Future trends in regional spinal opioids.
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Analgesics, Opioid↗
Biomedical subjects
S Cotev
Publications and source records attributed to S Cotev.
The use of continuous flow of oxygen and PEEP during apnea in the diagnosis of brain death.
The establishment of apnea for the diagnosis of brain death by disconnecting the patient from the ventilator may lead to dangerous hypoxemia at the end of the test period. We established apnea for 4 min in 8 patients with suspected brain death, both by disconnecting them from the ventilator after 10 min ventilation with FIO2 = 1.0 (method "A"), and by leaving them attached to an IMV ventilator circuit with a continuous flow of 100% O2 and PEEP of 4-8 cm H2O without mechanical ventilation (method "B"). PaO2 decreased during the apneic period by 143 +/- 65 (SD) mmHg using method "A", and by 48 +/- 28 mmHg using method "B" (p less than 0.002). The changes in PaCO2 and pH were similar following both apneic methods. We conclude that it is safer to test for apnea by leaving the patients on a continuous flow of 100% oxygen and low PEEP than to disconnect them from the ventilator.
Adolescent↗
Acute bronchoconstriction associated with transtentorial herniation in a patient with elevated intracranial pressure.
A patient with acutely elevated intracranial pressure (ICP) and a severe attack of bronchoconstriction is presented. Further investigation after treating the combined emergency situation revealed uncompensated hydrocephalus. Possible mechanisms which might be responsible for the coexisting emergency states are discussed. The urgent need for immediate simultaneous treatment of both disease entities is emphasized.
Acute Disease↗
Long-term barbiturate infusion to reduce intracranial pressure.
We report two cases of children, 7 and 14 yr old, in whom prolonged infusion of thiopental sodium (TS) was used to control intracranial hypertension previously unresponsive to conventional therapy. Intracranial hypertension followed removal of a large tumor in 1 case, and trauma in the other. TS was administered at a rate of up to 7 mg/kg . h for 8 days in 1 patient, and up to 12 mg/kg . h for 10 days in the other. Both children regained consciousness and made significant recovery of neurological function. The advantage and the side-effects of the prolonged use of TS for intracranial hypertension are discussed.
Adolescent↗
Intravenous albumin administration in acid aspiration syndrome in rabbits.
The possible value of albumin in a rabbit model of the acid aspiration syndrome was studied. Hydrochloric acid was instilled into the respiratory tracts of three groups of rabbits: Group A received a high intravenous dose of human albumin (1.5 gm/kg body weight); Group B (control) was given Hartmann's solution, and Group C a low dose of albumin (0.25 gm/kg body weight). The total amount of intravenous fluids was identical in all groups. Serum and pulmonary edema fluid (PEF) concentrations of total protein were highest in Group A. Simultaneous concentration gradients between serum and PEF for total protein, human and rabbit albumin, and globulin fractions were not statistically different in the three groups. In Group A, PEF appeared first and PaO2, static compliance, and hematocrit decreased significantly more than those of the two other groups. Survival of animals in Group C was highest. An additional Group (D) of rabbits received the same high dose of albumin without acid aspiration. In Group D hematocrit decreased while serum total protein and pulmonary function remained unchanged. It seems that a high dose of albumin causes a further deterioration of lung function following acid aspiration because of extravasation into the interstitial space. The administration of low doses of albumin was not different than Hartmann's solution, but led to the best survival in our model.
Animals↗
[Continuous positive airway pressure mask in acute respiratory failure].
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Acute Disease↗
Positive end-expiratory pressure (PEEP) and cerebrospinal fluid pressure during normal and elevated intracranial pressure in dogs.
The effect of up to 15 cm H2O positive end-expiratory pressure (PEEP) on cerebrospinal fluid pressure (Pcsf) was investigated in five anaesthetised, mechanically ventilated dogs during normal and then elevated (40-50 cm H2O) intracranial pressure (ICP). Stepwise elevations of PEEP in 5 cm H2O increments resulted in small rises in Pcsf at normal ICP and in significantly larger rises when ICP was elevated. The regression equations for the relationships between Pcsf and end-expiratory pressure (EEP) were as follows: Pcsf = 12.95 + 0.82 EEP for normal ICP, and Pcsf = 46.41 + 2.06 EEP for elevated ICP. Mean PaCO2 rose from 39.7 +/- 2.5 to 47.6 +/- 5.0 torr during normal ICP, and from 34.2 +/- 2.9 to 50.9 +/0- 5.3 torr at elevated ICP as PEEP was elevated to 15 cm H2O. We conclude that PEEP raised Pcsf, and that this increase is more severe under conditions of elevated ICP. The rise in Pcsf due to PEEP may be explained by either the rise in intrathoracic pressure or the rise in PaCO2, or both.
Animals↗
A computer program for bedside renal function studies.
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Diagnosis, Computer-Assisted↗
Persistent nonketotic hyperglycemia as a grave prognostic sign in head-injured patients.
The authors studied 86 consecutive patients admitted to the ICU after severe head trauma. Of these, 19 nondiabetic patients developed persistent nonketotic hyperglycemia (NKH), defined as plasma glucose greater than 270 mg/dl (15 mM/L), 1.7 +/- 1.1 (SD) days after injury. When NKH occurred, all patients were in very deep coma (Glasgow Coma Scale score 3), and when intracranial pressure (ICP) was measured (12 patients), its mean value was 59.8 +/- 20.4 mm Hg. Although 11 of 19 patients had associated diabetes insipidus (DI), NKH was not related to increased fluid and glucose loading. All patients with NKH died (mean time of survival after NKH was 2.1 +/- 1.4 days) in contrast to a 17.1% early mortality rate in patients with severe head injury without NKH. The authors could not show a direct correlation between the height of ICP and the level of blood glucose.
Adolescent↗
Coexistence of pheochromocytoma and renal artery occlusion in a patient with malignant hypertension.
A patient with malignant hypertension due to the simultaneous occurrence of pheochromocytoma and renal artery occlusion is described. The pheochromocytoma was resected, but hypertension persisted postoperatively and significant renovascular disease was observed. The blood pressure returned to normal after nephrectomy. The possible pathogenetic link between the two conditions is discussed, and a therapeutic approach is suggested.
Adrenal Gland Neoplasms↗
Reversal of ergotamine-induced arteriospasm by mechanical intra-arterial dilatation.
Two patients with imminent gangrene of the extremities caused by ergot-induced arteriospasm underwent mechanical dilatation of the arteries when conventional measures such as anticoagulation, vasodilation, and sympathetic blockade produced no improvement. Dilatation by a balloon-tipped catheter produced an immediate and sustained reversal of the arteriospasm, together with a dramatic relief of symptoms and signs.
Adult↗
Aspiration in caesarean section successfully treated with high continuous positive airway pressure (CPAP).
A case of aspiration pneumonitis during Caesarean section is described. The patient was treated with high-level continuous positive airway pressure (CPAP) resulting in marked improvement and discharge from the Intensive Care Unit 44 hours after the aspiration had occurred.
Carbon Monoxide↗
Observations on extradural morphine analgesia in various pain conditions.
We report the extradural administration of low-dose morphine in 10 ml of 10% dextrose (2-3 mg) to 98 adult patients with various types of acute and chronic pain. Extradural morphine injections were given either via a Tuohy needle (single or repeat injection) or via an extradural catheter. Pain relief was evaluated by subjective scoring and by the subsequent need for systemic analgesics. In 56% of patients, pain relief was considered good or excellent, in 24% it was fair, and in 20%, poor. The best results were after surgery and trauma and in patients with advanced peripheral vascular disease. The analgesia of each dose of extradural morphine lasted for 8 h (mean range 4-36 h). There was no motor, sensory or sympathetic blockade and no respiratory or haemodynamic complications. Dizziness and vomiting occurred in two patients, and urinary retention for about 12 h in three.
Adult↗
The use of continuous positive airway pressure in blast injury of the chest.
A 15-year-old boy suffered blast injury of the lungs and developed acute respiratory distress with severe hypoxemia. The patient required mechanical ventilation with high-level PEEP, in the early postblast injury period. In order to reduce the risk of air embolization and barotrauma, we reverted to spontaneous breathing using intermittent mechanical ventilation (IMV) and continuous positive airway pressure (CPAP) as early as possible. The patient recovered after successful treatment. Treatment with IMV and CPAP is discussed and recommended in such cases.
Adolescent↗
Neurogenic pulmonary edema associated with a colloid cyst in the third ventricle. Case report.
Neurogenic pulmonary edema (NPE) is usually the result of head trauma. The authors describe the case of a 13-year-old girl, in whom NPE was associated with a colloid cyst of the third ventricle causing acute hydrocephalus. The mechanisms involved in the development of NPE are briefly discussed. The possible role of the colloid cyst in the distortion of the anatomical relationships in the vicinity of the hypothalamic nuclei is considered.
Adolescent↗
Effect of an acute increase in cerebrospinal fluid pressure on lung compliance in the rabbit.
Cerebrospinal fluid pressure (Pcsf) was increased acutely by the injection of normal saline into the cisterna magna of anaesthetized rabbits to values which interrupted cerebral flow. When increased Pcsf was maintained for a minimum of 3 min, static lung compliance decreased and lung weight (after sacrifice) increased without marked change in arterial blood-gas tensions. The magnitude of the increase in Pcsf did not affect the change in compliance and weight. There was marked unexplained metabolic acidosis. The pulmonary findings may result from a massive shift of blood from the systemic to the pulmonary circulation leading to increased permeability of the interendothelial junctions of the pulmonary capillaries.
Acidosis↗
Intermittent mandatory ventilation during anaesthesia using the Manley Servovent ventilator.
The lungs of 25 patients were ventilated with intermittent mandatory ventilation (IMV) during anaesthesia using the Manley Servovent Model MS. This ventilatory mode is especially suitable for prolonged operations in which there is no need for muscle relaxation. While incorporating the advantages of spontaneous and mechanical ventilation, it is superior to both in selected cases. The Manley Servovent Model MS ventilator is capable of delivering IMV without modification, using a single source of gas.
Adolescent↗
Mechanical inspiratory peak flow as a determinant of tidal volume during IMV and PEEP.
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Acute Disease↗