Tracheal Intubation Medications Publications (932)


Tracheal Intubation Medications Publications

Biomed Res Int
Biomed Res Int 2016 29;2016:4582439. Epub 2016 Nov 29.
Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Rheumatology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan; Department of Nursing, College of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan.

OBJECTIVE Posttraumatic seizure is a major complication following traumatic brain injury (TBI). The aim of this study was to determine the variation in seizure prophylaxis in select pediatric trauma centers. The authors hypothesized that there would be wide variation in seizure prophylaxis selection and use, within and between pediatric trauma centers. Read More

METHODS In this retrospective multicenter cohort study including 5 regional pediatric trauma centers affiliated with academic medical centers, the authors examined data from 236 children (age < 18 years) with severe TBI (admission Glasgow Coma Scale score ≤ 8, ICD-9 diagnosis codes of 800.0-801.9, 803.0-804.9, 850.0-854.1, 959.01, 950.1-950.3, 995.55, maximum head Abbreviated Injury Scale score ≥ 3) who received tracheal intubation for ≥ 48 hours in the ICU between 2007 and 2011. RESULTS Of 236 patients, 187 (79%) received seizure prophylaxis. In 2 of the 5 centers, 100% of the patients received seizure prophylaxis medication. Use of seizure prophylaxis was associated with younger patient age (p < 0.001), inflicted TBI (p < 0.001), subdural hematoma (p = 0.02), cerebral infarction (p < 0.001), and use of electroencephalography (p = 0.023), but not higher Injury Severity Score. In 63% cases in which seizure prophylaxis was used, the patients were given the first medication within 24 hours of injury, and 50% of the patients received the first dose in the prehospital or emergency department setting. Initial seizure prophylaxis was most commonly with fosphenytoin (47%), followed by phenytoin (40%). CONCLUSIONS While fosphenytoin was the most commonly used medication for seizure prophylaxis, there was large variation within and between trauma centers with respect to timing and choice of seizure prophylaxis in severe pediatric TBI. The heterogeneity in seizure prophylaxis use may explain the previously observed lack of relationship between seizure prophylaxis and outcomes.


High doses of sedating drugs are often used to manage critically ill patients with alcohol withdrawal syndrome.
To describe outcomes and risks for pneumonia and endotracheal intubation in patients with alcohol withdrawal syndrome treated with high-dose intravenous sedatives and deferred endotracheal intubation.
Observational cohort study of consecutive patients treated in the intensive care unit (ICU) of a university-affiliated, community hospital for alcohol withdrawal syndrome, where patients were not routinely intubated to receive high-dose or continuously infused sedating medications. Read More

We studied 188 patients hospitalized with alcohol withdrawal syndrome from 2008 through 2012 at one medical center. The mean age (SD) of the subjects was 50.8 ± 9.0 years and their mean ICU admission APACHE (Acute Physiology and Chronic Health Evaluation) II score was 6.2 ± 3.4. Thirty subjects (16%) developed pneumonia, and 38 (20.2%) required intubation. All of the 188 patients received lorazepam (median total dose, 42.5 mg), and 170 of 188 received midazolam, all but 2 by continuous intravenous infusion (median total dose, 527 mg; all administered in ICU); 19 received propofol (median total dose, 6,000 mg); and 19 received dexmedetomidine (median total dose, 1,075 mg). Intubated patients received substantially more benzodiazepine (median total dose, 761 mg of lorazepam equivalent vs. 229 mg for subjects in the nonintubated group; P < 0.0001). Endotracheal intubation was associated with pneumonia and higher acuity of illness (APACHE II score, >10). Intubated patients had a longer duration of hospital stay (median, 15 d vs. 6 d; P ≤ 0.0001). One patient did not survive hospitalization.
In this single-center, observational study, where endotracheal intubation was deferred until aspiration or cardiopulmonary decompensation, treatment of alcohol withdrawal syndrome with high-dose, continuously infused sedating medications was not associated with excess morbidity or mortality.

Acta Med Iran
Acta Med Iran 2015 Dec;53(12):733-7
Department of Anesthesiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.

A varieties of medications have been suggested to prevent hemodynamic instabilities following laryngoscopy and endotracheal intubation. This study was conducted to determine the beneficial effects of gabapentin on preventing hemodynamic instabilities associated with intubation in patients who were a candidate for coronary artery bypass surgery (CABG). This double blinded randomized, parallel group clinical trial was carried out on 58 normotensive patients scheduled for elective CABG under general anesthesia with endotracheal intubation in Shariati Hospital. Read More

Patients were randomly allocated to two groups of 29 patients that received 1200 mg of gabapentin in two dosages (600 mg, 8 hours before anesthesia induction and 600 mg, 2 hours before anesthesia induction) as gabapentin group or received talc powder as placebo (placebo group). Heart rate, mean arterial pressure, systolic and diastolic blood pressure were measured immediately before intubation, during intubation, immediately after intubation, 1 and 2 minutes after tracheal intubation. Inter-group comparisons significantly showed higher systolic and diastolic blood pressure, mean arterial pressure and heart rate immediately before intubation, during intubation, immediately after intubation, 1 and 2 minutes after tracheal intubation in the placebo group in comparison to gabapentin group. The median of anxiety verbal analog scale (VAS) at the pre-induction room in gabapentin and placebo groups were 2 and 4, respectively that was significantly lower in the former group (P. value =0.04 ); however, regarding median of pain score no difference was observed between them (P. value =0.07). Gabapentin (1200 mg) given preoperatively can effectively attenuate the hemodynamic response to laryngoscopy, intubation and also reduce preoperative related anxiety in patients who were a candidate for CABG.

Cochrane Database Syst Rev
Cochrane Database Syst Rev 2016 Jan 5(1):CD005059. Epub 2016 Jan 5.
Department of Anesthesiology, Faculty of Medicine, University of Sherbrooke, Sherbrooke, QC, Canada.

Epidural analgesia offers greater pain relief compared to systemic opioid-based medications, but its effect on morbidity and mortality is unclear. This review was originally published in 2006 and was updated in 2012 and again in 2016.
To assess the benefits and harms of postoperative epidural analgesia in comparison with postoperative systemic opioid-based analgesia for adults undergoing elective abdominal aortic surgery. Read More

In the updated review, we searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, and five trial registers in November 2014, together with reference checking to identify additional studies.
We included all randomized controlled trials comparing postoperative epidural analgesia and postoperative systemic opioid-based analgesia for adults who underwent elective open abdominal aortic surgery.
Two authors independently assessed trial quality and extracted data. We contacted study authors for additional information and data when required. We assessed the level of evidence according to the scale provided by the GRADE working group.
We included 15 trials published from 1987 to 2009 with 1498 participants in this updated review. Participants had a mean age between 60.5 and 71.3 years. The percentage of women in the included studies varied from 0% to 28.1%. Adding an epidural to general anaesthesia for people undergoing abdominal aortic repair reduced myocardial infarction (risk ratio (RR) 0.54 (95% confidence interval (CI) 0.30 to 0.97); I(2) statistic = 0%; number needed to treat for one additional beneficial outcome (NNTB) 28 (95% CI 19 to 1423), visual or verbal analogical scale (VAS) scores up to three days after the surgery (mean difference (MD) -1.78 (95% CI -2.32 to -1.25); I(2) statistic = 0% for VAS scores on movement at postoperative day one), time to tracheal extubation (standardized mean difference (SMD) -0.42 (95% CI -0.70 to -0.15); I(2) statistic = 83%; equivalent to a mean reduction of 36 hours), postoperative respiratory failure (RR 0.69 (95% CI 0.56 to 0.85); I(2) statistic = 0%; NNTB 8 (95% CI 6 to 16)), gastrointestinal bleeding (OR 0.20 (95% CI 0.06 to 0.65); I(2) statistic = 0%; NNTB 32 (95% CI 27 to 74)) and time spent in the intensive care unit (SMD -0.23 (95% CI -0.41 to -0.06); I(2) statistic = 0%; equivalent to a mean reduction of six hours). We did not demonstrate a reduction in the mortality rate up to 30 days (RR 1.06 (95% CI 0.60 to 1.86); I(2) statistic = 0%). The level of evidence was low for mortality and time before tracheal extubation; moderate for myocardial infarction, respiratory failure and intensive care unit length of stay; and high for gastrointestinal bleeding and VAS scores.
Epidural analgesia provided better pain management, reduced myocardial infarction, time to tracheal extubation, postoperative respiratory failure, gastrointestinal bleeding, and intensive care unit length of stay compared with systemic opioid-based drugs. For mortality, we did not find a difference at 30 days.

Braz J Anesthesiol
Braz J Anesthesiol 2015 Nov-Dec;65(6):450-4. Epub 2013 Oct 26.
Social Medicine Department, School of Medicine, Mashhad University of Medical Science, Mashhad, Iran.

Laryngeal mask airway is still accompanied by complications such as sore throat. In this study, effects of three methods of reducing postoperative sore throat were compared with the control group.
240 patients with ASA I, II candidates for cataract surgery were randomly divided into four same groups. Read More

No supplementary method was used in the control group. In the second, third and fourth groups, lidocaine gel, washing cuff before insertion, and washing mouth before removing laryngeal mask airway were applied, respectively. Anesthesia induction was done with fentanyl, atracurium, and propofol and maintained with propofol infusion. The incidence of sore throat was evaluated during the recovery, 3-4h later and after 24h using verbal analog scale. The data were analyzed by t-test, analysis of variance and chi-square using SPSS V11.5.
Age, gender, duration of surgery and cuff pressure were the same in all the four groups. Incidence of sore throat at recovery room was highest in the control group (43.3%) and lowest in the washing mouth group (25%). However, no significant statistical difference was observed between these four groups (recovery, p=0.30; discharge, p=0.31; examination, p=0.52). In this study, increased duration of operation had a significant relationship with the incidence of sore throat (p=0.041).
Sore throat is a common postoperative problem, but no special method has been found completely efficient yet. In this study, cuff washing, lidocaine gel, and mouth washing before removing laryngeal mask airway were not helpful for sore throat.

J Cardiothorac Surg
J Cardiothorac Surg 2015 Nov 4;10:148. Epub 2015 Nov 4.
Department of Anesthesia, First hospital of Jilin University, No.71st Xinmin ST, Changchun, Jilin, 130021, China.

Patients undergoing total aortic arch replacement or aortic dissecting aneurysmectomy are generally managed with medications to control hypotension and blood coagulation to minimize mortality and morbidity. However, prolonged mechanical ventilation via tracheal intubation increases the risk of tracheal stenosis in such patients.
We present 2 cases (a 49-year-old woman and a 62-year-old man) of post-intubation tracheal stenosis occurring after surgery for the correction of complicated aortic dissection; both cases were successfully managed by tracheal cryotherapy. Read More

Continuous monitoring of cuff pressure and regular cuff palpation are necessary to minimize the incidence of tracheal stenosis. If the patients have concomitant local or systemic infection, adequate preventive measures should be taken to reduce the incidence of post-intubation tracheal stenosis. Tracheal cryotherapy is recommendable for the management of post-intubation tracheal stenosis.