PubMed · 3842172
The source did not provide an abstract. Follow the original record for more information.
Explore connections, maps & timelines
S B Torrey. 1985. Apnea.. https://doi.org/10.1097/00006565-198512000-00013
Cite the original work for its findings. Save a collection to share your selection of sources.
KEEP EXPLORING
As a part of a prospective multi-disciplinary study, all children born with a Chiari II malformation within the Uppsala region during a 3-year period were evaluated for any difficulties in breathing or swallowing. The evaluation was repeated at regular intervals during their first 18 months. Direct laryngoscopies were performed using flexible fiberscopes. Four out of 22 children were found to have disturbed breathing. Among those, two suffered from central apnoeic spells as well as bilateral vocal fold motion impairment, one from apnoeic spells only and one from bilateral vocal fold motion impairment only. All four also had dysphagia with aspiration. Three of the children developed respiratory symptoms within the first 3 months and the symptoms of the fourth begun within the first 6 months. One infant with severe symptoms expired at the age of 3 months. The vocal fold paralysis, apnoeic spells and swallowing difficulties of another infant resolved following active neurosurgical management. The conclusion that laryngologic issues are prominent in the severe Chiari II syndrome was further supported by a review of four more cases managed in recent years. Laryngologic assessment in the neonatal period can help to raise the issue of early neurosurgical intervention as well as identify some of the infants who will need extensive habilitation. Screening of laryngeal function by means of flexible fiberoptic laryngoscopy is recommended.
OBJECTIVE: To determine changes of blood pressure and heart rate during apnoea testing for brain death without (A) and with (B) artificial CO2 augmentation. DESIGN: Prospective, consecutive study. SETTING: 12 intensive care units in six towns in Northern Bavaria. PATIENTS AND PARTICIPANTS: A total of 55 apnoea tests were performed on 55 consecutive patients as part of the determination of brain death, 27 without and 28 with CO2 augmentation. INTERVENTIONS: Apnoea tests following oxygenation with 100% O2 either after reduction of ventilatory volume (A) or after insufflation of CO2 during normoventilation (B). In each case, an arterial partial CO2 pressure of at least 8 kPa was documented. RESULTS: All apnoea tests were without serious adverse effects (hypoxia, newly induced cardiac arrhythmia, cardiac asystole). An increased dopamine infusion rate was deemed necessary in only one case of group (A) because of marked systolic hypotension (< 8 kPa). Individual variation of systolic and diastolic blood pressure (BP) did not exceed + 62 to -46% and + 49 to -52% respectively, in group (A) and + 35 to -57% and + 40 to -48% respectively, in group (B). Variation of heart rate (HR) remained within the range + 24 to -31% in group (A) and + 37 to -22% in group (B). CONCLUSIONS: HR varied less than BP. The possibility of a marked relative rise of fall of BP in group (A) was equal; in group (B) there was a lower change of rising BP. The chances for a rise or fall in HR were equal for the two groups. There was a tendency for less variation of cardiovascular parameters in group (B).
OBJECTIVE: The study the population pharmacokinetics of caffeine after intravenous administration to premature infants with apnea. METHODS: A prospective, blinded parallel study in which daily caffeine citrate doses of 30, 15, and 3 mg/kg were administered over 7 days by intermittent intravenous infusion. Arterial blood samples (three to six per patient) were assayed for caffeine content by means of HPLC. Population pharmacokinetic modeling was performed with NONMEM. RESULTS: Clearance (L/hr) = (0.00000399 . current weight [grams]) + (0.000128 . postnatal age [days]). For gestational age > 28 weeks, volume of distribution (L) = (0.000764 . weight [grams] + (0.0468 . postnatal age [days]); for gestational age < or = 28 weeks, volume of distribution (L) = (0.000755 . weight [grams]) + (0.0224. postnatal age [days]). Interpatient variability (coefficient of variation, in percent) was approximately 25% for clearance and approximately 11% for volume of distribution. Intrapatient error (standard deviation) was 3.9 mg/L. There was insignificant bias between observed and model-predicated serum caffeine concentrations in a separate group of 30 infants. CONCLUSIONS: Caffeine was well tolerated at all doses. Clearance was markedly lower and volume of distribution was higher than the values reported previously for term infants and adults. Both parameters were significantly influenced by postnatal age and current body weight, whereas volume of distribution in infants > 28 weeks' gestational age was higher than that in more premature babies. The predictive performance and the clinical application of the derived population models was satisfactorily shown.