ABSTRACT
Verification of the proper placement of a tracheal tube by capnography in rapid sequence induction can lead to aspiration if the patient is ventilated with the tube in the esophagus. In this study we have associated the capnography with the esophageal detector device as modified by Nunn. In 49 patients, two endotracheal tubes were introduced, one in the esophagus and the other in the trachea. An anesthesiologist, unaware of which tube is in the trachea, squeezed the bulb of the esophageal detector device, attached it to the sidestream of the capnography and the endotracheal tubes, then released it. No reinflation of the bulb was seen with the esophageal tube. Two types of reinflation were seen with the tracheal tube: slow (6 cases), all were obese, and instant (43 cases) in the remaining patients. The air aspirated from the respiratory tract by the bulb was analyzed by the capnograph; CO2 was detected from all the tracheal tubes but not from the esophageal ones. We concluded that the esophageal detector device and capnography used as described in our study is a simple reliable test to confirm the proper placement of a tracheal tube before starting ventilation in rapid sequence induction.
Subject(s)
Capnography/methods , Esophagus , Intubation, Intratracheal/methods , Adolescent , Adult , Aged , Anesthesia, Intravenous , Anesthetics, Intravenous/administration & dosage , Capnography/instrumentation , Carbon Dioxide/analysis , Equipment Design , Female , Fentanyl/administration & dosage , Humans , Intubation, Intratracheal/adverse effects , Intubation, Intratracheal/instrumentation , Male , Middle Aged , Obesity/physiopathology , Reproducibility of Results , Respiration, Artificial , Single-Blind Method , Suction , Thiopental/administration & dosageSubject(s)
Anti-Inflammatory Agents/therapeutic use , Blood Pressure/drug effects , Heparin Antagonists/adverse effects , Hydrocortisone/therapeutic use , Premedication , Protamines/adverse effects , Anti-Inflammatory Agents/administration & dosage , Cardiac Output/drug effects , Cardiopulmonary Bypass , Coronary Artery Bypass , Heart Valve Prosthesis , Heparin Antagonists/administration & dosage , Histamine Antagonists/administration & dosage , Histamine Antagonists/therapeutic use , Humans , Hydrocortisone/administration & dosage , Hypotension/chemically induced , Injections, Intravenous , Protamines/administration & dosage , Vascular Resistance/drug effectsABSTRACT
A size 2 laryngeal mask airway (ID 7 mm) was used for general anaesthesia during fibreoptic bronchoscopy in a six-year-old child. The mask permitted the use of an adult bronchoscope with an external diameter of 5 mm. Throughout bronchoscopy, adequate controlled ventilation could be achieved easily without excessive air leak or airway resistance; the Spo2 was always > 97%, and the end-tidal Pco2 ranged between 3.9-4.5 kPa (30-35 mmHg).
Subject(s)
Anesthesia, General , Bronchoscopy , Laryngeal Masks , Airway Resistance , Bronchoscopes , Carbon Dioxide/blood , Child , Equipment Design , Fiber Optic Technology/instrumentation , Humans , Male , Oxygen/blood , Respiration, Artificial , Tidal VolumeABSTRACT
Intermittent jet ventilation was used during anaesthesia in a 66-yr-old woman who had severe tracheal narrowing secondary to compression by a retrosternal goitre. The trachea was intubated by a small-bore tube, which was placed above the site of narrowing. An injector was connected to the proximal end of the tracheal tube on one side and to the anaesthesia circuit on the other. Intermittent jets of 66% nitrous oxide in oxygen via the injector resulted in adequate oxygenation and carbon dioxide elimination. Arterial blood gas analysis during jet ventilation showed PaO2 150 mmHg, PaCO2 35 mmHg and pH 7.4. It is concluded that low-frequency jet ventilation may provide adequate oxygenation and carbon dioxide elimination in the presence of tracheal narrowing.
