Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0010200 (cough)
 23,843 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The purpose of this study is to investigate the satisfactory (excellent or good) intubation conditions attained when the TOF ratio was zero in anesthetized children. Sixty children undergoing elective ophthalmic surgery were allocated randomly into three groups. Anesthesia was induced with thiopentone 4 mg/kg and halothane in combination with 66% N2O and O2 (2 L/min). Patients maintained spontaneous breathing with assisted ventilation to limit the values of end tidal CO2 within the range of 36-44 mmHg, maintained the stable end tidal expiratory 1 MAC halothane concentration for three minutes and followed by 0.1 mg/kg vecuronium in group 1, 0.6 mg/kg rocuronium in group 2, and 0.9 mg/kg rocuronium in group 3. Intubation was attempted as the TOF ratio decreased from 1.0 to 0. The intubation condition was scored by assessing the degree of jaw relaxation, vocal cord opening grades, and cough responses. The overall intubation conditions were graded as excellent, good, fair, and poor on the basis of the scores. Excellent or good intubation conditions were considered satisfactory. After neuromuscular blockade administration, TOF ratio required 160.5 +/- 28.9 seconds in group 1, 70.7 +/- 18.5 seconds in group 2, and 55.7 +/- 13.5 seconds in group 3 to decrease to zero. There is a significant difference between group 1 and group 2 and 3 (p < 0.001, group 1 vs group 2 and group 3). All children were intubated, during which procedures satisfactory intubation conditions were observed in all of the group 3 patients, in 17 of the 20 group 2, and in 16 of the 20 group 1 patients. We concluded that zero of TOF from monitoring the adductor pollicis muscle indicated the proper moment for intubation in anesthetized pediatric patients and it was a reliable guide in adequately anesthetized children to achieve satisfactory intubation conditions following 0.9 mg/kg rocuronium administration.
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PMID:The train of four ratio decreases to zero in anesthetized children is the guide to achieve a satisfactory intubation condition. 1201 79

When alkalinized lidocaine instead of air is used to fill the endotracheal tube (ETT) cuff, coughing, and bucking are decreased during extubation when ventilation is controlled with N2O. However, sodium bicarbonate (NaHCO3) used to transform lidocaine hydrochloride (L-HCl) to lidocaine base induces a pH increase that could be irritating for mucosa in the case of cuff rupture. Therefore, we determined, in a randomized controlled study with controlled patient ventilation without N2O, whether the smallest concentrations of NaHCO3 (1.4% versus 8.4%) reduced diffusion (in vitro evaluation) and other secondary clinical benefits. After pH determination of different solutions (2 mL of 2% L-HCl and 2 to 6 mL of 8.4%, or 1.4% NaHCO3), an in vitro lidocaine diffusion through the ETT cuffs was evaluated (2 mL of 2% L-HCl and 3 mL of 8.4% or 1.4% NaHCO3). Then, adult patients scheduled for total thyroidectomy surgery were consecutively enrolled (n = 20 for each group). The ETT cuff was filled with air (group air) or with alkalinized lidocaine (2 mL of 2% L-HCl) using 8.4% (group large dose) or 1.4% (group small dose) of NaHCO3. After tracheal extubation, sore throat was evaluated by visual analog scale as the main end-point of the study. Hoarseness, bucking, dysphonia, dysphagia, cough, restlessness, and postoperative nausea and vomiting were also evaluated. There was a slight tendency toward a slower release when a small concentration of NaHCO3 was used (i.e., 1.4%). Compared with group air, the alkalinized-lidocaine groups had a significant reduction in sore throat during the 24-h postoperative period (P < 0.0001). The difference was not significant between the two alkalinized lidocaine groups. This increase in ETT tolerance was confirmed by the analysis of secondary end-points. No laryngospasm, rupture of ETT cuff, or depression of the swallowing reflex were recorded. A decrease in sore throat during the postoperative period was recorded when the cuff was inflated with a small dose of alkalinized lidocaine (i.e., 40 mg of L-HCl and 1.4% of NaHCO3) rather than with air when ventilation was controlled without N2O.
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PMID:Alkalinization of intracuff lidocaine: efficacy and safety. 1624 28

We determine the feasibility of using the intubating laryngeal mask airway Fastrach (ILM) as a ventilatory device during emergence from anesthesia after use as an airway intubator in patients undergoing carotid endarterectomy. Thirty-five patients (ASA 2-3, 53-84 yr) were studied. Induction was with midazolam/fentanyl/etomidate and maintenance was with sevoflurane 1-2% in O2 33-50% and N2O. Neuromuscular blockade was with cisatracurium. Tracheal intubation was with a flexible lightwand via the ILM. After successful intubation, the ILM remained in the pharynx, but with the cuff deflated. After surgery, but before anesthesia was discontinued, baseline cardiovascular variables were recorded. The ILM cuff was then reinflated, the tracheal tube removed, the anesthesia breathing system connected to the ILM and anesthesia discontinued. Any changes in the cardiovascular variables greater than +/- 20% baseline values were noted from cuff reinflation to 1 minute after ILM removal. Any adverse respiratory (laryngospasm, coughing, gagging, stridor, SpO2 <94%, end-tidal carbon dioxide >45 mmHg, regurgitation/aspiration) or electrocardiographic (ST segment or rhythm changes) events were also noted. Patients were questioned about postoperative sore throat at 2 and 24 hr. ILM insertion and intubation through the ILM were successful in all patients. Adequate ventilation was achieved in all patients before intubation and after extubation. The mean (range) time taken from cuff reinflation to ILM removal was 9 (5-21) min. The rate pressure product remained within +/- 20% baseline values in all patients. There were no adverse respiratory or electrocardiographic events. There were no adverse neurological events. The surgical field was satisfactory. Postoperative sore throat occurred in 14% at 2 hr and 0% at 24 hr. We conclude that the ILM can be used as a ventilatory device for emergence from anesthesia after use as an airway intubator for carotid endarterectomy.
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PMID:The intubating laryngeal mask airway Fastrach for emergence after carotid endarterectomy. 1638 Dec 61

Trials of the King LT trade mark (LT, King Systems, Noblesville, IN) in controlled ventilation of the lungs have shown that it is an effective supraglottic airway device. We designed this study to evaluate the King LT regarding ease of insertion, position within the airway, and anatomic sealing properties during spontaneous ventilation in 50 ASA physical status I-III, Mallampati I-III, adult patients undergoing routine general anesthesia. Anesthesia was induced with up to 2 microg/kg fentanyl and 1.5-2 mg/kg propofol and maintained with 70% N2O/30%O2 and isoflurane. Insertion time, oropharyngeal leak pressures, fiberoptic position, and spirometry and hemodynamic data were recorded. Any complications were noted. Insertion was determined to be easy and a patent airway was achieved in all patients. First, second, and third attempt insertion rates were 86%, 12%, and 2%, respectively. Time to place the King LT trade mark was <5 s in 90% of cases. Baseline leak pressures were 31 +/- 8.8 cm H2O (17-50 cm H2O). Complications included laryngospasm (1) and coughing (3) on extubation. The incidence of sore throat at 1 h and 24 h postoperatively was 22% and 15%, respectively. The King LT trade mark is a simple and reliable supraglottic airway device for airway management during spontaneous ventilation.
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PMID:An evaluation of the insertion and function of a new supraglottic airway device, the King LT, during spontaneous ventilation. 1642 73


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