Physiologic and Pathophysiologic Responses to Intubation

2019 ◽  
Author(s):  
Gilbert S Tang
Keyword(s):  
Endotracheal Tube ◽  
Systemic Disease ◽  
Upper Airway ◽  
Noxious Stimulation ◽  
Negative Effects ◽  
Sympathetic Response ◽  
Airway Control ◽  
Artery Disease ◽  
Airway Devices ◽  
Airway Physiology

The placement of an endotracheal tube provides definitive airway control for the anesthesiologist and protects the patient from aspiration, hypoventilation and hypoxemia. Airway instrumentation and intubation, however, cause physiologic changes that may have negative effects especially in patients with systemic disease. An abundance of sensory receptors and nerve endings exist in the upper airway that respond to noxious stimulation by activation of the autonomic nervous system, which cause brief but profound cardiovascular and neurologic effects. Stimulation of upper airway receptors may elicit reflexes such as sneezing, coughing, gagging, swallowing, vomiting, laryngospasm and bronchospasm. The presence of the endotracheal tube also bypasses the normal conduit for air movement and changes the airway physiology. This review contains 4 figures, 3 tables, and 45 references. Keywords: intubation, sympathetic response, coronary artery disease, aortic dissection, aortic aneurysm, intracranial pressure, attenuating response, airway devices

LMA PROSEAL: AN ALTERNATIVE TO ENDOTRACHEAL IN- TUBATION IN OPEN APPENDECTOMY OPERATION.' IN THE DEPARTMENT OF ANESTHESIOLOGY, MEDICAL COLLEGE, KOLKATA

2021 ◽  
pp. 74-76
Author(s):  
Manas Karmakar ◽  
Pallab Kanti Nath ◽  
Ashok Das
Keyword(s):  
Endotracheal Tube ◽  
West Bengal ◽  
Operative Procedure ◽  
Open Appendectomy ◽  
Open Appendicectomy ◽  
Safe Alternative ◽  
Operation Theatre ◽  
Medical College ◽  
Airway Devices ◽  
Strict Protocol

INTRODUCTION One of the important responsibilities of an Anaesthesiologist is to maintain a patent airway during any surgical procedure. Since the early days of Anaesthesia, various efforts have been made to dispel the problem of airway maintenance. AIMS AND OBJECTIVES The study entitled “LMAProSeal: An alternative to endotracheal intubation in open appendicectomy operation” was conducted with the aims to compare the efcacy of LMA ProSeal and Endotracheal Tube in patients undergoing Open Appendectomy under General Anaesthesia. MATERIALAND METHODS Study Area: This study was conducted in Medical College, Kolkata (West Bengal), under the department of Anaesthesiology in General Surgery Operation Theatre (C. B. Top OT/ Green OTComplex), after clearance from the Hospital ethical committee, during the period from 1st may 2013 to 31st January 2014. Awritten informed consent was taken from all patients included in the study. StudyPopulation:Patients postedforopenAppendicectomyoperationwithBMIbetween18.50–24.99kg/m2andbodyweightbetween30—60kg. Sample Size: 100 RESULTS AND OBSERVATIONS The effects were observed by monitoring heart rate, blood pressure and SPO2 preoperatively (as baseline), after intubation or placement of LMAProSeal at 1 min, 3 mins, 5mins and every 5 mins thereafter till the reading at removal of the device. For both the groups baseline ETCO2 was taken from connection of ETCO2 cable following placement of airway devices. SUMMARY AND CONCLUSION The study revealed that both the airway devices (ET tube and LMA ProSeal) were successful in operative procedure (open appendicectomy) in all the patients without any signicant complication. In experienced hands and following a strict protocol of insertion, the LMA ProSeal can prove to be an efcient and safe alternative to endotracheal tube for airway management of elective patients undergoing laparotomy procedure like open appendicectomy.

AIDS and Suctioning Newborn Infants

PEDIATRICS ◽  
1988 ◽  
Vol 82 (3) ◽  
pp. 520-521
Author(s):  
PAUL M. KEMPEN
Keyword(s):  
Endotracheal Tube ◽  
Endotracheal Intubation ◽  
Negative Pressure ◽  
Newborn Infants ◽  
Upper Airway ◽  
Suction Catheter ◽  
Meconium Aspiration ◽  
Endotracheal Suction ◽  
Suction Device ◽  
Recommended Therapy

To the Editor.— The current recommended therapy for patients with meconium aspiration consists of extensive suctioning of the oropharynx and nasopharynx after delivery of the head, with subsequent endotracheal intubation and deep suction with the endotracheal tube as the suction catheter. The upper airway is commonly cleared with a bulb syringe and/or a Delee suction device. With both the Delee and the currently recommended endotracheal suction methods, the physician's mouth is the source of negative pressure.

Effect of upper airway CO2 on breathing in awake ponies

1985 ◽  
Vol 59 (4) ◽  
pp. 1222-1227 ◽  
Author(s):  
H. V. Forster ◽  
L. G. Pan ◽  
C. Flynn ◽  
G. E. Bisgard ◽  
R. E. Hoffer
Keyword(s):  
Endotracheal Tube ◽  
Environmental Temperature ◽  
Upper Airway ◽  
Gas Mixture ◽  
Upper Airways ◽  
Co2 Gas ◽  
Arterial Pco2 ◽  
Cuffed Endotracheal Tube ◽  
Breathing Room ◽  
Sensory Mechanism

We determined whether the [CO2] in the upper airways (UA) can influence breathing in ponies and whether UA [CO2] contributes to the attenuation of a thermal tachypnea during periods of elevated inspired CO2. Six ponies were studied 1 mo after chronic tracheostomies were created. For one protocol the ponies were breathing room air through a cuffed endotracheal tube. Another smaller tube was placed in the tracheostomy and directed up the airway. By use of this tube, a pump, and prepared gas mixtures, UA [CO2] was altered without affecting alveolar or arterial PCO2. When the ponies were at a neutral environmental temperature (TA) and breathing frequency (f) was 8 breaths X min-1, increasing UA [CO2] up to 18–20% had no effect on f. However, when TA was increased 20 degrees C to increase f to 50 breaths X min-1, then increasing UA [CO2] to 6% or to 18–20% reduced f by 5 +/- 1.7 (SE) and 12 +/- 1.6 breaths X min-1, respectively (t = 3.3, P less than 0.01). These data suggest that in the pony there exists a UA CO2-H+ sensory mechanism. For a second protocol the ponies were breathing a 6% CO2 gas mixture for 15 min in the normal fashion over the entire airway (nares breathing, NBr) or they were breathing this gas mixture for 15 min through the cuffed endotracheal tube (TBr). At a neutral TA, increasing inspired [CO2] to 6% resulted in a 6-breaths X min-1 increase in f during both NBr and TBr.

scholarly journals Critical upper airway obstruction as the first symptom of acute myeloid leukemia - an anesthesiologic reminder

2020 ◽  
Vol 10 (2) ◽  
Author(s):  
Øyvind Bruserud ◽  
Øystein Wendelbo ◽  
Nils Vetti ◽  
Frederik Kragerud Goplen ◽  
Silje Johansen ◽  
...  
Keyword(s):  
Emergency Management ◽  
Airway Obstruction ◽  
Myeloid Leukemia ◽  
Early Recognition ◽  
Upper Airway ◽  
Upper Airway Obstruction ◽  
Airway Control ◽  
Computer Tomography Scan ◽  
Surgical Tracheotomy ◽  
Tomography Scan

Acute upper airway obstruction can be fatal. Early recognition of airway distress followed by diagnostic laryngoscopy and prompt intervention to secure airway control is crucial. We here present a 62-year old male patient who presented with cough and increasing respiratory distress for three weeks. Within the next 24 h, he developed symptoms of critical upper airway obstruction, endotracheal intubation was not possible, and an acute surgical tracheotomy was performed to retain patent airways. A computer tomography scan revealed severe laryngopharyngeal soft tissue thickening and upper airway obstruction caused by leukemic infiltration. He was diagnosed with acute leukemia and responded to induction chemotherapy. This case report points out the importance of establishing the diagnosis of critical upper airway obstruction in patients presenting with respiratory symptoms, and highlights the emergency management of airway obstruction due to malignant infiltration of leukemic blasts.

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