scholarly journals Intubation without Muscle Relaxant: An Alternative Technique for Rapid Tracheal Intubation

1996 ◽  
Vol 24 (2) ◽  
pp. 224-230 ◽  
Author(s):  
A. K. H. Wong ◽  
G. S. Teoh
Keyword(s):  
Tracheal Intubation ◽  
Endotracheal Tube ◽  
Muscle Relaxant ◽  
Elective Surgery ◽  
Saline Control ◽  
Alternative Technique ◽  
Double Blind ◽  
Intubating Conditions

The quality of laryngoscopy and tracheal intubation with propofol augmented by alfentanil was investigated as an alternative technique for rapid tracheal intubation. 119 patients aged between 18 and 60 years (ASA 1 and 2) undergoing elective surgery were prospectively studied in a randomized double-blind controlled fashion. Tracheal intubation facilitated by suxamethonium 1.0 mg/kg, alfentanil 15 μg/kg, alfentanil 30 μg/kg or saline control was compared after propofol induction. The quality of laryngoscopy and intubation were graded according to jaw relaxation, ease of insertion of the endotracheal tube and coughing on intubation. Failure to intubate occurred in 4% and 17% with alfentanil 15 μg/kg and saline control respectively. Tracheal intubation was successful in all patients with alfentanil 30 μg/kg and suxamethonium 1.0 mg/kg. Alfentanil 15 μg/kg was not statistically significantly different from saline (P = 0.112). Alfentanil 30 μg/kg provided similar overall intubating conditions (P = 0.5) to suxamethonium 1.0 mg/kg. Alfentanil in both dosages effectively attenuated the haemodynamic responses to laryngoscopy and tracheal intubation.

scholarly journals Comparison of Lignocaine and Esmolol in attenuating cardiovascular response to laryngoscopy and endotracheal intubation

2015 ◽  
Vol 1 (1) ◽  
pp. 29-35
Author(s):  
Anil Shrestha ◽  
Subhash Prasad Acharya ◽  
Roshna Amatya
Keyword(s):  
Blood Pressure ◽  
Tracheal Intubation ◽  
Elective Surgery ◽  
Cardiovascular Response ◽  
Cerebrovascular Disorders ◽  
Study Drug ◽  
Controlled Study ◽  
Saline Control ◽  
Control Group ◽  
Double Blind

Background: Laryngoscopy and tracheal intubation induces cardiovascular stress response characterized by tachycardia and hypertension, which are well tolerated in normotensive individuals but are of greater significance in patients with cardiovascular and cerebrovascular disorders. The quest for an effective suppression of these responses continues.Materials and Methods: A randomized, prospective, double blind, placebo controlled study was conducted in which the efficacy of Lignocaine 1.5 mg/kg and Esmolol 1.5 mg/kg were compared in attenuating the cardiovascular response to laryngoscopy and tracheal intubation in sixty patients undergoing elective surgery under general endotracheal anaesthesia. Patients were divided into three groups receiving Lignocaine, Esmolol or Normal saline (control). Anaesthesia was induced with intravenous Thiopental Sodium 5 mg/kg and intubation was facilitated with Vecuronium 0.12 mg/kg after administering the study drug. Blood pressure and heart rate were compared among the three groups.Results: The increase in Systolic blood pressure was not significant, but Diastolic and Mean Arterial Pressures increased significantly in control group whereas it was attenuated more effectively in Esmolol group (p<0.05) compared to lignocaine group. The increase in HR was significantly lower (p<0.05) in Esmolol group compared with lignocaine and control group.Conclusion: Esmolol is more effective than lignocaine in attenuating cardiovascular response to laryngoscopy and tracheal intubationJournal of Society of Anesthesiologists 2014 1(1): 29-35

PROPOFOL-FENTANYL FOR TRACHEAL INTUBATION IN CHILDREN WITHOUT NEUROMUSCULAR BLOCK

2019 ◽  
Vol 3 (1) ◽  
Author(s):  
Dr. Anil Kumar Gupta ◽  
Dr. Pawan Kumar Agrawal
Keyword(s):  
Tracheal Intubation ◽  
Muscle Relaxant ◽  
Neuromuscular Block ◽  
Neuromuscular Blocking ◽  
Muscle Relaxants ◽  
Intubating Conditions ◽  
Group 2 ◽  
Prior Administration ◽  
Group 1

INTRODUCTION:  In paediatric anaesthesia tracheal intubation without prior administration of muscle relaxants is well-established practice. Depolarizing muscle relaxant such as suxamethonium is also used in induction but it may be associated with side effects such as postoperative myalgia, prolonged paralysis, and increase in intraocular pressure and hyperkalaemia. MATERIAL AND METHODS:A total of 60 children were included in the study, of both sex, aged between 2 and 12 years. Patients were randomised in to two groups: Group 1: Inj. Fentanyland Inj. Propofoland group 2 : Inj. Propofol  and Inj. suxamethonium.The quality of intubation was graded by the consultant using the scoring system devised by Helbo-Hansen Raulo and Trap-Anderson. RESULTS: A total of 60 patients were included in the study and were randomised in to two groups of 30 each.In group 1 mean age was 8.24±2.65 and in group 2 it was 7.96±2.77. Weight in group 1 was 21.58±6.22 and in group 2 was 22.87±5.59. There were 18 male and 12 female in group 1, while in group 2 there were 19 male and 11 female. No statistically significance e=was observedin both the group.Acceptable intubating conditions were observed in 29 (97%) out of 30 patients in group 1, whereas all (100%) patients in group S had excellent intubating conditions. CONCLUSION: Tracheal intubation can be accomplished using a combination of Fentanyl Propofol combination and suxamethonium (muscle relaxant) can be avoided. When neuromuscular blocking drugs are contraindicated this method can be used.

scholarly journals Comparison of non-invasive haemodynamic monitors of stress response to endo-tracheal intubation with perfusion index in patients undergoing elective surgery

2020 ◽  
Vol 23 (2) ◽  
pp. 9-13
Author(s):  
Sushila Lama Moktan ◽  
Manan Karki
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Stress Response ◽  
Tracheal Intubation ◽  
Endotracheal Tube ◽  
Diastolic Blood Pressure ◽  
Endotracheal Intubation ◽  
Elective Surgery ◽  
Perfusion Index ◽  
Non Invasive

Introduction: Laryngoscopy and intubation is always associated with a short term reflex sympathetic pressor response. The perfusion index is an indirect, non-invasive, and continuous measure of peripheral perfusion by pulse oximeter which can detect the stress response to intubation similar to heart rate, systolic blood pressure and diastolic blood pressure. Methods: This prospective observational study enrolled sixty-five normotensive patients of American society of anesthesiologists physical status grade I and II scheduled for elective surgery under general anaesthesia. Tracheal intubation was performed after induction with intravenous fentanyl, propofol and vecuronium. Heart rate, Systolic and Diastolic Blood Pressure and Perfusion Index were measured before induction of anesthesia, before intubation and one minute, three minutes, five minutes after the insertion of the endotracheal tube. Increase in heart rate by ?10 beats per minute, systolic and diastolic blood pressure by ?15 millimeters of mercury and decrease in Perfusion index ?10% after endotracheal intubation as compared to preintubationvalue were considered positive haemodynamic changes. Results: Endotracheal intubation produced a significant increase in heart rate and blood pressure whereas perfusion index decreased significantly. Our study showed that perfusion index response criterion achieved 97.7% (Confidence interval 97.58-97.86) sensitivity in detecting the stress response to insertion of endotracheal tube whereas systolic and diastolic blood pressure achieved sensitivity of 90% and 92% respectively. Conclusion: Perfusion Index is easier, reliable and non-invasive alternative to conventional haemodynamic criteria for detection of stress response to endotracheal intubation.

scholarly journals Ultrasonography as a Tool for Identifying the Correct Placement of the Endotracheal Tube

2018 ◽  
Vol 1 (4) ◽  
pp. 331-338
Author(s):  
Rubén Algieri ◽  
María Ferrante ◽  
Miguel Duarte ◽  
Guillermo Bodner ◽  
Juan Fernández
Keyword(s):  
Quality Of Care ◽  
Tracheal Intubation ◽  
Difficult Airway ◽  
Endotracheal Tube ◽  
Emergency Surgery ◽  
Human Anatomy ◽  
Esophageal Intubation ◽  
Correct Placement ◽  
Shock Room

The ultrasound is a noninvasive diagnostic method and gained increasing importance in the plane of the emergency. Their usefulness for the recognition of anatomical structures and detection of a difficult airway. This method increases the quality of care in the emergency room. The objective of the study was to evaluate the ultrasound ́ training for the identification of normal and variation in the anatomic airway, and their usefulness during tracheal intubation. There were two periods of training. First period: 2013- February/2013 July, learning of normal human anatomy in cadaveric material corpses (in formaldehyde 10%) and the identification of normal anatomic structures. Training in the use of ultrasound (transdutor 7.5 MHz). Second period: August/2013- December/2013, case of patients that requiring emergency intubation were analyzed in which airway ultrasound were performed. The anatomo-clinical-surgical/ultrasonographic correlation was analyzed during placement of the endotracheal tube and its identification in the airway. Two hundred twenty ultrasound examinations were performed during tracheal intubation. 134 (60.91%) were made during surgery, 110 (82.09%) were programmed surgery and 24 (17.91%) emergency surgery; and 86 (39.09%) required intubation in shock room. Two groups were classified: Group 1: surgically treated patients (Group A: programed surgery: 104 (94.54%) correctly identified intubation, and in 6 (5.46%) esophageal intubation was detected, and Group B emergency surgery: in 23 (95.83%) correct placement was identified and 1 (4.17%) was esophageal intubation. Group 2: patients intubated in the shock room: 80 (93.03%) were correctly intubated and, 6 (6.97%) had esophageal intubation. In all groups, esophageal intubation was detected only in 13 patients (5.91%), using ultrasound during the procedure. The use of ultrasound for the recognition of the airway, is useful to favor the correct intubation and management of difficult airway. The ultrasound training and anatomo-clinical-surgical application is critical because it would improve the quality of care and decreasing the risk of adverse events.

Role of Magnesium Sulfate in Postoperative Analgesia

1996 ◽  
Vol 84 (2) ◽  
pp. 340-347. ◽  
Author(s):  
Martin R. Tramer ◽  
Jurg Schneider ◽  
Rene-Andreas Marti ◽  
Kaplan Rifat
Keyword(s):  
Magnesium Sulfate ◽  
Postoperative Analgesia ◽  
Postoperative Period ◽  
Peak Flow ◽  
Saline Control ◽  
Double Blind Study ◽  
Quality Of Sleep ◽  
Analgesic Requirement ◽  
Double Blind

Background N-methyl-D-aspartate antagonists may play a role in the prevention of pain. An assessment was made of the effect of the physiologic N-methyl-D-aspartate antagonist magnesium on analgesic requirements, pain, comfort, and quality of sleep in the postoperative period. Methods In a randomized, double-blind study, 42 patients undergoing elective abdominal hysterectomy with general anesthesia received 20% magnesium sulfate or saline (control) 15 ml intravenously before start of surgery and 2.5 ml/h for the next 20 h. Postoperative morphine requirement was assessed for 48 h using patient-controlled analgesia. Maximum expiratory flow (peak flow), pain at rest and during peak flow, and discomfort were evaluated up to the 48th postoperative hour, and 1 week and 1 month after surgery. Insomnia was evaluated after the first and second postoperative nights. Results Compared to control subjects, magnesium-treated patients consumed less morphine during the first 48h (P&lt;0.03), which was most pronounced during the first 6 h (P&lt;0.004), and experienced less discomfort during the first and second postoperative days (P&lt;0.05-0.005). The magnesium-treated group revealed no change in postoperative sleeping patterns when compared to preoperative patterns. Control patients showed an increase in insomnia during the first and second postoperative nights (P&lt;0.002 and P&lt;0.005, respectively) compared to preoperative values. Conclusions This is the first clinical study showing that the perioperative application of magnesium sulfate is associated with smaller analgesic requirement, less discomfort, and a better quality of sleep in the postoperative period but not with adverse effects. Magnesium could be of interest as an adjuvant to postoperative analgesia.

scholarly journals Intubating Conditions with three different doses of Rocuronium in surgery of cancer patients

2017 ◽  
Vol 1 (1) ◽  
pp. 28-35
Author(s):  
Bhawana Wagle ◽  
Yogesh Regmi
Keyword(s):  
Tracheal Intubation ◽  
Surgical Procedures ◽  
Double Blind Study ◽  
Double Blind ◽  
Duration Of Action ◽  
Intubating Conditions ◽  
Elective Surgical Procedures ◽  
Train Of Four ◽  
Tactile Response ◽  
Group B

Background: This is a prospective randomized, double blind study to determine the doses of rocuronium that would give 90% and 95% probabilities of successful tracheal intubation within 60s after administration. This study evaluated intubating conditions and duration of action of 0.4 mg, 0.8 mg and 1.2 mg of rocuronium, administered intravenously in patients undergoing elective surgical procedures. Goal in this study is to define doses level of rocuronium that would provide optimal relaxation for tracheal intubation in patients in whom succinylcholine was relatively contraindicated. Methods: Sixty patients both male and female, ASA I & II, age between 18–60 years, with BMI of less that 30 who were planned for elective surgical procedures were randomized into three groups. Group A received 0.4 mg (n=20), Group B received 0.8 mg (n=20) and Group C received 1.2 mg (n=20) of rocuronium. At 60 seconds after injection of the rocuronium, laryngoscopy was initiated, with the goal being endotracheal tube passed through the patient's vocal cords and the cuff inflated within the trachea in 20s. Intubating conditions was graded excellent, good or poor according to Cooper scoring system criteria. When the patient lost consciousness, train-of-four (TOF) stimulation (at 2 Hz and repeated every 12s) were recorded. Immediately after tracheal intubation and every 5 min thereafter the investigator counted the number of tactile TOF responses. The duration of action of rocuronium was defined as the time from the end of injection of rocuronium until reappearance of first tactile response to TOF stimulation. Results: There were twelve patients in the 0.4mg/kg rocuronium group, two in the 0.8mg/kg group, and one in the 1.2mg/kg rocuronium group with an unacceptable intubation grade caused by sustained coughing at intubation. The D90 and D95 doses were 0.83(0.59 -1.03) and 1.04 (0.76-1.36) mg/kg, respectively. Estimated time until first tactile train-of-four response after D50 and D95 doses were 43min and 52 min, respectively. Conclusion: After induction with pethedine and sodium thiopentone, rocuronium in a dose of 0.8mg/kg produces equivalent intubating conditions as that of 1.2mg/kg after 60 seconds of administration

scholarly journals Evaluation of Prophylactic Effect of Intramuscular Diclofenac Sodium for Prevention of Succinylcholine-Induced Myalgia

KYAMC Journal ◽  
2019 ◽  
Vol 10 (1) ◽  
pp. 35-38
Author(s):  
Muhammad Sazzad Hossain ◽  
Md Afzalur Rahman ◽  
Syed Ariful Islam ◽  
Md Waliullah
Keyword(s):  
Intramuscular Injection ◽  
Elective Surgery ◽  
Demographic Data ◽  
Diclofenac Sodium ◽  
Saline Control ◽  
Control Group ◽  
Double Blind Study ◽  
Double Blind ◽  
Duration Of Action ◽  
Group I

Background: Succinylcholine a depolarizing muscle relaxant with rapid onset, predictable course and short duration of action is associated with myalgia. Objectives: To assess the efficacy of intramuscular injection of diclofenac sodium in preventing succinylcholine-induced myalgia. Materials and Methods: Eighty healthy adults scheduled for elective surgery under general anesthesia were enrolledin a double-blind study and randomly allocated into two groups of forty patients. Patients in Group I (diclofenacgroup) were pretreated with inj. diclofenac 75 mg deep intramuscularly into gluteal region one hour prior to induction of anesthesia, while patients in Group II (saline group) received an equivalent volume of saline inj. in same site. Anesthesia was induced in both groups with fentanyl 1.5 mcg/kg, propofol 2.0 mg/kg and succinylcholine1.5 mg/kg. Postoperative myalgia was assessed 24 hours after induction and graded as nil, mild, moderate, or severe. Results:The demographic data for both groups were comparable (p > 0.05). Postoperative myalgia was recorded at 24 hours after induction in diclofenac group with twelve (30%) patients and 24 (60%) patients in normal saline (control) group respectively (p < 0.05). Conclusion: Prophylactic use of intramuscular injection of diclofenac is effective in the prevention of postoperative myalgia KYAMC Journal Vol. 10, No.-1, April 2019, Page 35-38

Optimal Dose of Succinylcholine Revisited

2003 ◽  
Vol 99 (5) ◽  
pp. 1045-1049 ◽  
Author(s):  
Mohamed Naguib ◽  
Abdulhamid Samarkandi ◽  
Waleed Riad ◽  
Saleh W. Alharby
Keyword(s):  
Rapid Sequence Induction ◽  
Optimal Dose ◽  
Spontaneous Respiration ◽  
Saline Control ◽  
Control Group ◽  
Double Blind Study ◽  
Double Blind ◽  
Intubating Conditions ◽  
Rapid Sequence ◽  
Sequence Induction

Background The authors reappraised the conventional wisdom that the intubating dose of succinylcholine must be 1.0 mg/kg and attempted to define the lower range of succinylcholine doses that provide acceptable intubation conditions in 95% of patients within 60 s. Methods This prospective, randomized, double-blind study involved 200 patients. Anesthesia was induced with 2 mug/kg fentanyl and 2 mg/kg propofol. After loss of consciousness, patients were randomly allocated to receive 0.3, 0.5, or 1.0 mg/kg succinylcholine or saline (control group). Tracheal intubation was performed 60 s later. A blinded investigator performed all laryngoscopies and also graded intubating conditions. Results Intubating conditions were acceptable (excellent plus good grade combined) in 30%, 92%, 94%, and 98% of patients after 0.0, 0.3, 0.5, and 1.0 mg/kg succinylcholine, respectively. The incidence of acceptable intubating conditions was significantly greater (P &lt; 0.05) in patients receiving succinylcholine compared with those in the control group but was not different among the different succinylcholine dose groups. The calculated doses of succinylcholine (and their 95% confidence intervals) that were required to achieve acceptable intubating conditions in 90% and 95% of patients at 60 s were 0.24 (0.19-0.31) mg/kg and 0.56 (0.43-0.73) mg/kg, respectively. Conclusions The use of 1.0 mg/kg of succinylcholine may be excessive if the goal is to achieve acceptable intubating conditions within 60 s. Comparable intubating conditions were achieved after 0.3, 0.5, or 1.0 mg/kg succinylcholine. In a rapid-sequence induction, 95% of patients with normal airway anatomy anesthetized with 2 mug/kg fentanyl and 2 mg/kg propofol should have acceptable intubating conditions at 60 s after 0.56 mg/kg succinylcholine. Reducing the dose of succinylcholine should allow a more rapid return of spontaneous respiration and airway reflexes.

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