PubMed · 16288634
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J Greenwood. 2005. Generic machine checks.. https://doi.org/10.1111/j.1365-2044.2005.04454.x
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The delay for loss of consciousness can be shortened by using high concentration sevoflurane > 6% and by adding N2O during inhalation induction with sevoflurane in paediatrics. Mean time for tracheal tube insertion is lower than 5 min in the majority of studies. This shorter delay is not associated with any significant increase in clinical side effects. However, recent studies have demonstrated the epileptogenic effect of high effect site sevoflurane concentration (occurrence of spike wave on the EEG). Inhalation induction with high alveolar sevoflurane concentration is questionable mainly when it is associated with hyperventilation. Positive pressure ventilation or pressure support ventilation make it possible to maintain normocapnia and to monitor FeSevo. Adding a narcotic decreases the target cerebral concentration required to perform tracheal intubation and consequently the risk of spike wave occurrence.
OBJECTIVE: Although the effects of halogenated agents on both normal and diseased left ventricles have been widely studied, the influence of these anesthetic agents on right ventricular (RV) performance remains less well characterized. This study was undertaken to examine the effects of 2 different concentrations of sevoflurane on RV function, and coronary and pulmonary hemodynamics in acutely instrumented anesthetized pigs. DESIGN: Prospective experimental study. SETTING: Laboratory of experimental research in a university teaching hospital. SUBJECTS: Anesthetized pigs. INTERVENTIONS: Regional RV function in 10 pigs was determined from pressure segment length loop analysis, global RV function from stroke work versus end-diastolic pressure relation, right coronary blood flow, and pulmonary vascular resistance (PVR), without and then with 2.6% (minimum alveolar concentration [MAC]) and 3.9 % (1.5 MAC) end-tidal sevoflurane concentrations. MAIN RESULTS: Sevoflurane preserved inflow systolic shortening and RV regional external work, but significantly depressed outflow systolic shortening (p < 0.05). Global RV stroke work was depressed to 72% +/- 12% and 61% +/- 10% of baseline value, respectively, with 1 and 1.5 MAC of sevoflurane (p < 0.05), but without alteration of PVR. Right coronary blood flow decreased dose dependently. CONCLUSIONS: Sevoflurane causes significant depression of global RV function associated with a qualitatively different effect on inflow and outflow tracts, without any modification of PVR.
BACKGROUND: The value of the laryngeal tube S (LTS) for emergency airway management was evaluated in comparison to endotracheal intubation (ETI). METHODS: Physicians were asked to perform simulated airway management in an airway mannequin. The physicians were allocated into three groups according to their experience in intubation (1: <50, 2: >50, 3: >500 intubations). The success rate using LTS and ETI, the time needed for securing the airway, and the rating of both techniques by the participants were recorded. RESULTS: A correct position was achieved with the LTS in 99.39% of attempts (n=325), and with the endotracheal tube in 92.35% (n=302). Using the LTS it took an average time of 10.85 s to achieve the first successful ventilation, as compared to 17.75 s in ETI (p<0.0001). Participants from group 1 needed longer to achieve ETI in the 2nd (18.4 s vs. 16.4 s, p<0.0001) and 3rd attempts (16.9 s vs. 15.8 s, p<0.0001) compared to those from group 3. CONCLUSIONS: The LTS represents a fast and reliable method to secure the airway and to achieve ventilation in the mannequin model described. The success rate, the time until successful ventilation and the rating by the participants indicates that the LTS is an important alternative to ETI. The LTS offers special benefits for the less experienced users.