Pneumothorax and subcutaneous emphysema complicating endotracheal intubation

We report subcutaneous emphysema and pneumothorax as immediate complications of endotracheal intubation in a patient with diffuse interstitial lung disease. We postulate increased intra-alveolar pressure during intubation leading to rupture of a subpleural bleb or cyst as a possible mechanism causing these complications.     

Massive subcutaneous emphysema following colonoscopy

A case of massive subcutaneous emphysema following colonoscopic polypectomy is reported. The incidence of colonic perforation following colonoscopy is 0.1% and may be intraperitoneal or retroperitoneal. Intraperitoneal perforation is usually immediately apparent and likely to require urgent surgical exploration. The development of subcutaneous emphysema or a pneumoscrotum suggests a retroperitoneal perforation and in the majority of cases management is conservative. Contrast studies are often unhelpful but plain x-rays may help to distinguish between intraperitoneal and retroperitoneal perforations.     

气管插管全麻病人胃管置入法的若干进展

在清醒状态下为病人插胃管,病人常有明显不适感觉,因而有学者主张手术病人放置胃管的时机选在麻醉用药后,但因气管插管全麻状态下的病人失去了主动配合的能力,且气管插管后病人咽部因气管导管的存在而有占位效应,食管因受气管导管套囊压迫相对闭合,常规方法插胃管多不易成功。随着医学科技的不断发展。插置胃管的方法也不断创新,本文对为气管插管全麻病人置胃管     

扭转痉挛患者经口气管插管期间的口腔护理

对1例扭转痉挛患者在经口气管插管期间运用喷雾影响口腔内环境及冲洗清洁口腔的方法,取得满意效果,该患者住院治疗15d,无口腔溃疡等并发症发生.     

Procedural experience with out-of-hospital endotracheal intubation

OBJECTIVE: Out-of-hospital rescuers likely need regular clinical experience to perform endotracheal intubation (ETI) in a safe and effective manner. We sought to determine the frequency of ETI performed by individual out-of-hospital rescuers. DESIGN: Analysis of an administrative database of all emergency medical services (EMS) patient care reports in Pennsylvania. SETTING: Commonwealth of Pennsylvania from January 1 to December 31, 2003. SUBJECTS: EMS advanced life support rescuers (paramedics, prehospital nurses, and EMS physicians) who reported at least one patient contact during the study period. INTERVENTIONS: None. MEASUREMENTS: We calculated individual rescuer ETI frequency and opportunity. We evaluated relationships between ETI frequency and the number of patient contacts. We also examined the relationship with practice setting (air medical vs. ground rescuers and urban vs. rural rescuers). MAIN RESULTS: In 1,544,791 patient care reports, 11,484 ETIs were reported by 5,245 out-of-hospital rescuers. The median ETI frequency was one (interquartile range, 0-3; range, 0-23). Of 5,245 rescuers, >67% (3,551) performed two or fewer ETIs, and >39% (2,054) rescuers did not perform any ETIs. The median number of ETI opportunities was three (interquartile range, 0-6; range, 0-76). ETI frequency was associated with patient volume (Spearman's rho = 0.67) and was higher for air medical (p = .006) and urban (p < .0001) rescuers. ETI frequency was not associated with response (Spearman's rho = -0.01) or transport (Spearman's rho = -0.06) times. CONCLUSIONS: Out-of-hospital ETI, an important and difficult resuscitation intervention, is an uncommon event for most rescuers.     

Pulmonary complications following endotracheal intubation for anesthesia in breech extraction

A 28-year-old, healthy pregnant patient developed bilateral pneumothorax, subcutaneous emphysema, pneumomediastinum, pneumoretroperitoneum and pneumoperitoneum following endotracheal intubation and manual ventilation during general anesthesia for breech extraction. It is likely that positive-pressure ventilation was the cause for this very rare combination of complications. Early recognition and treatment may prevent such a catastrophe.     

Spontaneous subcutaneous emphysema

Subcutaneous emphysema is an unusual complication of bronchiolitis. The investigators describe a patient with bronchiolitis who developed extensive subcutaneous emphysema. Despite an alarming appearance, the patient recovered with symptomatic care and observation. Review of the literature shows a multitude of causes of subcutaneous emphysema. The vast majority of cases resolve without intervention.     

Emphysematous cystitis with clinical subcutaneous emphysema

Emphysematous cystitis (EC) is the presence of intramural gas, with or without luminal gas, within the bladder as a result of a primary infection of the lower urinary tract with a gas-producing organism. It is a well-recognised complication of urinary tract infections involving Escherichia coli in diabetic patients. Clinical subcutaneous emphysema is a rare complication of EC that appears to have poor prognosis. Only careful clinical judgement, and a high degree of suspicion, will lead to its early diagnosis and treatment. Here, we report a case of subcutaneous emphysema due to EC based on a clinical diagnosis confirmed using computed tomography (CT).     

Complications of endotracheal intubation

Tracheal intubation for airway control, once done only by anesthesiologists during surgical procedures, is now being done by physicians in other specialties and by nurses, technicians, and paramedics in areas other than the operating room. Intubation, however, does not always assure a patent airway. Unrecognized esophageal placement of endotracheal tubes is the major cause of cardiac arrest and brain damage associated with intubation. Though auscultation for breath sounds is the universally accepted method of verifying proper tube placement, recent studies indicate that it is reliable only approximately two thirds of the time in situations in which verification of proper placement is needed most and is least obvious. The usefulness of this technique merits reassessment. Identification of carbon dioxide in end-expired air is the most reliable method for verification, but instruments to detect carbon dioxide are usually immediately available only in special care and surgical suites. Mouth-to-tube insufflation with a two-way disposable microbial filter differentiates immediately between esophageal and tracheal placement and can be used in any area. Malpositioned and malfunctioning tubes cause partial or complete obstruction accompanied by varying degrees of hypoxemia and hypercapnia. Respiratory and circulatory derangements and brain damage ensue if the problem is not promptly recognized and corrected. We discuss the most common causes of tube malfunction.     

A descriptive study of blood in the mouth following routine oral endotracheal intubation.

Oral endotracheal intubation and extubation are two routine procedures performed by anesthesia providers which could lead to breaches of mucosal integrity and slight or moderate bleeding, thereby providing a vector for transmission of a blood-borne disease. This study was designed to determine the incidence of occult or overt blood in the oral and pharyngeal areas during the intubation and extubation periods. A convenience sample of 163 patients from 18 to 70 years of age who underwent an oral endotracheal intubation for general anesthesia were included. Within 15 minutes of endotracheal intubation, the patients were tested at five designated sampling sites for the presence of overt or occult blood. The results demonstrated that blood was present after 34% of the intubations, with 70% of those being positive in the oral/pharyngeal cavity and 52% exhibiting blood on the laryngoscope blade. Upon extubation 72% were positive, with 97% of those being positive at the distal tip of the endotracheal tube. The blood found during both these events was primarily occult. The results suggest that the potential for blood, both overt and occult, to be present in the mouth of patients is significant enough to recommend that all practitioners adhere to the universal barrier precautions to limit their exposure to the transmission of potentially fatal blood-borne viruses.     

Effect of nicardipine on haemodynamic and bispectral index changes following endotracheal intubation

We investigated the effect of IV nicardipine on haemodynamic and bispectral index responses to the induction of general anaesthesia and intubation. Forty patients were randomly allocated to two groups of 20 to receive normal saline or nicardipine 15 microg/kg IV 30 s after induction. Ninety seconds later, tracheal intubation was performed. Systolic blood pressure, heart rate and bispectral index were measured at baseline, 1 min after induction, pre-intubation, and every minute until 5 min after endotracheal intubation. Rate-pressure product values were calculated. In the nicardipine group, systolic blood pressure decreased compared with the control group, and heart rate increased comparedwith the control group. Bispectral index and rate-pressure product showed no differences between the two groups. In conclusion, the administration of 15 microg/kg nicardipine IV does not affect anaesthetic depth in response to the induction of general anaesthesia and intubation.     

Polymicrobial bacterial pericarditis with mediastinitis after endotracheal intubation

Polymicrobial bacterial pericarditis with mediastinitis after traumatic endotracheal intubation is an unusual condition. We report a 54-year-old man, a victim of nasopharyngeal carcinoma, who developed pericardial effusion with tamponade after traumatic endotracheal intubation. The diagnosis of polymicrobial bacterial pericarditis was made when pericardiocentesis revealed purulent fluid that grew a mixed culture of anaerobic and aerobic bacteria, reflecting the normal upper airway flora. By bronchoscopic study, a laceration over the lower trachea was detected. The patient received prolonged aggressive antibiotic therapy and pericardial drainage. The infection improved, but the patient later died from another episode of nosocomial infection.