Theses (M Med.(Anaesthesiology))--University of Limpopo, 2007. / Comparison of Alfentanil and Lignocaine in blunting the pressor response during endotracheal intubation. Laryngoscopy and tracheal intubation produce marked increases in heart rate and blood pressure, which is potentially dangerous in certain patients. Various pharmacological agents have been used before laryngoscopy and tracheal intubation in an attempt to attenuate the adrenergic response, but with varying degree of success. OBJECTIVE To compare the efficacy of lignocaine to alfentanil in blunting the pressor response to endotracheal intubation. DESIGN An open label comparative study. POPULATION Seventy eight ASA I and II adult patients between the ages of 18 and 65 years booked for elective surgery which requires endotracheal intubation. SETTING Dr George Mukhari Hospital, a tertiary level training hospital in Gauteng, South Africa. 2 METHOD After obtaining ethical clearance the study was conducted on 78 ASA class I & II patients. The patients were randomly allocated to three groups according to their treatment regime. All patients were premedicated with diazepam 10mg 2 hours pre operatively. Anaesthesia was induced with Thiopentone 5mg/kg followed by Vecuronium 0,1mg/kg and maintained with Isoflurane in nitrous oxide and oxygen mixture. Group A patients received lignocaine 1.5mg/kg iv 3 minutes before intubation. Group B – alfentanil 15ug/kg iv 1 minute before intubation and group C patients did not receive any treatment before intubation. Heart rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure were recorded at the following intervals: pre- induction, pre- intubation 1, 2 and 3 minutes post intubation. STATISTICS Statistical analysis was done by Chi Square test followed by the normal approximation of the binomial distribution. Increase in blood pressure and heart rate in the three treatment groups were compared by analysis of variance, followed by pairwise comparisons. A p- value <_ 0,05 was considered significant. 3 MAIN RESULT The three treatment groups did not differ in relation of Gender ratio, Mean weight and Mean age. ALFENTANIL GROUP There was a non significant increase in heart rate 1 minute post intubation (P= 0,7625), and there was no increase 2 and 3 minutes post intubation. A decrease in SBP, DBP and MAP was observed at 1, 2 and 3 minutes post intubation. LIGNOCAINE GROUP There was an increase in all parameters 1 minute post intubation which was comparable to the control group. A decrease in all parameters which differed from that of the control group except for heart rate, was observed at 2 and 3 minutes post intubation. CONTROL GROUP There was an increase in all parameters 1 minute post intubation. A decrease in all parameters 2 and 3 minutes post intubation remained above the baseline. CONCLUSION Alfentanil is superior to lignocaine in blunting the pressor response to endotracheal intubation.

The aim of this thesis is to quantify the intubation success rates and complication rates associated with GlideScope® video laryngoscopy in pediatric difficult airway patients. Difficult intubation is a major source of anesthesia-related morbidity and mortality in both adults and children (1-3). A number of studies have demonstrated that video laryngoscopy has helped to address this problem in adults, producing high intubation success rates with minimal complications (4-6). However, the literature on the use of videoscopes in children with difficult airways is sparse. We therefore sought to examine success and complication rates with the GlideScope®, a common type of video laryngoscope. To do so, we examined patient data from the Pediatric Difficult Intubation Registry, a collection of information on difficult airway incidents at fourteen pediatric teaching hospitals in the United States. From these data we calculated overall, first-pass, and rescue success rates on a per-attempt and per-patient basis, comparing them to success rates that resulted from using direct laryngoscopy. We also examined success rates for smaller groups of patients divided by Cormack-Lehane airway grade, weight, and muscle relaxant use. Finally, we assessed complication rates for patients undergoing GlideScope® intubation attempts and direct laryngoscopy. The GlideScope® produced lower success rates in our sample than those documented in adult difficult airway patients. This was particularly the case among smaller children and those with poor glottis visualization. However, the GlideScope® was superior to direct laryngoscopy by all measures and in all patient subgroups. We also found lower rates of hypoxemia and overall complications among patients receiving intubation attempts with only the GlideScope® versus only direct laryngoscopy. We believe this result may be related to the greater number of intubation attempts among patients receiving direct laryngoscopy.

Introduction: Adequate post-intubation sedation and analgesia (PISA) practices are important in the pre-hospital setting where vibration and noise of the transport vehicle may contribute to anxiety and pain in the patient. Inadequate post-intubation practices may lead to long-term detrimental effects in patients. Despite this, these practices are poorly described in the prehospital setting. This study aims to describe the current pre-hospital PISA practices in a private South African emergency medical service. Methodology: Patient report forms (PRF) of intubated patients between 1 Jan 2017 and 31 Dec 2017 from a single private ambulance service were reviewed. Data was analysed descriptively. Correlations were calculated with Spearman's Rank correlations and group differences were calculated with Independent T tests and Mann-Whitney U tests. Significant correlations were entered into a binomial regression model to determine predictive value of receiving PISA. Results: The number of PRFs included for analysis was 437. Of these, 69% of patients received some type of PISA. The estimated time from intubation to 1st PISA ranged from 9 to 12 minutes. There were statistically significantly more PISA interventions in patients who had received Rocuronium (p< 0.01). There was weak but significant correlation between the number of interventions and the mean arterial pressure, (rs = 0.17, p< 0.01) and Glasgow Coma Scale (rs = -0.15, p< 0.01) prior to intubation, along with the transport time to hospital (rs = 0.23, p< 0.01). Conclusion: The PISA practices in the South African pre-hospital setting is comparable to international pre-hospital settings. The time to 1st PISA appears to be shorter in the SA setting. There is an increased number of interventions in the patients who received Rocuronium, which may indicate practitioners being mindful of wakeful paralysis. Practitioners also take the level of consciousness and blood pressure prior to intubation into account when administering PISA. Longer transport times attribute to patients receiving more PISA interventions.

Introduktion: Att skapa fri luftväg i samband med prehospitalt hjärtstopp är en komplicerad åtgärd i en stressande situation. Det finns flera metoder för denna åtgärd och de har olika svårighetsgrad beroende på vilken metod som ambulanssjuksköterskan behöver använda för att nå framgång. Denna åtgärd förväntas ambulanssjuksköterskan klara av trots att miljön är utmanande och tidspressen stor.   Syfte: Att beskriva ambulanssjuksköterskors upplevelser av etablering av fri luftväg i samband med hjärtstopp.   Metod: Kvalitativ intervjustudie som analyseras med latent innehållsanalys. Tolv semistrukturerade intervjuer genomfördes på tre verksamhetsställen i södra Sverige.   Resultat: Ambulanssjuksköterskorna berättade om hur luftvägshantering är en liten men viktig del av allt de ska klara av i sin yrkesroll. Det finns en otrygghet i momentet intubation som beror på bristande utbildning i kombination med hur sällan ambulanssjuksköterskan gör detta i det dagliga arbetet. Studien resulterade i tre huvudkategorier: Otrygghet i yrkesrollen, Prehospitala framgångsfaktorer och Personcentrerad vård genom samarbete med tillhörande tolv subkategorier. Det som bekymrade ambulanssjuksköterskorna mest var luftvägshantering på barn. Det som upplevs vara den största framgångsfaktorn betonades vara de enkla åtgärderna när det gäller luftvägshantering.   Slutsats: För att öka ambulanssjuksköterskans trygghet i luftvägshantering krävs ökade utbildningsinsatser. Arbetsgivaren bör ta ett ökat ansvar för utbildning genom att skapa förutsättningar och uppföljning. Vidare bör de riktlinjer som finns för luftvägshantering ses över. De enklaste metoderna är oftast de bästa prehospitalt. / Introduction: To manage an airway in a prehospital environment is a complex measure in a stressful situation. There are several methods for this measure and they have various level of severity depending on the method the ambulance nurse chooses to apply. This measure is expected to be managed by the ambulance nurse despite rough environment and lack of time.   Purpose: To describe the ambulance nurse’s experiences of airway management in a cardiac arrest situation.   Method:  Twelve semi-structured qualitative interviews was made and analyzed by content analysis. The interviews were made at three different ambulance organizations in the south of Sweden     Result: The ambulance nurses told about how small but essential task airway management is. But it’s still a task they must be able to perform in their work.  There is an insecurity in the moment of intubation which is related to lack of training and how rarely they perform the moment in their daily duties. The study resulted in three main categories: Insecurity in the profession, Prehospital success factors and Person-centered care through teamwork with twelve subcategories. What concerned the ambulance nurses the most was airway management on children. They describe the greatest success factor to be the simplest possible measures when it comes to airway management.   Conclusion: To increase the ambulance nurse’s security in airway management more education efforts is needed. Employers should take a greater responsibility for education by creating conditions and monitoring. Therefore, should the guidelines for airway management be reviewed. The simplest methods in airway management are often the most successful.

Being a patient in intensive care can be experienced terrifying. Studies have demonstrated the link between unpleasant memories of hospitalization in the ICU and the development of posttraumatic stress disorder, depression, anxiety, and perception of quality of life in its aftermath. Placed on a ventilator, the patient is exposed to multiple invasive procedures. The aim was to describe critical care patients' experience of being intubated or tracheostomated. Method: Literature review using conventional content analysis. Searches were made in the databases Cinahl and Pubmed. Results: The study revealed four main categories: Discomfort, Vulnerability and Communication difficulties that were tied together by category Relief. It turned out that the patients experienced a discomfort caused by the endotracheal tube. Suctioning of airways remembered many of the patients in both discomfort and relief. Being dependent on a ventilator and equipment in order to survive, causing a feeling of vulnerability. Many patients lost hope when they could not communicate, make themselves understood and to be involved in their care. The medical staff has a significant impact on their experiences of intensive care. To find out the reason they were intubated / tracheostomated reduced their fear. This information helped them to bond with reality. The nurse has responsibility to act with compassion and empathy, theory and knowledge to reduce anxiety and facilitate hospital stay for patients.

Orientador: Francisco Jose´[UNESP] Teixeira Neto / Resumo: Girotto, C.H. Avaliação da máscara laríngea como alternativa a sonda endotraqueal para manutenção da anestesia inalatória sob ventilação espontânea em capivaras (Hydrochoerus hydrochaeris). 47 p. Dissertação (Mestrado) – Faculdade de Medicina, Universidade Estadual Paulista, Botucatu, 2018. A intubação orotraqueal roedores é um procedimento de maior dificuldade que em outras espécies. Este estudo comparou o uso máscara laríngea humana (ML) com a sonda endotraqueal (Sonda-ET) para manter a patência da via aérea em capivaras anestesiadas sob ventilação espontânea. Seis capivaras (24-54 kg) foram contidas quimicamente com cetamina (7,2 ± 1,1 mg/kg), midazolam (0,16 ± 0,04 mg/kg) e acepromazina (0,03 ± 0,01 mg/kg) em duas ocasiões (intervalos ≥ 7 dias entre procedimentos). A anestesia foi mantida com isoflurano diluído em oxigênio durante 90-120 minutos sob ventilação espontânea. Durante cada anestesia, a patência da via aérea foi mantida aleatoriamente com a Sonda-ET ou ML. Tomografia computadorizada (TC) da faringe/laringe foi realizada em 3/6 animais com a ML e 2/6 animais com a Sonda-ET. A ANOVA de duas vias para medidas repetidas, teste t pareado ou de Wilcoxon foram utilizados para análise estatística (P < 0,05). A concentração de isoflurano expirado (ETiso), freqüência cardíaca (FC), pressão arterial média invasiva (PAM), pH arterial, pressão parcial de dióxido de carbono arterial (PaCO2) e pressão parcial de oxigênio arterial (PaO2) não diferiram entre os tratamentos. Os ... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Abstract Girotto, C.H. Evaluation of a laryngeal mask as an alternative to orotracheal intubation for maintenance of inhalant anesthesia under spontaneous ventilation in capybaras (Hydrochoerus hydrochaeris). 47 p. Dissertation (MSc) – School of Medicine, São Paulo State University, Botucatu, 2018. Orotracheal intubation carries greater difficulty in rodents than in most domestic species. This study compared the human laryngeal mask (LMA) with an endotracheal tube (ETtube) for maintaining airway patency in anesthetized capybaras (Hydrochoerus hydrochaeris). Six capybaras (24–54 kg) were remote darted with ketamine (7.2 ± 1.1 mg/kg), midazolam (0.16 ± 0.04 mg/kg) and acepromazine (0.03 ± 0.01 mg/kg) in two occasions (≥ seven-day intervals). Anesthesia was maintained with isoflurane in oxygen for 90–120 min under spontaneous ventilation. During each anesthetic, the airway was randomly maintained with an ETtube or LMA. Computed tomography of the pharynx/larynx was performed in 3/6 animals and 2/6 animals with the LMA and ETtube, respectively. Data was analyzed with a two-way ANOVA for repeated measures, paired t-test or Wilcoxon´s signed-rank test. End-tidal isoflurane (ETiso), heart rate (HR), invasive mean arterial pressure (MAP), arterial pH, arterial carbon dioxide partial pressure (PaCO2), and arterial oxygen partial pressure (PaO2) did not differ between treatments. Median (lower–upper range) of ETiso values were 0.6 (0.5–1.5)% and 0.6 (0.4-0.9)% with the ETtube and LMA, r... (Complete abstract click electronic access below) / Mestre

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Syfte: Att undersöka huruvida patienterna upplever det postoperativa förloppet avseende smärta i hals, heshet, smärta vid sväljning samt generellt obehag beroende på om endotrakealtub (ETT) eller i-gel supraglottic airway device (SAD) använts i samband med generell anestesi vid elektiv kirurgi. Metod: I denna kvantitativa tvärsnittsstudie samlades informationen in på formulär. Parametrarna skattades av patienterna med hjälp av visuell analog skala (VAS). 60 patienter tillfrågades konsekutivt till studien och 13 föll bort vilket resulterade i 47 patienter som fullföljde studien. Resultat: Gällande graden av smärta i hals, heshet, sväljsvårigheter och allmänt obehag postoperativt så skattade sammanlagt sju deltagare i grupperna med ETT och i-gel ett VAS värde över 3. Patienter som haft ETT upplevde signifikant mer heshet, och sväljsvårigheter än patienter som haft i-gel. Slutsats: Denna studie visar att patienter som får ETT eller i-gel skattar sina besvär avseende smärta i hals, heshet, sväljsvårigheter och allmänt obehag i en låg frekvens. Dessutom påvisas att majoriteten av de som skattar besvär gör detta i de lägre segmenten av VAS skalan. / Aim: To examine how patients perceive the postoperative recovery in regards of pain in the throat, hoarseness, dysphagia, and general discomfort due to the endotracheal tube (ETT) or the i-gel supraglottic airway device (SAD) used in general anaesthesia during elective surgery. Method: This quantitative cross-sectional study gathered information on forms. The parameters were estimated by patients using visual analogue scale (VAS). 60 patients were asked consecutively to the study and 47 patients completed. Results: The level of pain in the throat, hoarseness, dysphagia and general discomfort post-operatively were estimated by a total of seven participants in the group with ETT and i-gel as higher VAS values than 3. Patients with ETT perceived significantly more hoarseness and dysphagia than patients with i-gel. Conclusion: This study shows that patients with ETT or i-gel estimates their complaint regarding pain in the throat, hoarseness, dysphagia and general discomfort in a low frequency. It also demonstrates that the majority of those who estimate these parameters do so in the lower segments of the VAS scale.