4).Results In induced phase,awakening hemodynamic changes of laryngeal mask group was tracheal intubation small group,the postoperative complications of laryngeal mask was tracheal intubation less group.Conclusions Compared with group B,group A offered better general anesthesia on LC for LMA insertion,conduced to degrade stress reaction,more stable haemodynamics effects,beneficial ventilation and.reduced dosage.The occurrence of postoperative sore throat is obviously lower in group A.%目的 比较喉罩(LMA)与气管插管用于全身麻醉腹腔镜胆囊切除术(LC)患者血流动力学的影响.方法 选择胆石症患者60例,随机分为喉罩组(A组)和气管插管组(B组).全身麻醉诱导咪唑0.1 mg/kg,舒芬太尼0.2 μg/kg,异丙酚2 mg/kg,阿曲库铵0.15 mg/kg,静脉给药.通气设置为潮气量6~8 ml/kg,频率12~14次/min,间歇正压通气(IPPV),C02气腹(压力<12 mm Hg,1 mm Hg=0.133 kPa).记录两组在诱导前(T0),插喉罩或气管导管后3 min(T1),气腹后(T2),

  19. 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.

  20. 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.

  1. Diagnostic value of the upper lip bite test in predicting difficulty in intubation with head and neck landmarks obtained from lateral neck X-ray

    OpenAIRE

    Zahid Hussain Khan; Shahriar Arbabi

    2013-01-01

    Background: Unanticipated difficult tracheal intubation remains a primary concern of anaesthesiologists and upper lip bite test (ULBT) is one of the assessments used in predicting difficult intubation. In this study, we aimed to check the utility of lateral neck X-ray measurements in improving the diagnostic value of the ULBT. Methods: In a prospective study conducted from January 2007 until December 2010, we recorded personal and demographic data of 4500 patients who entered the study and su...

  2. Effect of Esmolol on variation of rate-pressure product due to tracheal intubation – An evaluation using invasive arterial pressure monitoring

    OpenAIRE

    Yallapragada, Srivishnu Vardhan; Vidadhala, Krishna Santh; Vemuri, Nagendra Nath; Shaik, Mastan Saheb

    2014-01-01

     Introduction: Laryngoscopy and tracheal intubation produce sympathetic over drive by catecholamine release resulting in hypertension and tachycardia. This is usually tolerated by healthy individuals but susceptible patients are likely to succumb to the hemodynamic fluctuations. Various agents are being tried to combat the intubation response over years. This study is aimed at evaluating the efficacy of Esmolol in attenuating the rise in rate- pressure product secondary to laryngoscopy and tr...

  3. 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

  4. An observational study of the feasibility of Airtraq guided intubations with Ring Adair Elvin tubes in pediatric population with cleft lip and palate

    Science.gov (United States)

    Sharma, Ashima; Durga, Padmaja; Gurajala, Indira; Ramchandran, Gopinath

    2015-01-01

    Context: The airway management requires refined skills and technical help when associated with cleft lip and palate. Airtraq has improved our airway management skills and has been successfully used for rescue intubation in difficult pediatric airways. Aims: This study was to evaluate the efficacy of Airtraq as the primary intubation device in patients with cleft lip and palate. The study adheres to the STrengthening the Reporting of OBservational Studies Epidemiology Statement. Subjects and Methods: A total of 85 children posted consecutively for lip and palate repair were enrolled. Children were intubated with Ring Adair Elvin (RAE) tube using size 1 and 2 of Airtraq device. The design of Airtraq has an anatomical limitation to hold RAE tubes. The preformed bend of the tube was straightened with a malleable stylet. The intubations were assessed for device manipulations and time taken for glottis visualization and intubation, airway complications such as bleeding, laryngospasm and failed intubations. Statistical Analysis Used: The outcome data were reported as numbers and percentages or range with identified median value, where applicable. Results: The success rate of Airtraq guided intubations was 98.21%. The cumulative insertion times and intubation times were 31.50 ± 12.57 s and 48.04 ± 35.73 s respectively. Airtraq manipulations were applied in 25.45% subjects. Conclusions: The presence of cleft lip or palate did not hamper the insertion of Airtraq. The use of malleable stylet to facilitate the loading of the preformed tube into the guide channel is a simple and efficacious improvisation. Airtraq can be utilized as a primary intubation device in children with orofacial clefts. PMID:26712974

  5. 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...

  6. A COMPARATIVE CLINICAL STUDY BETWEEN IV ESMOLOL AND IV FENTANYL ON ATTENUATION OF HAEMODYNAMIC RESPONSES TO LARYNGOSCOPY AND INTUBATION

    Directory of Open Access Journals (Sweden)

    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.

  7. Resuscitation prior to emergency endotracheal intubation: results of a national survey

    OpenAIRE

    Green, Robert S.; Fergusson, Dean A; Turgeon, Alexis F; McIntyre, Lauralyn A; Kovacs, George J.; Griesdale, Donald E.; Zarychanski, Ryan; Butler, Michael B.; Kureshi, Nelofar; Erdogan, Mete

    2016-01-01

    Introduction: Respiratory failure is a common problem in emergency medicine (EM) and critical care medicine (CCM). However, little is known about the resuscitation of critically ill patients prior to emergency endotracheal intubation (EETI). Our aim was to describe the resuscitation practices of EM and CCM physicians prior to EETI. Methods: A cross-sectional survey was developed and tested for content validity and retest reliability by members of the Canadian...

  8. Comparison of successful intubation with two different blades of laryngoscope: single-use and reusable.

    OpenAIRE

    Ali Shahriari; Maryam Khooshideh; Hassan Enayaty

    2007-01-01

    BACKGROUND: Many types of single-use blades are manufactured with different designs and materials. There have been several reports of difficulties in obtaining a view of the glottis with single-use laryngoscopes. The purpose of this prospective study was to compare the quickness and the success rate of endotracheal intubations with two different laryngoscope blades: disposable laryngoscope blades and reusable laryngoscope blades. METHODS: The study included 200 patients aged 18 to 70 who were...

  9. Tracheal damage after endotracheal intubation: comparison of two types of endotracheal tubes.

    OpenAIRE

    Honeybourne, D; Costello, J C; Barham, C.

    1982-01-01

    Twenty-eight patients who required endotracheal intubation for open-heart surgery were randomly allocated to one of two types of endotracheal tube. The tracheal mucosa was examined with a fibreoptic bronchoscope at the time of extubation, usually 24 hours after operation. The degree of oedema, inflammation, and ulceration was scored by the bronchoscopist, who also photographed the whole length of the trachea. An independent observer subsequently scored any tracheal damage from these photograp...

  10. Use of Adult Fibreoptic Bronchoscope for Difficult Paediatric Intubation: A Case Report

    Directory of Open Access Journals (Sweden)

    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.

  11. Tunge- og stemmebåndsparese efter endotrakeal intubation for Legionella-pneumoni

    DEFF Research Database (Denmark)

    Sønnichsen, Rikke; Lauritsen, Anne Oberg; Nielsen, Rikke Vibeke

    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....

  12. The causes of difficult tracheal intubation and preoperative assessments in different age groups

    OpenAIRE

    Moon, Hyoung-Yong; Baek, Chong Wha; Kim, Jin-Seo; Koo, Gill Hoi; Kim, Jin-Yun; Woo, Young-Cheol; Jung, Yong Hun; Kang, Hyun; Shin, Hwa-Yong; Yang, So-Young

    2013-01-01

    Background We studied the differences in airway assessment factors among old, middle, and young age groups, and evaluated the frequency and causes of difficult intubation among these groups. Methods Patients were divided into young (< 40 yr, n = 75 ), middle (40-59 yr, n = 83), and old (≥ 60 yr, n = 89) group. Airway assessment factors such as head and neck movement, thyromental distance, interincisor gap, dentition, Mallampati score, and Arné score were assessed. After muscle relaxation, cer...

  13. Tunge- og stemmebåndsparese efter endotrakeal intubation for Legionella-pneumoni

    DEFF Research Database (Denmark)

    Sønnichsen, Rikke; Lauritsen, Anne Oberg; Nielsen, Rikke Vibeke

    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....

  14. ATTENUATION OF HAEMODYNAMIC RESPONSES TO LARYNGOSCOPY AND ENDOTRACHEAL INTUBATION: ROLE OF I.V. BOLUS DOSE OF ESMOLOL HYDROCHLORIDE AND LIGNOCAINE HYDROCHLORIDE : A COMPARATIVE STUDY

    Directory of Open Access Journals (Sweden)

    Padma

    2015-09-01

    Full Text Available AIM: The aim of the study is to compare the efficacy of intravenous Bolus dose of Esmolol Hydrochloride and Lignocaine Hydrochloride to attenuate the Haemodynamic responses to Laryngoscopy and Endotracheal intubation. MATERIALS & METHODS : A study of Esmolol hydrochloride and Lignocaine hydrochloride in attenuation of the cardiovascular respons e during Laryngoscopy and intubation was compared in 50 adult patient, undergoing surgery under general anaesthesia. This study was taken in 2 groups. Group - I consists of 25 patients, where Lignocaine hydrochloride 2 mg per kg IV was used for attenuation of cardiovascular response to Laryngoscopy and intubation. Group - II consists of 25 patients where Esmolol hydrochloride 200 mg IV bolus was used as study drug. RESULTS : Results of the present study are consistent with the studies in attenuating haemodyna mic responses to Laryngoscopy and intubation by the use of intravenous bolus dose of 200 mg of Esmolol is superior to Lignocaine hydrochloride. 2mg per kg body weight IV bolus. CONCLUSION : It establishes the usefulness of intravenous bolus dose of Esmolol to attenuate the haemodynamic responses to Laryngoscopy and endotracheal intubation. This study shows the 200 mg of bolus dose of Esmolol hydrochloride is superior to intravenous Lignocaine hydrochloride 2 mg per kg body weight IV bolus to attenuate the ha emodynamic responses to Laryngoscopy and endotracheal intubation. No side effects were noted with Esmolol and Lignocaine hydrochloride

  15. Validation of modified Mallampati test with addition of thyromental distance and sternomental distance to predict difficult endotracheal intubation in adults

    Directory of Open Access Journals (Sweden)

    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.

  16. 浅部吸痰在气管插管机械通气患者中的安全性和有效性的探讨%Discuss about the efficacy and safety of shallow sputum suction on patients with tra-cheal intubation and mechanical ventilation

    Institute of Scientific and Technical Information of China (English)

    张桦; 张艳; 钱霞; 邵丽丽

    2016-01-01

    目的:探讨浅部吸痰在气管插管机械通气患者中的安全性和有效性。方法将本气管插管机械通气的患者60例,随机分为实验组及对照组,每组30例。观察两组患者分别于吸痰前1 min、吸痰后5 min 记录患者的心率、收缩压、指脉血氧饱和度、呼吸频率、潮气量、气道峰压的变化值;两组吸痰前后痰鸣音改善情况、吸痰后患者的舒适度以及患者机械通气时间;记录两组患者吸痰出现刺激性咳嗽、黏膜损伤出血、痰痂堵塞情况、机械通气5d内呼吸机相关性肺炎发生率比较。结果两组患者比较,浅部吸痰组患者心率增加值、收缩压增加值、呼吸频率增加值低于深部吸痰组,组间差异有统计学意义( P0.05);鸣音改善情况和机械通气时间,两组比较差异无统计学意义( P>0.05);浅部吸痰组吸痰前后患者的舒适度好于深部吸痰组,组间差异有统计学意义( P0.05)。结论浅部吸痰在气管插管机械通气患者中是一种较为安全有效的吸痰方式。%Objective To investigate the safety and efficacy of shallow sputum suction in patients with tracheal intubation and mechanical ventilation. Methods Totally 60 cases of patients with tracheal intubation and mechanical ventilation were randomly divided into experimental group and control group, with 30 cases in each group. The change of heart rate, systolic blood pressure, oxygen saturation ( SpO2 ) , respiratory rate, tidal volume, and peak airway pres-sure between 1 min before and 5 min after sputum suction were observed in each group. The improvement of wheezy phlegm, the comfort of patients, and the time of mechanical ventilation before and after sputum suction in two groups of patients were also observed. The comparation of irritating cough, mucous membrane injury and bleeding, sputum block-age , and the incidence of ventilator associated pneumonia with 5 days of mechanical ventilation in two

  17. The effects of beta2 adrenoceptor gene polymorphisms on pressor response during laryngoscopy and tracheal intubation.

    Science.gov (United States)

    Kim, N-S; Lee, I-O; Lee, M-K; Lim, S-H; Choi, Y-S; Kong, M-H

    2002-03-01

    We investigated whether human beta2 adrenoceptor (beta2AR) gene polymorphisms are associated with the pressor response to laryngoscopy and tracheal intubation. Ninety-two patients undergoing elective surgery under general anaesthesia were enrolled into this study. Arterial systolic pressure, heart rate and rate pressure product were measured before induction of anaesthesia and 1 min following laryngoscopy and tracheal intubation. Genomic DNA was then used to identify the beta2AR-16 and beta2AR-27 genes using an allele-specific polymerase chain reaction method. Using multiple linear regression models, controlling for age, sex, weight, baseline blood pressure, heart rate and rate pressure product, we found that patients who possessed the glutamic acid homozygote of beta2AR-27 produced significantly greater changes in mean arterial pressure and rate pressure products than patients with the glutamine homozygote of beta2AR-27 (beta coefficient for mean blood pressure = 11.81, beta coefficient for pulse-pressure product = 8.76, both p-values = 0.023). These findings suggest that genetic variability in the human beta2AR gene polymorphisms may be associated with the pressor response to laryngoscopy and tracheal intubation. PMID:11879211

  18. 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.

  19. Effect of a single dose of esmolol on the bispectral index to endotracheal intubation during desflurane anesthesia

    OpenAIRE

    Choi, Eun Mi; Min, Kyeong Tae; Lee, Jeong Rim; Lee, Tai Kyung; Choi, Seung Ho

    2013-01-01

    Background In this prospective, randomized, double-blind, placebo-controlled trial, we investigated the effect of a single dose of esmolol on the bispectral index (BIS) to endotracheal intubation during desflurane anesthesia. Methods After induction of anesthesia, 60 patients were mask-ventilated with desflurane (end-tidal 1 minimum alveolar concentration) for 5 min and then received either normal saline, esmolol 0.5 or 1 mg/kg, 1 min prior to intubation (control, esmolol-0.5 and esmolol-1 gr...

  20. Clinical observation of dexmedetomidine for intubation in patients with potential difficult airways%右美托咪定用于困难气道患者纤维支气管镜清醒气管插管的临床观察

    Institute of Scientific and Technical Information of China (English)

    王前; 王天龙; 吴岚; 薛纪秀

    2013-01-01

    目的 观察右美托咪定用于困难气道患者纤维支气管镜清醒气管插管的临床效果.方法 选择MallampattiⅢ~Ⅳ级择期手术的患者40例,采用随机数字表法分为2组,右美托咪定组(DEX组,20例)和咪唑安定联合芬太尼组(C组,20例).DEX组给予右美托咪定1μg/kg,15 min输注完毕.C组给予咪唑安定1 mg、芬太尼0.1~0.15 mg.两组患者均采用1%丁卡因实施上呼吸道表面麻醉,随后纤维支气管镜引导经口气管插管.气管插管成功后立即给予镇静、镇痛及肌松药,连接麻醉机行机械通气.记录患者入室(T1)、药物输注完毕(T2)、置入纤维支气管镜前(T3)、气管插管即刻(T4)的BP、HR、SpO2、BIS及OAA/S评分.术后1d随访,记录患者对气管插管的记忆情况.结果 DEX组BP无明显变化,T2时HR明显低于T1、T4(P<0.05).C组T3时SBP明显低于T1(P <0.05),T4时HR高于T3(P <0.05).DEX组T2、T3时SBP高于C组(P<0.05),T2、T4时HR低于C组(P<0.05).两组患者SpO2、BIS及OAA/S评分比较差异无统计学意义(P>0.05).DEX组气管插管的记忆率高于C组(P<0.05).结论 清醒气管插管前静脉缓慢给予右美托咪定镇静血流动力学平稳,无呼吸抑制的风险,可以安全用于困难气道患者清醒气管插管.%Objective To evaluate the efficacy of dexmedetomidine for awake intubation in patients with potential difficult airways.Methods 40 patients with mallampatti grade of Ⅲ~ Ⅳ were randomly divided into two groups:dexmedetomidine group (group D,n =20) and control group (group C,n =20).In group D,dexmedetomidine 1 μg/kg was infused during 15 min.In group C,patients received midazolam 1 mg and fentanyl 0.05 ~0.1 mg.All patients were given enough topical anesthetics with 1% dicaine in upper respiratory tract.Then awake intubation with fiberoptic bronchoscope was conducted.BP,HR,SpO2,BIS and OAA/S were recorded before drug infusion(T1),at the end of infusion (T2),before intubation (T3)and

  1. Instrument content validation on nasogastric intubation skills

    Directory of Open Access Journals (Sweden)

    Rosana Kelly da Silva Medeiros

    2015-06-01

    Full Text Available The objective was to validate the content of an instrument on nasogastric intubation skills based on Pasquali's model of content validation. This was a methodological study conducted with 23 nursing teachers in public higher education institutions in Rio Grande do Norte. The Content Validation Index (CVI and Kappa Index was applied. In the overall evaluation, the instrument obtained a CVI with values above 0.75 with a total CVI of 0.95 and a total Kappa of 0.91. However, some changes were made on the instructional sequence requirements of the topics, and to vocabulary. The instrument proved to be reliable and trustworthy in facilitating nursing care quality and can be used for health services and educational institutions to assess skill levels of professionals and undergraduate students. However, the instrument requires additional stages for a more precise and specific content validation.

  2. Hemodynamic responses to orotracheal intubation with a video laryngoscope

    Directory of Open Access Journals (Sweden)

    Shahnaz Shayeghi

    2007-10-01

    Full Text Available Background: Differences in airway anatomy make the potential for technical airway difficulties greater in infants than in
    teenagers or adults. Endotracheal intubation by direct vision using a laryngoscope is frequently associated with an increase
    in arterial blood pressure and heart rate. In different studies, the time to intubation with a video laryngoscope was
    longer than with direct laryngoscopy using Macintosh, and this longer duration may be accompanied by more hemodynamic
    responses.
    METHODS: Sixty-four infants who were scheduled for elective surgery requiring general anesthesia with orotracheal
    intubation were randomly assigned to intubation by direct laryngoscopy using a Macintosh size 1 blade or to intubation
    using a video laryngoscope. Systolic and diastolic blood pressures, heart rate and oxygen saturation were recorded at the
    following time points: (1 before induction, (2 after induction and before intubation, and (3 1 minute and (4 5 minutes
    after intubation.
    RESULTS: No significant differences were found either between the two groups or among the different study periods.
    The duration for laryngoscopy and intubation with a video laryngoscope was 20.87 ± 7.95 seconds (mean ± standard
    deviation and that with Macintosh was 15.41 ± 4.1 seconds (P < 0.01.
    CONCLUSIONS: Similar hemodynamic responses in both groups suggest that laryngoscopy and intubation with a video
    laryngoscope, although with longer duration and therefore resulting in more stimulation, has no significant effect on
    hemodynamic status and oxygen saturation in infants.
    KEY WORDS: Video laryngoscope, laryngoscopy, blood pressure, heart rate

  3. Effect of Esmolol and Propofol on the Endotracheal Intubation Stress Response of Hypertensive Elderly Pa-tients with Cholecystectomy%艾司洛尔复合异丙酚对行胆囊切除术老年高血压患者气管插管应激反应的影响

    Institute of Scientific and Technical Information of China (English)

    唐优仕

    2015-01-01

    目的:观察艾司洛尔复合异丙酚对行胆囊切除术老年高血压患者气管插管应激反应的影响。方法:36例拟行胆囊切除术的老年高血压患者随机均分为对照组(D0组)、艾司洛尔0.5 mg/kg组(D1组)、艾司洛尔1 mg/kg组(D2组)。各组患者均以异丙酚1.5 mg/kg为静脉麻醉诱导,D0组患者静脉注射0.9%氯化钠注射液10 ml;D1组患者静脉注射盐酸艾司洛尔注射液0.5 mg/kg;D2组患者静脉注射盐酸艾司洛尔注射液1 mg/kg。观察各组患者插管前及插管后1、3、5 min时的收缩压(SBP)、舒张压(DBP)、心率(HR)及血浆儿茶酚胺水平[去甲肾上腺素(NE)、肾上腺素(E)],并记录不良反应发生情况。结果:与插管前比较,D0组患者插管后1、3、5 min时SBP、DBP、HR均明显升高;D1组患者插管后1 min时SBP、DBP、HR均显著低于D0组,3、5 min时SBP、DBP、HR均显著低于同组插管前及D0组;D2组患者插管后1、3、5 min时SBP、DBP、HR均显著低于同组插管前及D0、D1组,差异均有统计学意义(P<0.05)。D1组患者插管后1 min时NE水平显著低于同组插管前,3、5 min时显著高于同组插管前,而1、3、5 min时E水平均显著高于同组插管前;D2组患者插管后1、3、5 min时NE、E水平均显著低于同组插管前,且1、3 min时E水平显著低于D1组,差异均有统计学意义(P<0.05)。两组患者均未见明显不良反应发生。结论:艾司洛尔1 mg/kg复合异丙酚用于老年高血压患者胆囊切除术麻醉,可有效缓解气管插管时的心血管应激反应,且安全性较好。%OBJECTIVE:To observe the effects of esmolol and propofol on the endotracheal intubation stress response of hyper-tensive elderly patients with cholecystectomy. METHODS:Totally 36 hypertensive elderly patients with cholecystectomy were ran-domly divided into control group(D0 group),esmolol 0.5 mg/kg group(D1 group

  4. Salivary alpha-amylase as a marker for stress response, caused by laryngoscopy and endotracheal intubation

    OpenAIRE

    Nataļja Jakušenko

    2011-01-01

    Salivary alpha-amylase as a marker for stress response, caused by laryngoscopy and endotracheal intubation Annotation Endotracheal intubation by the direct laryngoscopy during anaesthesia is the anaesthesiologists’ routine practice. Industries of medical technology are working at the manufacturing of alternative and much safer intubation appliances, for instance, firobronchoscope, videolaryngoscope, etc. In order to estimate various intubation appliances, one has to assess the pat...

  5. Comparison of the Laryngeal Mask Airway (CTrachTM and Direct Coupled Interface-Video Laryngoscope for Endotracheal Intubation: a Prospective, Randomized, Clinical Study

    Directory of Open Access Journals (Sweden)

    Kamil Toker

    2012-09-01

    Full Text Available Objective: Video laryngoscopy was developed to facilitate tracheal intubation of difficult airways. We aimed to compare the efficacy of CTrach™ (CT and Direct Coupled Interface-Videolaryngoscope (DCI-VL in patients with normal airways. Material and Methods: Sixty ASA I–II (American Society of Anesthesiologists adult patients admitted for elective surgery were enrolled in this prospective study. The patients were randomly assigned to two groups, where intubation was performed via CT or DCI-VL. Time to obtain a good glottic view, total intubation time, success rates and the number of patients who required maneuvers for a good glottic view were recorded.Results: The mean time to obtaining a good glottic view was significantly longer with CT than with DCI-VL (29.4±20.3 seconds vs. 12.8±1.9 seconds, respectively; p=0.01. Intubation was achieved on the first attempt in 28 patients in the CT group (93.3% and in 24 in the DCI-VL group (80% (p=0.77. The total intubation time for CT was significantly longer compared to DCI-VL (99.9±36.0 seconds vs. 39.2±21.4 seconds, respectively; p=0.01. Optimization maneuvers were required in eight and two patients in the CT and DCI-VL groups, respectively (p=0.03.Conclusion: Although the normal airway endotracheal intubation success rates were similar in both groups, the time to obtain a good glottic view and the total intubation time were significantly shorter with DCI-VL.

  6. Evidence for benefit vs novelty in new intubation equipment

    DEFF Research Database (Denmark)

    Behringer, E C; Kristensen, M S

    2011-01-01

    A myriad of new intubation equipment has been introduced commercially since the appearance of Macintosh/Miller blades in the 1940s. We review the role of devices that are relevant to current clinical practice based on their presence in the scientific literature. The comparative performance of new...... vs traditional direct laryngoscopes, their complications, their use in awake intubation techniques and the prediction of unsuccessful intubation with new devices are reviewed. Manikin studies are of limited value in this area. We conclude that in both predicted and unpredicted difficult or failed...

  7. Normative Values and Interrelationship of MDVP Voice Analysis Parameters Before and After Endotracheal Intubation

    DEFF Research Database (Denmark)

    Sørensen, Martin Kryspin; Durck, Tina Trier; Bork, Kristian Hveysel;

    2016-01-01

    PURPOSE: The Multi-Dimensional Voice Program (MDVP) is used for assessment of voice quality. A simple procedure for MDVP recordings was used in a randomized clinical trial (RCT) on induced vocal fold trauma due to intubation. This secondary study compares the common MDVP parameters with other...... the best-of-three standardized recording were performed in 121 patients with normal voices included consecutively in the RCT. The procedures of anesthesia were standardized. RESULTS: The normative MDVP values of this study are consistently lower compared with most normative values presented in other...... normative values for adults and investigates the correlation between these MDVP parameters in relation to the "standardized" trauma of endotracheal intubation. METHODS: Preoperative and postoperative assessments of vocal fold pathology with flexible videolaryngoscopy and voice analysis with MDVP using...

  8. An unexpected diagnosis during laryngeal intubation: osseous polypoid lesion of the tongue: osteoma or choristoma?

    Directory of Open Access Journals (Sweden)

    Ertap AKOĞLU

    2006-05-01

    Full Text Available Soft tissue osteoma is a rare entity having a strong predilection for the head and neck region, mainly posterior region of the tongue. The so-called lingual osteoma is mostly manifested as an asymptomatic exophytic lesion. It can be diagnosed by physical or radiological examinations.We represent a patient with undiagnosed lingual osteoma, accidentally detected during laryngoscopy for intubation for a gynecologic surgery. General anesthesia was planned for a 52 year-old undergoing gynecologic surgery. Before surgery a laryngoscopy was performed for intubation. During this procedure a pedunculated mass was seen in the posterior region of the tongue. Although the pathogenesis and terminology is controversial, surgical excision is the preferred treatment modality. We aimed to present an osseos lesion in tongue, to review the literature in regard to relevant clinical, histological features and to discuss the pathogenesis and terminology involved.

  9. Adjunctive valproic acid for delirium and/or agitation on a consultation-liaison service: A report of six cases

    OpenAIRE

    Bourgeois, James A. O.D., M.D.; Koike, A K; Simmons, J.E.; Telles, S; Eggleston, C

    2005-01-01

    The authors present six cases in which valproate was used in patients seen by a consultation-liaison service (CLS) to manage delirium and/or psychotic agitation. The intravenous (IV) preparation (Depacon, Abbott Laboratories) was used in two nothing by mouth (NPO) patients, while the liquid oral preparation (Depakene, Abbott Laboratories) was used via nasogastric tube (NGT) in the other patients. All of these cases had suboptimal responses and/or concerning side effects from conventional ther...

  10. 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.

  11. Agitation predicts response of depression to botulinum toxin treatment in a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Marc Axel Wollmer

    2014-03-01

    Full Text Available In a randomized, controlled trial (n=30 we showed that botulinum toxin injection to the glabellar region produces a marked improvement in the symptoms of major depression. We hypothesized that the mood-lifting effect was mediated by facial feedback mechanisms. Here we assessed if agitation, which may be associated with increased dynamic psychomotor activity of the facial musculature, can predict response to the treatment. To test this hypothesis we re-analyzed the data of the scales from our previous study on a single item basis and compared the baseline scores in the agitation item (item 9 of the Hamilton Depression Rating Scale (HAM-D between responders (n=9 and participants who did not attain response (n=6 among the recipients of onabotulinumtoxinA (n=15. Results: Responders had significantly higher item 9 scores at baseline (1.56+0.88 vs. 0.33+0.52, t(13=3.04, d=1.7, p=0.01, while no other single item of the HAM-D or the Beck Depression Inventory was associated with treatment response. The agitation score had an overall precision of 78% in predicting response in a receiver operating characteristic (ROC analysis (area under the curve, AUC=0.87. These data provide a link between response to botulinum toxin treatment with a psychomotor manifestation of depression and thereby indirect support of the proposed facial feedback mechanism of action. Moreover, it suggests that patients with agitated depression may particularly benefit from botulinum toxin treatment.

  12. The effect of lidocaine on neutrophil respiratory burst during induction of general anaesthesia and tracheal intubation.

    LENUS (Irish Health Repository)

    Swanton, B J

    2012-02-03

    BACKGROUND AND OBJECTIVE: Respiratory burst is an essential component of the neutrophil\\'s biocidal function. In vitro, sodium thiopental, isoflurane and lidocaine each inhibit neutrophil respiratory burst. The objectives of this study were (a) to determine the effect of a standard clinical induction\\/tracheal intubation sequence on neutrophil respiratory burst and (b) to determine the effect of intravenous lidocaine administration during induction of anaesthesia on neutrophil respiratory burst. METHODS: Twenty ASA I and II patients, aged 18-60 years, undergoing elective surgery were studied. After induction of anaesthesia [fentanyl (2 microg kg-1), thiopental (4-6 mg kg-1), isoflurane (end-tidal concentration 0.5-1.5%) in nitrous oxide (66%) and oxygen], patients randomly received either lidocaine 1.5 mg kg-1 (group L) or 0.9% saline (group S) prior to tracheal intubation. Neutrophil respiratory burst was measured immediately prior to induction of anaesthesia, immediately before and 1 and 5 min after lidocaine\\/saline. RESULTS: Neutrophil respiratory burst decreased significantly after induction of anaesthesia in both groups [87.4 +\\/- 8.2% (group L) and 88.5 +\\/- 13.4% (group S) of preinduction level (P < 0.01 both groups)]. After intravenous lidocaine (but not saline) administration, neutrophil respiratory burst returned towards preinduction levels, both before (97.1 +\\/- 23.6%) and after (94.4 +\\/- 16.6%) tracheal intubation. CONCLUSION: Induction of anaesthesia and tracheal intubation using thiopentone and isoflurane, inhibit neutrophil respiratory burst. This effect may be diminished by the administration of lidocaine.

  13. Curative effect observation of Esmolol on the hemodynamics response to tracheal intubation in patients with hypertension and coronary heart disease%艾司洛尔在减轻高血压冠心病患者气管插管反应中的疗效观察

    Institute of Scientific and Technical Information of China (English)

    郝永婷

    2011-01-01

    Objective: To investigate the effect of Esmolol on the hemodynamics response to tracheal intubation in patients with hypertension and coronary heart disease. Methods: 76 case of patients with hypertension and coronary heart disease underwent anesthesia operation from February 2008 to June 2010 were randomly divided into experiment group and control group, each 38 cases. Esmolol was given to experiment group 5 min before tracheal intubation, conventional treatment was given to control group. Mean arterial pressure (MAP) and heart rate (HR) were monitored 2,5,10 mine after tracheal intubation. Results: MAP [(63.92±6.37)mm Hg, (61.85±8.32)mm Hg, (60.74±7.23)mm Hg] and heart rate [(82.64±7.34) times/min, (82.47±6.78)times/min, (82.31 ±4.66)times/min] 2, 5, 10 min after tracheal intubation of control group were significantly higher than experiment group [MAP (60.80±6.58)mm Hg, (57.62±9.34)mm Hg, (56.73±6.45)mm Hg, HR (80.65±4.25)times/min, (80.47±5.47)time/min., (80.54±4.23)times/min] (P<0.05). There were 4 cases of ventricular arrhythmias in control group, but none arrhythmias in experimental group. Conclusion: Esmolol can reduce the hemodynamics response to tracheal intubation effectively and safely in patients with hypertension and coronay heart disease.%目的:观察艾司洛尔在减轻高血压冠心病患者气管插管反应的作用.方法:选取2008年2月~2010年6月在我院行全麻手术的高血压冠心病患者76例,随机分为对照组和实验组,每组各38例.实验组在插管前5 min给予艾司洛尔(1.5 mg/kg),对照组常规给药.监测并记录插管后2、5、10 min患者的平均动脉压、心率.结果:插管后2、5、10 min,实验组的平均动脉压分别为(60.80±6.58)mm Hg、(57.62±9.34)mm Hg、(56.73±6.45)mm Hg,对照组的平均动脉压分别为(63.92±6.37)mm Hg、(61.85±8.32)mm Hg、(60.74±7.23)mm Hg;实验组的心率分别为(80.65±4.25)次/min、(80.47±5.47)次/min、(80.54±4.23)次/min

  14. A COMPARATIVE STUDY OF EFFICACY OF ESMOLOL AND FENTANYL FOR ATTENUATION OF INTUBATION RESPONSE DURING LARYNGOSCOPY

    OpenAIRE

    Varma,, M.; Aparanji; Uma

    2015-01-01

    AIM: To compare the attenuation of haemodynamic changes to laryngoscopy and intubation with IV bolus Esmolol 2mg/kg and IV Fentanyl 2μg/kg. METHODS: 90 adult patients of both sex between age 18 and 55 years with ASA grade I and II normotensive with normal rhythm in ECG are divided randomly into three groups. Group - C was control group. In these patients no drug was given. Group - E was Esmolol group. In this group patients were given Inj. Esmolol - 2...

  15. Computational Flow Modeling of Multiphase Mechanically Agitated Reactors

    OpenAIRE

    Ranganathan, Panneerselvam; Savithri, Sivaraman

    2010-01-01

    In this present work, Eulerian multi-fluid approach along with standard k-ε turbulence model has been used to study the solid suspension in liquid-solid and gas–liquid–solid mechanically agitated contactor. CFD predictions are compared quantitatively with literature experimental data (Spidla et al., 2005a,b) in terms of critical impeller speed based on the criteria of standard deviation method and cloud height in a mechanically agitated contactor. An adequate agreement was found between ...

  16. Power Characteristics of a Screw Agitator in a Tube

    Directory of Open Access Journals (Sweden)

    F. Rieger

    2001-01-01

    Full Text Available Screw agitators rotating in tubes are very efficient tools for mixing and pumping viscous liquids. The power characteristic of the agitator-tube assembly must be known to enable its power consumption in a given configuration to be calculated. The dimensionless power characteristic is described by Eq. (6. An estimate of power consumption from the power characteristic is schematically shown in Fig. 1. The dependence of the coefficients in Eq. (6 on the Reynolds number is shown in Fig. 5. The power characteristics for selected Reynolds number values are shown in Figs. 6- 9.

  17. Esmolol vs. nitroglycerin: attenuating hemodynamic response to laryngoscopy and intubation

    OpenAIRE

    Cassie Held

    2016-01-01

    Hemodynamic response to laryngoscopy and intubation is a common occurrence with the potential for harmful effects. Many drugs have been utilized throughout the years to attenuate this response with mixed results. This review compares the efficacy of two drugs, esmolol and nitroglycerin, in attenuating hemodynamic response to laryngoscopy and intubation. A systematic review was performed compiling all previous studies detailing the efficacy of esmolol in comparison to nitroglycerin for this pu...

  18. Comparison of the Glidescope and Pentax AWS laryngoscopes to the Macintosh laryngoscope for use by advanced paramedics in easy and simulated difficult intubation.

    LENUS (Irish Health Repository)

    Nasim, Sajid

    2009-01-01

    BACKGROUND: Intubation of the trachea in the pre-hospital setting may be lifesaving in severely ill and injured patients. However, tracheal intubation is frequently difficult to perform in this challenging environment, is associated with a lower success rate, and failed tracheal intubation constitutes an important cause of morbidity. Novel indirect laryngoscopes, such as the Glidescope and the AWS laryngoscopes may reduce this risk. METHODS: We compared the efficacy of these devices to the Macintosh laryngoscope when used by 25 Advanced Paramedics proficient in direct laryngoscopy, in a randomized, controlled, manikin study. Following brief didactic instruction with the Glidescope and the AWS laryngoscopes, each participant took turns performing laryngoscopy and intubation with each device, in an easy intubation scenario and following placement of a hard cervical collar, in a SimMan manikin. RESULTS: Both the Glidescope and the AWS performed better than the Macintosh, and demonstrate considerable promise in this context. The AWS had the least number of dental compressions in all three scenarios, and in the cervical spine immobilization scenario it required fewer maneuvers to optimize the view of the glottis. CONCLUSION: The Glidescope and AWS devices possess advantages over the conventional Macintosh laryngoscope when used by Advanced Paramedics in normal and simulated difficult intubation scenarios in this manikin study. Further studies are required to extend these findings to the clinical setting.

  19. A Randomized Comparison Simulating Face to Face Endotracheal Intubation of Pentax Airway Scope, C-MAC Video Laryngoscope, Glidescope Video Laryngoscope, and Macintosh Laryngoscope

    Directory of Open Access Journals (Sweden)

    Hyun Young Choi

    2015-01-01

    Full Text Available Objectives. Early airway management is very important for severely ill patients. This study aimed to investigate the efficacy of face to face intubation in four different types of laryngoscopes (Macintosh laryngoscope, Pentax airway scope (AWS, Glidescope video laryngoscope (GVL, and C-MAC video laryngoscope (C-MAC. Method. Ninety-five nurses and emergency medical technicians were trained to use the AWS, C-MAC, GVL and Macintosh laryngoscope with standard airway trainer manikin and face to face intubation. We compared VCET (vocal cord exposure time, tube pass time, 1st ventilation time, VCET to tube pass time, tube pass time to 1st ventilation time, and POGO (percentage of glottis opening score. In addition, we compared success rate according to the number of attempts and complications. Result. VCET was similar among all laryngoscopes and POGO score was higher in AWS. AWS and Macintosh blade were faster than GVL and C-MAC in total intubation time. Face to face intubation success rate was lower in GVL than other laryngoscopes. Conclusion. AWS and Macintosh were favorable laryngoscopes in face to face intubation. GVL had disadvantage performing face to face intubation.

  20. Comparison of the Glidescope® and Pentax AWS® laryngoscopes to the Macintosh laryngoscope for use by Advanced Paramedics in easy and simulated difficult intubation

    Directory of Open Access Journals (Sweden)

    O' Donnell John

    2009-05-01

    Full Text Available Abstract Background Intubation of the trachea in the pre-hospital setting may be lifesaving in severely ill and injured patients. However, tracheal intubation is frequently difficult to perform in this challenging environment, is associated with a lower success rate, and failed tracheal intubation constitutes an important cause of morbidity. Novel indirect laryngoscopes, such as the Glidescope® and the AWS® laryngoscopes may reduce this risk. Methods We compared the efficacy of these devices to the Macintosh laryngoscope when used by 25 Advanced Paramedics proficient in direct laryngoscopy, in a randomized, controlled, manikin study. Following brief didactic instruction with the Glidescope® and the AWS® laryngoscopes, each participant took turns performing laryngoscopy and intubation with each device, in an easy intubation scenario and following placement of a hard cervical collar, in a SimMan® manikin. Results Both the Glidescope® and the AWS® performed better than the Macintosh, and demonstrate considerable promise in this context. The AWS® had the least number of dental compressions in all three scenarios, and in the cervical spine immobilization scenario it required fewer maneuvers to optimize the view of the glottis. Conclusion The Glidescope® and AWS® devices possess advantages over the conventional Macintosh laryngoscope when used by Advanced Paramedics in normal and simulated difficult intubation scenarios in this manikin study. Further studies are required to extend these findings to the clinical setting.

  1. Gargling with sodium azulene sulfonate reduces the postoperative sore throat after intubation of the trachea.

    Science.gov (United States)

    Ogata, Junchi; Minami, Kouichiro; Horishita, Takafumi; Shiraishi, Munehiro; Okamoto, Takashi; Terada, Tadanori; Sata, Takeyoshi

    2005-07-01

    Postoperative sore throat (POST) is a complication that remains to be resolved in patients undergoing endotracheal intubation. In this study, we investigated whether preoperative gargling with sodium 1,4-dimethyl-7-isopropylazulene-3-sulfonate monohydrate (sodium azulene sulfonate, Azunol) reduces POST after endotracheal intubation. Forty patients scheduled for elective surgery under general anesthesia were randomized into Azunol and control groups. In the Azunol group, patients gargled with 4 mg Azunol diluted with 100 mL tap water (40 microg/mL). In the control group, patients gargled with 100 mL of tap water. After emergence from general anesthesia, the patients with POST were counted and POST was evaluated using a verbal analog pain scale. There were no significant differences between the two groups by age, height, body weight, gender distribution, or duration of anesthesia and surgery. In the control group, 13 patients (65%) complained of POST, which remained 24 h later in nine patients (45%). In the Azunol group, five patients (25%) also complained of POST, which completely disappeared by 24 h later. The incidence of POST and verbal analog pain scale scores in the Azunol group decreased significantly compared with the control group. We demonstrated that gargling with Azunol effectively attenuated POST with no adverse reactions.

  2. Comparison of hemodynamic response to tracheal intubation with Macintosh and McCoy laryngoscopes

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    Mehtab A Haidry

    2013-01-01

    Full Text Available Background: Use of McCoy blade laryngoscope avoids the lifting force in the vallecula and theoretically should lead to a lower hemodynamic response related to laryngoscopy and tracheal intubation. The available literature on the topic is conflicting. Materials and Methods: We studied the hemodynamic response to laryngoscopy and tracheal intubation in 60 ASA 1 AND 2 adult patients using either Macintosh or McCoy laryngoscopes. The change in systolic, diastolic, mean arterial pressure, and heart rate (HR was observed for 10 min post intubation. Arrhythmias and ST changes were also observed. Results: The maximum change in HR was 18.7% in the Macintosh and 7.7% in the McCoy group, and in systolic arterial pressure was 22.9% in the Macintosh and 10.3% in the McCoy group. This difference between groups was significant ( P < 0.0001. The change lasted for a lesser duration in the McCoy group. No arrhythmias or ST changes were observed in either group. Conclusion: Hemodynamic changes with use of McCoy laryngoscope were lesser in magnitude and of shorter duration.

  3. Comparison of tracheal intubation using the Airtraq® and Mc Coy laryngoscope in the presence of rigid cervical collar simulating cervical immobilisation for traumatic cervical spine injury

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    Padmaja Durga

    2012-01-01

    Full Text Available Background: It is difficult to visualise the larynx using conventional laryngoscopy in the presence of cervical spine immobilisation. Airtraq® provides for easy and successful intubation in the neutral neck position. Objective: To evaluate the effectiveness of Airtraq in comparison with the Mc Coy laryngoscope, when performing tracheal intubation in patients with neck immobilisation using hard cervical collar and manual in-line axial cervical spine stabilisation. Methods: A randomised, cross-over, open-labelled study was undertaken in 60 ASA I and II patients aged between 20 and 50 years, belonging to either gender, scheduled to undergo elective surgical procedures. Following induction and adequate muscle relaxation, they were intubated using either of the techniques first, followed by the other. Intubation time and Intubation Difficulty Score (IDS were noted using Mc Coy laryngoscope and Airtraq. The anaesthesiologist was asked to grade the ease of intubation on a Visual Analogue Scale (VAS of 1-10. Chi-square test was used for comparison of categorical data between the groups and paired sample t-test for comparison of continuous data. IDS score and VAS were compared using Wilcoxon Signed ranked test. Results: The mean intubation time was 33.27 sec (13.25 for laryngoscopy and 28.95 sec (18.53 for Airtraq (P=0.32. The median IDS values were 4 (interquartile range (IQR 1-6 and 0 (IQR 0-1 for laryngoscopy and Airtraq, respectively (P=0.007. The median Cormack Lehane glottic view grade was 3 (IQR 2-4 and 1 (IQR 1-1 for laryngoscopy and Airtraq, respectively (P=0.003. The ease of intubation on VAS was graded as 4 (IQR 3-5 for laryngoscopy and 2 (IQR 2-2 for Airtraq (P=0.033. There were two failures to intubate with the Airtraq. Conclusion: Airtraq improves the ease of intubation significantly when compared to Mc Coy blade in patients immobilised with cervical collar and manual in-line stabilisation simulating cervical spine injury.

  4. A controlled study of risperidone oral solution combine with clonazepam tablet in the treatment of acute agitation in patients with schizophrenia%利培酮口服液合并氯硝西泮片治疗精神分裂症急性激越的对照研究

    Institute of Scientific and Technical Information of China (English)

    张庆娥; 王刚; 张玲; 王雪; 罗炯; 路亚洲; 姜涛; 王智民; 朱辉

    2012-01-01

    Objective: To compare the efficacy and safety of risperidone oral solution combined with clonazepam tablet versus haloperidol intramuscular treatment in the treatment of acute agitation in patients with schizophrenia. Method: A total of 60 schizophrenic patients with acute agitation were equally randomly assigned to receive either risperidone oral solution (2-6 mg/d) and clonazepam tablets (2-8 mg/d) ( RIS) or haloperidol intramuscular injection treatment( 10-20 mg/d) ( HAL) for 7 days. The efficacy outcome was measured by using the positive and negative syndrome scale (PANSS) , the positive and negative syndrome scale excited component(PANSS-EC) ,the assessment of patients'cooperation, the modified overt aggression scale( MOAS) and the clinical global impression scale (CGI). Safety was evaluated by using the Simpson-Angus rating scale (SAS) ,the Barnes Akathisia scale(BAS) ,the treatment emergent symptom scale(TESS) .adverse events and lab tests. Results:At the end of study,the mean scores of PANSS-EC were (11.1,3.6) and (12.9,5.2)respectively in RIS and HAL, with the significant reduction from baseline (P>0.05). There were no differences of the PANSS-EC scores and the total PANSS scores between two groups (P > 0.05). The improvements of the PANSS positive scores,the MOAS scores and the assessment of patients'cooperation scores were significant higher in RIS than in HAL( P < 0.05). The rates of myotonia and akathisia in RIS were significantly lower than in HAL (P<0. 01 ). Conclusion:The efficacy of risperidone oral solution combined with clonazepam tablet in the treatment of acute agitation in patients with schizophrenia is comparable to haloperidol intramuscular treatment. Treatment with risperidone oral solution combine with clonazepam tablet does better in controlling positive symptoms, aggressive behavior,compliance and tolerability than haloperidol intramuscular treatment.%目的:比较利培酮口服液合并氯硝西泮片与氟哌啶醇肌内注射治疗

  5. A comparative study of efficacy of esmolol and fentanyl for pressure attenuation during laryngoscopy and endotracheal intubation

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    Shobhana Gupta

    2011-01-01

    Full Text Available Objective: To compare the effectiveness of single bolus dose of esmolol or fentanyl in attenuating the hemodynamic responses during laryngoscopy and endotracheal intubation. Methods: Ninety adult ASA I and ASA II patients were included in the study who underwent elective surgical procedures. Patients were divided into three groups. Group C (control receiving 10 ml normal saline, group E (esmolol receiving bolus dose of esmolol 2 mg/kg and group F (fentanyl receiving bolus dose of fentanyl 2 μg/kg intravenously slowly. Study drug was injected 3 min before induction of anesthesia. Heart rate, systemic arterial pressure and ECG were recorded as baseline and after administration of study drug at intubation and 15 min thereafter. Results: Reading of heart rate, blood pressure and rate pressure product were compared with baseline and among each group. The rise in heart rate was minimal in esmolol group and was highly significant. Also the rate pressure product at the time of intubation was minimal and was statistically significant rate 15 min thereafter in group E. Conclusion: Esmolol 2 mg/kg as a bolus done proved to be effective in attenuating rises in heart rate following laryngoscopy and intubation while the rise in blood pressure was suppressed but not abolished by bolus dose of esmolol.

  6. A comparison of conventional endotracheal tube with silicone wire-reinforced tracheal tube for intubation through intubating laryngeal mask airway

    OpenAIRE

    Shah, Veena R.; Bhosale, Guruprasad P.; Tanu Mehta; Parikh, Geeta P.

    2014-01-01

    Background: A specially designed wire-reinforced endotracheal tube - the Fastrach silicone tube (FTST) designed to facilitate endotracheal intubation through intubating laryngeal mask airway (ILMA) are expensive and not readily available. Hence, it is worth considering alternative such as polyvinyl chloride tracheal tube (PVCT), which is disposable, cheap and easily available. The aim of the present study was to compare the clinical performance of FTST with conventional PVCT for tracheal intu...

  7. Mechanisms of cell damage in agitated microcarrier tissue culture reactors

    Science.gov (United States)

    Cherry, Robert S.; Papoutsakis, E. Terry

    1986-01-01

    Cells growing on microcarriers may be damaged by collisions of the microcarrier against another microcarrier or the reactor agitator. Bead-bead collisions are caused by small-scale turbulence, which can also cause high local shear stress on the cells. The cells are also exposed to 10-20 Hz cyclic shear stress by bead rotation.

  8. 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

  9. 右美托咪定与芬太尼类药物在清醒气管插管患者麻醉诱导效果比较的 Meta 分析%Comparison of anesthesia induction efficacy of dexmedetomidine with fentanyl-class drugs in patients un-dergoing awake intubation:a meta-analysis

    Institute of Scientific and Technical Information of China (English)

    方向志; 张扬; 高巨

    2014-01-01

    目的:采用 Meta 分析比较右美托咪定与芬太尼类药物在清醒气管插管患者中麻醉诱导的效果。方法检索 Cochrane 图书馆、PubMed、Embase、中国生物医学文献数据库(CBM)、CNKI、维普、万方数据库,检索时间从1990年至2014年2月。收集清醒气管插管患者使用右美托咪定与常用芬太尼类药物(芬太尼、舒芬太尼、瑞芬太尼)作为麻醉诱导的临床随机对照研究(RCT)。采用 Cochrane 协作网系统评价法评价纳入文献的质量,采用 RevMan 5.0软件对收集的患者资料进行 Meta 分析评价。结果纳入10篇研究400例患者,其中右美托咪定组197例,芬太尼类药物组203例。在插管前即刻右美托咪定组患者的镇静效果(RSS 评分)明显优于芬太尼类药物组(WMD 1.29,95%CI 1.02~1.56),插管完成即刻右美托咪定组的镇静效果(RSS 评分)同样优于芬太尼类药物组(WMD 1.41,95%CI 1.10~1.72)。右美托咪定组呛咳反射发生率明显低于芬太尼类药物组(OR 0.10,95%CI 为0.03~0.31)。右美托咪定组高血压发生率明显低于芬太尼类药物组(OR 0.25,95%CI 0.11~0.57)。右美托咪定组呼吸抑制发生率明显低于芬太尼类药物组(OR 0.33,95%CI 0.16~0.72)。右美托咪定组术后不良记忆发生率明显低于芬太尼类药物组(OR 0.50,95%CI 0.28~0.92)。结论与芬太尼类药物比较,右美托咪定用于清醒气管插管更具有优势。%Objective To systematically review the efficacy of dexmedetomidine and fentanyl-class drugs for induction in awake intubation patients.Methods We searched the PubMed,Embase, Cochrane library,Wanfang Database,CNKI,VIP and China Biology Medicine (CBM)for all ran-domized controlled trials (RCTs)about the efficacy of dexmedetomidine versus drugs of fentanyl class (fentanyl,sufentanil,remifentanil)for induction in awake intubation patients.The quality of the

  10. To evaluate the effects of dexmedetomidine on intraocular pressure and haemodynamic changes in response to laryngoscopy and tracheal intubation

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    Tanuja

    2014-01-01

    Full Text Available Background: The most important prerequisites for neurosurgeries are brain relaxation, need of stable haemodynamics with less fluctuation in intracranial pressure and speedy recovery from anaesthesia. Endotracheal intubation is the major stressful stimuli that can elicit a marked pressor response. Various drugs have been used to attenuate these reflexes. Dexmedetomidine, a highly selective alpha 2-adrenoceptor agonist, have neuroprotective, cardioprotective, and sedative effects so it is potentially useful during neuroanaesthesia. This is a prospective randomised control trial carried out to see whether administration of Dexmedetomidine prior to intubation can attenuate the various haemodynamic responses, intraocular pressure (IOP and the requirement of induction dose of propofol in control and study group. Materials and Methods: Fifty patients (ASA grade 1, 2 scheduled for intracranial tumour surgeries were divided into two groups (25 each. Group D received Dexmedetomidine 0.8 μg/kg i.v. over 10 mins and group C received 20 ml saline. Anaesthesia induced with Propofol, dose adjusted using bispectral index monitor. The groups were compared with IOP, Heart rate (HR, Mean arterial pressure (MAP, and dose of Propofol required for induction. Results : Groups were well matched for their demographic data and pre-operative. IOP in both the eyes decreases significantly after premedication and remained below baseline even after 10 th min of intubation in group D while in Group C; it increased significantly after intubation and remained above baseline. The difference between groups was also statistically significant. HR and MAP decreased significantly in patients of group D compared to group C (P < 0.05. Patients were more haemodynamicaly stable at all time points after premedication in group D (P < 0.05. Propofol requirements for induction was lesser in group D (P < 0.05. Bradycardia and hypotension incidences were higher in group D. Conclusion

  11. COMPARISON OF INDUCTION, INTUBATION AND RECOVERY CHARACTERISTICS OF HALOTHANE + PROPOFOL V/S SEVOFLURANE + PROPOFOL IN CHILDREN UNDERGOING ADENOTONSILLECTOMY

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    Sarabjit kaur , Veena Chatrath , Gagandeep Kaur , Vishal Jarewal , Kulwinder S Sandhu , Sudha

    2015-04-01

    Full Text Available Purpose: General anaesthesia for oral surgeries in paediatric patients is always challenging for an anaesthesiologist. Aim was to compare halothane+propofol and sevoflurane+propofol in paediatric patients undergoing adenotonsillectomy without muscle relaxant. Method: In a double blind manner, eighty patients of 3-10 years were premedicated with inj. Atropine and randomly divided into two groups of forty each. In Group A, priming was done with 50% oxygen+50% nitrous oxide+4% halothane for 1 minute, after loss of eye lash reflex and centralisation of pupil intravenous cannulation done. Inj. midazolom, lignocaine and Propofol were given and trachea was intubated. Maintenance was done with 1-2% halothane+ nitrous oxide+ oxygen and continuous propofol infusion. Similar technique was used in group B except for priming done with sevoflurane 7% and maintenance with 2-3%. Both groups were compared for induction, intubating conditions, haemodynamics and emergence characteristics. Results: Induction was rapid in group B as time for loss of eye lash reflex and centralisation of pupil was less in group B (21.88±12.6 &114.40±28.8 seconds as compared to group A (33.05±4.0 & 140.05±12.1 sec p<0.001. Intubating conditions were excellent but mean intubation time was less in group B as compared to group A p<0.001. Heart rate and blood pressure remained on lower side in group A. Emergence was significantly rapid in group B. No side effect or complications were noted. Conclusion: Both groups provided excellent intubating conditions but sevoflurane+propofol group was better as it provided faster induction and rapid recovery from anaesthesia with more stable haemodynamics as compared to Halothane+propofol group.

  12. Comparison of the Effect of Fentanyl, Sufentanil, Alfentanil and Remifentanil on Cardiovascular Response to Tracheal Intubation in Children

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    Mohamad-Esmaeil Darabi

    2011-06-01

    Full Text Available Objective:Laryngoscopy and tracheal intubation may cause significant cerebral and systemic hemodynamic responses. Many drugs have been shown to be effective in modifying these hemodynamic responses, including fentanyl, sufentanil, alfentanil and remifentanil. The purpose of the current study was to compare the efficacy of fentanyl, sufentanil, alfentanil and remifentanil on blunting cardiovascular changes during laryngoscopy and intubation in children. Methods:Eighty children, 1-6 years old, classified as American Society of Anesthesiologists physical status I and II who were scheduled for elective surgery with general anesthesia and orotracheal intubation, were enrolled in this randomized and double-blinded study. Patients were randomly assigned into four groups of 20 patients. Group F received fentanyl 1µg/kg-1, group S received sufentanil 0.1 µg/kg-1, group A received alfentanil 10 µg/kg-1 and group R received remifentanil 1 µg/kg-1 intravenously. After establishment of neuromuscular blockade confirmed with a nerve stimulator, laryngoscopy and orotracheal intubation were performed 3 min after induction. Hemodynamic variables including systolic and diastolic blood pressure (SAP, DAP and heart rate (HR were recorded at base line (before opioid administration, before laryngoscopy and one minute after orotracheal intubation. Findings:The patients characteristics and laryngoscopy grade were similar in all groups. There was no significant difference in the mean values of SAP, DAP and HR at each measured time between the four groups. There was significant difference in the mean values of SAP, DAP and HR measured over time in each group. Conclusion:The intravenous fentanyl attenuated laryngoscopy-induced SAP, DAP and HR increases better than sufentanil, alfentanil or remifentanil and hemodynamic stability is better preserved with fentanyl.

  13. Comparing the Effect of Dexamethasone before and after Tracheal Intubation on Sore Throat after Tympanoplasty Surgery: A Randomized Controlled trial

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    Mahmoud Eidi

    2014-04-01

    Full Text Available Introduction: Presence of a sore throat after surgery is a common side effect of general anesthesia with intratracheal intubation and can cause discomfort for the patient and prolong the recovery process. In this study we compared the effect of dexamethasone before and after intubation on the incidence of sore throat after tympanoplasty surgery.   Materials and Methods: In a double-blind, randomized clinical trial, 70 patients aged 30–60 years with American Society of Anesthesiologists (ASA physical status I or II who were candidates for tympanoplasty under anesthetic conditions were studied in two separate groups. The first group received intravenous (IV dexamethasone (8 mg 30 mins prior to intubation while the second group received the same dose of dexamethasone 30 mins after intubation. The incidence and severity of the sore throat in both groups were then evaluated.   Results: There was no significant difference between two groups in intensity of sore throat (62.9% vs. 57.1%, cough (65.7% vs. 62.9%, or hoarseness (62.9% vs. 65.7% within 24 h after surgery. Detection of blood in oral secretions or on the tracheal tube was the same in both groups (5.7%. The incidence of coughs during the extubation was 0% in first group and 11.4% in second group.   Conclusion:  According to the results of this research there was no significant difference in incidence and intensity of sore throat in patients receiving dexamethasone before or after intubation. Further, no significant difference in intensity of coughs or hoarseness was observed.  

  14. Unusual Displacement of a Mobilised Dental Bridge during Orotracheal Intubation

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    Paolo Feltracco

    2011-01-01

    Full Text Available Dental trauma during tracheal intubation mostly happens in case of poor dentition, restricted mouth opening, and/or difficult laryngoscopy. 57-year-old man undergoing laparoscopic radiofrequency ablation of unresectable hepatocellular carcinoma had his dental work detached at induction of anesthesia. Oropharyngeal direct view, manual inspection, fibreoptic nosendoscopy, tracheobronchoscopy, and fiberoptic inspection of the esophagus and stomach were unsuccessful in locating the dislodged bridge. While other possible exams were considered, such as lateral and AP x-ray of head and neck, further meticulous manual “sweepings” of the mouth were performed, and by moving the first and second fingers below the soft palate deep towards the posterolateral wall of the pharynx, feeling consistent with a dental prosthesis was detected in the right pharyngeal recess. Only after pulling the palatopharyngeal arch upward was it possible to grasp it and extract it out with the aid of a Magill Catheter Forceps. Even though the preexisting root and bridge deficits were well reported by the consultant dentist, the patient was fully reimbursed. The lack of appropriate documentation of the advanced periodontal disease in the anesthesia records, no mention of potential risks on anesthesia consent, and insufficient protective measures during airway instrumentation reinforced the reimbursement claim.

  15. Ergonomics of novices and experts during simulated endotracheal intubation.

    Science.gov (United States)

    de Laveaga, Adam; Wadman, Michael C; Wirth, Laura; Hallbeck, M Susan

    2012-01-01

    Endotracheal Intubation (ETI) is an airway procedure commonly used to secure the airway for a variety of medical conditions. Proficiency in ETI procedures requires significant clinical experience and insufficient data currently exists describing the physical ergonomics of successful direct laryngoscopy. The research objectives of this study were to examine how ETI time, error and practitioner biomechanics varied among clinical experience levels and hospital bed heights. The participant population included novice and expert personnel, differentiated by their exposure to ETI procedures. Participants used a standard laryngoscope and blade to perform ETI trials on an airway manikin trainer at predesigned hospital bed heights. Participants were evaluated based on ETI time and accuracy, as well as wrist postures and muscle utilization. Hospital bed height did not affect task completion time, error rates or muscle utilization. Expert participants exhibited less ulnar deviation and forearm supination during task trials, as well as a higher utilization of the bicep brachii and anterior deltoid muscles. Expert grasped instrumentation differently, requiring less wrist manipulation required to achieve ideal instrument positions. By encouraging ergonomic best-practices in hand and arm postures during ETI training, the opportunity exists to improve patient safety and reduce the learning curve associated with ETI procedures.

  16. 31-Year-Old Female Shows Marked Improvement in Depression, Agitation, and Panic Attacks after Genetic Testing Was Used to Inform Treatment

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    Scott Lawrence

    2014-01-01

    Full Text Available This case describes a 31-year-old female Caucasian patient with complaints of ongoing depression, agitation, and severe panic attacks. The patient was untreated until a recent unsuccessful trial of citalopram followed by venlafaxine which produced a partial response. Genetic testing was performed to assist in treatment decisions and revealed the patient to be heterozygous for polymorphisms in 5HT2C, ANK3, and MTHFR and homozygous for a polymorphism in SLC6A4 and the low activity (Met/Met COMT allele. In response to genetic results and clinical presentation, venlafaxine was maintained and lamotrigine was added leading to remission of agitation and depression.

  17. Magnetic shaft seals prevent hazardous leakage from wastewater agitators

    International Nuclear Information System (INIS)

    The US Department of Energy's laboratory in Miamisburg, OH, operated by Monsanto Research Corporation, processes approximately 45,000 gallons per week of low-level radioactive wastewater to meet Federal Environmental Protection Agency quality standards. Preventing the spread of radioactive contamination throughout the operating area demands effective sealing of all process piping, valves, pumps, and agitators. Rotating shafts of pumps and agitators installed a the start of operations in 1947 were sealed by stuffing glands with graphite impregnated asbestos packing. These pumps proved to be unsatisfactory. In the mid-1970's, new process pumps with mechanical seals and some with magnetic drives were installed. Later, in January 1979, new agitator shaft drives with double tandem, spring-loaded mechanical seals were installed, maintenance of these pumps was costly. The agitator drive shafts were redesigned to accommodate magnetic seals of the type successfully used in blowers and vacuum/pressure pumps in other plant locations. One inherent advantage of the magnetic seal is that it operates with a face loading as much as 50% less than a conventional spring-loaded mechanical seal. The lower loading by a predetermined uniform magnetic force contributes to long face life. Other advantages include compactness, ease of assembly with only a few parts, and insensitivity to vibration. The magnetic shaft seals installed on the agitator shafts in February 1983 are still in service without any leakage or need for maintenance. Based on current operating data and a projected five-year meantime between failures, the estimated cost benefit of the magnetic seals over spring-loaded mechanical seals over spring-loaded mechanical seals will be $640 vs $2400 respectively per seal, with 60% less downtime for maintenance

  18. Effect of dexmedetomidine on efective target plasma concentrations of remifentanil required to prevent tracheal intubation response in 50% of patients anesthetized with propofol by TCI%右美托咪啶对异丙酚靶控输注时瑞芬太尼抑制气管插管反应的半数有效血浆浓度的影响

    Institute of Scientific and Technical Information of China (English)

    赵晓虹; 高成杰; 王建; 王惠霞; 刘健

    2012-01-01

    目的 测定预先静脉注射小剂量右美托咪啶时成年患者异丙酚靶控输注(TCI)诱导时瑞芬太尼抑制气管插管反应的半数有效血浆浓度(Cp50).方法 择期全麻手术患者40例,ASAⅠ或Ⅱ级,年龄18~60岁,体质量指数20~30 kg/m2,随机分为右美托咪啶组(D组)和对照组(C组).D组患者首先给予0.4 μg/kg右美托咪啶缓慢静脉注射(5 min注射完毕),C组患者给予相同方法静脉注射生理盐水;观察10 min后开始麻醉诱导.瑞芬太尼TCI 5 min后TCI血浆靶浓度为3 mg/L 的异丙酚,患者意识消失后给予罗库溴铵行气管插管.瑞芬太尼的血浆靶浓度按序贯法确定,相邻血浆靶浓度之间的比率为1.2.结果 TCI血浆靶浓度为3 mg/L 的异丙酚麻醉诱导时,D组和C组瑞芬太尼抑制气管插管的Cp50分别为2.88 μg/L和3.72 μg/L,95%的可信区间分别为2.75~3.02 μg/L和3.54~3.89 μg/L.结论 成年患者在TCI血浆靶浓度为3 mg/L 的异丙酚麻醉诱导时,D组和C组瑞芬太尼抑制气管插管反应的Cp50分别为2.88 μg/L和3.72 μg/L,右美托咪啶能减少瑞芬太尼抑制气管插管反应的Cp50,这可能与右美托咪啶与瑞芬太尼具有协同作用有关.%Objective To observe the effect of single dose dexmedetomidine on efective target plasma concentrations of remifen-tanil required to prevent tracheal intubation response in 50% of adult patients (Cp50 ) anesthetized with propofol by TCI. Methods Forty ASA class I or II patients,aged 18 to 60 years old, with body mass index 20 - 30 kg/m2 undergoing elective general anesthesia were enrolled in the study. The patients were randomly divided into 2 groups:dexmedetomidine (D) group and control (C) group. Group D received dexmedetomidine 0. 4 μg/kg by intravenous injection,and the whole dose was given within 5 minutes,and Group C received equal volume of normal saline as Group D intravenously without dexmedetomidine,observed 10 min before induction of anesthesia. Remifentanil was

  19. Pharmacodynamics of remifentanil blunting responses to tracheal intubation performed under peopofol anesthesia administered by TCI In patients with myasthenia gravis%复合靶控输注异丙酚时瑞芬太尼抑制重症肌无力患者气管插管反应的药效学

    Institute of Scientific and Technical Information of China (English)

    石好; 左明章; 孟小燕; 闫春伶; 杨宁

    2009-01-01

    目的 探讨复合靶控输注异丙酚时瑞芬太尼抑制重症肌无力患者气管插管反应的药效学.方法 拟行经胸骨正中劈开胸腺切除术的重症肌无力患者45例,ASA Ⅰ或Ⅱ级,TCI异丙酚和瑞芬太尼进行麻醉诱导,异丙酚血浆靶浓度为4 μg/ml,瑞芬太尼初始效应室靶浓度(Ce)为1.8 ng/ml,依次按2.7、4.0、6.0 ng/ml梯度递增,至患者可耐受喉麻管置入声门下进行气管内表麻后,进行气管插管.采用概率单位回归分析法分别计算瑞芬太尼抑制气管插管反应的Ce50和Ce95.结果 瑞芬太尼抑制气管插管反应的Ce50为2.2 ng/ml,其95%可信区间为2.0~2.3 ng/ml;抑制气管插管反应的Ce95为3.0 ng/ml,其95%可信区间为2.8~3.5 ng/ml.结论 复合靶控输注异丙酚(血浆靶浓度为4 μg/ml)时,瑞芬太尼抑制重症肌无力患者气管插管反应的Ce50和Ce95分别为2.2、3.0 ng/ml.%Objective To investigate the pharmacodynamies of remifentanil blunting the responses to tracheal intubation performed under propofol anesthesia in patients with myasthenia gravis. Methods Forty-five ASA Ⅰ or Ⅱ patients with myasthenia gravis aged 18-64 yr weighing 45-95 kg scheduled for trans-stemal thymectomy were enrolled in this study. ECG, BP, HR, SpO2 and BIS were monitored. Anesthesia was induced with propofol and remifentanil both administered by TCI. The target plasma concentration (Cp) of propofol was set at 4 μg/ml during induction. The initial target effect-site concentration (Ce) of remifentanil was set at 1.8 ng/ml and was increased step by step to 2.7, 4.0 and 6.0 ng/ml until the patients could tolerate laryngoscopy and insertion of larynx unesthetic tube into subglottic space without body movement, coughing or bucking. Topical anesthesia of trachea was then performed by spraying 2% lidocaine 2 ml through the larynx anesthetic tube. Laryngoscope and larynx anesthetic tube were removed and the patients were ventilated with O2 through anesthetic mask

  20. External laryngeal manipulation done by the laryngoscopist makes the best laryngeal view for intubation

    Directory of Open Access Journals (Sweden)

    Mohamed Shaaban Ali

    2014-01-01

    Full Text Available Purpose: External laryngeal manipulation (ELM is used to get better laryngeal view during direct laryngoscopy. This study was designed to test the hypothesis that ELM done by the intubating anesthetist (laryngoscopist offers the best laryngeal view for tracheal intubation. Materials and method: A total of 160 patients underwent different surgical procedures were included in this study. Percentage of glottic opening (POGO score and Cormack and Lehane scale were used as outcome measures for comparison between different laryngoscopic views. Four views were described; basic laryngoscopic view and then views after ELM done by the assistant, by the laryngoscopist and finally by the assistant after the guidance from the laryngoscopist respectively. The last three views compared with the basic laryngoscopic view. Results: ELM done by the laryngoscopist or by the assistant after guidance from the laryngoscopist showed significant improvement of Cormack grades and POGO scores compared with basic laryngoscopic view. Number of patients with Cormack grade1 increased from 39 after direct laryngoscopy to 97 and 96 patients (P < 0.001 by Fisher′s exact test, after ELM done by the laryngoscopist and that done by the assistant after guidance from the anesthetist respectively. Furthermore, the number of patients with POGO scores of 100% increased from 39 after direct laryngoscopy to 78 and 61 (P < 0.01 patients after ELM done by the laryngoscopist and that done by the assistant after guidance from the anesthetist respectively. Conclusion: It appeared from this study that ELM done by the anesthetist makes the best laryngeal view for tracheal intubation.

  1. Modeling enzyme production with Aspergillus oryzae in pilot scale vessels with different agitation, aeration, and agitator types

    DEFF Research Database (Denmark)

    Albæk, Mads Orla; Gernaey, Krist; Hansen, Morten S.;

    2011-01-01

    tank reactors. Different conditions of agitation and aeration were employed as well as two different impeller geometries. The limiting factor for the productivity was oxygen supply to the fermentation broth, and the carbon substrate feed flow rate was controlled by the dissolved oxygen tension...

  2. Related factors of postoperative pulmonary infections in patients after tracheal intubation under general anesthesia and preventive strategies%气管插管全麻患者术后肺部感染的相关因素分析及预防策略

    Institute of Scientific and Technical Information of China (English)

    吴天良

    2013-01-01

    目的 探讨气管插管全麻患者肺部术后感染的相关因素及预防策略.方法 采用回顾性调查分析统计2011年3-9月麻醉科气管插管全麻患者术后肺部感染率、病原菌分布、感染相关因素.结果 760例患者术后发生肺部感染24例,感染率为3.16%;检出病原菌51株,分布最多的为肺炎克雷伯菌占23.53%、鲍氏不动杆菌占17.65%、金黄色葡萄球菌占15.69%;手术部位以颅脑、胸部、腹部的患者发生肺部感染构成比较高,分别占33.33%、25.00%、25.00%;肺部感染相关危险因素是高龄、基础疾病、手术部位、气管导管留置时间和住院时间,差异均有统计学意义(P<0.05).结论 加强围术期患者的管理,针对术后肺部感染的危险因素积极采取有效措施,合理使用抗菌药物可减少肺部感染的发生.%OBJECTIVE To explore the related factors for postoperative pulmonary infections in the patients after tracheal intubation under the general anesthesia so as to put forward the preventive strategies. METHODS The patients, who underwent the tracheal intubation under the general anesthesia in department of anesthesiology from Mar. 2011 to Sep. 2011, were enrolled in the study, and the incidence of the postoperative pulmonary infections, distribution of pathogens, and the related factors of infections were statistically analyzed. RESULTS Of 760 patients investigated, the postoperative pulmonary infections occurred in 24 cases(3. 16%); there were totally 51 strains of pathogens isolated, among which the Klebsiella pneumoniae accounted for 23. 53%, Acinetobacter bau-mannii 17. 65% , and Staphylococcus aureus 15. 69% ; among the different surgical sites, the pulmonary infection patients who underwent the thoracic surgery accounted for 25. 00%, the patients undergoing the abdominal surgery 25.00%, and the patients undergoing cerebaral surgery 33. 33%; the advanced age, underlying disease, surgical site, the duration

  3. 船型垫式口咽通气道喉罩与气管插管在全身麻醉妇科腹腔镜手术中的应用%Application of streamlined liner of the pharynx airway laryngeal mask and tracheal intubation in gynecological laparoscopic operation of general anesthesia

    Institute of Scientific and Technical Information of China (English)

    刘国中; 杨同文

    2013-01-01

    ,the differences were statistically significant (P < 0.05).The cover (tube) of the patients between the two groups were successful,but in the SLIPA laryngeal mask agitation,the restlessness of recovery period and oropharyngeal discomfort after postoperative 24 h of patients was significantly lower than those of the endotracheal intubation group,the differences were statistically significant (P < 0.05).Conclusion The SLIPA laryngeal mask is used in gynecologic laparoscopic operation of general anesthesia,it has satisfactory ventilation effect and less damage to the throat,it is safe,reliable and easy to operate,and can be safely used in gynecological laparoscopic operation of general anesthesia.%目的 观察船型垫式口咽通气道(SLIPA)喉罩与气管插管应用于全身麻醉妇科腹腔镜手术中的效果.方法 选择北京市平谷区妇幼保健院择期妇科腹腔镜手术患者100例,美国麻醉师协会分级为Ⅰ~Ⅱ级,随机将患者分为SLIPA喉罩组和气管插管组,每组50例.记录入室基础值(T0)、置罩(管)前(T1)、置罩(管)后(T2)和拔除罩(管)后(T3)各时点的收缩压(SBP)、舒张压(DBP)、心率(HR)和血氧饱和度(SpO2),SLIPA喉罩和气管插管控制呼吸时气腹前后不同时段的气道峰压(Pmax)、潮气量(Vt)、呼气末二氧化碳分压(PETCO2).记录置罩(管)成功率,并比较2组术中及术后的相关并发症.结果 2组患者T1时SBP均显著低于T0时,差异有统计学意义(P <0.05);T2与T3时HR较T0显著升高,差异有统计学意义(P<0.05).T2时气管插管组患者SBP、DBP和HR显著高于SLIPA喉罩组,差异有统计学意义(P <0.05);T3时气管插管组患者SBP和HR显著高于SLIPA喉罩组,差异有统计学意义(P<0.05).2组患者组内气腹后Pmax和PETCO2均较气腹前高,差异有统计学意义(P<0.05).2组患者置罩(管)均获得成功,但SLIPA喉罩组患者苏醒期躁动、术后24h口咽部不适明显少于气管插管组,差异有统计学意义(P<0

  4. IS AIRTRAQ VIDEO LARYNGOSCOPE A BETTER ALTERNATIVE TO CONVENTIONAL MACINTOSH DIRECT LARYNGOSCOPE DURING ROUTINE INTUBATION? A COMPARATIVE STUDY

    OpenAIRE

    Syed Faza; Padmanabha

    2015-01-01

    The Airtraq is designed to allow visualization of the glottis without alignment of the oral, pharyngeal, and laryngeal axes. The Airtraq differs in many ways from the conventional Macintosh laryngoscope and is suiTable scope for managing anticipated/unanticipated difficult airway situations. Here tracheal intubation performance of standard Macintosh laryngoscope was compared with Airtraq in normal patients. METHODS: Sixty patients (ASA I and II) who required surgery under gene...

  5. A comparative study of efficacy of esmolol and fentanyl for pressure attenuation during laryngoscopy and endotracheal intubation

    OpenAIRE

    Gupta, Shobhana; Tank, Purvi

    2011-01-01

    Objective: To compare the effectiveness of single bolus dose of esmolol or fentanyl in attenuating the hemodynamic responses during laryngoscopy and endotracheal intubation. Methods: Ninety adult ASA I and ASA II patients were included in the study who underwent elective surgical procedures. Patients were divided into three groups. Group C (control) receiving 10 ml normal saline, group E (esmolol) receiving bolus dose of esmolol 2 mg/kg and group F (fentanyl) receiving bolus dose of fentanyl ...

  6. EFFECT OF 0.75mg/Kg ESMOLOL ON PRESSOR RESPONSE DURING LARYNGOSCOPY AND ENDOTRACHEAL INTUBATION : A COMPARATIVE STUDY

    Directory of Open Access Journals (Sweden)

    Roopa

    2015-09-01

    Full Text Available Laryngoscopy and intubation contravene the patient’s protective airway reflexes and lead to physiological changes involving various systems of the body Reflex changes in the cardiovascular system are more marked after laryngoscopy and intubation Esmolol is an ultra - short acting beta - l adrenergic blocking drug, with cardio selectivity, rapid onset of action and extremely short elimination half - life. AIM OF STUDY: To study the efficacy and safety of attenuation of pressor response during laryngoscopy and tracheal intubation using esmolol, administered in dose of 0.75mg/kg single IV bolus prior to induction of anesthesia. MATERIALS AND METHODS: The study was conducted in 50 patients, who were randomly assigned into 2 groups of 25 each. Group A (25 not received any drug and Group B (25 received Inj. Esmolol 0.75mg/kg I.V before induction. RESULTS: There was an increase in heart rate and blood pressure in the Group A whereas there was a decrease in blood pressure heart rate in the Group B immediately after intubation and at the end of 4 th min. CO NCLUSION: In this study, the esmolol group showed a decrease in mean values of Heart Rate, Blood Pressure immediately after administration .

  7. Circulatory responses to nasotracheal intubation: comparison of GlideScope(R) videolaryngoscope and Macintosh direct laryngoscope

    Institute of Scientific and Technical Information of China (English)

    XUE Fu-shan; LI Xuan-ying; LIU Qian-jin; LIU He-ping; YANG Quan-yong; XU Ya-chao; LIAO Xu; LIU Yi

    2008-01-01

    Background The GlideScope videolaryngoscope (GSVL) has been shown to have no special advantage over theMacintosh direct laryngoscope (MDL) in attenuating the circulatory responses to orotracheal intubation, but no study has compared the circulatory responses to nasotracheal intubation (NTI) using the two devices. This prospective randomized clinical study was designed to determine whether there was a clinically relevant difference between the circulatory responses to NTI with the GSVL and the MDL.Methods Seventy-six adult patients were randomly allocated equally to the GSVL group and the MDL group. After induction of anesthesia, NTI was performed. Non-invasive blood pressure (BP) and heart rate (HR) were recorded before induction (baseline values) and immediately before intubation (post-induction values), at intubation and every minute for a further five minutes. During the observation, times required to reach the maximum values of systolic BP (SBP) and HR, times required for recovery of SBP and HR to postinduction values and incidence of SBP and HR percent changes>30% of baseline values were also noted. The product of HR and systolic BP, I.e. Rate pressure product (RPP), and the areas under SBP and HR vs. Time curves (AUCSBP and AUCHR) were calculated.Results The NTI with the GSVL resulted in significant increases in BP, HR and RPP compared to postinduction values, but these circulatory changes did not exceed baseline values. BPs at all measuring points, AUCSBP, maximum values of BP and incidence of SBP percent increase>30% of baseline value during the observation did not differ significantly between groups. However, HR and RPP at intubation and their maximum values, AUCHR and incidence of HR percent increase > 30% of baseline value were significantly higher in the MDL group than in the GSVL group. -times required for recovery of SBP and HR to postinduction values were significantly longer in the MDL group than in the GSVL group.Conclusions The pressor response to

  8. 右美托咪定用于重症监护病房正颌外科术后留置气管插管患者的镇静%Dexmedetomidine for sedation during intubation period in postoperative patients receiving orthognathic surgery in intensive care unit

    Institute of Scientific and Technical Information of China (English)

    方舒东; 朱也森; 徐辉; 姜虹

    2012-01-01

    AIM To study the effectiveness and safety of dexmedetomidine for sedation during intubation period in postoperative patients receiving orthognathic surgery admitted to intensive care unit (ICU). METHODS Forty post-operative patients undergoing orthognathic surgery with tracheal intubation in ICU were enrolled and randomized into 2 groups to receive either midazolam or dexmedetomidine. The dexmedetomidine group starting dose was 0.4μg·kg-1·h-1 without a loading dose and adjusted 0.2 to 0.7 μg ·kg·h-1. The midazolam group starting dose was 0.1 mg·kg-1·h-1 and adjusted 0.05 to 0.2 mg·kg·h-1, the dose of sedation was regulated by Ramsay Sedation Score (RSS) maintain 2 to 4 sedative score. During the course, RSS, heart rate (HR) , blood pressure, respiratory rate ( RR) and pulse oxygen saturation ( SpO2) were observed and registered continuously. The amount of the drug, and incidence of adverse reactions, such as hypotension, bradycardia, delirium, etc. were recorded in two groups. RESULTS The expected sedative scores were obtained in all patients in two groups. The HR and mean arterial blood pressures ( MAP) showed no significantly different between two groups before sedation (P > 0.05). The HR in the dexmedetomidine group at 1, 2, 3, 4, 6, 8, 12 and 16 h were lower compared with those in the midazolam group ( P < 0.05) . The MAP in the dexmedetomidine group at 1, 2, 3, and 4 h were lower than those in the midazolam group (P < 0.05) .The times of dose adjustment needed were significantly lower in the dexmedetomidine group ( 2 patients with 1 adjustment each) than those in the midazolam group ( 3 patients with 1 adjustment, 4 patients with 2 adjustments). Atropine was administered to 2 patients in the dexmedetomidine group because of bradycardia. No serious adverse reactions occurred in both groups. CONCLUSION Dexmedetomidine 0.4 μg · kg-1 · h-1 is effective sedatives for post-operative patients undergoing orthognathic surgery with tracheal intubation in

  9. A RANDOMIZED CLINICAL TRIAL OF ENDOTRACHEAL INTUBATION FOLLOWING THIOPENTAL - SUCCINYLCHOLINE OR SEVOFLURANE - NITROUS OXIDE ANESTHESIA FOR GENERAL ANESTHESIA IN ELECTIVE SURGERIES IN ADULTS

    OpenAIRE

    A.S. Kameswara; P. Sai; V. Harinath; P. Sankara

    2013-01-01

    We performed a double - blinded , prospective , randomized controlledtrial to compare intubating conditions facilitated by succinylcholineor sevoflurane. One hundred twenty patients were randomizedto receive either succinylcholine or sevoflurane for trachealintubation. For the Succinylcholine group , patients were inducedwith thiopental 5 mg · kg - 1 and tracheally intubatedafter administra...

  10. 齐拉西酮合并氯硝西泮治疗急性期伴激越精神分裂症患者的对照研究%A controlled study of ziprasidone combined with clonazepam in treatment of patients with acute agitation of schizophrenia

    Institute of Scientific and Technical Information of China (English)

    陈琦; 薄奇静; 迟勇; 赵幸福; 李晓驷; 谭云龙; 杜波; 王传跃

    2012-01-01

    Objective:To investigate the efficacy and adverse profiles of ziprasidone combined with clonazepam for treatment of acute agitation in schizophrenia. Method:A total of 120 schizophrenic patients with moderate acute agitation was randomized to receive ziprasidone combined with clonazepam or olanzapine treatment. Clinical effects were monitored by the positive and negative syndrome scale ( PANSS) and side effects by the UKU (Udvalg for Kliniske Undersogelser side effect rating scale) at the baseline,4 days,7 days, 14 days and 28 days. 22 cases were off and 98 cases were analyzed. Results:(1)The reduced scores of PANSS between the two groups were no significant difference ( F = 0. 264, P = 0. 608 ) ; The scores of the PANSS excited com-ponets(PANSS-EC) were significant difference (F = 194. 984,P = 0.000) in observed points,while no significant difference between the two groups ( F = 0. 047, P = 0.828) ;(2)The level of weight, triglycerides and cholesterol were significant difference in two groups (F=4.274,P =0.041 ,F =4. 967,P = 0. 028;F = 3.991 ,P =0.049). The changes of weight,triglycerides and cholesterol in olanzapine group were more higher than in ziprasidone;(3) Compare to the scores of UKU,time factors were significantly different (F =4. 9,P =0.002) and group factors were no statistically significant difference ( F = 1. 425, P = 0. 236). Conclusion: Ziprasidone combined with clonazepam and olanzapine demonstrate similar efficacy for acute agitation in schizophrenia. The change of weight and lipemia in group of olanzapine are more than in ziprasidone.%目的:评估齐拉西酮合并氯硝西泮治疗精神分裂症患者急性期兴奋激越的有效性和安全性. 方法:120例中度急性期伴激越患者,随机分为齐拉西酮合并氯硝西泮治疗组和奥氮平治疗组,分别在治疗基线、第4天、第7天、第14天和第28天进行疗效和安全性评估.共脱落22例,98例纳入分析. 结果:①阳性与阴性症状量表(PANSS)的减分

  11. Effects of ketamine and midazolam on emergence agitation after sevoflurane anaesthesia in children receiving caudal block: a randomized trial

    Directory of Open Access Journals (Sweden)

    Ayse Ozcan

    2014-12-01

    Full Text Available Background and objectives: Emergence agitation is a common postanaesthetic problem in children after sevoflurane anaesthesia. We aimed to compare the effects of ketamine and midazolam administered intravenously, before the end of surgery, for prevention of emergence agitation in children who received caudal block for pain relief under sevoflurane anaesthesia. Methods: 62 American Society of Anesthesiologists patient classification status I children, aged 2–7 years, scheduled for inguinal hernia repair, circumcision or orchidopexy were enrolled to the study. Anaesthesia was induced with sevoflurane 8% in a mixture of 50% oxygen and nitrous oxide. After achieving adequate depth of anaesthesia, a laryngeal mask was placed and then caudal block was performed with 0.75 mL kg−1, 0.25% bupivacaine. At the end of the surgery, ketamine 0.25 mg kg−1, midazolam 0.03 mg kg−1 and saline were given to ketamine, midazolam and control groups, respectively. Agitation was assessed using Paediatric Anaesthesia Emergence Delirium scale and postoperative pain was evaluated with modified Children's Hospital of Eastern Ontario Pain Scale. Results and conclusions: Modified Children's Hospital of Eastern Ontario Pain Scale scores were found higher in control group than in ketamine and midazolam groups. Paediatric Anaesthesia Emergence Delirium scores were similar between groups. Modified Children's Hospital of Eastern Ontario Pain Scale and Paediatric Anaesthesia Emergence Delirium scores showed a significant decrease by time in all groups during follow-up in postanaesthesia care unit. The present study resulted in satisfactory Paediatric Anaesthesia Emergence Delirium scores which are below 10 in all groups. As a conclusion, neither ketamine nor midazolam added to caudal block under sevoflurane anaesthesia did show further effect on emergence agitation. In addition, pain relief still seems to be the major factor in preventing emergence agitation after

  12. INTRAVENOUS 2 μG/KG CLONIDINE IN COMPARISON TO INTRAVENOUS 2 μG/KG FENTANYL FOR ATTENUATION OF HAEMODYNAMIC RESPONSE TO LARYNGOSCOPY AND OROTRACHEAL INTUBATION

    Directory of Open Access Journals (Sweden)

    Cordeiro

    2016-03-01

    Full Text Available BACKGROUND Laryngoscopy and intubation cause discernible haemodynamic changes following sympathetic stimulation. These responses are endured by healthy individuals, however, can produce calamitous changes in compromised individuals. Hence, attenuation is prudent and favourable. AIM To compare the effectiveness and safety of Clonidine and Fentanyl in attenuation of pressor response to direct laryngoscopy and endotracheal intubation. SETTING Tertiary care hospital. DESIGN Randomized, prospective, double blind study. METHODS 100 patients, aged 18-60 years who presented for elective, non-cardiovascular surgeries were divided into 2 groups; group-C to receive IV Clonidine; and group-F IV Fentanyl respectively, administered 5 min. prior to intubation. Each group had 50 patients of ASA-1 or II. We monitored the heart rate, systolic, diastolic and mean arterial blood pressure. STATISTICAL ANALYSIS ANOVA (Analysis of Variance method for intragroup comparison. The ANOVA method calculated Greenhouse-Geisser value, degree of freedom and p value. A p value <0.05 was considered significant. RESULTS At 10 min. of intubation, decrease in heart rate was maximum with Clonidine than Fentanyl with mean values 61.84/min and 84.64/min respectively, statistically significant (p<0.001. The systolic and diastolic blood pressure also showed a significant suppression (P<.001 with Clonidine showing better results. CONCLUSION Sympathetic response is better attenuated with Clonidine, which is statistically highly significant. Administration of intravenous Clonidine 2 μg/kg, 5 minutes before the laryngoscopy can be recommended to attenuate the sympathetic response to laryngoscopy and intubation.

  13. An Investigation of Heat Transfer in a Mechanically Agitated Vessel

    Directory of Open Access Journals (Sweden)

    A. Debab

    2011-01-01

    Full Text Available The objective of this study is to optimize experimental conditions of agitating a non-Newtonian liquid using experimental design methodology. The measurements of the temperatures have been carried out in a jacketed vessel equipped with Turbine impellers. The rheological properties of aqueous solutions of carboxymethylcellulose sodium salt had been studied using shear stress/shear rate data. The results of the experimental studies, concerning the effect of the diameter of the impeller, the impeller speed and baffled or unbaffled vessel on the overall heat transfer coefficient have been approximated in the form of equations. Based on the optimization criterion, an agitated vessel equipped with Flat Blade Disc Turbine (FBDT of diameter ratio d/D = 0.6 and baffles is proposed as the most advantageous for heat transfer processes.

  14. Agitation of yield stress fluids in different vessel shapes

    Directory of Open Access Journals (Sweden)

    Houari Ameur

    2016-03-01

    Full Text Available The Agitation of yields stress fluids with a six-curved-blade impeller (Scaba 6SRGT is numerically investigated in this paper. The xanthan gum solution in water which is used as a working fluid is modeled by the Herschel–Bulkley model. The main purpose of this paper is to investigate the effect of vessel design on the flow patterns, cavern size and energy consumption. Three different vessel shapes have been performed: a flat bottomed cylindrical vessel, a dished bottomed cylindrical vessel and a closed spherical vessel. The comparison between the results obtained for the three vessel configurations has shown that the spherical shapes provide uniform flows in the whole vessel volume and require less energy consumption. Effects of the agitation rate and the impeller clearance from the tank bottom for the spherical vessel are also investigated. Some predicted results are compared with other literature data and a satisfactory agreement is found.

  15. Agitation and Propagandistic Work in Soviet POW Camps

    Directory of Open Access Journals (Sweden)

    Gulzhaukhar K. Kokebayeva

    2014-06-01

    Full Text Available The paper studies the problem of agitation work done among POWs in Soviet camps, the creation of military units and political organizations from POWs. Not only armed force was used during the Second World War, but also the power of words. The battles were accompanied by the information warfare. Opponents tried to use all possible means to manipulate people’s minds. Main directions of agitation and propaganda were defined by the «Soviet bureau of military and political propaganda», as well as the 7th Division of Soviet army. In the propaganda work among German POWs, the priority was given on shaping the ideological and political views of former soldiers and officers of the Wehrmacht. As the result of the analysis of sources the author comes to conclusion that POWs of the Second World War period became the object of testing means and methods of ideological struggle of warring nations.

  16. Transoral tracheal intubation of rodents using a fiberoptic laryngoscope.

    Science.gov (United States)

    Costa, D L; Lehmann, J R; Harold, W M; Drew, R T

    1986-06-01

    A fiberoptic laryngoscope which allows direct visualization of the deep pharynx and epiglottis has been developed for transoral tracheal intubation of small laboratory mammals. The device has been employed in the intubation and instillation of a variety of substances into the lungs of rats, and with minor modification, has had similar application in mice, hamsters, and guinea pigs. The simplicity and ease of handling of the laryngoscope permits one person to intubate large numbers of enflurane anesthetized animals either on an open counter top or in a glove-box, as may be required for administration of carcinogenic materials. Instillation of 7Be-labeled carbon particles into the lungs of mice, hamsters, rats, and guinea pigs resulted in reasonably consistent interlobal distribution of particles for each test animal species with minimal tracheal deposition. However, actual lung tissue doses of carbon exhibited some species dependence.

  17. 急诊困难气管插管的危险因素分析%Risk factors of difficult intubation in the emergency setting

    Institute of Scientific and Technical Information of China (English)

    李文强; 周永明; 祁必富; 魏捷

    2012-01-01

    目的 评价急诊困难气管插管的预测因子.方法前瞻性研究246例急诊插管患者,气道管理方案适用于所有的急诊气管插管患者.记录患者的一般资料、改良的LEMON评分、Cormack and Lehane分级、成功率及相关并发症,通过多元逻辑回归分析预测困难插管的独立危险因子.结果 248例患者中,第一次插管成功186例(75.0%)为容易插管组,不成功62例(25.0%)为困难插管组.困难插管组中大切牙、大舌头、颏骨至舌骨距离<3指、舌骨至甲状软骨切迹距离<2指、颈部活动困难、肥胖患者和创伤患者的比率显著高于容易插管组(均P<0.05).多元逻辑回归分析发现舌骨至甲状软骨切迹距离<2指(OR值3.54;95%可信区间1.29~7.23,P=0.007)和大舌头(OR值2.89,95%可信区间0.87~5.98,P=0.048)是困难插管的独立危险因子.Cormack and Lehane分级分级1~4级,级别越高插管越困难.结论 改良LEMON评分适合急诊状态下区分困难气管插管,甲状软骨至舌骨的距离<2指和大舌头是急诊预测困难插管的独立危险因子.%Objective To evaluate the risk factors of difficult intubation in the emergency setting. Methods Two hundred and forty-eight patients requiring intubation in the ED were prospective observed. Same airway management protocol was used all intubations. Patients's information, modified LEMON score, Cormack and Lehane classification, success rate, and associated complications were recorded. The independent risk factors in predicting difficult intubation were determined by logistic regression analysis. Results One hundred and eighty-six ( 75. 0% ) patients intubated successfully at the first attempt classified in the easy intubation group and the others 62 (25. 0% )patients in the difficult intubation group. The ratios of large incisors,large tongue,hyoid-to-mental distance less than 3 fingers,thyroid-to-hyoid distance less than 2 fingers,poor neck mobility,obstructed airway,and trauma in the

  18. Purification of Octacosanol by Agitated Short-Path Distillation

    Institute of Scientific and Technical Information of China (English)

    许松林; 王军武; 徐世民; 王淑华

    2003-01-01

    Octacosanol is purified by agitated short-path distillation (SPD). Effects of evaporation temperature,number of SPD steps in series and other distillation method on the octacosanol recovery and decomposition are studied. Although the experimental results indicate some decomposition when the mixture of higher primary aliphatic alcohols is distillated by SPD, SPD is still an effective method to purify octacosanol. It is concluded that evaporation temperature affects greatly on the purity and recovery of octacosanol.

  19. Laminar Mixing in Stirred Tank Agitated by an Impeller Inclined

    OpenAIRE

    Koji Takahashi; Yoshiharu Sugo; Yasuyuki Takahata; Hitoshi Sekine; Masayuki Nakamura

    2012-01-01

    The mixing performance in a vessel agitated by an impeller that inclined itself, which is considered one of the typical ways to promote mixing performance by the spatial chaotic mixing, has been investigated experimentally and numerically. The mixing time was measured by the decolorization method and it was found that the inclined impeller could reduce mixing time compared to that obtained by the vertically located impeller in laminar flow region. The effect of eccentric position of inclined ...

  20. LMA通气复合七氟烷及丙泊酚麻醉在颅内动脉瘤栓塞术的应用%Application of tracheal intubation with sevoflurane and propofol intravenous anesthesia in intracranial aneurysm embolization

    Institute of Scientific and Technical Information of China (English)

    许银实; 赵鲜虎

    2012-01-01

    OBJECTIVE To compare the feasibility and safety of laryngeal mask airway (LMA) and tracheal intubation with sevoflurane and propofol intravenous anesthesia in intracranial aneurysm embolization. METHODS 60 patients with DSA embolization of intracranial aneurysms were randomly divided into the laryngeal mask and tracheal intubation group. In surgery, we pumped the propofol and sevoflurane with micro pump to keep anesthetizing the patients. We recorded the change of blood pressure, heart rate, oxygen saturation, before induction of anesthesia (TO), the LMA and tracheal tube before (Tl), immediately after insertion (T2), after intubation 3 (T3) minutes, and extraction of the laryngeal mask or tracheal catheter. When we removed the LMA or Tracheal extubation, we recorded the patients' agitation, cough, regurgitation and postoperative complications. RESULTS The LMA combined sevoflurane and propofol intravenous anesthgsia for embolization of intracranial a-neurysms in patients with induction of anesthesia, in surgery and postoperative recovery in the maintenance of stable hemody-namics, sevoflurane and propofol with less, rapidly waking up and low incidence of sore throat. CONCLUSION The LMA has the advantages of simple operation, small stimulation, reliable ventilation and lighting on the environment cycle. Combined Sevoflurance and Propofol Intravenous Anesthesia is good for stable hemodynamics, postoperation recovery faster and orientation recovery is good. If you have a good indication, the LMA is more suitable for intracranial artery embolization than the Tracheal.%目的 对比研究喉罩通气和气管插管七氟醚复合丙泊酚静脉麻醉在颅内动脉瘤栓塞术的应用的可行性和安全性.方法 将60例经DSA行颅内动脉瘤栓塞术的患者随机分为喉罩组和气管插管组,术中以微量泵持续泵注丙泊酚、七氟醚维持麻醉.记录在病人麻醉诱导前(T0),插入喉罩或气管导管前(T1),插入后即刻(T2),插管后3 (T3