PubMed · 4065830
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H O Conn, J Skornicki. Halothane hepatitis sans halothane.. https://doi.org/10.1002/hep.1840050631
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Twenty-two horses with ulnar fractures were treated, using tension band wires alone or tension band wires in combination with pins or cortical bone screws. Age of the horses ranged from 2 weeks to 12 years (median, 4 months), and body weight ranged from 68 to 477 kg (median, 181 kg). Fractures were classified according to the Donecker and Bramlage ulnar fracture classification and included type 1-a (4 horses), type 1-b (4), type-2 (6), type-3 (1), type-4 (3), and type-5 (4), fractures. Tension band wires alone were used in 7 horses. Tension band wires were used in conjunction with unthreaded pins in 10 horses. In 3 horses, 5.5-mm cortical bone screws were inserted longitudinally instead of pins. A combination of a 5.5-mm cortical bone screw and a pin was used in 2 horses. In addition to pins and tension band wires, 4.5-mm cortical bone screws were placed in lag fashion to aid reduction of comminuted or oblique fractures in 7 of the 22 horses. Fractures healed in 18 (82%) horses. Four horses were euthanatized because of complications that included catastrophic failure of fixation during recovery from general anesthesia in 1 foal, septic arthritis and hyperextension of the contralateral metacarpophalangeal joint in 1 foal, and wound infection with partial disruption of repair in 2 horses. Nonfatal complications developed in 6 horses and included incision infection, partial wound dehiscence, carpal contraction, carpus varus of the contralateral forelimb, slight distraction of proximal fragments of the fractures, bent implants, and distal migration of pins. Long-term monitoring was performed on 17 horses.(ABSTRACT TRUNCATED AT 250 WORDS)
During initial clinical tests to calibrate our reflectance pulse oximetry system, we observed serious physiologic limitations to the use of pulse oximetry in the forehead region. We present a case of simultaneous reflectance and transmission mode pulse oximetry monitoring in a child undergoing cardiac surgery for congenital cyanotic heart disease with a large intracardiac shunt. During general anesthesia, when the patient was endotracheally intubated and mechanically ventilated, the transmission mode saturation agreed well with arterial oxygen saturation measurements; but, our reflectance pulse oximeter, with the sensor applied to the forehead, displayed spuriously lower (-18%) oxygen saturations. Before and after anesthesia and surgery, there was fine agreement between reflectance and transmission mode saturation values. We suggest that the difference was caused by vasodilatation and pooling of venous blood due to compromised venous return to the heart, and a combination of arterial and venous pulsations in the forehead region. This means that the reflectance pulse oximeter measured a mixed arterial-venous oxygen saturation.