PURPOSE: To investigate the differences in postoperative sore throat and hoarseness by adjustment of endotracheal tube cuff pressure (CP) during nitrous oxide (N2O) and air anesthesia. METHODS: A one-equivalent control group pretest-posttest design was used. Data were collected from August 8 to October 19, 2017 and analyzed using the independent t-test and repeated measures ANOVA. Eighty-four participants were enrolled and divided into three groups: 28 in the Control Group (CP adjusted every 30 minutes using N2O), 28 in Experimental Group 1 (CP adjusted every 10 minutes using N2O), and 28 in Experimental Group 2 (non-adjusted CP using air), all of whom underwent urologic, gynecologic, and orthopedic surgeries at the G University hospital. Sore throat was assessed using a numeric rating scale; hoarseness was evaluate using the Stout classification at 1, 6, and 24 hours after surgery. RESULTS: Scores for sore throat and hoarseness were significantly different between the groups at each measurement time, and scores were consistently higher in the control group. During subsequent measurements, sore throat and hoarseness scores were significantly lower at 6 hours. Cuff pressure changed significantly using air anesthesia (χ2=10.41, p=.015) up to 2 hours after induction. Severe sore throat and hoarseness was observed for up to 6 hours after surgery. CONCLUSION: Cuff pressure adjustment at short time intervals would be helpful in reducing postoperative sore throat and hoarseness. Nursing intervention focused on prevention of sore throat and hoarseness should be required up to 6 hours postoperatively in patients undergoing endotracheal intubation.
Anesthesia ; Classification ; Hoarseness ; Humans ; Intubation ; Intubation, Intratracheal ; Nitric Oxide ; Nitrous Oxide ; Nursing ; Orthopedics ; Pharyngitis

PURPOSE: The purpose of this study was to examine the effects of a closed endotracheal suction system(CES) on oxygen saturation, ventilator associated pneumonia(VAP), and nursing efficacy in mechanically ventilated patients. METHOD: This study was conducted in the intensive care unit of a University Hospital in Gwangju City. Data was collected from July to October, 2003. Seventy mechanically ventilated patients were randomly divided into two groups; 32 for CES and 38 for open endotracheal suction system(OES) protocol. Twenty one nurses were also involved to examine the nurses' attitude of usefulness about CES. RESULT: SaO2 was significantly different between CES and OES. The incidence of VAP in CES was lower than that of OES. Nursing efficacy was related to time, cost, and usefulness of the suction system. Time of suctioning in CES was shorter than that of OES. CES also contributed significantly to lower the cost of treatment than OES. The usefulness score of CES increased after 6 months of use. CONCLUSION: CES prevented VAP, was cost effective, and a safe suctioning system. CES ncan be used with patients with sensitivity to hypoxygenation and with a high risk of VAP.
Adult ; Cross Infection/*etiology ; Female ; Humans ; Intubation, Intratracheal/*adverse effects/methods/nursing ; Male ; Middle Aged ; Nursing Care/standards ; Pneumonia/*etiology ; Respiration, Artificial/*adverse effects/nursing

This study was conducted to investigate the effects of a no saline, a 2 ml and a 5 ml saline instillation prior to endotracheal suctioning on oxygen saturation in patients with pneumonia. The subjects in this study were 16 pneumonic patients with a tracheotomy tube, who had been admitted to the neuro-surgical intensive care unit at a university hospital in Seoul Korea. All three (0, 2 and 5 ml) saline instillation methods were applied to the 16 patients. The methods were randomly assigned to each patient. Each of the instillation methods was applied in a four-step sequence: 1) recording the level of oxygen saturation (baseline levels), 2) instilling normal saline, 3) supplying oxygen and suctioning, and 4) recording the level of oxygen saturation. The oxygen saturation was evaluated using pulse oximetry. The recovery times for oxygen saturation to return to baseline levels following suctioning were, just after suctioning, 45seconds after suctioning and in excess of 5 minutes with 0, 2 and 5 ml saline instillations, respectively. Instillation of normal saline before suctioning could have an adverse effect on oxygen saturation, and should be used carefully as a routine intervention in patients who have pneumonia.
Adult ; Aged ; Aged, 80 and over ; Female ; Human ; Instillation, Drug ; Intubation, Intratracheal/*nursing ; Male ; Middle Age ; Oxygen/metabolism ; Pneumonia/*nursing ; Sodium Chloride/*administration & dosage ; Suction/*nursing ; Tracheotomy

OBJECTIVETo investigate the effect of exchange of tracheal tube for a laryngeal mask airway (LMA) on intratracheal extubation stress response under deep anesthesia level after surgery in elderly patients with hypertension.

METHODSFrom October 2008 to June 2009, 40 hypertension patients aged from 65 to 78 years scheduled for upper abdominal surgery were randomly divided into 2 groups, one was extubated intratracheal tube when being awake (group TT, n = 20) and the other was extubated and exchanged for LMA under deep anesthesia (group LM, n = 20). The American Society of Anesthesiologists (ASA) of the patients were I o rII. The data of mean arterial pressure (MAP), heart rate(HR), pulse oxygen saturation (SPO(2)), end-tidal carbon dioxide tension (P(ET)CO(2)) and rate pressure product(RPP) were recorded before induction of anesthesia (T(0)), suction (T(1)) and at 0 (T(2)), 5(T(3)), and 10 (T(4)) and 15 min (T(5)) after extubation tracheal tube or LMA in two groups. The indices mentioned above also were recorded before and after extubation in group LM. Blood samples were taken at T(0), skin incision, T(2), T(3), for determination of serum concentrations of blood glucose and cortisol. The airway adverse events in the recovery period were recorded.

RESULTSCompared with group LM, MAP, HR and RPP were significantly higher at T(1), T(2), T(3) than T(0) in group TT (P < 0.05). There was no significant difference in the indices mentioned above during extubated intratracheal tube and exchanged for LMA under deep anesthesia in group LM (P > 0.05). The incidence rate of glossoptosis in group TT was significantly higher than those in group LM (P < 0.01), while complications, such as cough, bucking, breath holding during the recovery stage in group TT were more than those in group LM (P < 0.05). Compared with the baseline value, blood glucose and cortisol concentration level were significantly increased in group TT than in group LM (P < 0.01).

CONCLUSIONSExchange of tracheal tube for LMA under deep anesthesia during recovery stage can decrease the stress response during the recovery stage and attenuate the harmful response of respiratory tract. It is suitable for the elderly patients with hypertension.

Aged ; Anesthesia, General ; Device Removal ; methods ; Female ; Humans ; Hypertension ; physiopathology ; Intubation, Intratracheal ; Laryngeal Masks ; Male ; Postanesthesia Nursing ; Stress, Physiological

PURPOSE: This study was conducted to develop a Web-based learning program on cardiopulmonary emergency care for clinical nurses and to evaluate learners' responses. METHODS: Based on the assessment of learning needs of clinical nurses, a total of three self-directed learning modules were developed according to the procedure of the ADDIE (assessment, design, development, implementation, & evaluation) model. RESULTS: Each learning module included the emergency treatments and drugs used in the real patients' situations with cardiopulmonary crisis, which had been adopted from the emergency department of a C University hospital located in G-city. Real video clips for endotracheal intubation and ACLS (advanced cardiac life support) were developed with the help of the staff of the department of emergency medicine using a human simulator, SimMan(R). The program published on the Web was evaluated by 20 clinical nurses who are working in the emergency department and wards of a C-University hospital. About 80% of the respondents were satisfied with the program contents, design, and learning strategy. CONCLUSION: Web-based learning programs on cardiopulmonary emergency care are needed for clinical nurses as educational material for staff education to increase their knowledge for making immediate clinical decisions and in giving skilled care in emergency situations.
Advanced Cardiac Life Support ; Computer-Assisted Instruction ; Surveys and Questionnaires ; Education, Nursing ; Emergencies ; Emergency Medical Services ; Emergency Medicine ; Emergency Treatment ; Humans ; Intubation, Intratracheal ; Learning

PURPOSE: This study was conducted to analyze intubation survival rates according to characteristics and to identify the risk factors affecting deliberate self-extubation. METHODS: Data were collected from patients' electronic medical reports from one hospital in B city. Participants were 450 patients with endotracheal intubation being treated in intensive care units. The collected data were analyzed using Kaplan-Meier estimation, Log rank test, and Cox's proportional hazards model. RESULTS: Over 15 months thirty-two (7.1%) of the 450 intubation patients intentionally extubated themselves. The patients who had experienced high level of consciousness, agitation. use of sedative, application of restraints, and day and night shift had significantly lower intubation survival rates. Risk factors for deliberate self-extubation were age (60 years and over), unit (neurological intensive care), level of consciousness (higher), agitation, application of restraints, shift (night), and nurse-to-patient ratio (one nurse caring for two or more patients). CONCLUSION: Appropriate use of sedative drugs, effective treatment to reduce agitation, sufficient nurse-to-patient ratio, and no restraints for patients should be the focus to diminish the number of deliberate self-extubations.
Age Factors ; Aged ; Consciousness ; Device Removal ; Female ; Humans ; Hypnotics and Sedatives/therapeutic use ; Intensive Care Units ; Intubation, Intratracheal/mortality/*nursing/psychology ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Nurses/statistics & numerical data/supply & distribution ; Proportional Hazards Models ; Psychomotor Agitation ; Retrospective Studies ; Risk Factors ; Workload