Effects Of Tracheal Intubation Research Articles

Effect of tracheal intubation on postoperative complications in patients with pulmonary hypertension combined with non-cardiothoracic, non-obstetric surgery.

Endotracheal intubation can be associated with certain complications in certain group of patients. However, the relationship between endotracheal intubation and postoperative complications is unclear in patients with pulmonary hypertension (PHTN). This study evaluated the relationship between endotracheal intubation and postoperative complications in non-cardiothoracic and non-obstetric surgery patients with PHTN. A secondhand analysis of non-cardiothoracic, non-obstetric procedures was performed on patients with PHTN between 2007 and 2013 in a hospital at the University of Washington. Multivariable logistic regression analyses were used to calculate the adjusted odds ratios to estimate the association between anesthesia and 30-day postoperative complications. Interaction and stratified analyses were conducted according to the American Society of Anesthesiologists score (ASA), smoking, hypertension, and open surgical approach. A total of 573 patients were included in this study, and the mean age was 60.3; 54% were male. In a multivariate regression model for patients with non-cardiothoracic, non-obstetric surgery combined with PHTN, the risk of 30-day postoperative complications was higher in the tracheal intubation group than in patients with non-intubated anesthesia after adjusting for potential covariates (adjusted odds ratio = 2.47; 95% CI, 1.28-4.78). However, there was no significant difference in postoperative mortality between these groups. Statistical analysis showed no interaction between the variables of tracheal intubation and 30-day postoperative complications. In this study, we found that tracheal intubation anesthesia is associated with increased risk of 30-day postoperative complications in PHTN patients undergoing non-cardiothoracic, non-obstetric surgery. Further studies are needed to confirm our findings.

INTUBATING CONDITIONS: PROPOFOL WITH MUSCLE RELAXSANT AND PROFOFOL WITHOUT MUSCLE RELAXANT A STUDY IN TERTIARY CARE CENTRE

Introduction: Neuromuscular blocking drugs, particularly Succinylcholine, may cause serious side effects, but remain in clinical use to facilitate tracheal intubation due to a lack of suitable alternatives. Recent studies have suggested that propofol provides good intubating conditions without muscle relaxants, due to its relaxing action on upper air way.. A search for better and ideal intravenous induction agent has led to propofol, a 2, 6, di-isopropyl phenol which was developed following a series of investigations. Propofol reduces hypertension and tachycardia during intubation. The changes in blood pressure observed are due to both decrease in cardiac output and decrease in systemic vascular resistance. Increasing the depth of anaesthesia by administering supplementary increments of induction agent, opioids or lignocaine may improve conditions. These techniques also protect against the potentially adverse effects of tracheal intubation namely systemic, intra-cranial and intra-ocular hypertensions and tachycardia.
 Material and Methods: The study comprised of 100 adult patients of ASA grade I & II of either sex belonging to the age group of 18-60 years, drawn from various surgical specialties and undergoing surgery under general anaesthesia. Thorough pre anesthetic checkup was carried out in all patients and informed consent for surgery and general anesthesia was obtained. Routine investigations were carried out in all patients. 100 patients were randomly divided into two groups of 50 patients each.
 Results: Youngest patient was of 18 years in group I and 20years in group II. Eldest patient was of 59 years in group I and 60 years in group II. Maximum number of patients were in 20-30 years of age group. The pre induction mean pulse rate (base line) was 101.04±11.78 and 102.36±15.14 in group I and group II respectively. There was slight decrease in pulse rate initially after induction with mean 98.23±13.87 and 97.31±12.60 in group I and group II respectively. The pre induction mean arterial pressure (MAP) (baseline) was 91.47±7.64 and 92.45±9.21in group I and group II respectively. There was slight decrease in arterial pressure initially after induction with mean 80.48±6.29and 83.31±8.41in group I and group II respectively, but the difference was not statistically significant (P>0.05) from the baseline values. There was slight increase in mean arterial pressure just after intubation with mean 93.10±8.47 and 94.58±9.33 in group I and group II respectively, which was not statistically significant (p>0.05).
 Conclusion: In healthy adults, with normal airway, propofol 2.5mg/kg when used alone as inducing agent without the use of any neuromuscular blocking agents produced acceptable intubating conditions, when compared to propofol, 2.5mg/kg along with succinylcholine. It was also demonstrated that there was no significant cardiovascular changes when intubation was done without relaxant after induction with propofol.
 Keywords: Neuromuscular blocking drugs, cardiovascular, propofol

Effects of tracheal intubation and tracheal tube position on regional lung ventilation: an observational study.

Anaesthesia and positive pressure ventilation cause ventral redistribution of regional ventilation, potentially caused by the tracheal tube. We used electrical impedance tomography to map regional ventilation during anaesthesia in 10 patients with and without a tracheal tube. We recorded impedance data in subjects who were awake, during bag-mask ventilation, with the tracheal tube positioned normally, rotated 90° to each side and advanced until in an endobronchial position. We recorded the following measurements: ventilation of the right lung (proportion, %); centre of ventilation (100%=entirely ventral); global inhomogeneity (0%=homogenous); and regional ventilation delay, an index of temporal heterogeneity. We compared the results using Student's t-tests. Relative to subjects who were awake, anaesthesia with bag-mask ventilation reduced right-sided ventilation by 5.6% (p=0.002), reduced regional ventilation delay by 1.6% (p=0.025), and moved the centre of ventilation ventrally from 51.4% to 58.2% (p=0.0001). Tracheal tube ventilation caused a further centre of ventilation increase of 1.3% (p=0.009). With the tube near the carina, right-sided ventilation increased by 3.2% (p=0.031) and regional ventilation delay by 2.8% (p=0.049). Tube rotation caused a 1.6% increase in right-sided ventilation compared with normal position (p=0.043 left and p=0.031 right). Global inhomogeneity remained mostly unchanged. Ventral ventilation with positive pressure ventilation occurred with bag-mask ventilation, but was exacerbated by a tracheal tube. Tube position influenced ventilation of the right and left lungs, while ventilation overall remained homogenous. Tube rotation in either direction resulted in ventilation patterns being closer to when awake than either bag-mask ventilation or a normally positioned tube. These results suggest that even ideal tube positioning cannot avoid the ventral shift in ventilation.

COMPARISON OF INTUBATING CONDITIONS, FOLLOWING PROPOFOL WITH MUSCLE RELAXSANT AND PROFOFOL WITHOUT MUSCLE RELAXANT

Introduction: After induction of anaesthesia, tracheal intubation is usually facilitated by the use of muscle relaxants. Neuromuscular blocking drugs, particularly Succinylcholine, may cause serious side effects, but remain in clinical use to facilitate tracheal intubation due to a lack of suitable alternatives. Recent studies have suggested that propofol provides good intubating conditions without muscle relaxants, due to its relaxing action on upper air way. A search for better and ideal intravenous induction agent has led to propofol, a 2, 6, di-isopropyl phenol which was developed following a series of investigations. Propofol reduces hypertension and tachycardia during intubation. The changes in blood pressure observed are due to both decrease in cardiac output and decrease in systemic vascular resistance. Increasing the depth of anaesthesia by administering supplementary increments of induction agent, opioids or lignocaine may improve conditions. These techniques also protect against the potentially adverse effects of tracheal intubation namely systemic, intra-cranial and intra-ocular hypertensions and tachycardia.
 Material and Methods: 50 patients were randomly divided into two groups of 25 patients each. Group I: 2.5 mg/kg body weight of propofol injected slowly over 20 seconds. Group II: 2.5 mg/kg body weight of propofol injected slowly over 20 seconds. After loss of eye lash reflex, induction time was noted with stop watch and then injection succinylcholine 2mg/kg body weight was injected. Patients were monitored throughout the operation E.C.G. using cardiac monitor on lead II, PaO2 with Pulse Oxymeter. Pulse and blood pressure were recorded.
 Results: Youngest patient was of 20 years in group I and 22 years in group II. Eldest patient was of 56 years in group I and 60 years in group II. Maximum number of patients were in 20-30 years of age 15 (60%) in group I and 11 (44%) in group II. Excellent intubating conditions were seen in 15 (60%) patients of group I and 25 (100%) patients of group II. The pre induction mean pulse rate (base line) was 103.04±13.08 and 104.56±17.14 in group I and group II respectively. There was slight decrease in pulse rate initially after induction with mean 99.92±13.87 and 98.32±14.60 in group I and group II respectively, but the difference was not statistically significant from the baseline values. (p>0.05). There was slight decrease in arterial pressure initially after induction with mean 80.88 ±6.59 and 85.31±8.71 in group I and group II respectively, but the difference was not statistically significant (P>0.05) from the baseline values. There was slight increase in mean arterial pressure just after intubation with mean 94.10 ±8.07 and 95.58±9.46 in group I and group II respectively, which was not statistically significant (p>0.05). These changes in M.A.P. values return to baseline values 5 minutes after intubation.
 Conclusion: Propofol 2.5mg/kg when used alone as inducing agent without the aid of any neuromuscular blocking agents produced acceptable intubating conditions, when compared to propofol, 2.5mg/kg along with succinylcholine. It was shown that there were no significant cardiovascular changes when intubation was done without relaxant after induction with propofol.

Effects of tracheal intubation without muscle relaxants on postoperative recovery conditions in patients with obstructive sleep apnea: A double-blind randomized controlled study

Aim: We aimed to compare intubation with and without neuromuscular blocking agents with regard to intubation success, hemodynamic parameters, and postoperative recovery in Obstructive sleep apnea patients.Materials and Methods: The study included 60 patients with a STOP-Bang (Snoring, Tiredness during daytime, Observed apnea, high blood Pressure, Body mass index, Age, Neck circumference, Gender) score of ≥3. The patients were randomly divided into two groups: (I) rocuronium group (Group E) and (II) remifentanil group (Group R). Group R received 4 mcg/kg remifentanil and Group E received 0.6 mg/kg rocuronium and then the patients’ intubation difficulty scale scores and their responses to train-of-four (TOF) nerve stimulation, and postoperative recovery were evaluated in both groups.Results: The median time to recovery of the TOF ratio to 0 following anesthetic induction was significantly higher in Group R compared to Group E (p0.001). The overall incidences of postoperative sore throat and hoarseness were remarkably high (p0.002 and p0.001, respectively). The numbers of patients with relaxed vocal cords and complete jaw relaxation were significantly higher in Group E compared to Group R (p0.001). Conclusion: The results indicated that rocuronium provides better intubation conditions and leads to less peri- and post-operative complications compared to remifentanil.Keywords: Obstructive sleep apnea syndrome; intubation without muscle relaxants; postoperative recovery; stop bang tracheal intubation.

Lidocaine: analysis of the intravenous use to mitigate the cardiovascular reflexes of laryngoscopy and tracheal intubation

Lidocaine is a local anesthetic of the amino amide type, with antiarrhythmic, analgesic, sedative and anti-inflammatoryactions actions. Because of such effects, intravenous lidocaine is widely used to mitigate the cardiovascular effects of tracheal intubation, which can lead to marked changes in blood pressure (BP) and heart rate (HR). These undesirable hemodynamic changes may increase per and postoperative morbidity and mortality. The lidocaine used intravenously was effective in attenuating cardiovascular reflexes from tracheal intubation, at all ages. It was effective in preventing the increase in HR, except in children, and systolic, diastolic and mean blood pressure in all age groups. There was a decrease in the incidence of arrhythmias and ECG changes at a dose of 1.5 mg/kg.

The effect of tracheal intubation with the McCoy or Macintosh laryngoscope on the blood pressure and heart rate during propofol-remifentanil induction.

This study was designed to compare the hemodynamic changes in response to direct laryngoscopy with using the McCoy or Macintosh blade. Seventy seven patients were randomly allocated into two groups. The induction of anesthesia was done with target controlled infusion of propofol (5 microgram/ml) and remifentanil (3 ng/ml) and vecuronium 0.1 mg/kg was also given. The vocal cords were visualized with either the McCoy or the Macintosh laryngoscope blade, and then tracheal intubation was performed. The heart rate and blood pressure were measured just before induction, at intubation and at 1, 3 and 5 minutes after intubation. There were no significant differences in the blood pressure and heart rate responses to tracheal intubation with using the McCoy or Macintosh blade. But, in the Macintosh groups, the blood pressure at 1 and 3 minutes and the heart rate at 1 minute after intubation were increased significantly compared with the preintubation values. Also, in the McCoy groups, the blood pressure and heart rate at 1 minute after intubation were significantly higher than the preintubation values. The McCoy and the Macintosh blade show similar changes in heart rate and blood pressure after tracheal intuba tion.

Haemodynamic effects of thoracic epidural anaesthesia during induction of anaesthesia: an investigation into the effects of tracheal intubation during target‐controlled infusion of propofol*

We compared haemodynamic changes following induction of anaesthesia with propofol during tracheal intubation with and without epidural anaesthesia. Nineteen patients were divided into two groups to receive epidurally administered saline (Group C) or lidocaine 1.5% (Group E). The propofol infusion was started to produce blood concentrations of 3 microg.ml(-1), and following fentanyl and vecuronium administration, tracheal intubation was performed. Mean arterial blood pressure (MBP), heart rate (HR), Bispectral index and effect-site propofol concentration were recorded. Time to loss of consciousness was significantly shorter in Group E than in Group C. The effect-site propofol concentration at loss of consciousness was significantly lower in Group E than in Group C. MBP and HR were significantly lower following propofol induction in both groups, and were significantly increased following intubation in Group C but not in Group E. In conclusion, epidural anaesthesia did not produce profound hypotension following induction of anaesthesia and produced a reduction in the haemodynamic response to tracheal intubation during a target controlled infusion of propofol.

Parathyroid Hormone Response to Tracheal Intubation in Hyperparathyroid Patients and Normal Subjects

The stress of direct laryngoscopy and passing an endotracheal tube through the vocal cords elicits haemodynamic, metabolic and hormonal changes such as raising blood catecholamine levels. Catecholamines are known stimulants of PTH secretion. The effect of tracheal intubation on plasma parathyroid hormone levels has not yet been investigated. We monitored changes in plasma parathyroid hormone levels before and after tracheal intubation in 72 hyperparathyroid patients undergoing elective parathyroidectomy for primary and secondary hyperparathyroidism. These findings were compared to data collected from 20 subjects who underwent elective surgery (thyroidectomy or laparoscopic cholecystectomy) under general anesthesia. In the control group, tracheal intubation significantly increased plasma parathyroid hormone levels from 59 +/- 31 pg/ml to 91 +/- 40 pg/ml (mean +/- SD) (p<0.0003). In primary hyperparathyroid patients, the identical procedure increased plasma parathyroid hormone levels from 206 +/- 104 pg/ml to 217 +/- 113 pg/ml (p = 0.12) and from 898 +/- 495 pg/ml to 1162 +/- 613 pg/ml (p = 0.07) in secondary hyperparathyroidism patients. We concluded that tracheal intubation raises plasma parathyroid hormone levels. The mechanism underlying this response requires further investigation.

Heartstart Scotland: the use of paramedic skills in out of hospital resuscitation

ObjectiveTo assess the frequency with which paramedic skills were used in out of hospital cardiac arrest and the effect of tracheal intubation on outcome.DesignRetrospective analysis of ambulance service reports and...

The Effects of Tracheal Intubation with McCoy or Macintosh Laryngoscope on Blood Pressure, Heart Rate

The Effects of Tracheal Intubation with McCoy or Macintosh Laryngoscope on Blood Pressure, Heart Rate

Cardiovascular effects of forces applied during laryngoscopy. The importance of tracheal intubation.

The relationship between the forces applied during laryngoscopy and cardiovascular changes were studied in patients undergoing laryngoscopy with or without intubation. This enabled us to differentiate between the cardiovascular effects of laryngoscopy and the effects of tracheal intubation. The forces applied during laryngoscopy were only weakly related to the cardiovascular changes, whereas tracheal intubation had a major influence. The many difficulties encountered in interpreting results from these studies are discussed. It is concluded that tracheal intubation causes more cardiovascular changes than laryngoscopy in routine uncomplicated procedures.

Changes in coagulation and fibrinolytic activity associated with tracheal intubation.

This study was carried out to clarify the effect of tracheal intubation on the coagulation and fibrinolytic system. It was performed on 20 patients (ASA class 1-2) undergoing elective surgery. Before and after tracheal intubation, hemodynamics, ACTH, cortisol, catecholamines, and several coagulation and fibrinolytic factors were measured. Tracheal intubation was accompanied by significant increases in the blood pressure, heart rate, and norepinephrine level. No changes were observed in fibrinopetide A, fibrinopeptide B(Beta15-42), tissue plasminogen activator antigen, plasminogen, fibrinogen, and Alpha(2) plasmin inhibitor. Patients exposed to long intubation time (>20 seconds) were found to have a significantly higher level of fibrinopeptide A than patients with short tracheal intubation time (</=20 seconds) ( P < 0.05). It therefore can be concluded that the increase in norepinephrine and changes in the hemodynamics following tracheal intubation have no impact on the coagulation and fibrinolytic activity. Also, if the duration of intubation is prolonged, thrombin activity may be promoted.

The effect of tracheal intubation and surgical stimulation on median nerve somatosensory evoked potentials during anaesthesia.

This study was designed to determine whether alterations in the median nerve somatosensory evoked potentials occur during the stimuli of tracheal intubation and skin incision. Twenty-two patients scheduled for elective surgery and who required tracheal intubation were studied. Median nerve somatosensory evoked potentials were recorded, analysed and stored approximately every 40 seconds. Anaesthesia was induced with thiopentone and vecuronium used for neuromuscular blockade; the trachea was intubated 2 minutes after induction. Fentanyl 1.5 micrograms/kg was administered subsequently. Evoked potential monitoring was continued until at least 2 minutes after surgical incision. Induction of anaesthesia was associated with an increase in evoked potential latency of 0.8 msec and reduction in amplitude of 1.7 microV. Small, statistically insignificant changes occurred between induction of anaesthesia and tracheal intubation. Surgical incision was accompanied by a statistically significant mean decrease in evoked potential latency of 0.5 msec and a statistically significant increase in evoked potential amplitude of 0.6 microV. The fact that surgical stimulation produced an activating effect on evoked potentials suggests that they may be used as a measure of the neurophysiological effects of anaesthesia.

Effects of Tracheal Intubation on Laryngeal Acoustic Waveforms

To assess the feasibility of noninvasive detection of laryngeal injury after tracheal intubation through acoustic waveform measurements, we studied the effects of intubation on "time-expanded" acoustic waveforms of the larynx in 16 patients given general anesthesia, 9 with and 7 without tracheal intubation. Recordings of several utterances were obtained by means of a microphone and an accelerometer attached to the skin at the midpoint of the suprasternal notch. Recordings were taken the day before induction of general anesthesia, 20 minutes after extubation, and 2 and 4 days after extubation. Waveforms of the recordings were subsequently assessed visually for features different from those of normal phonation as determined in preliminary studies. Waveforms in several of the recordings taken soon after extubation showed marked intraperiod and interperiod irregularities. These abnormalities improved and disappeared over the following 4 days. No changes were observed in the acoustic waveforms of seven patients given general anesthesia without tracheal intubation. The analysis of time-expanded acoustic waveforms of the larynx indicates that this technique has considerable potential as a sensitive, noninvasive technique that helps to evaluate the effects of tracheal intubation on laryngeal function, a technique that warrants further study and evaluation.