جستجوی مقالات مرتبط با کلیدواژه « لوله گذاری تراشه » در نشریات گروه « پزشکی »

Due to the high prevalence of complications during and after laryngoscopy, especially hemodynamic disturbances, and the absence of a suitable solution for preventing these complications, this study was conducted to compare the effect of“Ketamine-Midazolam-Sufentanil” with “Etomidate-Sufentanil” combinations on changes in heart rate and blood pressure after laryngoscopy and endotracheal intubation.

In this controlled, triple-blind randomized clinical trial, 96 laryngoscopy candidate patients were divided into three groups of 32 members and were given “Ketamine-Midazolam-Sufentanil” (KMS), “Etomidate-Sufentanil” (ES) and” Etomidate-Normal Saline” (NS) respectively before laryngoscopy.Hemodynamic parameter changes at baseline and 1,3,5and 10 minutes after laryngoscopy, were measured and compared between the 3 groups.

During the study, the 3 groups KMS, ES, and NS had 0%, 15.6% and, 3.1% bradycardia respectively (p value = 0.024). Changes in systolic blood pressure were significantly different in the 3 groups (p value = 0.043). However, the incidence of tachycardia, hypertension, and hypotension were not significantly different among the 3 groups.

Results of this study showed that using the “Ketamine-Midazolam-Sufentanil” combination before laryngoscopy can reduce hemodynamic disturbances during and after laryngoscopy. Patients who receive this drug combination seem to have more desirable hemodynamic stability during and after laryngoscopy

Unplanned removal of the endotracheal tube is one of the quality criteria of care in the intensive care unit and may lead to irreversible complications. The aim of this study was to investigate the risk factors for unplanned endotracheal tube removal in adult patients admitted to the General Special Care Department of Shahid Beheshti Hospital of Qom, Iran in 2021.

This study was conducted in the year 2021 using a retrospective descriptive analytical method. The statistical sample included all patients over 18 years of age admitted to the intensive care unit who had unplanned tracheal tube removal. In this study, a researcher-made extubation checklist was used. Data analysis was done using SPSS version 23 through descriptive and regression tests. A significance level of 0.05 was considered significant.

18.33% of patients had the experience of unplanned tracheal tube removal. Their mean age was 54.62 ± 6.54 and their level of consciousness was 10.54 ± 2.07. Furthermore, 72.06% of the patients were agitated. The variables of age, workload of nurse, level of consciousness, restlessness, history of drug use, and occurrence of delirium after hospitalization in ICU played a role in unplanned tracheal tube removal. In the examination of complications, the most complications were related to aspiration and then to damage to the larynx.

Unplanned extubation is more common in internal ward patients than in surgical ward patients. It is also more common in elderly people, people with a history of drug use, the disproportion between the number of patients and the number of nurses, but it has no relationship with patient gender.

Dexmedetomidine is a new sedative that has analgesic and sympatholytic effects. This study was performed to compare the hemodynamic response of dexmedetomidine and fentanyl after endotracheal intubation in lumbar spine surgery.

In a double-blind clinical trial, 80 patients aged 20-65 years candidates for elective spinal surgery were randomly divided into two groups to receive either dexmedetomidine or fentanyl. In case group, dexmedetomidine (0.5 mcg/kg) and in control group fentanyl (1 mcg/kg in 50 ml of normal saline) were administered 10 minutes before endotracheal intubation. Heart rate and mean arterial pressure were measured at 1, 3, 5, and 10 minutes after intubation. Endotracheal intubation quality and first time of postoperative pain were also measured using Copenhagen score and numerical rating scale, respectively.

Heart rates at 1, 3, 5, and 10 minutes after intubation were 77.60±8.29, 75.73±8.12, 76.44±9.62, and 76.43±7.87 in dexmedetomidine group and 82.7±11.31, 82.08±10.91, 79.93±10.0, and 74.28±14.04 in fentanyl group, respectively (P˂0.001). Mean arterial pressure at 1, 3, 5, and 10 minutes after intubation were 87.45±18.68, 82.25±13.78, 81.78±13.77, and 79.13±14.81 in dexmedetomidine group and 94.95±19.40, 92.23±17.51, 88.28±15.20, and 83.18±13.43 in fentanyl group, respectively (P˂0.001). Quality of intubation was not found to be significantly different between the two groups (P= 0.10). The mean of first time postoperative pain was 9.34±7.11 minutes in fentanyl group and 13.66±10.21 minutes in dexmedomidine group (P= 0.03).

This study showed that hemodynamic changes after endotracheal intubation were less in patients who received dxmedetomidine compared to those that received fentanyl.

Airway management is a fundamental principle in treatment of emergency patients and reduction of mortality. The purpose of this study was to determine the performance of prehospital emergency medicine servises (EMS) in endotracheal intubation and its related factors in mannequin.

This cross-sectional analytic study was performed in 70 EMS  staff in Rasht, Iran 2019. The participants were selected through census sampling. Demographic and occupational characteristics questionnaire and a checklist for tracheal intubation performance were used. Data were analyzed in SPSS V21, using Mann-Whitney U Test, Kruskal–Wallis Test, and ordinal logistic regression.

The overall performance of EMS staff in placing endotracheal tube was moderate. There were significant correlations between endotracheal intubation and work experience (P=0.051), and experience and numbers of tracheal intubation in human (P=0.051, P=0.022, and P=0.021, respectively).

According to this study, frequent in-service training courses are needed to improve the performance of EMS staff.

Sore throat after endotracheal intubation during general anesthesia is a common complaint of patients especially in children. Strabismus surgery in one of the common procedures in child patients. The present study investigates the use of intratracheal ketamine administration in reducing sore throat after strabismus surgery.

This study was performed on 60 patients undergoing elective strabismus surgery under general anesthesia from December 2019 to February 2020 in Farabi eye hospital, Tehran University of medical sciences, Tehran, Iran. These cases were referred to our center for strabismus operation from other centers of our country. Patients were randomly divided into two equal groups. After sufficient depth of anesthesia with sevoflurane and injection of fentanyl, endotracheal intubation was performed. In the control group, the endotracheal tube was inserted and 2 ml of ketamine solution at a concentration of 5 mg/ml were administered in endotracheal tube. The severity of sore throat, length of stay in recovery, incidence of delirium in recovery, satisfaction of recovery nurses and their parents and other complications were compared between the two groups.

Mean age, sex and weight were not significantly different between the two groups and were comparable. The mean duration of stay in recovery was higher in the case group than in the control group. The mean postoperative sore throat was significantly higher in the control group. Moreover, the mean incidence of delirium in the postoperative phase was higher in the case group. Besides, the rate of nurse satisfaction in the control group was higher than the case group. The incidence of bronchospasm, laryngospasm, and postoperative nausea and vomiting was not significantly different between the two groups.

Intratracheal ketamine can reduce postoperative sore throat and the need for postoperative analgesic medications. Postoperative complications were not increased with this strategy, but the length of recovery stay increased in these patients.

Failure to maintain airway after induction of general anesthesia or in patients with multiple trauma who need airway resuscitation or oxygen delivery is one of the most common causes of mortality and disability. Therefore, in this study we aimed to investigate the association between the neck circumference and the distance between the outer ear canal and the upper edge of the manubrium compared to Cormack-Lehane score in patients undergoing laryngoscopy.

In this cross-sectional study, the neck circumferential of patients was determined by the location of the thyroid gland in centimeters and the distance between the outer ear canal and the upper edge of the manubrium was determined and divided by the circumference of the neck to achieve the index. In the next step, using the score of Cormack-Lehane, the grading of larynx was assessed and compared with the index.

18 patients (15.65%) had severe laryngoscopy and 97 (84.35%) had easy laryngoscopy. The area under the receiver operating characteristic (ROC) diagram was between 0.5 and 0.6 which was less than 0.6 and indicated that the studied index was not a suitable criterion for assessment of the difficulty of laryngoscopy and was not different from random selection (P = 0.255).

Taken together, the results of our study showed that the ratio of the peripheral neck circumference to distance between the outer canal and manubrium could not be used as a suitable alternative to the Cormack-Lehane score for prediction of difficult intubation.

The purpose of this study was to compare the effect of thiopental sodium-midazolam combination on the stress response and hemodynamic changes between tracheal intubation and laryngeal mask airway insertion during airway management. In this clinical trial study, 70 patients ASA 1, 2 candidates for elective surgery were randomly divided into two groups of tracheal intubation and laryngeal airway mask insertion. Hemodynamic variables including mean arterial pressure, heart rate, and arterial oxygen saturation were measured and compared between the two groups before and after intubation. There was no significant difference between the two groups in regard to demographic data (age, sex, height, and weight), heart rate, mean arterial pressure and arterial oxygen saturation at 1 and 3 minutes after induction of anesthesia and 1, 3, 5 and 10 minutes after intubation. (P> 0.05). But there were significant differences between the two groups in relation to heart rate at 1 and 3 minutes after intubation, so that heart rate at these times was significantly higher in the intubation group than in the laryngeal airway mask group (P <0.05). Based on the findings of this study, use of thiopental sodium midazolam combination was effective and safe and attenuated the stress response to airway management with resultant minimal changes in the heart rate and blood pressure.

Painful stimulation during laryngoscopy and endotracheal intubation results in increased hemodynamic side effects. The aim of current study was to compare the effects of intranasal dexmedetomidine and remifentanil on reduction of hemodynamic changes following endotracheal intubation in children undergoing general anesthesia. A double-blind clinical trial was performed in 104 children aged 6-12 years old, undergoing general anesthesia in Isfahan Imam Hossein Hospital, Iran, 2017-2018. Patients were randomly assigned into three groups to receive intranasal (IN) remifentanil 4µg/kg, dexmedetomidine 2µg/kg (IN), or normal saline 1mL, 0.9% (IN) before the induction of anesthesia. Hemodynamic changes were recorded at one and five minutes following intubation. ANOVA and Chi-square were applied to analyze the data. Heart rate was higher in patients receiving normal saline and lower in patients
receiving dexmedetomidine (p=0.22). Mean arterial blood pressure (p=0.98) and arterial oxygenation (p=0.81) were not significantly different between the three groups. No significant side effects were observed in any group. Administration of pre-intubation intranasal dexmedetomidine, results in heart rate stabilization following intubation.

Postoperative coughing and hoarseness are two of the most common complications occur following endotracheal intubation and pharyngitis, laryngitis, and tracheitis. Eucalyptus lozenges are used in the treatment of many sign of common colds, such as cough, sore throat, etc. Therefore, the aim of this research was to study the effect of sucking Eucalyptus lozenges on coughing and hoarseness following endotracheal intubation in patients undergoing orthopedic surgery under general anesthesia. In this clinical trial study, 134 patients undergoing orthopedic surgery under general anesthesia were selected using convenience sampling method, and were allocated into two equal groups of control and intervention via random assignment method. Following obtaining informed consent, half an hour before surgery and in intervals of six hours after the surgery, eucalyptus lozenges were administered to intervention group. Postoperative coughing and hoarseness were measured 2, 6, 12, and 24 hours following endotracheal intubation using coughing and hoarseness checklists. Data were analyzed using descriptive statistics, Fisher's exact, chi-square, and t test, and generalized estimating equation (GEE) measures in SPSS software. P values of less than 0.05 were considered significant. Findings: The severity of coughing (P = 0.004) and hoarseness (P < 0.001) during the time were significantly less in the intervention group compared to the control group. Eucalyptus lozenges are effective in reducing coughing and hoarseness caused by endotracheal intubation in patients undergoing orthopedic surgery under general anesthesia.

Tracheal intubation is an essential procedure during general anesthesia which may cons hemodynamic conditions to become unstable (high blood pressure, tachycardia increased pulmonary capillary wedge pressure & etc…) Magnesium sulfate could decrease catechol amine release from adrenal gland therefore could potentially decrease the side effects of tracheal intubation.
In this double blinded RCT, 50 patients candidate for non obstetric gynecologic abdominal surgery were randomly allocated into two groups of each 25 patients in case group, patients recieve 20mg/kg magnesium sulfate derag imin before infusion and control group recieve iv saline as some volume. Hemodynamic values were scored before induction and 1,5,10 and 15 minutes after intubation for all patients collected data were analyzed using SPSS ver. 18 and proper statistical tests.
Mean recovery time was 4f.92±6.7 min and 51.64±5.2 in control & case groups respectively study showed that mean hr before induction mean systolic BP before induction, on 1st minute and is minutes after intubation, mean diastolic BP in 1st minute, and mean arterial pressure (MAP) in all times except intubation time, mean spo2 in 5th minute and mean recovery time was statistically meaningful.
The mean of three values of systolic, diastolic & mean BP were statistically meaning in all times. Based on the findings of the study, low dose infusion of magnesium sulfate could increase cardiovascular response and recovery time after tracheal intubation

Aim and Tracheal intubation remains the choice method for keeping airways open during mechanical ventilation. Among the various methods, standard method of direct laryngoscopy generally used by non-skilled staff increases the risk of failure. This study was performed to evaluate and compare the results of tracheal intubation using laryngeal masks vs. glidescope led by novice personnel.
Methods and Materials: This descriptive-prospective study were conducted on 31 trainees and interns of Birjand University of Medical Sciences. Each of the participants randomly intubated two patient with laryngeal mask airway or glidescope, and the results were recorded a professional as observer. The maximum authorized turn to try tracheal intubation was once per person with a time limit of 90 seconds. If the participant had two unsuccessful tries or due to a problem regarding the intubation process an anesthesiologist took the control and performed the intubation and the intubation try by the study participant was considered unsuccessful.
Findings: Tracheal intubation success rate in laryngoscopic and laryngeal mask airway )LMA( was 90.3% and 96.8%, respectively )P=0.325(. Average time of tracheal intubation in laryngeal mask airway and laryngoscopy group was 29.25 ± 3.90 and 48.25 ± 4.90 )P

The main aim of this study was to compare the effect of labetalol and remifentanil on blood pressure and heart rate after laryngoscopy and intubation in comparison with the control group.
In a clinical trial study, 105 patients scheduled for surgery were randomly assigned to three groups receiving 1 mg/kg of labetalol, 1 µg/kg remifentanil, or the same amount of normal saline. Hemodynamic parameters were measured and compared.
Findings: The incidence of bradycardia in groups receiving labetalol, remifentanil and control was 28.6%, 22.9% and 5.7%, respectively, and the difference between three groups was significant (P = 0.040). In contrast, the incidence of tachycardia in the three groups was 2.9%, 5.7% and 28.6%, respectively, and significant difference was observed between the groups (P = 0.002). The prevalence of hypotension in the three groups was 22.9%, 14.3% and 2.9%, respectively, and there were significant differences among them (P = 0.047). The prevalence of hypertension in the three groups was 6.3%, 18.8% and 34.3%, respectively, and the difference between the groups was significant (P = 0.001).
Based on the results of the present study, intravenous administration of 1 mg/kg labetalol in patients under laryngoscopy tends to more favorable hemodynamic stability and less hemodynamic imparements compared to remifentanil; using this dose before the laryngoscopy is more favorable.

Most cause of difficult intubation are anatomically disorders such as micrognathia, head and neck deformities, cervical spine disorders .Most of post-anesthetic harmful complications are due to airway management problems and hypoxemia. Therefore one of the most important points in the airway management is the appropriate selection of safe policy.
In this study we introduce a 79 – years old man, who was candidate for elective endoscopic dacriocystorhinostomy. He had congenital spastic torticollis. Finally we did successful awake fiberoptic-guided tracheal intubation with sedation.
In neck deformities and torticollis which airway anatomy is distorted, it seems reasonable to intubate trachea with sedation and preservation of spontaneous breathing by fiberoptic broncoscope.

Case report: Severe burn injuries are associated with significant pathologic changes in nearly all of organ systems، among them are facial and airway injuries. Thus، one of the important points is airway management in head and facial burn injuries which lead to difficult or impossible tracheal intubation in these patients. In this study we introduce a 37 year-old man، who was burned with electricity and had contracture injuries in his face، hands، and circumorally. He was candidate for reconstructive lid surgery 84 days post-burn. Because of severe restriction in the mouth opening we intubated him Trans nasally with preservation of spontaneous breathing. In circumoral post burn injuries with restriction in mouth opening، it seems reasonable to intubate trachea with preservation of spontaneous breathing and extreme caution when using drugs; especially when flexible fiberoptic bronchoscope is not available. In these situations، nasal tracheal intubation with head and neck movement by Glidescope could be useful as an alternative.

Tracheal intubation is one of the most essential skills employed by all healthcare providers, nevertheless novice intubators turn out to be less successful when they initially perform the intubation. Video- laryngoscopes (GlideScopes) are novel instruments able to increase the success rate of tracheal intubation training. The aim of this study was to compare the success rate of tracheal intubation following training with GlideScope and training with Macintosh laryngoscope. In this quasi-experimental study, a total of 30 semester-three anesthetics students of Zanjan Nursing School with no intubation skill served as participants of this study. They were assigned into two 15-person groups using convenience sampling after theoretical teaching and training on manikin. Next, they were trained to perform tracheal intubation on patients using GlideScope in one group and Macintosh laryngoscope in the other group. Then, the success rate and intubation time of 10 intubation trials done by each student were measured, recorded and analyzed through T-Test, X2 and ANOVA. The success rate and the mean time of intubation after ten times of intubation were 86.7% and 18.14sec and 60% and 19.46sec in the GlideScope and Macintosh groups respectively. The success rates of intubation from the first one to the tenth one were higher in GlideScope group than those of Macintosh group. (p<0.05) The finding indicated that tracheal intubation training with GlideScope, compared to this training with laryngoscope improves the success rate and intubation time more significantly, thus training of students and all healthcare providers using these novel instruments is strongly recommended.

Fiberoptic endotracheal intubation is a professional procedure in anesthesiology and recommended for patients with unstable cervical spines or difficult airways، and could be done with the aid of facilitating maneuvers and combination of techniques. In this study، we compare jaw thrust maneuver and transillumination in oral intubation with flexible fiberoptic laryngoscope. Materials and methodes: 91 patients candidated for elective surgeries were divided in 3 groups. After induction in similar way، they were intubated with flexible fiberoptic laryngoscope. We used jaw thrust and tongue traction maneuver in group one، transillumunation with inspection through bronchoscope in group two and the last group was intubated using transillumunation without inspection. Intubation time was calculated from insertion of bronchoscope in the mouth until the end of intubation and connecting the capnograph to tracheal tube. Hemodynamic responses such as systolic pressures، diastolic pressures، the MAP and heart rate before and after induction and every minute for 5 minutes were recorded.

Mean duration time in third group are smaller than the others، but is not different between group one and two. Mean of all hemodynamic parameters decreased during a period of time، similarly in the group.

According to shorter duration of time with similar hemodynamic responses in transillumination technique، this maneuver can be considered as an alternative technique in fiberoptic intubation.

During menstural cycle in the follicular and lutheal phases arise multiple hormonal physiological and psychological changes. These alterations could change analgesics and anesthetics requirements. Preceding studies have marked the correlation between increased proges-terone level and hypersensitivity to pain. This study aimed to evaluate the effect of various phases of the menstural cycle on the hemodynamic response to laryngoscopy and tracheal intubation

This cross sectional study was performed on 68 patients. They were candidated for an elective head and neck surgery under general anesthesia with endotracheal intubation in Amir – Al – Momenin academic hospital in Rasht during 1390- 91. On the basis of the phase of the menstural cycle patients were divided into two groups follicular (5to 15th days) and lutheal (15 to 28 th days). Anesthesia protocol was similar in all patients. Heart rate، Systolic، Diastolic، Mean Arterial BP and Rate Pressure Product were measured in the baseline، immediately after intubation، 2 and 5 minutes after orotracheal intubation and the results were compared.

Age، ASA class and BMI were not significantly meaningful in two groups. The course of HR، SBP، DBP، MAP، RPP changes were considered which were not significantly statistically meaningfull.

This study defined that hemodynamic changes in response to laryngoscopy and intubations in follicular and lutheal phases were not significantly statistically meaningful.

Hormonal, physical, and psychological fluctuations occur during the menstrual cycle. Previous studies have shown that hormonal changes during the normal menstrual cycle affect anesthesia and analgesia. The limitation of previous studies are that they did not measure luteal hormone (LH), Follicular stimulating hormone (FSH), estradiol, progesterone and cortisol levels. Our goal was to find more suitable conditions in menstrual periods for intubation of patient. American Society of Anesthesiologists physical status I patients, 16 to 40 years, undergoing general anesthesia for elective surgery were enrolled in this study and conducted at Imam Khomeini Medical Center in 2013. The patients were assigned into two groups according to the phase of their menstrual cycle. Levels of sex hormones and hemodynamic variables were recorded for all the patients and statistical analysis performed. In 77 patients, 38 women were in the luteal phase (49.4%) and 39 women were in the follicular phase (50.6%). All tracheal intubations were successful on the first attempt with a mean duration of 2558±5.07 and 25.84±5.32 seconds in groups F and L, respectively (P=0.489). None of the patients were excluded for long tracheal intubation time. Systolic blood pressure after intubation in the follicular phase (138.4±20 mm Hg) was significantly higher vs. the luteal phase (127.7±18 mm Hg) (P<0.01), as well as the women’s heart rate after intubation in the luteal phase (90.7±12 beats per minute), was significantly higher than in the follicular phase (85.3±11 beats per minute) (P=0.05). Heart rate was higher in the luteal group than the follicular group thus the women’s heart rate after intubation in the luteal phase (90.7±12 bpm) was significantly greater than the follicular phase (85.3±11 bpm) (P=0.05). Reviewing and comparing the results show that elective surgeries are bet-ter to be done in the luteal phase because of stable hemodynamic conditions.

Background and Administration of high dose of remifentanil and propofol provides adequate coditions for tracheal intubation without musclerelaxants. Intubating conditions with meperidine, propofol and low doses of remifentanilcompared in this study. After premedication withmidazolam 0.03 mg/kg and meperidine1mg/kg, 60 patients under orthopedic surgeryrandomized equally to one of two study groups, each receiving the following: remifentanil 1 (Group I) or 1.5 µg/kg (Group II). remifentanilwas injected, anesthesia was induced withpropofol 2mg/kg. Ninety seconds after the administration of propofol, laryngoscopy and intubation were attemped. Intubation conditions were assessed as excellent,good or poor to ease of laryngoscopy, vocal cord position, coughing and jaw relaxation. There were no significant differences in the assessments of intubating conditions between the two groups(P=0.56). Compared with the baseline levels, the decrease in mean arterial pressure and heart rate were significant in two groups after anesthetic induction and endotracheal intubation(P<0.001). No patient needed treatment for hypotention or bradycardia. Our results show that meperidine, low doses of remifentanyl(1-1.5µg/kg) and propofol provided excellent or good conditions for tracheal intubation in healthy patients.

Tracheal intubation is an essential and critical technique in emergency and operating rooms، where the lack of proper treatment (esophageal intubation) can be catastrophic. In this study، we compared an esophageal detector device (EDD) with a capnograph (EtCo2) for verifying tracheal tube placement. After the approval and support of the Research Council of Mashhad University of Medical Sciences، In this single-subject prospective study، 114 patients who were candidates for general or orthopedic surgery were enrolled. After anesthesia and tracheal intubation، tube position was first assessed by EDD (suction bulb type)، followed by evaluation using an EtCo2 monitor. Data was analyzed with SPSS v16، McNemar’s، chi-square، and t-tests. Sensitivity، specificity، and positive and negative predictive values were evaluated. P<0. 05 was considered as the level of significace. In total، 114 patients underwent 124 intubation attempts due to several difficult esophageal intubations. Sensitivity and positive predictive values for EtCo2 were 100% and for EDD was 98. 2% and 95. 6%، respectively. Therefore، capnography was a more reliable method for verifying endotracheal tube placement (P=0. 016). Capnography is the gold standard for recognition of tube position. EDD was less successful (sensitivity=98. 2% vs 100%) for elective situations، but it provides rapid recognition and high sensitivity for verifying the tracheal tube position، particularly in cases of emergency and cardiac arrest. Because of high sensitivity and positive predictive value، EDD can be used for tube position recognition if necessary، but EtCo2 monitor is more accurate and reliable.