Blind Intubation Research Articles

ANAESTHESIA IN UPPER RESPIRATORY OBSTRUCTION

The causes of upper respiratory obstruction are reviewed. The symptoms and signs are graded according to severity. It is stressed that cyanosis indicates very severe obstruction, and that stridor at rest is a very informative local sign of severe obstruction. In severe obstruction respiratory depressant drugs and atropine are contraindicated while helium may be helpful. When general anaesthesia is necessary in severely obstructed patients, the obstruction may first be bypassed by nasotracheal or orotracheal intubation, tracheostomy or bronchoscopy. Each of these can be performed with local anaesthesia. The value of blind nasal intubation in the conscious patient cannot be over-stressed. When tracheostomy is indicated it should be done early, as an elective procedure.

A Method of Blind Nasal Intubation for the Conscious Patient

A Method of Blind Nasal Intubation for the Conscious Patient

Tobacco bronchitis; an anesthesiologic study.

Excerpt Bronchitis is a recognized hazard in anesthesia and surgery because coughing and tracheobronchial hyperirritability and hypersecretion predispose the patient to the following complications:...

Blind Intubation

AnaesthesiaVolume 7, Issue 2 p. 118-118 Free Access Blind Intubation W. M. Brown, Search for more papers by this author W. M. Brown, Search for more papers by this author First published: April 1952 https://doi.org/10.1111/j.1365-2044.1952.tb01441.xCitations: 2AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume7, Issue2April 1952Pages 118-118 ReferencesRelatedInformation

Endotracheal catheter gun.

WITH THE development of thoracic medicine and surgery in the past decades, the desirability of tracheobronchial catheterization has become ever more frequent. Whereas in the beginning it was seldom used except for the introduction of lipiodal into the tracheobronchial tree, the procedure, in one form or another, can be adapted in a multitude of ways in modern diagnosis and treatment. One point that is of interest to an endoscopist is the apparent difficulty which many members of the profession have in getting the catheter into the trachea. Even among endoscopists themselves, the various methods of introduction of such a catheter run a gamut of instrumentation from blind intubation to the use of the more complicated laryngoscopes and bronchoscopes.

Cyclopropane anesthetic, for oral surgery with nasoendotracheal intubation

Cyclopropane fulfills all the requirements of an anesthetic agent for oropharyngeal surgery. It has a potency sufficient to carry anesthesia to a plane deep enough for relaxation of intrinsic and extrinsic muscles of the larynx with depression of reflexes. There is no anoxia or hypoxia because of an increase of 55 per cent oxygen above other gas anesthetics. The previously mentioned properties of the anesthetic agent, combined with the skill of the anesthetist, permit establishment of a controlled airway throughout the operation. The danger of aspirating foreign bodies is considerably lessened, and the anesthetist's equipment is out of the surgeon's field of operation. It has been shown through careful study and preparation of the structures involving the pharynx and larynx that a blind intubation may be successfully accomplished without trauma. The procedure for endotracheal intubation takes less than two minutes and not more than five. A rapid and pleasant induction is ensured. An established airway is maintained through adequate relaxation of the muscles.

Blind Intubation and the Signs of Anaesthesia.

No other journal can match Anesthesia & Analgesia for its original and significant contributions to the anesthesiology field. Each monthly issue features peer-reviewed articles reporting on the latest advances in drugs, preoperative preparation, patient monitoring, pain management, pathophysiology, and many other timely topics. Backed by internationally-known authorities who serve on the Editorial Board and as Section Editors, Anesthesia &Analgesia is your gateway to everything that is happening in anesthesia and 14 related subspecialties: Analgesia; Ambulatory Anesthesia; Anesthetic Pharmacology; Cardiovascular Anesthesia; Critical Care and Trauma; Economics, Education, and Policy; Neurosurgical Anesthesia; Obstetric Anesthesia; Pain Mechanisms; Pain Medicine; Pediatric Anesthesia; Regional Anesthesia; Patient Safety; and Technology, Computing and Simulation.

Anæsthesia in Chest Surgery, with Special Reference to Controlled Respiration and Cyclopropane

Problems in chest surgery: Cases with prolonged toxæmia or amyloid disease require an anæsthetic agent of low toxicity. When sputum or blood are present in the tracheobronchial tree the anæsthesia should abolish reflex distrubances and excessive sputum be removed by suction. The technique should permit the use of a high oxygen atmosphere; controlled respiration with cyclopropane or ether fulfil these requirements. Open pneumothorax is present when a wound of the chest wall allows air to pass in and out of the pleural cavity. The lung on the affected side collapses and the mediastinum moves over and partly compresses the other lung.The dangers of an open pneumothorax: (1) Paradoxical respiration-the lung on the affected side partially inflates on expiration and collapses on inspiration. Part of the air entering the good lung has been shuttled back from the lung on the affected side and is therefore vitiated. Full expansion of the sound lung is handicapped by the initial displacement of the mediastinum which increases on inspiration. The circulation becomes embarrassed.(2) Vicious circle coughing. During a paroxysm of coughing dyspnœa will occur. This accentuates paradoxical respiration and starts a vicious circle. Death from asphyxia may result.Special duties of the anæsthetist: (1) To carry out or supervise continuous circulatory resuscitation. During a thoracotomy a drip blood transfusion maintains normal blood-pressure and pulse-rate.(2) To maintain effcient respiration.Positive pressure anæsthesia: Risk of impacting secretions in smaller bronchi with subsequent atelectasis; eventual risk of CO(2) poisoning without premonitory signs.Controlled respiration: (1) How it is produced. (2) Its uses in chest surgery.Controlled respiration means that the anæsthetist, having abolished the active respiratory efforts of the patient, maintains an efficient tidal exchange by rhythmic squeezing of the breathing bag. This may be done mechanically by Crafoord's modification of Frenkner's spiropulsator or by hand.Active respiration will cease (i) if the patient's CO(2) is lowered sufficiently by hyperventilation, (ii) if the patient's respiratory centre is depressed sufficiently by sedative and anæsthetic drugs, and (iii) by a combination of (i) and (ii) of less degree.The author uses the second method, depressing the respiratory centre with omnoponscopolamine, pentothal sodium, and then cycloprȯpane. The CO(2) absorption method is essential for this technique, and this and controlled respiration should be mastered by the anæsthetist with a familiar agent and used at first only in uncomplicated cases.The significance of cardiac arrhythmias occuring with cyclopropane is discussed.The place of the other available anæsthetic agents is discussed particularly on the advisability of using local anæsthesia for the drainage of empyema or lung abscess.Pharyngeal airway or endotracheal tube? Anæsthesia may be maintained with a pharyngeal airway in many cases but intubation must be used when tracheobronchial suction may be necessary and when there may be difficulty in maintaining an unobstructed airway.A one-lung anæsthesia is ideal for pneumonectomy. This may be obtained by endotracheal anæsthesia after bronchial tamponage of the affected side (Crafoord, v. fig. 6b) or by an endobronchial intubation of the sound side (v. figs. 9b and 9c). Endobronchial placing of the breathing tube may be performed "blind". Before deciding on blind bronchial intubation, the anæsthetist must examine X-ray films for any abnormality deviating the trachea or bronchi. Though the right bronchus may be easily intubated blindly as a rule, there is the risk of occluding the orifice of the upper lobe bronchus (fig. 9d) when the patient will become cyanosed. If the tube bevel is facing its orifice the risk of occlusion will be decreased (fig. 9c).Greater accuracy in placing the tube can be effected by inserting it under direct vision. Instruments for performing this manœuvre are described.In lobectomy for bronchiectasis the anæsthetist must try to prevent the spread of infection to other parts. Ideally, the bronchus of the affected lobe should be plugged with ribbon gauze (Crafoord, v. fig. 6c) or a suction catheter with a baby balloon on it placed in the affected bronchus. In the presence of a large bronchopleural fistula controlled respiration cannot be established during operation. As the surgeon is rarely able to plug the fistula, if pneumonectomy is to be performed intubation for a one-lung anæsthesia is the best method. During other procedures it is essential to maintain quiet respiration.In war casualties it is almost always possible, with the technique described, to leave the lung on the affected side fully expanded and thus frequently to restore normal respiratory physiology. Co-operation between surgeon and anæsthetist is essential.