THE CONSCIOUS patient does not tolerate an endotracheal tube. The unconscious patient is often anesthetized more deeply than necessary for surgery, in order to prevent straining ("bucking") on the endotracheal tube. For many years, the vocal cords have been sprayed with local anesthetic to obtund the cough reflex. The effect lasts for less than one hour. With the advent of muscle relaxants, it was noted that many patients underventilated postoperatively, especially if administered narcotics. The development of pulmonary therapy has taught that many patients with various diseases die from hypoventilation. Patients who have undergone open heart surgery (split sternum), patients with barbiturate intoxication or severe pneumonias, or patients in an unconscious state may require assisted ventilation for several days for survival. Prolonged endotracheal intubation is required, and several methods are in use.
The most widely used method has been to perform a tracheostomy, insert a cuffed tracheostomy tube, and mechanically
Jackson RR, Rokowski WJ. An Endotracheal Tube With a Cellophane Cuff. JAMA. 1967;199(10):756–757. doi:10.1001/jama.1967.03120100118034
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